A systems-based assessment of Palestine's current and future infrastructure requirements.

The occupied Palestinian territories of West Bank and Gaza Strip are currently experiencing many challenges in the provision of infrastructure services for their inhabitants. This includes an undersupply of infrastructure services across multiple sectors - an issue exacerbated by population growth, increasing urbanisation, economic growth and climate change. We address this challenge by providing a systems-based assessment of Palestine's infrastructure requirements and identifying broad strategies for how those needs might be met. This assessment involved four key components including: 1) defining and assessing the current system and planned infrastructure investments; 2) assessing potential future demand for infrastructure services; 3) identifying alternative strategies for future infrastructure provision beyond planned investments; and 4) analysing the performance of each strategy against a series of key performance indicators. Results from the assessment highlight the magnitude of the current and future need for urgent infrastructure investment in Palestine. The most immediate need is to alleviate the water crises in Gaza Strip, which will require at least twice as much water infrastructure investment over the coming decade than is currently in the pipeline, even if the goal is only to achieve the most basic World Health Organisation water availability requirements. To move beyond this protracted state of crises will then require a doubling of investments across all sectors to bring Palestine up to the standards of services already enjoyed by its neighbours. Such investments can have even greater impact on delivery of infrastructure services through the strategic use of interdependencies between infrastructure sectors, such as water re-use and energy-from-waste. In the pursuit of global sustainable development, the systems-based approach presented here provides an important first step in the assessment of infrastructure needs and opportunities for any country. It is particularly important for states like Palestine where key resources, such as water and energy, are so acutely constrained.

Productivity in a dominant herbaceous species is largely unrelated to soil macronutrient stocks.

To predict ecosystem responses to anthropogenic change it is important to understand how and where plant productivity is limited by macronutrient availability. Nitrogen (N) is required in large quantities for plant growth, and is readily lost through leaching or gas fluxes, but reactive nitrogen can be obtained through dinitrogen fixation, and phosphorus (P) is often considered a more fundamental long-term constraint to growth and carbon sequestration in terrestrial ecosystems. Phosphorus limitation may be becoming more prevalent due to widespread pollution by atmospheric N. Assessments of the effects of macronutrient availability on productivity in natural ecosystems are however scarce. We measured standing biomass of bracken Pteridium aquilinum as a proxy for productivity across sites with similar climate but varied geology. Total above-ground biomass varied from 404 to 1947gm-2, yet despite 12-fold to 281-fold variation in soil macronutrient stocks these were remarkably poor at explaining variation in productivity. Soil total nitrogen, organic phosphorus, calcium, magnesium and zinc had no relationship with productivity, whether expressed as concentrations, stocks or element/C ratios, and nor did foliar N/P. Soil potassium (K) and molybdenum stocks both showed weak relationships with productivity. The stock of K in bracken biomass was considerably greater as a proportion of soil stock than for other nutrient elements, suggesting that this nutrient element can be important in determining productivity. Moisture availability, as indicated by environmental trait scores for plant species present, explained considerably more of the variation in productivity than did K stock, with less production in wetter sites. Soil N/C ratio and organic P stock were relatively unimportant in determining productivity across these bracken sites. It is possible that more-direct measures of N and P availability would explain variation in productivity, but the study shows the importance of considering other essential elements and other environmental factors when predicting productivity.

Analysis of touch used by occupational therapy practitioners in skilled nursing facilities.

Instrumental touch is identified as having purposeful physical contact in order to complete a task. Expressive touch is identified as warm, friendly physical contact and is not solely for performing a task. Expressive touch has been associated with improved client status, increased rapport and greater gains made during therapy. The purpose of the study was to observe the frequency of expressive and instrumental touch utilized by an occupational therapist during an occupational therapy session. Thirty-three occupational therapy professionals, including occupational therapists and occupational therapy assistants, employed at skilled nursing facilities in southwest Florida were observed. Data were collected on the Occupational Therapy Interaction Assessment. The results of the data analysis showed a positive relationship between the gender of the therapist and the frequency of expressive touch. The data also showed that a large majority of touches were instrumental touch and pertained to functional mobility. The results of the study can contribute to a better understanding of the holistic aspects of occupational therapy. By the use of more expressive touch, occupational therapy practitioners may have a positive, beneficial effect on both the client and the therapy process as a whole. Further research is needed to determine the effect an occupational therapy setting has on the frequency of instrumental and expressive touch. A larger sample size and a distinction between evaluation and treatment sessions would benefit future studies.

Application of a simple multiplicative spatio-temporal stream water quality model to the river Conwy, North Wales.

We use a simple multiplicative spatio-temporal model to describe variability in a sequence of water quality monitoring data from headwater streams in the Conwy catchment, North Wales. The spatial component of the model treats concentrations as due to simple mixing of a small number of distinct source types, each associated with particular upstream catchment characteristics. The temporal component allows concentration variability due to seasonal or hydrological change. We apply the model using three candidate catchment characteristic classifications to generate mixing concentrations, and a seasonal component to describe temporal variability, and test a range of sub-models. We identify a cross-classification of soil and land cover as providing the best spatial indicator of water quality of the classifications considered. The spatial model based on a selected grouped cross-classification was shown to account for between 35% and 90% of the spatial variability and the seasonal model accounted for between 45% and 100% of the temporal variability in the data. Analysis of residuals showed an inverse relationship between DOC and sulphate and between hydrogen ion concentration and calcium and magnesium. We also found residual correlations between sites which are strongly related to landscape class. These are attributed to landscape class by time interactions which are not accounted for in the simple multiplicative model.

Values in global health governance.

In the 60 years since the Universal Declaration of Human Rights was promulgated, the promise of achieving respect for the human rights, health and well being of all is becoming an ever more distant prospect. We have not even remotely met the challenge of improving health for a large proportion of the world's population, and the prospects for improving global health seem to be receding in the current deteriorating economic and political climate. As global health remains one of the most pressing problems of our time, we must question the values that direct our actions and current approaches, which proclaim 'human rights to health' but which subsume these rights to a broader paradigm of unregulated global market economics and national politics, rather than working to make these oft-contradictory goals mutually compatible through justifiable and accountable global governance processes. We suggest that a new balance of values and new ways of thinking and acting are needed. These must transcend national and institutional boundaries and recognise that health in the most privileged nations is closely linked to health and disease in impoverished countries. Sustainable development of health and well-being is a necessity for all, and values for health should permeate every area of social and economic activity.

Lupus-prone New Zealand Black/New Zealand White F1 mice display endothelial dysfunction and abnormal phenotype and function of endothelial progenitor cells.

Patients with systemic lupus erythematosus (SLE) have an impairment in phenotype and function of endothelial progenitor cells (EPCs) which is mediated by interferon alpha (IFN-alpha). We assessed whether murine lupus models also exhibit vasculogenesis abnormalities and their potential association with endothelial dysfunction. Phenotype and function of EPCs and type I IFN gene signatures in EPC compartments were assessed in female New Zealand Black/New Zealand White F(1) (NZB/W), B6.MRL-Fas(lpr)/J (B6/lpr) and control mice. Thoracic aorta endothelial and smooth muscle function were measured in response to acetylcholine or sodium nitropruside, respectively. NZB/W mice displayed reduced numbers, increased apoptosis and impaired function of EPCs. These abnormalities correlated with significant decreases in endothelium-dependent vasomotor responses and with increased type I IFN signatures in EPC compartments. In contrast, B6/lpr mice showed improvement in endothelium-dependent and endothelial-independent responses, no abnormalities in EPC phenotype or function and downregulation of type I IFN signatures in EPC compartments. These results indicate that NZB/W mice represent a good model to study the mechanisms leading to endothelial dysfunction and abnormal vasculogenesis in lupus. These results further support the hypothesis that type I IFNs may play an important role in premature vascular damage and, potentially, atherosclerosis development in SLE.

Low-Afterglow CsI:Tl microcolumnar films for small animal high-speed microCT.

Dedicated high-speed microCT systems are being developed for noninvasive screening of small animals. Such systems require scintillators with high spatial resolution, high light yield, and minimal persistence to ensure ghost free imaging. Unfortunately, the afterglow associated with conventional CsI:Tl microcolumnar films used in current high-speed systems introduces image lag, leading to substantial artifacts in reconstructed images, especially when the detector is operated at several hundreds of frames per second. At RMD, we have discovered that the addition of a second dopant, Eu(2+), to CsI:Tl crystals suppresses the afterglow by as much as a factor of 40 at 2 ms after a short excitation pulse of 20 ns, and by as much as a factor of 15 at 2 ms after a long excitation pulse of 100 ms. Our observations, supported by theoretical modeling, indicate that Eu(2+) ions introduce deep electron traps that alter the decay kinetics of the material, making it suitable for many high-speed imaging applications. Here we report on the fabrication and characterization of CsI:Tl,Eu microcolumnar films to determine if the remarkable afterglow properties of CsI:Tl,Eu crystals are preserved in the CsI:Tl,Eu microcolumnar films. Preliminary results indicate that the codoped microcolumnar films show a factor of 3.5 improvement in the afterglow compared to the standard CsI:Tl films.

Functional properties of DOM in a stream draining blanket peat.

The functional properties of dissolved organic matter (DOM) from Rough Sike, a stream draining blanket peat in the northern Pennines, UK, were investigated using a series of 12 standardised assays. Nine stream samples were collected at different discharges during 2003--2006, and DOM concentrates obtained by low temperature rotary evaporation. Suwannee River Fulvic Acid was used as a quality control standard in the assays. Dissolved organic matter in high-discharge samples was more light-absorbing at 280 and 340 nm and adsorbed more strongly to alumina, than DOM characteristic of low streamflow, but was less fluorescent and hydrophilic, and poorer in proton-dissociating groups. No significant differences were found in light absorption at 254 nm, copper- or benzo(a)pyrene binding, or photochemical fading. Combination of the Rough Sike data with previously-published results for other streams and a lake yields totals of 20-23 values per assay, for a range of DOM types. For the combined data, variability in all the assays is significant (p < 0.001), as judged by comparison with variations in repeat measurements on the quality control standard. Analysis of the combined data shows that DOM hydrophilicity and adsorption are well-predicted by linear relationships with the extinction coefficient at 340 nm (E340), while good quadratic relationships exist between E340 and both buffering capacity and fluorescence.

Relating dissolved organic matter fluorescence and functional properties.

The fluorescence excitation-emission matrix properties of 25 dissolved organic matter samples from three rivers and one lake are analysed. All sites are sampled in duplicate, and the 25 samples include ten taken from the lake site, and nine from one of the rivers, to cover variations in dissolved organic matter composition due to season and river flow. Fluorescence properties are compared to the functional properties of the dissolved organic matter; the functional assays provide quantitative information on photochemical fading, buffering capacity, copper binding, benzo[a]pyrene binding, hydrophilicity and adsorption to alumina. Optical (absorbance and fluorescence) characterization of the dissolved organic matter samples demonstrates that (1) peak C (excitation 300-350 nm; emission 400-460 nm) fluorescence emission wavelength; (2) the ratio of peak T (excitation 220-235 nm; emission 330-370 nm) to peak C fluorescence intensity; and (3) the peak C fluorescence intensity: absorbance at 340 nm ratio have strong correlations with many of the functional assays. Strongest correlations are with benzo[a]pyrene binding, alumina adsorption, hydrophilicity and buffering capacity, and in many cases linear regression equations with a correlation coefficient >0.8 are obtained. These optical properties are independent of freshwater dissolved organic carbon concentration (for concentrations <10 mg L(-1)) and therefore hold the potential for laboratory, field and on-line monitoring and prediction of organic matter functional properties.

Functional variability of dissolved organic matter from the surface water of a productive lake.

Functional variability of dissolved organic matter (DOM) from the surface water of Esthwaite Water (N. England) was investigated using a series of 12 standardised assays, which provide quantitative information on light absorption, fluorescence, photochemical fading, pH buffering, copper binding, benzo(a)pyrene binding, hydrophilicity, and adsorption to alumina. Ten lakewater samples were collected at different times of year during 2003-2005, and DOM concentrates obtained by low-temperature rotary evaporation. Suwannee River Fulvic Acid was used as a quality control standard. For nine of the assays, variability among DOM samples was significantly (p<0.01) greater than could be explained by analytical error. Seasonal trends observed for six of the assays could be explained by a simple mixing model in which the two end-members were DOM from the catchment (allochthonous) and DOM produced within the lake (autochthonous). The fraction of autochthonous DOM predicted by the model is significantly correlated (p<0.01) with chlorophyll concentration, consistent with production from phytoplankton. Autochthonous DOM is less light-absorbing, less fluorescent, more hydrophilic, and possesses fewer proton-dissociating groups, than allochthonous material.

Long-term nitrate increases in two oligotrophic lakes, due to the leaching of atmospherically-deposited N from moorland ranker soils.

During the last 50 years nitrate concentrations in Buttermere and Wastwater (Cumbria, UK) have risen significantly, by 70 and 100%, respectively. By estimating contemporary nitrate fluxes in the lakes' catchments and in sub-catchments and comparing them with the fractional areas of different soil types, it is deduced that the surface water nitrate is derived almost entirely from organic-rich ranker soils that have a limited ability to retain atmospherically-deposited nitrogen. Little or no nitrate leaches from the other major soil type, a brown podzol, despite it having a lower C:N ratio (12.0 g g(-1)) than the ranker (17.0 g g(-1)), nor is there much contribution from the small areas of improved (chemically fertilised) grassland within the catchments. Although some nitrate leaching is occurring, total N losses are appreciably smaller than atmospheric inputs, so the catchment soils are currently accumulating between 3 and 4 g N m(-2) a(-1).

WITHDRAWN: Continuous electronic heart rate monitoring for fetal assessment during labor.

BACKGROUND: Electronic fetal monitoring (EFM) is used in the management of labor and delivery in nearly three of four pregnancies in the United States. The apparent contradiction between the widespread use of EFM and expert recommendations to limit routine use indicates that a reassessment of this practice is warranted. OBJECTIVES: To compare the efficacy and safety of routine continuous EFM during labor with intermittent auscultation, using the results of published randomized controlled trials (RCTs). SEARCH STRATEGY: We identified RCTs by searching MEDLINE and the register maintained by the Cochrane Pregnancy and Childbirth Group, and by contacting experts, and reviewing published references. Date of last search: January 2001. SELECTION CRITERIA: Randomized controlled trials. DATA COLLECTION AND ANALYSIS: Data were abstracted by one of us, and their accuracy was confirmed independently by a second person. A single reviewer assessed study quality based on criteria developed by others for RCTs. Data reported from similar studies were used to calculate a combined risk estimate for each of eight outcomes. MAIN RESULTS: Our search identified 13 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. Four trials that did not fulfil our selection criteria were excluded. The remaining nine trials included 18,561 pregnant women and their 18,695 infants in both high- and low-risk pregnancies from seven clinical centers in the United States, Europe, and Australia. Overall, a statistically significant decrease was associated with routine EFM for neonatal seizures (relative risk (RR) 0.51, 95% confidence interval (CI) 0.32-0.82). The protective effect for neonatal seizures was only evident in studies with high-quality scores. No significant differences were observed in 1-minute Apgar scores below four or seven, rate of admissions to neonatal intensive care units, perinatal deaths or cerebral palsy. An increase associated with the use of EFM was observed in the rate of cesarean delivery (RR 1.41, 95% CI 1.23-1.61) and operative vaginal delivery (RR 1.20, 95% CI 1.11-1.30). AUTHORS' CONCLUSIONS: The only clinically significant benefit from the use of routine continuous EFM was in the reduction of neonatal seizures. In view of the increase in cesarean and operative vaginal delivery, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use continuous EFM or intermittent auscultation during labor.

Development and application of functional assays for freshwater dissolved organic matter.

A series of 11 standardised, reproducible, assays have been developed of physico-chemical functions of dissolved organic matter (DOM) in freshwaters. The assays provide quantitative information on light absorption, fluorescence, photochemical fading, pH buffering, copper binding, benzo(a)pyrene binding, hydrophilicity and adsorption to alumina. To obtain DOM for the assays, a 45 L sample of filtered freshwater was rotary-evaporated to reduce the volume to ca. 500 cm3. The concentrate was then passed through a strong cation exchanger, in the Na+ form, to remove alkaline-earth cations, and then through 0.7 and 0.2 microm filters. Eight samples, two each from a lake and three streamwaters, were processed. The yields of dissolved organic carbon (DOC) ranged from 70% to 107% (average 91%). The samples of DOM, stored in the dark at 4 degrees C, retained their functional assay characteristics for up to 7 months. When assaying the concentrates, parallel assays were performed with Suwannee River fulvic acid (SRFA), as a quality control standard. For most of the assays, the results for eight freshwater DOM samples are similar to those obtained with SRFA, the chief exception being the greater hydrophilicity of the DOM samples. For eight of the assays, variability among the DOM samples is significantly (p < 0.01) greater than can be explained by analytical error, i.e. by comparison with results for the SRFA quality standard; the three exceptional assays are photochemical fading, copper binding and benzo(a)pyrene binding. The two lakewater samples studied gave the most extreme assay results, probably because of the influence of phytoplankton-derived DOM. Significant correlations of hydrophilicity and adsorption with optical absorbance may mean that some DOM functional properties can be predicted from comparatively simple measurements.

Prevention of knee injuries in sports. A systematic review of the literature.

AIM: We reviewed evidence regarding risk factors associated with incidence of knee injuries both to assess the effectiveness of prevention strategies, and to offer evidence-based recommendations to physicians, coaches, trainers, athletes, and researchers. METHODS: We searched electronic data bases without language restriction for the years 1966 - September 1, 2001, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 328 citations identified, we emphasized the results from the 13 reports that compared alternative methods to prevent knee injury and assessed the methodologic quality of these reports using a standardized instrument. RESULTS: Five studies addressed the effectiveness of bracing in football players; these studies showed no consistent evidence of benefit. Two studies comparing alternative cleat designs and a controlled study testing the effects of adjustments in the ski boot/binding system were difficult to interpret because of inadequate reporting of methodology. Six prospective studies that addressed the impact of conditioning and training showed promise of proprioception and neuromuscular training for protection against knee injury. We identified serious flaws in study design, control of bias, and statistical methods; the median quality scores ranged from 11 to 56 (out of 100). CONCLUSION: Structured training programs that emphasize neuromuscular and proprioceptive training offer encouraging evidence for the prevention of knee injuries. However, flaws in study design and implementation have limited the effectiveness of work in this field. A rigorously implemented research program is needed to address this critically important sports medicine problem.

Fifty years of epidemiology at the Centers for Disease Control and Prevention: significant and consequential.

The Epidemic Intelligence Service (EIS) was the vision of Alexander Langmuir, who developed a program with a vital mission to address an unmet need in the United States. The Communicable Disease Center, now the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia), and the EIS steadily expanded from focusing on infectious disease to address chronic diseases, health statistics, occupational and environmental health and safety, injury prevention and control, and reproductive health. Langmuir recognized the need for epidemiologists to collaborate with others, initially from the laboratory and later including veterinarians, demographers, statisticians, nutritionists, behavioral and social scientists, industrial hygienists, and sanitarians. These partnerships stimulated the further evolution of the EIS Program to include sophisticated statistical analysis, economics, and the tools of the behavioral and social sciences. A mixture of analytical rigor and practical application characterizes the practice of epidemiology at CDC and in the EIS. Thus, the "significant" in the title of this paper refers to the analytical rigor of the public health approach and the validity of the results, while the "consequential" reflects the practical application of the results, trying to make a difference in health outcomes.

Epidemic intelligence service of the Centers for Disease Control and Prevention: 50 years of training and service in applied epidemiology.

The Epidemic Intelligence Service (EIS) was established in 1951 at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, as a combined training and service program in the practice of applied epidemiology. Since then, nearly 2,500 professionals have served in this 2-year program of the US Public Health Service. The experience of an EIS Officer has been modified because of the increased need for more sophisticated analytical methods and the use of microcomputers, as well as CDC's expanded mission into chronic diseases, environmental health, occupational health, and injury control. Officers who have entered the EIS in the past 20 years are more likely than their predecessors to stay in public health either at the federal level or in state and local health departments. The EIS Program continues to be a critical source for health professionals trained to respond to the demand for epidemiologic services both domestically and internationally.

Partnerships in international applied epidemiology training and service, 1975-2001.

In 1951 the Centers for Disease Control and Prevention created the Epidemic Intelligence Service to provide training and epidemiologic service on the model of a clinical residency program. By January 2001, an additional 28 applied epidemiology and training programs (AETPs) had been implemented around the globe (with over 945 graduates and 420 persons currently in training). Field Epidemiology Training Programs and Public Health Schools Without Walls are the most common models. Applied epidemiologists, or field epidemiologists, use science as the basis for intervention programs designed to improve public health. AETPs train people by providing them with health competencies through providing service to public health intervention programs and strengthening health systems. AETPs are relatively expensive to create and maintain, but they are highly sustainable and can produce immediate benefits. Of the 19 programs that began before 1997, 18 (95%) continue to produce graduates. The Training Programs in Epidemiology for Public Health Interventions Network was organized in 1997 to provide support, peer review, and quality assurance for AETPs. In 2001, new programs are planned or in development in India, Argentina, China, and Russia.

Historical controversy in health technology assessment: the case of electronic fetal monitoring.

Electronic fetal monitoring (EFM) was introduced in the late 1950s as an alternative to traditional auscultation by stethoscope or fetoscope in the management of labor and delivery. The new technology was seen as a valuable tool in the prevention of cerebral palsy and other adverse fetal outcomes and diffused rapidly into clinical practice. In the late 1970s, some scepticism began to be voiced about the evidence for the effectiveness of EFM. The authors published a systematic review of the evidence in 1979 that concluded that there was insufficient evidence for the effectiveness of the routine use of EFM and a clear rise in the cesarean delivery rate associated with its use. The analysis was based on a thorough review of approximately 600 books and articles, but focused heavily on the evidence of four randomized clinical trials (RCTs) that had been published. An economic analysis further underscored the importance of this issue. The report was met with harsh ad hominem criticism from clinicians both in public venues and in the medical literature. Subsequently, additional RCTs were conducted and other analyzes were published, and in 1987 the American College of Obstetricians and Gynecologists recommended that auscultation was an acceptable alternative to EFM in routine labor and delivery. Yet, today EFM continues to be the standard of practice, used in 80% of labors in this country. The most important conclusion drawn from this experience is the need to evaluate new technologies before their widespread diffusion into clinical practice.