Pinning Down Social Vulnerability to Climate Change in Sindh, Pakistan: From Narratives to Numbers, and Back Again

This paper reflects critically on the results of a vulnerability assessment process at the household and community scale using a quantitative vulnerabilities and capacities index. It validates a methodology for a social vulnerability assessment at the local scale in 62 villages across four agro‐ecological/livelihood zones in Sindh Province, Pakistan. The study finds that the move from vulnerability narratives to numbers improves the comparability and communicational strength of the concept. The depth and nuance of vulnerability, however, can be realised only by a return to narrative. Caution is needed, therefore: the index can be used in conjunction with qualitative assessments, but not instead of them. More substantively, the results show that vulnerability is more a function of historico‐political economic factors and cultural ethos than any biophysical changes wrought by climate. The emerging gendered vulnerability picture revealed extremes of poverty and a lack of capacity to cope with contemporary environmental and social stresses

Economic Feasibility of a New Method to Estimate Mortality in Crisis-Affected and Resource-Poor Settings

INTRODUCTION: Mortality data provide essential evidence on the health status of populations in crisis-affected and resource-poor settings and to guide and assess relief operations. Retrospective surveys are commonly used to collect mortality data in such populations, but require substantial resources and have important methodological limitations. We evaluated the feasibility of an alternative method for rapidly quantifying mortality (the informant method). The study objective was to assess the economic feasibility of the informant method. METHODS: The informant method captures deaths through an exhaustive search for all deaths occurring in a population over a defined and recent recall period, using key community informants and next-of-kin of decedents. Between July and October 2008, we implemented and evaluated the informant method in: Kabul, Afghanistan; Mae La camp for Karen refugees, Thai-Burma border; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We documented the time and cost inputs for the informant method in each site, and compared these with projections for hypothetical retrospective mortality surveys implemented in the same site with a 6 month recall period and with a 30 day recall period. FINDINGS: The informant method was estimated to require an average of 29% less time inputs and 33% less monetary inputs across all four study sites when compared with retrospective surveys with a 6 month recall period, and 88% less time inputs and 86% less monetary inputs when compared with retrospective surveys with a 1 month recall period. Verbal autopsy questionnaires were feasible and efficient, constituting only 4% of total person-time for the informant method's implementation in Chiradzulu District. CONCLUSIONS: The informant method requires fewer resources and incurs less respondent burden. The method's generally impressive feasibility and the near real-time mortality data it provides warrant further work to develop the method given the importance of mortality measurement in such settings

Foaming of PS/wood fiber composites using moisture as a blowing agent

This paper presents an experimental study on foam processing of polystyrene (PS) and high-impact polystyrene HIPS/wood-fiber composites in extrusion using moisture as a blowing agent. Wood-fiber inherently contains moisture that can potentially be used as a blowing agent. Undried wood-fiber was processed together with PS and HIPS materials in extrusion and wood-fiber composite foams were produced. The cellular morphology and volume expansion ratios of the foamed composites were characterized. Because of the high stiffness of styrenic materials, moisture condensation during cooling after expansion at high temperature did not cause much contraction of the foamed composite and a high volume expansion ratio up to 20 was successfully obtained. The experimental results showed that the expansion ratio could be controlled by varying the processing temperature and the moisture content in the wood fiber. The effects of a small amount of a chemical blowing agent and mineral oil on the cell morphologies of plastic/wood-fiber composite foams were also investigated

Handboek Het verbonden winkelgebied: hoe collectieve digitale marketing kan bijdragen aan een aantrekkelijke binnenstad

Veel stedelijke winkelgebieden kampen met teruglopende bezoekersaantallen en dalende winkelomzetten. Men komt er vaker om recreatieve redenen, als ‘click & collect’-bestemming voor het ophalen van online gekochte artikelen en voor advies over producten en diensten. Ondernemers, gemeentes en andere stakeholders werken steeds vaker collectief samen om het winkelgebied toekomstbestendig te maken. De marketing van het winkelgebied is daarbij een belangrijk thema, waarbij online een steeds prominentere rol gaat spelen binnen de totale strategie. In de praktijk zijn maar weinig van deze collectieven echt succesvol in de digitale marketing van hun winkelgebied. Met dit handboek willen we collectieven, centrum- managers, ondernemers en andere partijen helpen met het opzetten van een duurzame digitale marketingstrategie van hun winkelgebied en deze effectief in te zetten. Dit handboek geeft praktische handvatten voor het ontwikkelen van effectieve online kanalen en digitale marketingactiviteiten en dient als aanvulling op een algemene collectieve marketingstrategie

Surgical Management of Giant Intracranial Arteriovenous Malformations: A Single Center Experience over 32 years

OBJECTIVE: Treatment of giant intracranial arteriovenous malformations (gAVMs) is a formidable challenge for neurosurgeons and carries significant morbidity and mortality rates for patients compared with smaller AVMs. In this study, we reviewed the treatments, angiographic results, and clinical outcomes in 64 patients with gAVMs who were treated at Henry Ford Hospital between 1980 and 2012. METHODS: The arteriovenous malformation (AVM) database at our institution was queried for patients with gAVMs (≥ 6 cm) and data regarding patient demographics, presentation, AVM angioarchitecture, and treatments were collected. Functional outcomes as well as complications were analyzed. RESULTS: Of the 64 patients, 33 (51.6%) were female and 31 (48.4%) were male, with an average age of 45.7 years (SD ± 15.5). The most common symptoms on presentation were headaches (50%), seizures (50%), and hemorrhage (41%). The mean AVM size was 6.65 cm (range, 6-9 cm). Only 6 AVMs (9.4%) were located in the posterior fossa. The most common Spetzler-Martin grade was V, seen in 64% of patients. Of the 64 patients, 42 (66%) underwent surgical excision, 10 (15.5%) declined any treatment, 8 (12.5%) were deemed inoperable and followed conservatively, 2 (3%) had stand-alone embolization, 1 (1.5%) had embolization before stereotactic radiosurgery, and 1 (1.5%) received stereotactic radiosurgery only. Complete obliteration was achieved in 90% of the surgical patients. Mortality rate was 19% in the surgical cohort compared with 22% in the observation cohort (P = 0.770). CONCLUSIONS: Treatment of gAVMs carries significant morbidity and mortality; however, good outcomes are attainable with a multimodal treatment approach in carefully selected patients

Handboek Het verbonden winkelgebied: hoe collectieve digitale marketing kan bijdragen aan een aantrekkelijke binnenstad

Veel stedelijke winkelgebieden kampen met teruglopende bezoekersaantallen en dalende winkelomzetten. Men komt er vaker om recreatieve redenen, als ‘click & collect’-bestemming voor het ophalen van online gekochte artikelen en voor advies over producten en diensten. Ondernemers, gemeentes en andere stakeholders werken steeds vaker collectief samen om het winkelgebied toekomstbestendig te maken. De marketing van het winkelgebied is daarbij een belangrijk thema, waarbij online een steeds prominentere rol gaat spelen binnen de totale strategie. In de praktijk zijn maar weinig van deze collectieven echt succesvol in de digitale marketing van hun winkelgebied. Met dit handboek willen we collectieven, centrum- managers, ondernemers en andere partijen helpen met het opzetten van een duurzame digitale marketingstrategie van hun winkelgebied en deze effectief in te zetten. Dit handboek geeft praktische handvatten voor het ontwikkelen van effectieve online kanalen en digitale marketingactiviteiten en dient als aanvulling op een algemene collectieve marketingstrategie