Five feet high and rising : cities and flooding in the 21st century

Urban flooding is an increasingly important issue. Disaster statistics appear to show flood events are becoming more frequent, with medium-scale events increasing fastest. The impact of flooding is driven by a combination of natural and human-induced factors. As recent flood events in Pakistan, Brazil, Sri Lanka and Australia show, floods can occur in widespread locations and can sometimes overwhelm even the best prepared countries and cities. There are known and tested measures for urban flood risk management, typically classified as structural or engineered measures, and non-structural, management techniques. A combination of measures to form an integrated management approach is most likely to be successful in reducing flood risk. In the short term and for developing countries in particular, the factors affecting exposure and vulnerability are increasing at the fastest rate as urbanization puts more people and more assets at risk. In the longer term, however, climate scenarios are likely to be one of the most important drivers of future changes in flood risk. Due to the large uncertainties in projections of climate change, adaptation to the changing risk needs to be flexible to a wide range of future scenarios and to be able to cope with potentially large changes in sea level, rainfall intensity and snowmelt. Climate uncertainty and budgetary, institutional and practical constraints are likely to lead to a combining of structural and non-structural measures for urban flood risk management, and arguably, to a move away from what is sometimes an over-reliance on hard-engineered defenses and toward more adaptable and incremental non-structural solutions.Hazard Risk Management,Wetlands,Natural Disasters,Adaptation to Climate Change,Climate Change Impacts

Five feet high and rising: Cities and flooding in the 21st Century

Urban flooding is an increasingly important issue.Disaster statistics appear to show flood events arebecoming more frequent, with medium-scale eventsincreasing fastest. The impact of flooding is driven bya combination of natural and human-induced factors.As recent flood events in Pakistan, Brazil, Sri Lanka andAustralia show, floods can occur in widespread locationsand can sometimes overwhelm even the best preparedcountries and cities. There are known and tested measuresfor urban flood risk management, typically classified asstructural or engineered measures, and non-structural,management techniques. A combination of measures toform an integrated management approach is most likelyto be successful in reducing flood risk. In the short termand for developing countries in particular, the factorsaffecting exposure and vulnerability are increasing atthe fastest rate as urbanization puts more people andmore assets at risk. In the longer term, however, climatescenarios are likely to be one of the most importantdrivers of future changes in flood risk. Due to the largeuncertainties in projections of climate change, adaptationto the changing risk needs to be flexible to a wide rangeof future scenarios and to be able to cope with potentiallylarge changes in sea level, rainfall intensity and snowmelt.Climate uncertainty and budgetary, institutional andpractical constraints are likely to lead to a combining ofstructural and non-structural measures for urban floodrisk management, and arguably, to a move away fromwhat is sometimes an over-reliance on hard-engineereddefenses and toward more adaptable and incrementalnon-structural solutions

Equine Polyclonal Antibodies Prevent Acute Chikungunya Virus Infection in Mice

Chikungunya virus (CHIKV) is a mosquito-transmitted pathogen that causes chikungunya disease (CHIK); the disease is characterized by fever, muscle ache, rash, and arthralgia. This arthralgia can be debilitating and long-lasting, seriously impacting quality of life for years. Currently, there is no specific therapy available for CHIKV infection. We have developed a despeciated equine polyclonal antibody (CHIKV-EIG) treatment against CHIKV and evaluated its protective efficacy in mouse models of CHIKV infection. In immunocompromised (IFNAR−/−) mice infected with CHIKV, daily treatment for five consecutive days with CHIKV-EIG administered at 100 mg/kg starting on the day of infection prevented mortality, reduced viremia, and improved clinical condition as measured by body weight loss. These beneficial effects were seen even when treatment was delayed to 1 day after infection. In immunocompetent mice, CHIKV-EIG treatment reduced virus induced arthritis (including footpad swelling), arthralgia-associated cytokines, viremia, and tissue virus loads in a dose-dependent fashion. Collectively, these results suggest that CHIKV-EIG is effective at preventing CHIK and could be a viable candidate for further development as a treatment for human disease

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

BackgroundEvaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).ObjectivesTo examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.Design, setting, and patientsPerformance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data.MeasurementsChanges in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores.ResultsHospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores.ConclusionsWhile Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458-465. © 2011 Society of Hospital Medicine

Improving women’s diet quality pre-conceptionally and during gestation: effects on birth weight and prevalence of low birth weight; a randomized controlled efficacy trial in India (Mumbai Maternal Nutrition Project)

BACKGROUND: Low birth weight (LBW) is an important public health problem in undernourished populations.OBJECTIVE: We tested whether improving women's dietary micronutrient quality before conception and throughout pregnancy increases birth weight in a high-risk Indian population.DESIGN: The study was a nonblinded, individually randomized controlled trial. The intervention was a daily snack made from green leafy vegetables, fruit, and milk (treatment group) or low-micronutrient vegetables (potato and onion) (control group) from ? 90 d before pregnancy until delivery in addition to the usual diet. Treatment snacks contained 0.69 MJ of energy (controls: 0.37 MJ) and 10-23% of WHO Reference Nutrient Intakes of ?-carotene, riboflavin, folate, vitamin B-12, calcium, and iron (controls: 0-7%). The primary outcome was birth weight.RESULTS: Of 6513 women randomly assigned, 2291 women became pregnant, 1962 women delivered live singleton newborns, and 1360 newborns were measured. In an intention-to-treat analysis, there was no overall increase in birth weight in the treatment group (+26 g; 95% CI: -15, 68 g; P = 0.22). There was an interaction (P &lt; 0.001) between the allocation group and maternal prepregnant body mass index (BMI; in kg/m(2)) [birth-weight effect: -23, +34, and +96 g in lowest (&lt;18.6), middle (18.6-21.8), and highest (&gt;21.8) thirds of BMI, respectively]. In 1094 newborns whose mothers started supplementation ? 90 d before pregnancy (per-protocol analysis), birth weight was higher in the treatment group (+48 g; 95% CI: 1, 96 g; P = 0.046). Again, the effect increased with maternal BMI (-8, +79, and +113 g; P-interaction = 0.001). There were similar results for LBW (intention-to-treat OR: 0.83; 95% CI: 0.66, 1.05; P = 0.10; per-protocol OR = 0.76; 95% CI: 0.59, 0.98; P = 0.03) but no effect on gestational age in either analysis.CONCLUSIONS: A daily snack providing additional green leafy vegetables, fruit, and milk before conception and throughout pregnancy had no overall effect on birth weight. Per-protocol and subgroup analyses indicated a possible increase in birth weight if the mother was supplemented ? 3 mo before conception and was not underweight. This trial was registered at www.controlled-trials.com/isrctn/ as ISRCTN62811278<br/

Summary of the Results from the Lunar Orbiter Laser Altimeter after Seven Years in Lunar Orbit

In June 2009 the Lunar Reconnaissance Orbiter (LRO) spacecraft was launched to the Moon. The payload consists of 7 science instruments selected to characterize sites for future robotic and human missions. Among them, the Lunar Orbiter Laser Altimeter (LOLA) was designed to obtain altimetry, surface roughness, and reflectance measurements. The primary phase of lunar exploration lasted one year, following a 3-month commissioning phase. On completion of its exploration objectives, the LRO mission transitioned to a science mission. After 7 years in lunar orbit, the LOLA instrument continues to map the lunar surface. The LOLA dataset is one of the foundational datasets acquired by the various LRO instruments. LOLA provided a high-accuracy global geodetic reference frame to which past, present and future lunar observations can be referenced. It also obtained high-resolution and accurate global topography that were used to determine regions in permanent shadow at the lunar poles. LOLA further contributed to the study of polar volatiles through its unique measurement of surface brightness at zero phase, which revealed anomalies in several polar craters that may indicate the presence of water ice. In this paper, we describe the many LOLA accomplishments to date and its contribution to lunar and planetary science

Visualization of the modeled degradation of building flooring systems in building maintenance

The development of a maintenance programme for construction projects is a highly complex and data intensive undertaking. This exercise is characterised by the lack of relevant data on the one hand and the overwhelming amount of extraneous data on the other. The uncertainties and complexities have resulted in increased conservatism in the development of lifecycle evaluation of building maintenance programing, subsequently, these programmes tend to display the symptoms of either the maintenance actions being uneconomical or fall short of providing the appropriate service to the users of the building. The current research project is based on the premise that the visual approach will facilitate a just-in-time solution to maintenance scheduling, hence, the use of virtual simulation of the building is proposed. The broader aim of this research is to develop a complete building maintenance programme through visualisation of buildings as they degrade over time. Here, the focus is on the flooring system and the manner they degrade over time. This requires a better understanding of their pattern and rate of usage. To this end, Anthroposophy and Anthropocentric descriptions of human movement pattern have been used to describe the behaviour of 'subjects' and subsequently represent the pattern and density of the degradation of flooring systems. The mathematics representing this behaviour has been developed which enables it to be embedded into the proposed overall visual building maintenance model

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy