Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia

<p>Abstract</p> <p/> <p>A pessimistic view of the impact of armed conflicts on the control of infectious diseases has generated great interest in the role of conflicts on the global TB epidemic. Nowhere in the world is such interest more palpable than in the Horn of Africa Region, comprising Ethiopia, Somalia, Eritrea, Djibouti, Kenya and Sudan. An expanding literature has demonstrated that armed conflicts stall disease control programs through distraction of health system, interruption of patients' ability to seek health care, and the diversion of economic resources to military ends rather than health needs. Nonetheless, until very recently, no research has been done to address the impact of armed conflict on TB epidemics in the Somali Regional State (SRS) of Ethiopia.</p> <p>Methods</p> <p>This study is based on the cross-sectional data collected in 2007, utilizing structured questionnaires filled-out by a sample of 226 TB patients in the SRS of Ethiopia. Data was obtained on the delay patients experienced in receiving a diagnosis of TB, on the biomedical knowledge of TB that patients had, and the level of self-treatment by patients. The outcome variables in this study are the delay in the diagnosis of TB experienced by patients, and extent of self-treatment utilized by patients. Our main explanatory variable was place of residence, which was dichotomized as being in 'conflict zones' and in 'non-conflict zones'. Demographic data was collected for statistical control. Chi-square and Mann-Whitney tests were used on calculations of group differences. Logistic regression analysis was used to determine the association between outcome and predictor variables.</p> <p>Results</p> <p>Two hundred and twenty six TB patients were interviewed. The median delay in the diagnosis of TB was 120 days and 60 days for patients from conflict zones and from non-conflict zones, respectively. Moreover, 74% of the patients residing in conflict zones undertook self-treatment prior to their diagnosis. The corresponding proportion from non-conflict zones was 45%. Fully adjusted logistic regression analysis shows that patients from conflict zones had significantly greater odds of delay (OR = 3.06; 95% CI: 1.47-6.36) and higher self treatment utilization (OR = 3.34; 95% CI: 1.56-7.12) compared to those from non-conflict zones.</p> <p>Conclusion</p> <p>Patients from conflict zones have a longer delay in receiving a diagnosis of TB and have higher levels of self treatment utilization. This suggests that access to TB care should be improved by the expansion of user friendly directly observed therapy short-course (DOTS) in the conflict zones of the region.</p

Managing Carbon

Storing carbon (C) and offsetting carbon dioxide (CO2) emissions with the use of wood for energy, both of which slow emissions of CO2 into the atmosphere, present significant challenges for forest management (IPCC 2001). In the United States, there has been a net increase in C in forests and in harvested wood products stocks (Tables 7.1 and 7.2), a result of historical and recent ecological conditions, management practices, and use of forest products (Birdsey et al. 2006). However, recent projections for the forest sector suggest that annual C storage could begin to decline, and U.S. forests could become a net C emitter of tens to hundreds of Tg C year ¹ within a few decades (USDA FS 2012a). It is therefore urgent to identify effective C management strategies, given the complexity of factors that drive the forest C cycle and the multiple objectives for which forests are managed. An ideal C management activity contributes benefits beyond increasing C storage by achieving other management objectives and providing ecosystem services in a sustainable manner. Strategies for effectively managing forest C stocks and offsetting C emissions requires a thorough understanding of biophysical and social influences on the forest C cycle (Birdsey et al. 1993). Successful policies and incentives may be chosen to support strategies if sufficient knowledge of social processes (e.g., landowner or wood-user response to incentives and markets) is available. For example, if C stocks are expected to decrease owing to decreasing forest land area caused by exurban development, policies or incentives to avoid deforestation in those areas may be effective. If C stocks are expected to decrease owing to the effects of a warmer climate, reducing stand densities may retain C over the long term by increasing resilience to drought and other stressors and by reducing crown fire hazard (Jackson et al. 2005; Reinhardt et al. 2008). Protecting old forests and other forests that have high C stocks may be more effective than seeking C offsets associated with wood use, especially if those forests would recover C more slowly in an altered climate. If climate change increases productivity in a given area over a long period of time, increasing forest C stocks through intensive management and forest products, including biomass energy, may be especially effective. It is equally important to know which strategies might make some management practices unacceptable (e.g., reducing biodiversity). However, no standard evaluation framework exists to aid decision making on alternative management strategies for maximizing C storage while minimizing risks and tradeoffs. Here we discuss (1) where forest C is stored in the United States, (2) how to measure forest C through space and time, (3) effectiveness of various management strategies in reducing atmospheric greenhouse gases (GHG), and (4) effectiveness of incentives, regulations, and institutional arrangements for implementing C management. Understanding of biophysical and social influences on the forest C cycle (Birdsey et al. 1993). Successful policies and incentives may be chosen to support strategies if sufficient knowledge of social processes (e.g., landowner or wood-user response to incentives and markets) is available. For example, if C stocks are expected to decrease owing to decreasing forest land area caused by exurban development, policies or incentives to avoid deforestation in those areas may be effective. If C stocks are expected to decrease owing to the effects of a warmer climate, reducing stand densities may retain C over the long term by increasing resilience to drought and other stressors and by reducing crown fire hazard (Jackson et al. 2005; Reinhardt et al. 2008). Protecting old forests and other forests that have high C stocks may be more effective than seeking C offsets associated with wood use, especially if those forests would recover C more slowly in an altered climate. If climate change increases productivity in a given area over a long period of time, increasing forest C stocks through intensive management and forest products, including biomass energy, may be especially effective. It is equally important to know which strategies might make some management practices unacceptable (e.g., reducing biodiversity). However, no standard evaluation framework exists to aid decision making on alternative management strategies for maximizing C storage while minimizing risks and tradeoffs. Here we discuss (1) where forest C is stored in the United States, (2) how to measure forest C through space and time, (3) effectiveness of various management strategies in reducing atmospheric greenhouse gases (GHG), and (4) effectiveness of incentives, regulations, and institutional arrangements for implementing C management

Antifouling activity of bromotyrosine-derived sponge metabolites and synthetic analogues

Eighteen brominated sponge-derived metabolites and synthetic analogues were analyzed for antilarval settlement of Balanus improvisus. Only compounds exhibiting oxime substituents including bastadin-3 (4), -4 (1), -9 (2), and -16 (3), hemibastadin-1 (6), aplysamine-2 (5), and psammaplin A (10) turned out to inhibit larval settling at 1 to 10 microM. Analogues of hemibastadin-1 (6) were synthesized and tested for structure activity studies. Debromohemibastadin-1 (8) inhibited settling of B. improvisus, albeit at lower concentrations than hemibastadin-1 (6). Both 6 and 8 also induced cyprid mortality. 5,5'-dibromohemibastadin-1 (7) proved to be nontoxic, but settlement inhibition was observed at 10 microM. Tyrosinyltyramine (9), lacking the oxime function, was not antifouling active and was non-toxic at 100 microM. Hemibastadin-1 (6) and the synthetic products showed no general toxicity when tested against brine shrimp larvae. In contrast to the lipophilic psammaplin A (10), the hydrophilic sulfated psammaplin A derivative (11) showed no antifouling activity even though it contains an oxime group. We therefore hypothesize that the compound needs to cross membranes (probably by diffusion) and that the target for psammaplin A lies intracellularly