Notes on Black Hole Fluctuations and Backreaction

In these notes we prepare the ground for a systematic investigation into the issues of black hole fluctuations and backreaction by discussing the formulation of the problem, commenting on possible advantages and shortcomings of existing works, and introducing our own approach via a stochastic semiclassical theory of gravity based on the Einstein-Langevin equation and the fluctuation-dissipation relation for a self-consistent description of metric fluctuations and dissipative dynamics of the black hole with backreaction of its Hawking radiance

The environmental impact of fertilizer embodied in a wheat-to-bread supply chain

Food production and consumption cause approximately one-third of total greenhouse gas emissions, and therefore delivering food security challenges not only the capacity of our agricultural system, but also its environmental sustainability. Knowing where and at what level environmental impacts occur within particular food supply chains is necessary if farmers, agri-food industries and consumers are to share responsibility to mitigate these impacts. Here we present an analysis of a complete supply chain for a staple of the global diet, a loaf of bread. We obtained primary data for all the processes involved in the farming, production and transport systems that lead to the manufacture of a particular brand of 800 g loaf. The data were analysed using an advanced life cycle assessment (LCA) tool, yielding metrics of environmental impact, including greenhouse gas emissions. We show that more than half of the environmental impact of producing the loaf of bread arises directly from wheat cultivation, with the use of ammonium nitrate fertilizer alone accounting for around 40%. These findings reveal the dependency of bread production on the unsustainable use of fertilizer and illustrate the detail needed if the actors in the supply chain are to assume shared responsibility for achieving sustainable food production

The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

BACKGROUND: There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period. METHODS: A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped. FINDINGS: Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions. CONCLUSIONS: The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.Scopu

Isolated Diaphyseal Fractures of the Radius in Skeletally Immature Patients

Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974–2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten were treated with manipulative reduction and immobilization in an above elbow cast and three had initial operative treatment with plate and screw fixation. These 13 patients were evaluated for an average of 18 months (range, 12 to 45 months) after injury using the system of Price and colleagues. The incidence of isolated diaphyseal radius fractures in skeletally immature patients was 0.56 per year in our database and represented 27% of the 63 patients with a diaphyseal forearm fracture. All 13 patients, with at least 1 year follow-up, regained full elbow flexion and extension and full forearm rotation. According to the classification system of Price, all 13 patients (100%) had an excellent result. As in adults, isolated radius fractures seem to occur in children more frequently than previously appreciated. Treatment of isolated radius fractures in skeletally immature patients has a low complication rate, and excellent functional outcomes are the rule