Complement activated granulocytes can cause autologous tissue destruction in man

Activation of polymorphonuclear granulocytes (PMNs) by C5a is thought to be important in the pathogenesis of multiple organ failure during sepsis and after trauma. In our experiment exposure of human PMNs to autologous zymosan activated plasma (ZAP) leads to a rapid increase in chemiluminescence. Heating the ZAP at 56°C for 30 min did not alter the changes, while untreated plasma induced only baseline activity. The respiratory burst could be completely abolished by decomplementation and preincubation with rabbit antihuman C5a antibodies. Observation of human omentum using electron microscopy showed intravascular aggregation of PMNs, with capillary thrombosis and diapedesis of the cells through endothelial junctions 90 s after exposure to ZAP. PMNs caused disruption of connections between the mesothelial cells. After 4 min the mesothelium was completely destroyed, and connective tissue and fat cells exposed. Native plasma and minimum essential medium did not induce any morphological changes. These data support the concept that C5a activated PMNs can cause endothelial and mesothelial damage in man. Even though a causal relationship between anaphylatoxins and organ failure cannot be proved by these experiments C5a seems to be an important mediator in the pathogenesis of changes induced by severe sepsis and trauma in man

Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted

Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

Background: Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable

Flood hazard risk forecasting index (FHRFI) for urban areas: the Hurricane Harvey case study

Hurricane Harvey caused at least 70 confirmed deaths, with estimated losses in the Houston urban area of Texas reaching above US$150 billion, making it one of the costliest natural disasters ever in the United States. The study tests two types of forecast index to provide surface flooding (inundation) warning over the Houston area: a meteorological index based on a global numerical weather prediction (NWP) system, and a new combined meteorological and land surface index, the flood hazard risk forecasting index (FHRFI), where land surface is used to condition the meteorological forecast. Both indices use the total precipitation extreme forecast index (EFI) and shift of tails (SoT) products from the European Centre for Medium‐Range Weather Forecasts (ECMWF) medium‐range ensemble forecasting system (ENS). Forecasts at the medium range (3–14 days ahead) were assessed against 153 observed National Weather Service (NWS) urban flood reports over the Houston urban area between August 26 and 29, 2017. It is shown that the method provides skilful forecasts up to four days ahead using both approaches. Moreover, the FHRFI combined index has a hit ratio of up to 74% at 72 hr lead time, with a false‐alarm ratio of only 45%. This amounts to a statistically significant 20% increase in performance compared with the meteorological indices. This first study demonstrates the importance of including land‐surface information to improve the quality of the flood forecasts over meteorological indices only, and that skilful flood warning in urban areas can be obtained from the NWP using the FHRFI

Der Umzug der Menschheit: Die transformative Kraft der Städte

Die Wucht der derzeitigen Urbanisierungsdynamik und ihre Auswirkungen sind so groß, dass sich weltweit Städte, Stadtgesellschaften, Regierungen und Internationale Organisationen diesem Trend stellen müssen. Ein „Weiter so wie bisher“, würde ohne gestaltende Urbanisierungspolitik zu einer nicht-nachhaltigen Welt-Städte-Gesellschaft führen. Nur wenn Städte und Stadtgesellschaften ausreichend handlungsfähig werden, können sie ihre Kraft für eine nachhaltige Entwicklung entfalten: In den Städten wird sich entscheiden, ob die Große Transformation zur Nachhaltigkeit gelingt. In diesem Buch werden die Erfolgsbedingungen dafür diskutiert

Humanity on the move: Unlocking the transformative power of cities

The momentum of urbanization and its impacts are so massive that we must face up to this trend. In view of the existing cognitive, technical, economic and institutional path dependencies, a policy of business as usual – i.e. an unstructured, quasi-automatic urbanization – would lead to a non-sustainable ‘world cities society’. Only if cities and urban societies are sufficiently empowered can they make use of the opportunities for sustainability and successfully follow the urban transformation pathways. The success or failure of the Great Transformation will be decided in the cities. The WBGU discusses the relevant conditions for the success of this transformation in this report

Development and justice through transformation: The Four Big ‘I’s. Special Report

2015 saw a historic double success for sustainability and climate policy. The 2030 Agenda for Sustainable Development, with its Sustainable Development Goals (SDGs), and the Paris Agreement on climate ­protection establish a system of ambitious policy goals for the world. The group of twenty major ­industrialized and emerging economies (G20) now needs to resolutely advance implementation of both agreements, seizing the opportunity of this ‘Great Transformation’ to sustainability as a unique ­modernization project that could offer substantial economic development opportunities. Complete ­decarbonization of the world economy, which is necessary to avoid the gravest climate risks, can only be achieved by profoundly ­transforming energy systems and other high-emissions infrastructures. This transformation could inspire ­Innovation and channel Investment into sustainability and climate protection, and into the kinds of ­sustainable Infrastructures that need to be ­established and expanded. At the same time, the transformation could combat inequality and promote ­Inclusion within societies and globally, thus becoming an equity project

Challenges to the surveillance of non-communicable diseases – a review of selected approaches

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low- and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low- and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low- and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources. Electronic supplementary material: The online version of this article (doi:10.1186/s12889-015-2570-z) contains supplementary material, which is available to authorized users