Desalination and the commons: tragedy or triumph?

A policy is more likely to be economically efficient when its costs and benefits fall on the same group, but politicians can allocate costs and benefits to different groups within their jurisdictional commons. This article examines the distribution of costs and benefits from desalination projects using examples from San Diego, Almeria and Riyadh. The examples illustrate how mismatches between costs and benefits can persist or change as politicians adjust the policy portfolio to balance inefficiency and political risk.Global Challenges (FGGA

Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease

Aims Coronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. Methods and results Separate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen's kappa 0.82, 95% confidence interval 0.74-0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients. Conclusion In patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information

Crise de abastecimento de água em São Paulo e falta de planejamento estratégico

Embora a crise no abastecimento de água na Região Metropolitana de São Paulo (RMSP) tenha se manifestado de maneira mais intensa no verão de 2013-2014, ela revela um problema crônico que vem afetando toda a Região nos últimos dez anos. Esse problema foi gerado pela falta de um planejamento estratégico que considere questões climatológicas que podem indicar, com meses de antecedência, problemas de recomposição dos níveis dos mananciais, permitindo que ações sejam empreendidas com razoável antecedência, reduzindo os impactos para a população. Este estudo mostra como é possível utilizar informações climáticas na gestão estratégica do sistema de abastecimento da RMSP.Though the crisis in the water supplying system in the Metropolitan Region of São Paulo (RMSP) was more intensively felt in the 2013-2014 summer, it reveals a chronic problem that has been affecting the whole RMSP for the past ten years. This problem is originated from the lack of a strategic planning that takes into consideration climate issues that could, months before, foresee problems to restore the levels of water resources, allowing measures to be implemented within a reasonable anticipation, therefore reducing the impacts on the population. This study shows how it is possible to use climate information in the strategic management of the water supply in the RMSP

The nutritive value of forage sorghum genotypes developed for the dry tropical highlands of Kenya as feed source for ruminants

in vitro studies were conducted on five sorghum genotypes developed for the dry tropical highland climate of Kenya and which can be fed to ruminants fresh or as silage. The five sorghum genotypes consisted of two normal white mid-rib (WMR) genotypes, coded E1291 and E65181, and three brown-midrib (BMR) genotypes, coded Lan-5, Lan-6 and Lan-12. Whole mature plants (herbage plus grain) and silage made from E 1291 were used in the study. An in vitro manual gas production technique was used to compare the nutritive characteristics of these genotypes for ruminants. These sorghums differed significantly in true organic matter degraded (OMDeg), which ranged from 520 to 678 g/kg after 24 h incubation and 706 to 805 g/kg after 72 h incubation. All the BMR sorghums had a higher degradability than the WMR genotype, E6518, and the silage, with Lan-5 having the highest degradability. Methane produced per g OMDeg ranged from 40.6 to 46.4 mL/g after 24 h incubation and from 53.1 to 62.6 mL/g after 72 h incubation. It was similar for all genotypes after 24 h incubation but Lan-12 had the highest methane production after 72 h incubation. After 24 h and 72 h incubation all the genotypes produced a similar total amount of gas per OMDeg (293 to 309 and 357 to 385 mL/g, respectively) with similar total short chain fatty acid concentrations in the liquid digesta (7.8 to 10.4 and 9.5 to 10.3 mmol, respectively) and acetate to propionate ratios of 2.16 to 2.49 and 2.35 to 2.87, respectively. The sorghums showed great potential as ruminant feed sources in the region

An innovative cold storage system for donor heart transportation-lessons learned from the first experience in Switzerland

Background The current standard for donor heart preservation consists of cold organ storage in three sequential plastic bags. This technique can cause freezing injuries of the donor heart as the temperature inside the transport box is not monitored routinely. The SherpaPak™ Cardiac Transport System (CTS) (Paragonix Technologies, Cambridge, MA, USA) aims to resolve this problem by maintaining a controlled preservation temperature between 4 and 8 °C. This study reports the first single-centre experience in Switzerland with this innovative single-use disposable device. Methods Between May and December 2020, four heart procurements using SherpaPak™ CTS were performed at our heart centre. Donor heart preservation fluid and ambient temperature were monitored using the InTempConnect$^{®}$ application (Onset Computer Corporation, Bourne, MA, USA). All patient data were collected retrospectively from the local hospital patient data capture system. Results Four recipients of a donor heart preserved with SherpaPak™ CTS were included in this study (3 male, 1 female). Mean transport distance was 86 km (range, 45-276 km). Mean storage time in the cooler was 73.5±19.33 minutes. Mean cold ischemic time was 199.25±11.67 minutes. The device kept the average organ temperature between 5.2 and 8.8 °C and hereby reached the recommended temperature range of 5-10 °C. Modifications of the procurement and storage process provided an optimization of the temperature course in the transportation box. There were no incidents during the transport. Organs transported with this novel storage system showed normal function after transplantation. Conclusions The SherpaPak™ CTS provides constant organ temperatures during transportation, prevents freezing injury and ensures mechanical protection of the graft. Keywords Heart transplantation; organ procurement; cold storage; hypothermic injury; graft transport