The missing link – the role of primary care in global health

This chapter provides an overview of the role of primary care in the context of global health. Universal health coverage is a key priority for WHO and its member states, and provision of accessible and safe primary care is recognised as essential to meet this important international policy goal. Nevertheless, more than three decades after Alma Ata, the provision of primary health care remains inadequate, indicating that primary care has not received the priority it deserves, in many parts of the world. This is despite the proven health benefits that result from access to comprehensive primary health care. We highlight some examples of good practice and discuss the relevance of primary care in the context of health equity and cost-effectiveness. Challenges that influence the success of primary care include the availability of a qualified workforce, financing and system design and quality assurance and patient safety

Décomposition chimique et isotopique d'un hydrogramme de crue d'un torrent méditerranéen - Réflexions méthodologiques

La décomposition chimique et isotopique d'un hydrogramme de crue d'un petit torrent méditerranéen (Cannone, Corse, France), a été tentée dans un cas simple, en confrontant les résultats des deux méthodes et en discutant leurs limites. L'outil isotopique permet de bien différencier l'eau préexistante et l'eau nouvelle. L'analyse de la variation des éléments chimiques met en évidence la participation d'eau du soi, sans qu'il soit possible de quantifier sa contribution; elle démontre que la composition de la pluie n'est pas conservative; le rôle du pluviolessivage est mis en évidence, conjointement à celui du transfert dans la zone non-saturée. Ainsi les décompositions chimiques des hydrogrammes (en particulier celles réalisées avec la conductivité) reposent le plus souvent sur des approximations théoriquement contestables et conduisent à des erreurs notables, à l'exception toutefois de celles réalisées avec la silice.Problems of environmental water quality such as transfer of pollutants and ecosystem acidification call for a new insight to the path and the contact time of water in the different subsurface reservoirs. An isotopic and chemical hydrograph separation is carried out for a flood in a small upland watershed in the Mediterranean region (Cannone, Corsica Island, France) with special attention to a comparison between the two methods and discussion of their limits. Here, old and new water are clearly distinguished by isotopic composition. The pattern of the dissolved constituents of stream water shows the contribution of ground water, often assumed to be negligible. The non-conservative behaviour of rain-water chemistry during its path to the stream channel due to enrichment by throughfall and leaching of soils, is the main obstacle to chemical separation. Chemical separation, especially through specific conductance seems generally to be hazardous, except perhaps for dissolved silica. Checking the variation of all dissolved constituents would prevent questionable approximations

Eutrophisation récente d'un lac de montagne sans occupation humaine (lac de Bastani, Corset : Conséquence d'agents atmosphériques?

Le Lac de Bastani (Corse - France), petit lac d'altitude (2089 m) à bassin versant rocheux, est dépourvu de toute implantation ou activité humaine. Ce lac est mésotrophe à eutrophe par certains de ses caractères alors que 4 autres lacs étudiés dans le même contexte sont oligotrophes. De plus, il était décrit au début du siècle comme oligotrophe.Dans ce type de lacs, les apports atmosphériques constituent la majeure partie de la source externe de nutriments. L'apport d'azote inorganique dissous atmosphérique au bassin versant est important, de l'ordre de 0,8 g.N.m-2 par an, soit l'équivalent du rejet d'une trentaine d'habitants permanents. Les trois-quarts sont relargués à la fonte, pendant environ un mois; cela représente l'équivalent des rejets d'environ 300 habitants sur le bassin qui, du fait de la faible activité biologique dans les sols à cette température, arrive pratiquement en entier au lac. Ces apports de nutriments à la fonte sont responsables du démarrage très précoce de la production primaire.En l'absence d'un bilan complet des nutriments la comparaison du lac de Bastani avec les autres lacs oligotrophes et en particulier avec celui de Capitello, aux caractéristiques voisines, permet de cerner les facteurs responsables de la différence de leur niveau de trophie. Bastani et Capitello recevant une charge externe semblable, la source interne est probablement responsable de la situation de Bastani. Les concentrations estivales de N-NO3 notables (0,2-0,3 mg.l-1) des lacs oligotrophes sont un indice de la limitation de leur production primaire par le phosphore. Par contre à Bastani, l'azote étant pratiquement entièrement consommé en été le lac ne semble pas limité par le phosphore. Le vent violent et fréquent qui règne à Bastani semble le facteur déterminant de son niveau trophique supérieur : il assure le brassage de l'eau du lac et la remontée du phosphore (et aussi de l'azote) libéré des sédiments jusque dans la zone photique. Le phytoplancton consomme presque entièrement l'azote, alors que dans les lacs oligotrophes abrités du vent où le phosphore est limitant, les nitrates restent à des teneurs notables.L'eutrophisation récente du lac de Bastani peut s'expliquer par l'accroissement des apports atmosphériques, les seuls qui aient varié. Le phosphore étant disponible la production primaire devait être limitée auparavant par l'azote. Les apports d'azote inorganique dissous ont été dans cette région multipliés par 2 au moins par la pollution à longue distance. Cette dernière pourrait entraîner à elle seule l'évolution trophique d'un lac de haute montagne, dans un site vierge de toute occupation humaine, lorsque le brassage par le vent assure la mobilisation du phosphore des sédiments.Lake Bastani (Corsica, France), a small alpine lake (2089 m), is located in a pristine rocky watershed. It presents some characteristics of eutrophic lakes, whereas four other similar lakes are oligotrophic or ultraoligotrophic. Moreover, at the beginning of the century it was described as being oligotrophic.The lake is ice-covered from November to June. Intense phytoplankton activity begins before the ice melts completely and goes on until fall freezing. Consequently Secchi disk transparency is between 3.2 m in June and 1.8 m in August. The algal biomass, as expressed by chlorophyll-a content, is maximum at the bottom. Chlorophyll-a is about 4-5 mg-m-3 at ice melting and reaches a maximum of 46 mg.m-3 in August. Primary production is highest in the upper levels of water with 41 mg.C.m-3.d-1 at - 5 m. These values are 20 to 80 times that of the other Corsican lakes. Regarding the different trophic classifications this lake presents some features of eutrophic lakes.In 1923 a survey of phytoplankton by Pestalozzi showed that the lake was oligotrophic. This trophic evolution is therefore recent; it is shown by the complete disappearance of Desmidiaceae, the near disappearance of Diatoms, the appearance of green algae with Oedogonium and Spirogyra dominant in summer and autumn, and the development of blue-green algae with Oscillatoria.The seasonal pattern of phytoplankton composition displays diatom development at ice- and snow-melting with the green algae Oedogonium. During the summer warmth, green algae are dominant with the blue-green Oscillatoria. Green algae Oedogonium and Spirogyra increase until the fall turnover.The lake is 2nd-order dimictic with two turnovers in spring and autumn, and two periods of thermal stratification. A strong and frequent wind stirs the lake water inducing homogeneisation of the epilimnion and sometimes the disappearance of the hypolimnion. Dissolved oxygen is always present even at the bottom where O2 saturation is about 50% in winter. Nitrogen is very low - 0.01-0.04 mg.l-1 N-NO3 - and phosphorus (PO4) is below the detection level in the epilimnion during summer, due to intense phytoplankton activity, The hypolimnion is richer in NH4, NO2 and PO4. In spring when the snow begins to melt the surficial waters are enriched with N (NO3 + NH4) and P-PO4, showing the contribution of concentrated snow water.In fact atmospheric input is the dominant external loading in such a watershed. Nitrogen atmospheric input is extrapolated from data obtained at Lake Bavella 30 km southwards for 3 years - 1984 to 1986. The dissolved inorganic nitrogen input is about 0.8 g.m-2 .y-1 , equivalent to wastes from some 30 permanent inhabitants for the whole watershed, About 80 % of annual rainfall is stored in the snowpack, as are ¾ of the dissolved inorganic nitrogen. This nitrogen returns to the lake during a period of about one month which represents 100 kg and a loading of 80 mg.m-2.d-1 for 30 days; it is equivalent to wastes from some three hundred capita during one month. Moreover it is known that the first melwaters are considerably enriched with several ions, especially those of ecological concern, H+, SO4--, NO3¯, NH4+. Using findings from literature we can estimate that in the first two weeks of melting, up to half the annual atmospheric input of dissolved inorganic nitrogen reaches the lake with meltwater concentrations of more than 1 mg.N.l-1. The total dissolved nitrogen input is estimated at 1.2 g.m-2.y-1 and the total nitrogen input at 1.3 g.m-2 .y-1.No data are available for the phosphorus atmospheric input but estimations from literature are about 10 mg.m-2 .y-1 for orthophosphate and 60 mg.m-2 .y-1 for total phosphorus. The release of P-PO4 from the melting snowcover and from ice, added to the tremendous release of inorganic nitrogen, explains the start of vigorous phytoplankton production before the ice melts completely. By this early start primary production may avoid the flush of nutriments resulting from the flow of melting water.Trophic conditions in Lake Bastani are a matter of question as the other four lakes studied with the same edaphic conditions are oligo- or ultraoligotrophic. A comparison between Lake Bastani and the ultraoligotrophic Capitello Lake, which has the same geomorphological and ecological environment, reveals the determining factors of this paradoxical situation, though a nutrient budget is still not available.A low flushing rate (17 months) cannot be the explanation, as that of Lake Capitello is similar (12 months).The external loading (from watershed and atmosphere)being the same, the difference between the two lakes is to be found in the internal loading.The fact that Lake Capitelto and the other oligotrophic lakes present notable N concentrations in summer (0.2-0.3 mg.l-1 ), when Bastani displays N- concentrations 10 times lower, is a sign that they are limited in phosphorus. Conversely Lake Bastani is not phosphorus-limited.The determining factor in this situation seems to be windstirring. Lake Bastani is downwind of a pass in the axial range of Corsica and is submitted to strong frequent winds. Windstirring induces an epilimnion homogeneisation, the downward migration of the thermo- and chemoclines. Thus phosphorus from the sediments can be transferred to the photic zone and is not limiting for phytoplankton. Phytoplankton exhausts nitrogen which is very low at the end of summer. In Lake Capitello as in the other lakes, shielded from the wind by rockwall screens, no mixing occurs, phosphorus cannot be supplied from the sediments and is limiting : nitrogen is not used up and remains at relatively high levels of 0.2-0.3 mg.l -1.Recent eutrophication cannot be explained by an increase of nutrient availability from the sediments due to windstirring, as no climatic change has occurred in the fast century. The probability that internal loading had reached a threshold by progressive accumulation of nutrients in the sediment is very slight if there is no change in the external loading (the unique source of "new" nutrients) and/or the trophic status of the lake. Thus an increase in the external loading seems to be responsible for the eutrophication of Lake Bastani. The atmospheric inupt is the only external reason for a change in the nutrient rate. An increase in the phosphorus atmospheric input by local (forest fires) and regional (long range pollution) human activities is suspected, but does not seem sufficient to change the trophic status of the lake as it has no effect on other lakes, which remain oligotrophic. Moreover, atmospheric P loading is well below the level of phosphorus release from sediments, as estimated from literature. Conversely, an atmospheric inorganic nitrogen input has increased at least twice due to long range pollution (agricultural, industrial and domestic activities). This was estimated from a typologic classification of rain events in Corsica. This increase in atmospheric nitrogen loading might explain the change in the trophic status of the lake, N having been limiting. In the other P-limited lakes the increased atmospheric N input has only increased the N-NO3 concentration in lake water. This explanation being the most realistic, it is of great interest to note that long range atmospheric pollution could induce the eutrophication of a pristine oligotrophic lake

Catàleg de les molses d'Andorra

El catàleg és una recopilació de totes les dades publicades que fan referència a les molses d'Andorra. S'han revisat tots els exemplars d'herbari assequibles corresponents a les espècies publicades. Aquest treball representa l'estat actual del coneixement de la brioflora (molses) d'Andorra.The catalogue is a compilation of all the data published relating to the species of mosses collected in Andorra. All the available specimens published have been revised. This work represents the current knowledge of the Andorran bryoflora (mosses)

Genome-wide signatures of population bottlenecks and diversifying selection in European wolves

Genomic resources developed for domesticated species provide powerful tools for studying the evolutionary history of their wild relatives. Here we use 61K single-nucleotide polymorphisms (SNPs) evenly spaced throughout the canine nuclear genome to analyse evolutionary relationships among the three largest European populations of grey wolves in comparison with other populations worldwide, and investigate genome-wide effects of demographic bottlenecks and signatures of selection. European wolves have a discontinuous range, with large and connected populations in Eastern Europe and relatively smaller, isolated populations in Italy and the Iberian Peninsula. Our results suggest a continuous decline in wolf numbers in Europe since the Late Pleistocene, and long-term isolation and bottlenecks in the Italian and Iberian populations following their divergence from the Eastern European population. The Italian and Iberian populations have low genetic variability and high linkage disequilibrium, but relatively few autozygous segments across the genome. This last characteristic clearly distinguishes them from populations that underwent recent drastic demographic declines or founder events, and implies long-term bottlenecks in these two populations. Although genetic drift due to spatial isolation and bottlenecks seems to be a major evolutionary force diversifying the European populations, we detected 35 loci that are putatively under diversifying selection. Two of these loci flank the canine platelet-derived growth factor gene, which affects bone growth and may influence differences in body size between wolf populations. This study demonstrates the power of population genomics for identifying genetic signals of demographic bottlenecks and detecting signatures of directional selection in bottlenecked populations, despite their low background variability.Heredity advance online publication, 18 December 2013; doi:10.1038/hdy.2013.122

Neocolonialism in education: Cooperative learning, Western pedagogy in an Asian Context

This article is concerned with the influence of western educational approaches in non-western countries and societies. This influence is frequently referred to as educational neocolonialism in the sense that western paradigms tend to shape and influence educational systems and thinking elsewhere through the process of globalisation. Given the perceived pressure to modernise and reform in order to attain high international standards, educational policy makers in non-western countries tend to look to the west. Thus they may 'borrow' policies and practices that were originally developed and operated, and which appeared to be effective, in a very different cultural context to that of their own societies. In effecting such transfer, detailed consideration of particular aspects of the culture and heritage of the originating country is often neglected. To illustrate some of the problems that result from this, the article presents a case study of the application of Cooperative Learning, an educational method developed in the west, within an Asian context. Drawing upon Trompenaars and Hampden-Turner's typology of seven cultural dimensions, our examination of western method and eastern context reveals a complex web of cultural conflicts and mismatches. The paper concludes by suggesting that non-western cultures should seek to reconstruct imported pedagogic practices in accordance with their own world views and in line with their own norms and values

Dietary Differentiation and the Evolution of Population Genetic Structure in a Highly Mobile Carnivore

Recent studies on highly mobile carnivores revealed cryptic population genetic structures correlated to transitions in habitat types and prey species composition. This led to the hypothesis that natal-habitat-biased dispersal may be responsible for generating population genetic structure. However, direct evidence for the concordant ecological and genetic differentiation between populations of highly mobile mammals is rare. To address this we analyzed stable isotope profiles (δ13C and δ15N values) for Eastern European wolves (Canis lupus) as a quantifiable proxy measure of diet for individuals that had been genotyped in an earlier study (showing cryptic genetic structure), to provide a quantitative assessment of the relationship between individual foraging behavior and genotype. We found a significant correlation between genetic distances and dietary differentiation (explaining 46% of the variation) in both the marginal test and crucially, when geographic distance was accounted for as a co-variable. These results, interpreted in the context of other possible mechanisms such as allopatry and isolation by distance, reinforce earlier studies suggesting that diet and associated habitat choice are influencing the structuring of populations in highly mobile carnivores

Impregnation of bone chips with alendronate and cefazolin, combined with demineralized bone matrix: a bone chamber study in goats

Contains fulltext : 108265.pdf (publisher's version ) (Open Access)BACKGROUND: Bone grafts from bone banks might be mixed with bisphosphonates to inhibit the osteoclastic response. This inhibition prevents the osteoclasts to resorb the allograft bone before new bone has been formed by the osteoblasts, which might prevent instability. Since bisphosphonates may not only inhibit osteoclasts, but also osteoblasts and thus bone formation, we studied different bisphosphonate concentrations combined with allograft bone. We investigated whether locally applied alendronate has an optimum dose with respect to bone resorption and formation. Further, we questioned whether the addition of demineralized bone matrix (DBM), would stimulate bone formation. Finally, we studied the effect of high levels of antibiotics on bone allograft healing, since mixing allograft bone with antibiotics might reduce the infection risk. METHODS: 25 goats received eight bone conduction chambers in the cortical bone of the proximal medial tibia. Five concentrations of alendronate (0, 0.5 mg/mL, 1 mg/mL, 2 mg/mL, and 10 mg/mL) were tested in combination with allograft bone and supplemented with cefazolin (200 mug/mL). Allograft not supplemented with alendronate and cefazolin served as control. In addition, allograft mixed with demineralized bone matrix, with and without alendronate, was tested. After 12 weeks, graft bone area and new bone area were determined with manual point counting. RESULTS: Graft resorption decreased significantly (p < 0.001) with increasing alendronate concentration. The area of new bone in the 1 mg/mL alendronate group was significantly (p = 0.002) higher when compared to the 10 mg/mL group. No differences could be observed between the group without alendronate, but with demineralized bone, and the control groups. CONCLUSIONS: A dose-response relationship for local application of alendronate has been shown in this study. Most new bone was present at 1 mg/mL alendronate. Local application of cefazolin had no effect on bone remodelling