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The Jordan River Basin is under great hydric stress. Increases in population and agricultural demand are contributing to the closure of the basin. This paper analyses the results of integrated water resources planning model (WEAP) by studying the vulnerability of water resources in the lower Jordan River under a changing climate pattern and growing water demands. Water balance models show that all aquifers supplying the city of Amman will be depleted within the next few decades. Mitigation measures should include the introduction of additional water into the basin through the Red Sea–Dead Sea canal, in addition to demand management measures such as water conservation and increase in irrigation efficiency. The findings of this study would provide a useful guide to the co-riparians for policy formulation, decision making and dispute resolution. Cooperation among the five riparian countries may be improved by building a Geographic Information System (GIS) database that provides access to accurate data for hydrological analysis.

Introduction: Heart failure (HF) is a frequent cause of hospitalization in the USA with readmission rates as high as 25%. Given the focus on healthcare costs, healthcare systems are investigating ways to lower readmission rates. Dedicated HF clinics have been shown to improve mortality and decrease hospitalizations. This study was designed to evaluate the impact of a HF clinic staffed by cardiology fellows at an urban institution with an ethnically diverse and economically disadvantaged patient population on institutional readmission rates for heart failure. Methods: Using a system wide discharge database and electronic health record (EHR), patients admitted with a primary diagnosis of HF were identified between January 1 st 2011 and March 2012. Using the EHR, patients who were followed up after their hospitalization in our HF discharge clinic were identified. In clinic, patients’ weights and volume status were clinically assessed, medications were optimized, HF education was reinforced to patients and caretakers and further outpatient follow up was arranged. The study group was comprised of those who were readmitted within 30 days for any cause and had been followed in the clinic. The 30-day all cause readmission rates following a HF hospitalization in the year prior to the initiation of the HF clinic and in the year after its creation were compared. Results: From January 2011 through March 2012, 154 patients were admitted with the diagnosis of HF; 61 of the 154 (39.6%) hospitalized were seen in the HF clinic following their hospitalization, with an average appointment time of 9.5 days after discharge; 23 of the 154 patients (14.9%) were readmitted within 30 days of their index HF hospitalization. Of the 23 patients readmitted, 4 were seen in the HF clinic following their index HF hospitalization; the average time to follow up in clinic of these 4 patients was 5 days. Accordingly, the 30-day readmission rate for patients seen in the HF clinic was 6.5% versus 20.4% for those not evaluated in the clinic (p = 0.018). In the year preceding the creation of the HF discharge clinic, the 30-day hospital readmission rate for an index HF admission was 20.6%, which decreased to 14.1% in the year after the founding of the clinic (p= 0.01). Conclusion: A HF clinic operated by Cardiology Fellows at an urban medical center with a diverse patient population where patients were seen in follow up shortly after a HF hospital discharge was associated with a 13.9% reduction in 30-day all cause rehospitalization. This study suggests that a dedicated heart failure clinic may be a factor in reducing heart failure readmissions.