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Promoting a transition to low-carbon energy systems to mitigate climate change requires an optimization of renewable energy (RE) planning. However, curated data for the most promising RE technologies, hydro-, wind and solar power, are missing, which limits data-based decision-making support. Here, a spatially explicit database for existing and proposed renewable power plants is provided: The Renewable Power Plant database for Africa (RePP Africa) encompasses 1074 hydro-, 1128 solar, and 276 wind power plant records. For each power plant, geographic coordinates, country, construction status, and capacity (in megawatt) are reported. The number of RePP Africa records exceeds the respective values in other existing open-access databases and matches available cumulative capacity data reported by international energy organizations best with deviations

This is a book review of Uma Maheswari Bhrugubanda, Deities & Devotees: Cinema, Religion, and Politics in South India (Oxford University Press, 2019).

This study aimed to evaluate the transition to adult care program instituted for liver transplant recipients (LTRs) at a large tertiary pediatric hospital in Melbourne, Australia. Evaluation included the change in a Global Assessment Measure (GAM) before and after the transition program, satisfaction with the program, and measures of transition success including rejection rates and attendance at appointments post-transfer. We hypothesized that the introduction of our structured transition program would improve disease understanding, health system understanding, and self-care. We also hypothesized that those who had undergone the transition program would have lower failure to attend rates and lower rates of rejection than historical controls.A LTR transition program was instituted at our service from 2013 to 2015. The program involved initial assessment of competencies with a Global Assessment Measure (GAM), followed by the introduction of a personalized goal setting program addressing issues identified in dedicated transition clinics. Assessment of competencies was compared between the commencement of the program and immediately prior to transfer. Patient satisfaction with the transition process was assessed at an interview 6-12 months after transfer to the adult service. Rejection rates and failure to attend rates were compared between the intervention group and a group of LTRs who did not receive the intervention.Twenty-eight LTRs participated in the study; 20 received the transition intervention and 8 served as controls. Within the intervention group, all domains of transition competency and reported anxiety regarding transferring had significantly improved at the conclusion of the intervention and all reported satisfaction with the transition program with most (81%) reporting readiness to transfer. There were no significant differences in rejection rates or failure to attend rates between those who did and did not receive the transition intervention.A longitudinal holistic transition program has the potential to positively impact the competencies and readiness of LTRs to successful transition and transfer to adult care.

River pollution through the discharge of untreated sewage and industrial effluent is a perverse outcome of rapid urbanisation and economic growth across Asia. To understand the socio-spatial and seasonal inequalities in pollution risks, we designed a direct observation method to record people’s daily river use activities across dry and wet seasons, complemented by monthly monitoring of river water quality, heavy metal and biotoxicity assessment a large-scale household survey along a 25km stretch of the Turag River and Tongi Khal in Dhaka, Bangladesh. We found very high ammonia and almost zero dissolved oxygen during the low flow season, further exacerbated by heavy metals from the annual Bishwa Ijtema gathering and downstream industrial zones. Pollution exposure through domestic activities prevailed throughout the year, particularly for women and girls along low-income settlements lacking adequate water and sanitation facilities. Swimming peaked among men and children in the monsoon, risking exposure to pathogen pollution. Recognising the social inequalities in risk can support the sequencing of policy action involving short-term adaptation (improved services, education, advocacy) and long-term mitigation (effluent treatment, regulation and enforcement) responses.

A new multibranch Integrated Catchment (INCA) model INCA-Metals has been developed to simulate the impact of tannery discharges on river systems. The model accounts for the key chemical reaction kinetic processes operating as well as sedimentation, resuspension, dilution, mixing and redistribution of pollutants in rivers downstream of tannery discharge points and for mine discharges or acid rock drainage sites. The model is dynamic and simulates the daily behaviour of hydrology and eight metals, including cadmium, mercury, copper, zinc, lead, arsenic, manganese and chromium, as well as cyanide and ammonia. The model is semi-distributed and can simulate catchments, tributaries and instream river behaviour. The model can also account for diffuse pollution from rural runoff as well as point sources from effluent and trade discharges. The model has been applied to the new Savar tannery complex on the Dhaleshwari River system in Bangladesh to assess the impacts on pollution levels in the river system and to evaluate a set of treatment scenarios for pollution control, particularly in the dry season. It is shown that the new effluent treatment plant at Savar needs to significantly improve its operation and treatment capability in order to alleviate metal pollution in the downstream Dhaleshwari River System and also protect the Meghna River System that falls in the Bay of Bengal.

Mitigating climate change, while human population and economy are growing globally, requires a bold shift to renewable energy sources. Among renewables, hydropower is currently the most economic and efficient technique. However, due to a lack of impact assessments at the catchment scale in the planning process, the construction of hydropower plants (HPP) may have unexpected ecological, socioeconomic, and political ramifications in the short and in the long term. The Vjosa River, draining parts of Northern Greece and Albania, is one of the few predominantly free-flowing rivers left in Europe, at the same time its catchment is identified an important resource for future hydropower development. While current hydropower plants are located along tributaries, planned HPP would highly impact the free-flowing main stem. Taking the Vjosa catchment as a case study, the aim of this study was to develop a transferable impact assessment that ranks potential hydropower sites according to their projected impacts on a catchment scale. Therefore, we integrated established ecological, social, and economic indicators for all HPP planned in the river catchment, while considering their capacity, and developed a ranking method based on impact categories. For the Vjosa catchment, ten hydropower sites were ranked as very harmful to the environment as well as to society. A sensitivity analysis revealed that this ranking is dependent upon the selection of indicators. Small HPP showed higher cumulative impacts than large HPP, when normalized to capacity. This study empowers decision-makers to compare both the ranked impacts and the generated energy of planned dam projects at the catchment scale.

This article presents a general overview on the flow of illegal firearms across Central America, a region with some of the world’s highest levels of criminal violence. Situated between the cocaine-producing countries of South America and consumers in North America, Central America has become a nexus for both drug traffickers and illicit weapons. Countries in the region are improving arms control institutions and regulations, largely inspired by the provisions of international agreements and with support from multilateral agencies including the OAS and UNLIREC. The reforms aim mainly to strengthen national control mechanisms, for example weapons marking and registration, which are crucial in preventing diversions from arsenals.

Zika virus (ZIKV) captured mass public attention in 2014–16 due to its potentially devastating teratogenic effects in unborn babies. Although recent years show a decline in disease activity as ZIKV settles into endemic New World cycles, the significant challenges that originally complicated its diagnosis remain, and linkages to foetal microcephaly make safe, accurate, and timely detection especially important. The present chapter seeks to define current direct and indirect immunological detection methods for ZIKV in the context of cross-reactive viral relatives, and will consider the utility and difficulties associated with each practice in resource-rich and resource-poor settings. A synthesis of general diagnostic approaches will more specifically cover immunological techniques spanning from serology to antigen-based immunoassay against the backdrop of common luminescent, fluorescent, and colorimetric output signal types. This analysis uses the diagnostic landscape of Zika virus as a ready template for the classification and contextual understanding of many methods within viral diagnostics.

Heavy metal pollution from tanneries is a global problem in many rapidly developing economies. Effluent discharges into rivers cause serious problems for water quality, damaging ecology and threatening the livelihoods of people, especially in developing urban centres which often have a high concentration of factories. The industry intensive capital area of Bangladesh is impacted with high levels of metals pollution in rivers in the Greater Dhaka Watershed. Sampling and modelling studies have been undertaken to assess pollution in the Buriganga River System in Dhaka. The process based, dynamic model INCA (Integrated Catchments) model has been used to simulate metals along the Buriganga River System in Central Dhaka. Observed and simulated metals concentrations are high, and the model shows that the proposed transfer of the tannery industry upstream helps to reduce the pollution significantly downstream. However, moving the industry upstream may be counterproductive as it is discharged into the upper reaches of the river. This will create pollution upstream unless the newly constructed effluent treatment system can operate at a high level.

Pollution in rapidly urbanising cities and in delta systems is a serious problem that blights the lives and livelihoods of millions of people, damaging and restricting potable water supply and supplies to industry (Whitehead et al, 2015, 2018). Employing new technology based on luminescent molecular biosensors, the toxicity in the rivers around Dhaka in Bangladesh, namely the Turag, Tongi, Balu and Buriganga, has been assessed. Samples taken at 36 sites during medium and low flow conditions and during the Bishwa Ijtema Festival revealed high levels of cell toxicity, as well as high concentrations of metals, particularly aluminium, cadmium, chromium, iron, zinc, lithium, selenium and nickel. Chemical analysis also revealed low dissolved oxygen levels and anoxic conditions in the rivers at certain sites. The bacterial molecular biosensors were demonstrated to be fast, with results in 30 min, robust and a highly sensitive method for the assessment of water toxicity in the field. Furthermore, the biosensor toxicity analysis correlated with the metals data, and a multivariate regression relationship was developed relating toxicity to key metals, such a selenium, zinc and chromium. The resulting model has been validated against split samples and the Bishwa Ijtema Festival data. The combination of modelling and the molecular biosensor technology provides a new approach to detecting and managing pollution in urban river systems.

Background Successfully transitioning to adult care is important for congenital heart disease (CHD) patients, particularly those at the worst end of the spectrum with a Fontan circulation, as their ongoing health engagement affects their health outcomes. Yet, there is a lack of literature exploring patient perspectives about their transition experiences, and what helps or hinders successful transition to adult care. Methods Young adults with a Fontan circulation (n = 18) from the Australian and New Zealand Fontan Registry participated in in-depth phone interviews. Thematic analyses were used to analyze the qualitative interview data. Results We identified six key themes which stood out from patient experiences, including differences between pediatric and adult congenital cardiac care, the need for preparation through formal transition programs, and the important role of support systems. Conclusion To become active managers of their healthcare and remain engaged with the healthcare system, young people would benefit from coordinated efforts between pediatric and adult care to formally prepare them for transition to adult care. This should include involvement from their support network and ongoing education about their health condition. The study highlights the importance of studying patient perspectives through qualitative research to better inform health service provision in the CHD space.

Background The most frequently pursued intervention in the $100 million, 18-state Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) quality demonstration (2010–2015) was quality improvement collaboratives, which 12 states offered to more than 300 primary care practices. A study was conducted to identify which aspects of these collaboratives were viewed by organizers and participants as working well and which were not. Methods Some 223 interviews were conducted in these states near the end of their collaboratives. Interview notes were coded and analyzed to identify trends. Results Aspects of collaboratives that interviewees valued were aimed at attracting participation , maintaining engagement , or facilitating learning . To attract participants , interviewees recommended offering maintenance-of-certification credits, aligning content with existing financial incentives, hiring a knowledgeable collaborative organizer of the same medical specialty as participants, and having national experts speak at meetings. Positively viewed approaches for maintaining engagement included meeting one-on-one with practices to articulate participation expectations in advance, tying disbursal of stipends to meeting participation expectations, and soliciting feedback and making mid-course adjustments. To facilitate learning , interviewees liked learning from other practices, interactive exercises, practical handouts, and meeting face-to-face with new referral partners. Conclusion Prior studies have tended to focus on strategies to maintain engagement . The interviewees valued these features but also valued aspects of collaboratives that attracted participants in the first place and facilitated learning after participants were actively engaged. The findings suggest that a wider array of features may be important when developing or evaluating collaboratives. Collaborative organizers may benefit from incorporating the recommended collaborative features into their own collaboratives.

River water quality in rapidly urbanising Asian cities threatens to damage the resource base on which human health, economic growth and poverty reduction all depend. Dhaka reflects the challenges and opportunities for balancing these dynamic and complex trade-offs which goals can be achieved through effective policy interventions. There is a serious problem of water pollution in central Dhaka, in the Turag-Tongi-Balu River system in Bangladesh with the river system being one of the most polluted in the world at the moment. A baseline survey of water chemistry and total coliforms has been undertaken and shows dissolved oxygen close to zero in the dry season, high organic loading together with extreme levels of Ammonium-N and total coliform in the water. Models have been applied to assess hydrochemical processes in the river and evaluate alternative strategies for policy and the management of the pollution issues. In particular models of flow, Nitrate-N, Ammonium-N and indicator bacteria (total coliforms) are applied to simulate water quality in the river system. Various scenarios are explored to clean up the river system, including flow augmentation and improved effluent treatment. The model results indicate that improved effluent treatment is likely to have a more significant impact on reducing Ammonium-N and total coliforms than flow augmentation, but a combined strategy would greatly reduce the pollution problems in the Turag-Tongi-Balu River System.

Background Little is known about adults living with a Fontan circulation's concerns outside the scope of their clinical outcomes. We examined adults with a Fontan circulations' greatest concerns, as well as their concerns around anti-coagulation, pregnancy and finances. Methods Adults with a Fontan circulation in the Australian and New Zealand Fontan Registry were invited to complete an anonymous online survey, of which 57 participated. A qualitative method approach using thematic analyses was used. Results The greatest concerns for adults living with a Fontan circulation were fear of death/uncertainty around life expectancy which for many individuals colored their concerns around physical health, pregnancy and having children, quality of life and finances. Improving information about outcomes to patients with a Fontan circulation might alleviate uncertainties about their future. Conclusions Fear of death is the primary concern of adults with a Fontan circulation. It may require improved communication and targeted psychological interventions. Physical exercise incorporated as part of their lifestyle should be encouraged to alleviate physical concerns and also improve psychological well-being.

Background Families of children at the worst end of the congenital heart disease endure a significant burden which is often not clearly delineated in the clinical literature. We examined the greatest concerns of parents whose children have a Fontan circulation. Methods Parents (N = 107) of children in the Australian and New Zealand Fontan Registry completed online surveys with open-ended and closed questions. A qualitative method approach incorporating thematic analyses was used. Results The greatest concerns for parents of a child with a Fontan circulation were centered on fear of death for their child and psychosocial well-being, followed by lesser themes around anti-coagulation use, pregnancy and financial burdens. Conclusions Fear of death and the psychological well-being of their children were the main parental concerns. It highlights the need to clearly communicate information on outcomes to families, and the need for family-focused psychological interventions to improve the psychosocial functioning of both parents and young people., Highlights • Fontan parents' greatest concern for their child is fear of death and well-being. • Clear communication around outcomes could help alleviate these fears. • It highlights the need for psychological support for parents and young people.

The 20th anniversary of the National Firearms Agreement (NFA) offers lessons for mental health and public health. Along with similar international legislation, the NFA exemplifies how firearms regulation can prevent firearm mortality and injuries. The gun lobby claims that mental illness underpins gun violence and should be a key site for intervention. A modest but significant link exists between mental disorders and community violence. However, the vast majority of mentally ill individuals are not violent. Despite media portrayals of their dangerousness, they are more likely to be victims of violence and of suicide. Most violent individuals do not have mental illness, and most mass murderers do not have identifiable severe mental illness. Many have maladaptive personality configurations. Gun availability and gun ownership, not severe mental illness, determines most gun homicides. Following recent gun massacres in the United States, there have been calls for better resourcing of mental health services to help identify and respond to those at risk and to regulate firearms access. Screening mentally ill populations for violence risk is misguided. However, clinicians can play a key role in working with legal authorities to monitor and assist regulation of firearm access, especially among high risk populations. Clinician involvement must be complemented by wider gun control measures. The gun lobby's turning the firearms availability debate into a question about whether people with mental illness histories should access such weapons is a calculated appeal to prejudice. Language: en

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states’ demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States’ MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.

Background Successful transition to adult healthcare is particularly important for congenital heart disease (CHD) patients who have undergone palliative surgery, as they risk adverse events if not followed closely. This study examines young people at the worst end of the CHD spectrum who are born with a single ventricle (pumping heart chamber), and who undergo a series of operations that culminate in the Fontan surgical procedure. Purpose To explore adolescents with a Fontan circulation, and their parents’, readiness for transition to adult care and pre-implementation of a transition program. Methods Seventeen adolescents (15–18 years) and 15 of their parents completed questionnaires at the start of their first transition clinic. Results Adolescents reported poor knowledge about their Fontan circulation, and 41% had a poor understanding of the purpose of their medications/treatments. Over half of the adolescents had poor knowledge around medical help-seeking (when, who, how). Most reported feeling comfortable with discussing their medical issues with their cardiologist, but considerably less so about sensitive adolescent issues, in particular, emotional wellbeing. Parents reported high levels of anxiety around transition to adult care services. Conclusion Findings pre-program indicate poor adolescent health knowledge, a lack of focus in health services on emotional wellbeing and high parental anxiety. These findings highlight the need for dedicated programs that focus on early preparation, parental involvement and acknowledgment, transition as a process, strong integration and prioritisation in the health system with a youth-friendly and holistic focus, in particular, around emotional wellbeing.

The Quantum® Cell Expansion System (Quantum; Terumo BCT, Inc, Lakewood, CO, USA) is a novel hollow fiber-based device that automates and closes the cell culture process, reducing labor intensive tasks such as manual cell culture feeding and harvesting. The manual cell selection and expansion processes for the production of clinical-scale quantities of bone marrow-derived human mesenchymal stromal cells (BM-hMSCs) have been successfully translated onto the Quantum platform previously. The formerly static, manual, in vitro process performed primarily on tissue culture polystyrene substrates may raise the question of whether BM-hMSCs cultured on a hollow fiber platform yields comparable cell quality.A rigorous battery of assays was used to determine the genetic stability of BM-hMSCs selected and produced with the Quantum. In this study, genetic stability was determined by assessing spectral karyotype, micronucleus formation and tumorigenicity to resolve chromosomal aberrations in the stem cell population. Cell phenotype, adherent growth kinetics and tri-lineage differentiation were also evaluated. HMSC bone marrow aspirates, obtained from three approved donors, were expanded in parallel using T225 culture flasks and the Quantum.BM-hMSCs harvested from the Quantum demonstrated immunophenotype, morphology and tri-lineage differentiation capacity characteristics consistent with the International Society of Cell Therapy standard for hMSCs. Cell populations showed no malignant neoplastic formation in athymic mice 60 days post-transplant, no clonal chromosomal aberrations were observed and no DNA damage was found as measured by micronucleus formation.Quantum-produced BM-hMSCs are of comparable quality and demonstrate analogous genetic stability to BM-hMSCs cultured on tissue culture polystyrene substrates.

Un millier de personnes meurent chaque jour a la suite de blessures causees par des armes a feu et trois fois plus subissent des blessures graves. Si les deces, les blessures et l’incapacite resultant des armes etaient classes dans la categorie des maladies, on pourrait parler d’epidemie. Pourtant, les medias et l’opinion publique donnent souvent a penser que la violence armee est simplement une consequence inevitable de la cruaute humaine et de la privation, plutot qu’un probleme de sante publique qui peut etre evite ou au moins reduit.

A thousand people die each day from gunshot wounds, and three times as many are left with severe injuries. If the death, injury and disability resulting from small arms were categorized as a disease, it would qualify as an epidemic. Yet the media and popular perception tend to suggest that gun violence is simply an unavoidable consequence of human cruelty or deprivation, rather than a public health problem which can be prevented or at least reduced.

Mitochondria play an important role in numerous diseases as well as normative aging. Severe reduction in mitochondrial function contributes to childhood disorders such as Leigh Syndrome, whereas mild disruption can extend the lifespan of model organisms. The Caenorhabditis elegans isp-1 gene encodes the Rieske iron-sulfur protein subunit of cytochrome c oxidoreductase (complex III of the electron transport chain). The partial loss of function allele, isp-1(qm150), leads to several pleiotropic phenotypes. To better understand the molecular mechanisms of ISP-1 function, we sought to identify genetic suppressors of the delayed development of isp-1(qm150) animals. Here we report a series of intragenic suppressors, all located within a highly conserved six amino acid tether region of ISP-1. These intragenic mutations suppress all of the evaluated isp-1(qm150) phenotypes, including developmental rate, pharyngeal pumping rate, brood size, body movement, activation of the mitochondrial unfolded protein response reporter, CO2 production, mitochondrial oxidative phosphorylation, and lifespan extension. Furthermore, analogous mutations show a similar effect when engineered into the budding yeast Rieske iron-sulfur protein Rip1, revealing remarkable conservation of the structure-function relationship of these residues across highly divergent species. The focus on a single subunit as causal both in generation and in suppression of diverse pleiotropic phenotypes points to a common underlying molecular mechanism, for which we propose a "spring-loaded" model. These observations provide insights into how gating and control processes influence the function of ISP-1 in mediating pleiotropic phenotypes including developmental rate, movement, sensitivity to stress, and longevity.

The “Notes Section” of the Christian Education Journal provides an opportunity for people in the field of Christian education to provide responses to articles in previous issues of the journal and to share more personal reflective articles that provide stimulating ideas for readers to think about. In this issue, Rebecca Peters reflects on how recent research on adolescent spirituality compares with research from half a century ago, and what we might learn from that comparison.

The purpose of this review was to identify instruments designed to predict future child maltreatment and to evaluate their predictive accuracy. A number of electronic databases were searched to identify published studies. Only studies that had utilized a prospective methodology and tested at least one standardized instrument designed to identify families during the antenatal or postnatal periods who are at increased risk of maltreatment were included in the review. Eight studies were included that had prospectively tested a standardized instrument to predict child maltreatment during the antenatal or postnatal periods. Only six of the included studies followed up the entire sample, and of these only two did not provide an intervention for some or all of the high-risk group. While many of the included instruments obtained sensitivity and specificity above 80%, only two of the included instruments combined specificity over 80% with a positive predictive value above 25%. Currently available instruments have limited accuracy, suggesting that they should only be used to focus non-punitive interventions. These findings, in conjunction with other issues such as the stigma attached to the use of such instruments and difficulties in their application within a clinical and research context, suggest the need for a new approach to the identification of parents in need of higher levels of intervention. Copyright © 2003 John Wiley & Sons, Ltd.

This Highlight examines the measurement of medical homeness in selected demonstration projects. It also describes the development of the Medical Home Index: Revised Short Form, an adaptation of the Medical Home Index, for use in evaluating the demonstration projects.

Implementation integrity is a potentially critical issue for problem-solving teams (PST) and most response-to-intervention models. The current study hypothesized that providing performance feedback, which has consistently been shown to increase implementation integrity, to PSTs would enhance the procedural integrity of the process. The PSTs for three elementary schools were provided performance feedback with a 20-item checklist created from the literature. A multiple-baseline design across schools revealed an immediate change in level after providing performance feedback. The resulting percentages of non-overlapping data were 90.9%, 90.0%, and 100%. However, PSTs still did not monitor student progress, assess the effectiveness of the intervention, or measure the integrity with which the intervention was implemented even after receiving feedback. Thus, providing performance feedback could be a method to increase the fidelity with which critical components of data-based problem-solving are implemented, but these data suggest the need for additional research.

This paper describes the problem of serious injuries and deaths caused by firearm injuries in NSW. It summarises the data describing deaths and hospital separations due to firearm injuries for the state. It also outlines the provisions of the current gun law, which contains specific powers for health professionals.