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Background: Competition for freshwater between cities and agriculture is projected to grow due to rapid urbanization, particularly in the Global South. Water reallocation from rural to urban regions has become a common strategy to meet freshwater needs in growing cities. Conceptual issues and associated measurement problems have impeded efforts to compare and learn from global experiences. This review examines the status and trends of water reallocation from rural to urban regions based on academic literature and policy documents. Methods: We conduct a systematic literature review to establish the global reallocation database (GRaD). This process yielded 97 published studies (academic and policy) on rural-to-urban reallocation. We introduce the concept of reallocation 'dyads' as the unit of analysis to describe the pair of a recipient (urban) and donor (rural) region. A coding framework was developed iteratively to classify the drivers, processes and outcomes of water reallocation from a political economy perspective. Results: The systematic review identified 69 urban agglomerations receiving water through 103 reallocation projects (dyads). Together these reallocation dyads involve approximately 16 billion m3 of water per year moving almost 13 000 kilometres to urban recipient regions with an estimated 2015 population of 383 million. Documented water reallocation dyads are concentrated in North America and Asia with the latter constituting the majority of dyads implemented since 2000. Synthesis: The analysis illustrates how supply and demand interact to drive water reallocation projects, which can take many forms, although collective negotiation and administrative decisions are most prevalent. Yet it also reveals potential biases and gaps in coverage for parts of the Global South (particularly in South America and Africa), where reallocation (a) can involve informal processes that are difficult to track and (b) receives limited coverage by the English-language literature covered by the review. Data regarding the impacts on the donor region and compensation are also limited, constraining evidence to assess whether a water reallocation project is truly effective, equitable and sustainable. We identify frameworks and metrics for assessing reallocation projects and navigating the associated trade-offs by drawing on the concept of benefit sharing.

Water-permit systems are widely used across Africa as a blanket requirement for small and micro irrigation enterprises, as well as large enterprises. The present study aimed to, first, further understand the implications of permit systems for both the most vulnerable and the state, and, second, based on the findings, identify options for pro-poor water legislation that also meet the water governance requirements of the state. The growing recognition of the importance of farmer-led irrigation development for food security across the continent underlines the importance of these questions. Focusing on Kenya, Malawi, South Africa, Uganda, Zimbabwe, and other African countries, we found that permit systems criminalized instead of protected the water rights of small-scale farmers. Moreover, little if any attention is paid to the logistical burdens and costs to the state of implementing such systems relative to the intended revenue generation. As many small-scale farmers in Africa were found to operate under customary land and water tenure systems, the study proposes a hybrid system of water rights that formally recognizes such practices, along with the use of permits, including enforcement of conditions for large users, to serve the interests of both the state and small-scale farmers.

Objectives Bone and soft-tissue calcifications are often coincidentally diagnosed on digital panoramic radiographs (DPRs). As the use of three-dimensional (3D) images has increased in the past decade for diagnostics in the mandibular region, we evaluated 3D volume images derived from 2D panoramic images to determine if this method is suitable for early detection of calcifications in this region. Methods In this study, three investigators retrospectively and independently evaluated 822 DPRs. If one or more calcifications were present, the 3D volume image from that patient was retrospectively evaluated to confirm the incidental findings. A radiographic system with a low-dose mode and a high-resolution 3D-image function was used. The investigators focussed on the most common calcifications, including tonsilloliths (TL), idiopathic osteosclerosis (IO) of the mandible, carotid artery calcifications (CAC), calcified submandibular lymph nodes (hereafter, CSL), and sialoliths of the submandibular salivary gland (SSG). Results One or more calcifications were identified in 415 (50.5%) DPRs. In total, 718 calcifications were detected, 30.2% of which were TL, 16.3% IO, 11.3% CAC, 8.8% CSL, and 1.7% SSG. Only 287 (39.97 %) of the calcifications were confirmed on 3D volume images; of these, 29.2% were TL, 58.5% IO, 0.2% CAC, and 1.4% SSG. No CSLs were detected. Conclusions Not all areas shown on the DPRs were visible in the retrospectively obtained 3D volume images. Whereas DPRs are used to diagnose calcifications such as IO, TL, SSG, CAC, and CSL, the 3D volume images were only useful for confirming the existence of IO, TL, and SSG calcifications.

This article unravels the notions of justice in statutory water law in Sub-Saharan Africa in general and South Africa in particular. These laws, which allocate and regulate water resources, are licence (or permit) systems. Three forms of injustices are identified for small-scale water users who typically encompass all poor water users: the reinforcement of the historical injustices by which colonial powers captured ownership of water resources and undermined customary water law; administrative discrimination as a result of governments' lack of capacity to license the large numbers of small-scale users; and discrimination of the smallest-scale users whose exemption from the obligation to apply for a licence relegates them to a second-class entitlement to water. Based on the texts and implementation experiences of the National Water Act (1998) and the pro-poor prioritisation rules in the National Water Resource Strategy-2 (2013), the authors propose the transformative legal tool of priority General Authorisations for black small-scale users to overcome these injustices. Via this tool all black small-scale users, including the poor, would obtain equal access to minimum quantities of water needed to progressively achieve constitutional rights to water, food, and non-discrimination, while the remaining water resources would be allocated to high-impact users through licences with strict and enforceable conditions.

Purpose Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder that affects almost 24 million Americans. Healthcare providers often do not initiate and/or intensify therapy appropriately during patient visits, which may be due, in part, to a lack of understanding of the new diabetes medications. This review focuses on means by which primary care nurse practitioners (NPs) might evaluate the utility of pharmacologic agents based upon their relation to the pathogenesis of T2DM. Data sources The evidence used in developing this review included evidence-based reviews, clinical trials, cohort studies, position statements, and guidelines. The authors obtained relevant reports through a computerized search of the literature using PubMed, MEDLINE, and other search engines and scanning syllabi from national and international meetings on the subject of type 2 diabetes. Conclusions Medications used to manage T2DM utilize different pharmacologic approaches. These include stimulating insulin production, reducing hepatic gluconeogenesis, slowing polysaccharide digestion, and increasing insulin sensitivity in muscle, liver, and fat to achieve euglycemia. Implications for practice Patients with T2DM should be treated to their lowest targeted glycemic goals as soon as they are diagnosed as safely and as rationally as possible. NPs in primary care practice can facilitate more effective diabetes management.

The UN recognition of a human right to water for drinking, personal and other domestic uses and sanitation in 2010 was a political breakthrough in states’ commitments to adopt a human rights framework in carrying out part of their mandate. This chapter explores other domains of freshwater governance in which human rights frameworks provide a robust and widely accepted set of normative values to such governance. The basis is General Comment No. 15 of the Committee on Economic, Social and Cultural Rights in 2002, which states that water is needed to realise a range of indivisible human rights to non-starvation, food, health, work and an adequate standard of living and also procedural rights to participation and information in water interventions. On that basis, the chapter explores concrete implications of the Comment for states’ broader infrastructure-based water services implied in the recognised need to access to infrastructure, rights to non-discrimination in public service delivery and respect of people’s own prioritisation. This implies a right to water for livelihoods with core minimum service levels for water to homesteads that meet both domestic and small-scale productive uses, so at least 50–100 l per capita per day. Turning to the state’s mandates and authority in allocating water resources, the chapter identifies three forms of unfair treatment of small-scale users in current licence systems. As illustrated by the case of South Africa, the legal tool of “Priority General Authorisations” is proposed. This prioritises water allocation to small-scale water users while targeting and enforcing regulatory licences to the few high-impact users.

One of the more pervasive challenges facing SADC is the variability in water availability over space and time. In response, SADC States have largely opted for large scale water storage and transfer infrastructure. However as climate and demographic changes, together with rapid economic growth, increase water stress and variability, larger scale infrastructure solutions will become increasingly expensive and environmentally unsustainable. As more basins face closure this will become a regional rather than national challenge, raising pressures around the reasonable and equitable use of water. A Virtual Water and nexus perspective may offer a different view for national planners, making better use of the total water footprint to support economic growth, as well as to meet social and environmental needs. This will require the allocation (or re-allocation) of water between sectors to formalise and regulate entitlements which optimise allocations across the full water footprint and which balance the water requirements of food and energy production. Similarly, inter-state allocations based on the reasonable and equitable use principles espoused in the SADC’s Revised Protocol on Shared Watercourses, may have to consider both the blue and green water contributions to the national economies of the riparian states. On a regional basis, while there has been some attention paid to importing of Virtual Water in agricultural products rather than to produce them locally, this concept has not gained much traction. It is therefore perhaps unrealistic to suggest that Virtual Water and Nexus based allocations per se would be a viable option to introducing the concepts to SADC. Nonetheless, the author argues that the introduction of the concepts into the national planning processes places other options on the table, promoting better trade-offs and an improved understanding of the contribution of water to the economy as a whole.

The use of computer-based information storage, tracking, and retrieval has become common across all health care practices. We describe the variables and key considerations that must be addressed to transition from a paper-based medical information request fulfillment system to an electronic capture and fulfillment process. We also address factors such as training and regulatory considerations as well as key metrics both before and after implementation of the electronic capture and fulfillment process. The application of the program described allows a medical information team to provide timely information to customers upon request while minimizing lost or unfulfilled requests. Such a program also improves the quality of the end product produced based on indirect measures.

M ore than 23 million individuals in the United States have diabetes, and ∼ 90% of those have type 2 diabetes. An important aspect of successful disease management for type 2 diabetes is effective use of the numerous pharmacological interventions that are available to target the metabolic defects contributing to the underlying pathology.1 After lifestyle modification and metformin, clinicians may consider many factors when selecting additional therapies. These include efficacy, safety, side effects, treatment complexity (i.e., dosing, administration, and convenience), unique patient characteristics (e.g., physical and cognitive capabilities, understanding of disease, comorbidities, and self-care involvement), and cost. Importantly, patients' ability to initiate and continue using a prescribed therapy is heavily dependent on the education they receive about the disease and its recommended treatments.2 Self-management education is an integral component of diabetes care and is emphasized in the American Diabetes Association's Standards of Medical Care in Diabetes3 and in the Chronic Care Model.4,5 Data support the positive impact of self-management education on quality of life, glycemic control, and psychological factors.6–9 Furthermore, self-management education raises patient awareness of the impact of poor disease management on the occurrence of disease-related complications, premature mortality, and morbidity.10 However, few patients are actually educated by trained professionals or have access to diabetes education training programs.11–14 Often, patients must rely on sources such as the Internet, lay and promotional materials, and peers to supplement the education received from providers who must balance patient needs with severe time and resource constraints.15 In addition, individual characteristics such as language, literacy, vision, comprehension of the need for a therapy, and willingness to try alternatives to managing the disease will influence understanding and subsequent use of any prescribed therapy.16,17 These education challenges also apply …

Purpose The purpose of this article is to present the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TOD2AY) study and a description of the implementation of the standard diabetes education (SDE) program. Methods A total of 218 participants (one third of the eventual sample of 750) were initially enrolled in the study. To date, the mean age of participants was 14.3 + 2.1 years, with 63% being female. Families of study participants were largely low or middle income (more than half report family income Results More than three-quarters (79%) of families achieved full mastery of the entire SDE program. Mastery required on average 5.5 + 1.3 sessions. In addition, 62% of the families were able to achieve mastery of the session topic in a single visit. Conclusions In summary, the TOD2AY study SDE program fills the need for effective, engaging materials for youth and their families to use in mastering essential type 2 diabetes skills and knowledge.

South Africa is a water-scarce country with a high level of income inequality, based largely on race. The issue of water pricing for water services and raw water has been shaped over the years to try to address both of these issues and to ensure a revenue stream that, with the parliamentary appropriation, is sufficient to fund the management and infrastructure-related costs of providing water and protecting water resources. This chapter deals with the key aspects of water pricing in South Africa for irrigation, municipal and industrial use, and power generation. It outlines the legal framework for water pricing and how this has been interpreted since the current legislation was promulgated in the late 1990s. It also outlines some of the key debates currently being addressed, such as how to deal with irrigation subsidies, how to address issues of equity, the possible adoption of a national charge for water, and how best to structure infrastructure-related charges.

The aims of the new water policies and laws of post-apartheid South Africa are to contribute to the eradication of the country's widespread poverty and to redress historical race and gender discrimination with regard to water. After placing these policy and legal changes in a historical context, the paper discusses their operationalization and impact during the first years of implementation. Three key aspects are highlighted. The first aspect concerns internal changes within the implementing government department, the Department of Water Affairs and Forestry (DWAF). The second aspect regards water services and sanitation directly targeted at poor women and men. Lastly, the paper discusses the emerging equity issues in public participation processes, as an illustration of the new approach to integrated water resources management.

Zunachst wird am Beispiel von haufig vorkommenden stumpfen Verletzungen (wie Distorsion des Sprunggelenkes, Muskelkontusion am dorsalen Oberschenkel und Reizerguss des Kniegelenkes) die typische Vorgehensweise bei der Entstauung dargestellt. Daruber hinaus wird eine vergleichbare Darstellung bei haufig vorkommenden postoperativen Situationen geboten. Weitere haufige Verletzungen ergeben sich am Handgelenk (Zustand nach Trummerfraktur von Handwurzelknochen) und an den Fingern (z. B. Kreissageverletzung). Auch auf die entstauungstechnische Behandlung nach Gliedmasenamputationen wird eingegangen.

Die gleichen Uberlegungen, die in Kapitel 25 im Hinblick auf die bewegungstherapeutischen Aspekte zum Tragen kommen, betreffen die atemtherapeutischen Moglichkeiten, und zwar in Bezug auf die groste Gruppe unter den sekundaren Lymphodemen. Hierbei half die Co-Autorin Barbara Schreiner, die praktischen Belange zu erlautern.

Zusammen mit der Co-Autorin Barbara Schreiner, einer sehr engagierten Physiotherapeutin, wird in diesem Kapitel dargestellt, welche Aspekte bei den Patientinnen nach Ablatio mammae zu beachten sind. Diese „schwierigen“ sekundaren Lymphodeme zeichnen sich durch ein heterogenes Befundbild aus. Deshalb kann es nicht sinnvoll sein, ein allgemeines Ubungsprogramm zu verordnen.

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder that affects almost 24 million Americans. Healthcare providers often do not initiate and/or intensify therapy appropriately during patient visits, which may be due, in part, to a lack of understanding of the new diabetes medications. This review focuses on means by which primary care nurse practitioners (NPs) might evaluate the utility of pharmacologic agents based upon their relation to the pathogenesis of T2DM.The evidence used in developing this review included evidence-based reviews, clinical trials, cohort studies, position statements, and guidelines. The authors obtained relevant reports through a computerized search of the literature using PubMed, MEDLINE, and other search engines and scanning syllabi from national and international meetings on the subject of type 2 diabetes.Medications used to manage T2DM utilize different pharmacologic approaches. These include stimulating insulin production, reducing hepatic gluconeogenesis, slowing polysaccharide digestion, and increasing insulin sensitivity in muscle, liver, and fat to achieve euglycemia.Patients with T2DM should be treated to their lowest targeted glycemic goals as soon as they are diagnosed as safely and as rationally as possible. NPs in primary care practice can facilitate more effective diabetes management.

We have recently identified a novel IgY specific chicken FcR (ggFcR) on chromosome 20, a region where no FcR gene is present in mammals. Serially deleted IgY fusion proteins were tested in a reporter assay to identify C(H) domains involved in ggFcR binding. Single C(H) domains did not bind to ggFcR, whereas Fcυ2 to Fcυ4 induced good and the Fcυ3 to Fcυ4 domains moderate activity. When IgY from diverse birds were assayed, only IgY from gallinaceous birds showed binding, which enabled us to pinpoint several potential contact sites by a sequence comparison and molecular modelling. Point mutations of critical residues at these sites revealed the Fcυ2 and Fcυ3 domains as major ggFcR:IgY binding sites similar to mammalian IgG. These results demonstrate that ggFcR has a contact site to IgY which closely resembles that of human IgG bound to FcR.

The Diabetes Family Behavior Scale (DFBS) was designed to measure diabetes-specific family support. The purposes of this study were to refine the scale and to assess reliability and criterion validity in terms of relationship to metabolic control. The DFBS was administered to 321 children and adolescents with insulin-dependent diabetes mellitus (IDDM). Blood was drawn for determination of glycosylated hemoglobin (HbA1c). Based on an item-analysis procedure, the DFBS was revised to include 47 items with two subscales, one to reflect guidance-control and one to reflect warmth-caring. Acceptable internal consistency was found for the DFBS total score (.86), and for the guidance-control (.81) and warmth-caring (.79) subscales. There was a statistically significant relationship in the expected direction between DFBS total score and HbA1c (r = -.12, P1c. (r=-.17, P

OBJECTIVE—Children with type 1 diabetes are frequently difficult to manage during times of gastroenteritis or poor oral intake of carbohydrates because of mild or impending hypoglycemia. The present study describes the effective use of small doses of subcutaneous glucagon in these children. RESEARCH DESIGN AND METHODS—We analyzed 33 episodes of impending or mild hypoglycemia in 28 children (ages 6.6 ± 0.7 years). All were healthy except for type 1 diabetes and an episode of gastroenteritis. Using a standard U-100 insulin syringe, children ages ≤2 years received two “units” (20 μg) of glucagon subcutaneously and those ages >2 years received one unit/year of age up to 15 units (150 μg). If the blood glucose did not increase within 30 min, the initial dosage was doubled and given at that time. We used patients’ self-glucose monitoring devices, aqueous glucagon, standard insulin syringes, and frequent phone contact with a physician and/or a diabetes nurse educator in this study. RESULTS—Blood glucose was 3.44 ± 0.15 mmol/l before and 8.11 ± 0.72 mmol/l 30 min after glucagon. In 14 children, relative hypoglycemia recurred, requiring retreatment (3.48 ± 0.18 to 6.94 ± 0.72 mmol/l). In four children, a third dose was required. The glucagon was well tolerated. In 28 of the 33 episodes of impending hypoglycemia, the children remained at home and fully recovered. Five children were taken to their local hospital because of concerns of dehydration or fever, but none for hypoglycemia. CONCLUSIONS—Mini-dose glucagon rescue, using subcutaneous injections, is effective in managing children with type 1 diabetes during episodes of impending hypoglycemia due to gastroenteritis or poor oral intake of carbohydrate.

Gender mainstreaming figures high in the post-1994 policies and laws in South Africa in general, and water policies in particular. This chapter analyses the implementation of these policies in two domains: within DWAF as a gender-sensitive workplace with sound gender training of its staff, and externally in the performance of DWAF in implementing its mandate for the benefit of all its citizens, in particular poor black women. In this task, gender concerns were effectively mainstreamed as part of the general efforts to democratise water management, especially in the creation of new equitable institutions such as Catchment Management Agencies and in public participation processes. Changes appeared more difficult in existing male-dominated institutions, though. With regard to the core issue of improving women’s access to water, the water services efforts implicitly benefitted women in particular. In contrast, women’s access to water for small-scale productive uses has deteriorated.

This chapter describes the political, social and economic context in which South Africa’s water reform was designed and implemented. The water reform was part of the nation’s wider transformation after 1994 from white minority rule and territorial and institutional segregation, to a democratic, non-racial state. This implied a major challenge to redress the legacy of gross inequities in access to water for domestic and productive uses and the persistently high poverty levels, especially in the rural areas. For a better understanding of the continuities and changes from the past for all aspects of water reform discussed in this volume, the history of water development and management in apartheid South Africa is traced. This encompasses the removal of land and water rights from black South Africans by the early 1900s; the hydraulic mission for white agriculture throughout the twentieth century; and the emergence of the centrally planned, urban-industrialized water economy from the 1970s onwards. Many concepts that would globally be seen as ‘best practice’ Integrated Water Resource Management according to the Dublin principles of 1992 originate in that era. The chapter concludes by introducing the subsequent chapters in this light.

This book discusses some issues of water policy and its implementation in South Africa. This chapter highlights some key, overarching issues related to the implementation of water policy in South Africa. These issues are discussed in the context of good water governance, based on three principles: a professional bureaucracy; predictable, open and enlightened policy making; and a strong civil society active in public affairs. The chapter closes with some discussion on some of the key challenges and priority actions in moving forward.

South African political reform coincided with a global trend in the reform of water resource management. Consequently, South Africa is an excellent case study in the role of water in addressing historic socio-economic inequity while at the same time trying to legislate for sustainable development. Undoing the legacy of more than a century of institutionalised discrimination is a complex undertaking made even more problematic by the fact that water scarcity constraints limit the future South African economic potential. Getting it right is therefore a political necessity and also a necessary condition for the future wellbeing of a country that plays a vital role as the engine of growth on the African continent. This chapter charts the evolution of a fledgling democracy in which water resources management is seen as a vehicle for social and environmental justice as well as a tool for deepening the democratic experience. The case of the Phongolopoort Dam is used to illustrate these complexities.

Although the number of children and youth with type 2 diabetes is increasing, a clear case definition that describes children with type 2 diabetes at presentation remains elusive. Most initial diagnoses are decided on the clinical picture at presentation (1). Characteristics and risk factors have been outlined in several review and clinical articles (2–4). The purpose of this study was to describe the characteristics of youth presenting for an initial visit to the outpatient clinic of a large tertiary children’s care center and diagnosed with type 2 diabetes. For this retrospective study, data were abstracted from a consecutive …

Diabetes management requires consistently implementing adherence behaviors in a variety of settings. For some adolescents, consistency may be difficult due to problems in communication and assertiveness. The purpose of the present study was to evaluate the impact of a camp curriculum to teach assertive communication skills to adolescents with diabetes. The curriculum included didactic information, sharing ofpersonal experiences, and role playing. Results showed a significant increase in adolescents' perceptions of their assertiveness from before to after the camp experience, an increase that was still apparent at a 3-month follow-up. No changes were reported in parental perceptions oftheir adolescents' degree of openness in communicating or in communication problems. In contrast, adolescents reported a significant decrease in their degree of openness in communicating with fathers, with a similar tnend for mothers. These results suggest that the curriculum was successful in meeting the primary goal of enhancing the adolescents' assertive communication skills but had a questionable impact on their general communications with parents.

The establishment of residential summer camps for children with dia betes has filled multiple needs: recrea tional, educational, and social. Provid ing a safe, fun, and productive sum mer program is the subject of this paper, with a focus on experiences ac cumulated over 25 years at one pro gram in Texas. Successful diabetes camps are forged from solid beliefs about diabetes management, high expectations, and qualifications of the medical staff, thoughtful and reasoned considerations of the purposes for camp, and the incorporation of know ledge about diabetes into quality, well- child care.