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The COVID-19 pandemic has required health protection responses with far-reaching consequences for society, livelihoods, and the wider economy. Future enquiries will in time evaluate the success of responses at all scales. But emerging lessons highlight immediate implications for addressing the growing climate crisis through a recovery from COVID-19 that advances population health, economic regeneration and climate action. Cities are where many of the most critical actions for health, greenhouse gas (GHG) emissions reduction, resilience and risk reduction must be taken, supported by national governments, multi-lateral agencies and other stakeholders. Rapid decarbonisation across all sectors of society is needed over this decade—further delay will seriously reduce the possibility of achieving the targets set out in the Paris Agreement. Now is therefore an especially important juncture for cities to act for both the near-term imperatives of the post-COVID recovery and the long-term welfare of their residents and the planet.

Standards for designing, improving, and maintaining the built environment have conceptual and practical value for health. Yet, their importance runs the risk of being subsumed in tangential discour...

The aim of this meta-analysis and systematic review is to summarize and critically analyze the influence of surgery-related factors in lumbar interbody fusion for degenerative spine diseases. A systematic review of the literature was carried out with a primary search being performed on Medline through PubMed. The 2009 PRISMA flowchart and checklist were taken into account. Sixty-seven articles were included in the analysis: 48 studies were level IV of evidence, whereas 19 were level III. All interbody fusion techniques analyzed have proved to reach a good fusion rate. An overall mean fusion rate of 93% (95% CI 92–95%, p

Networks are increasingly important for advancing urban science, policy and practice. The complexity that cities present to stakeholders of all kinds demands systems-based and networked approaches to solving sustainability challenges. This article analyses the contemporary rise of global networks of urban science, policy, and practice. We provide an overview of urban science, policy, and practice networks followed by a detailed case study of the emerging Future Earth Urban Knowledge Action Network (Urban KAN), highlighting its vision, initial activities and impacts, and challenges and remaining tasks. Findings from the case study reveal that a network across science, policy and practice can make significant contribution in cutting-edge knowledge generation, global research agenda setting, timely contribution to global policy processes, catalyzing the formation of new national and thematic research-action networks, among others. In contrast, such a network also faces challenges, in terms of attraction and representation of the composition, maintaining initial momentum, turning the science-policy integration and collaboration into reality, and obtaining strong and continued financial and institutional support. We conclude that networks across the boundaries of science-policy-practice are still in their infancy, and deeper collaborations across sector, scale, and networks that enable the implementation of effective new actions will be key indicator in measuring the success of these networks.

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.

Overweight and obesity in Malaysia pose serious threats to health. Prevalence has escalated to alarming levels in recent decades despite a multitude of dietary public health messages geared toward obesity prevention and health promotion. Gaps between health messages, messengers, and the public must be identified and closed to effectively combat obesity and overweight. This review article aims to examine dietary public health messages, guidelines, and programmes for the prevention of obesity in Malaysia, and explore potential reasons for the continued rise in prevalence. Dietary public health communication in Malaysia has progressed and improved substantially over the years. However, most messages have been designed for a general audience, with little consideration of differences in physical, social, cultural, and environment backgrounds, and varying levels of comprehension. We offer several recommendations to increase the effectiveness of dietary public health messages in fighting the obesity epidemic, based on a cross-sectoral, place-based approach that recognizes the complexity of underlying causes of obesity.

Experiences with a systems approach to urban health and well-being in the Asia-Pacific region underline the need to: Understand and underscore the centrality of health in development by formalizing links between health and other sectors. Move beyond simple indicators to a recognition of the consequences of complexity, and particularly of the dynamics of causal feedback loops.

CITY KNOW-HOWHuman health and planetary health are both influenced by city lifestyles, city leadership, and city development. For both, worrying trends are leading to increasing concern. It is imperative that both become core foci in urban policy. Changing the trajectory will require concerted action. The journal Cities & Health journal is dedicated to supporting the flow of knowledge, in all directions to help make this happen. We want to support communication between researchers, practitioners, policy-makers, communities and decision-makers in cities. This is the purpose of this City Know-how section of the journal. ‘Research for city practice’ disseminates lessons from research, explaining the key messages for city leaders, communities and the professions involved in city policy and practice. ‘City shorts’ provide glimpses of what is being attempted or achieved. ‘Case studies’ are where you will find evaluations of interventions and ‘Commentary and debate’ helps extend the conversations we are having a...

Complexity is the hallmark of our habitats, our livelihoods and our health. These objects of analysis, understanding and intervention extend from our homes to our streets and neighbourhoods...

Background Localisation is a pervasive challenge in achieving sustainable development. Contextual particularities may render generalized strategies to achieve the Sustainable Development Goals (SDGs) unfeasible, impractical, or ineffective. Furthermore, many localities are resource- and data-poor, limiting applicability of the global SDG indicator framework. Tools to enable local actors to make sense of complex problems, communicate this understanding, and act accordingly hold promise in their ability to improve results. Aim Systems approaches can help characterise local causal systems, identify useful leverage points, and foster participation needed to localise and catalyse development action. Critically, such efforts must be deeply rooted in place, involving local actors in mapping decision-processes and causation within local physical, social and policy environments. Given that each place has a unique geographical or spatial extent and therein lies its unique characters and problems, we term these activities “placially explicit.” We describe and reflect on a process used to develop placially explicit, systems-based (PESB) case studies on issues that intersect with and impact urban health and wellbeing, addressing the perspectives of various actors to produce place-based models and insights that are useful for SDG localisation. Methods Seven case studies were co-produced by one or more Partners with place-based knowledge of the case study issue and a Systems Thinker. In each case, joint delineation of an appropriate framing was followed by iterative dialogue cycles to uncover key contextual factors, with attention to institutional and societal structures and paradigms and the motivations and constraints of other actors. Casual loop diagrams (CLDs) were iteratively developed to capture complex narratives in a simple visual way. Results Case study development facilitated transfer of local knowledge and development of systems thinking capacity. Partners reported new insights, including a shifting of problem frames and corresponding solution spaces to higher systems levels. Such changes led partners to re-evaluate their roles and goals, and thence to new actions and strategies. CLD-based narratives also proved useful in ongoing communications. Conclusion Co-production of PESB case studies are a useful component of transdisciplinary toolsets for local SDG implementation, building the capacity of local actors to explore complex problems, identify new solutions and indicators, and understand the systemic linkages inherent in SDG actions across sectors and scales.

Resumen: Los cultivos lignocelulósicos se han desarrollado como alternativa en la matriz energética. Tres especies de interés en Uruguay son Arundo donax, Pennisetum purpureum y Panicum virgatum. El objetivo fue comparar la producción de estas tres especies, cuantificar la respuesta al agregado de nitrógeno, fósforo y sus efectos en el carbono del suelo (COS) luego de 6 años. Los cultivos se instalaron en 2007 y se evaluaron desde setiembre de 2011 a agosto de 2013. Los tratamientos de fertilización consistieron en: 1. testigo sin fertilización; 2. 100 kg ha-1 de N; 3. 100 kgha-1 de P2O5; y 4. 100 kg ha-1 de N y de P2O5. La producción fue mayor en el año 2013. Arundo donax produjo significativamente más biomasa área (18,6 Mgha-1 año-1) que P. virgatum (15,6 Mg ha-1año-1) y P. purpureum (14,9 Mg ha-1año-1). La fertilización con N aumentó 50 % la producción en las tres especies, aunque en A. donax el incremento no fue significativo. No hubo respuesta a la fertilización con P. Las diferencias debido a especies o en producción de biomasa debido a la fertilización no generaron diferencias de contenidos de COS luego de 6 años. Panicum virgatum, fue la especie que presentó menor contenido de humedad (16 %), lo que es una característica favorable como materia prima para la producción de energía. Los rendimientos fueron los esperables para nuestra región, con variabilidad anual atribuible a las condiciones climáticas y se pueden aumentar al fertilizar con N. Summary: Lignocellulosic crops have been developed as an alternative in the energy matrix. Three species of interest in Uruguay are Arundo donax, Pennisetum purpureum and Panicum virgatum. In these crops nitrogen fertilization is the largest energy input. The objective was to compare the production of these three species, quantify the response to the addition of nitrogen and phosphorus and compare the final carbon content in the soil. The cultures were installed in 2007 and were evaluated from September 2011 to August 2013. The fertilization treatments after cutting were: witness without fertilization; 100 kg ha-1 N; 100 kg ha-1 of P2O5; and 100 kg ha-1 of N and P2O5. The production was higher in 2013. Arundo donax, with a production of 18.6 Mg ha-1 y-1, produced more than P.purpureum, with a production of 14.9 Mg ha-1 y-1, while P. virgatum had intermediate values, 15.6 Mgha-1y-1. N fertilization increased production by 50% in the three species, though in A. donax the increase was not significant. There was no response to fertilization with P. Differences in biomass production did not generate differences in soil carbon content at the end of the evaluation. In spite P. virgatum intermediate yield, it was the species with the lowest moisture content (16 %), which is favorable as raw material for energy production. The yield were the expected ones for our region, with an annual variability attributable to climatic conditions and that can be increased with N fertilization.

The question of how to achieve healthy, sustainable urban futures demands a singular emphasis. The scale and rate of change of modern urbanisation is unprecedented—so much so that it threatens the health gains of the past century. Urbanisation is the greatest ecological shift in human history, and in modern times has attained dimensions never seen before. We have mere decades to enact the greatest transformational change the planet has ever seen, if we are to safeguard a sustainable future. Indeed, the scope, scale, and ambition of transformative efforts need to accelerate dramatically, if humanity is to achieve sustainability before being overwhelmed by global change.

The sustainable development of cities is increasingly recognized as crucial to meeting collectively agreed sustainability goals at local, regional and global scales, and more broadly to securing hu ...

Cities are complex adaptive systems whose responses to policy initiatives emerge from feedback interactions between their parts. Urban policy makers must routinely deal with both detail and dynamic complexity, coupled with high levels of diversity, uncertainty and contingency. In such circumstances, it is difficult to generate reliable predictions of health-policy outcomes. In this paper we explore the potential for low-order system dynamics (LOSD) models to make a contribution towards meeting this challenge. By definition, LOSD models have few state variables (≤5), illustrate the non-linear effects caused by feedback and accumulation, and focus on endogenous dynamics generated within well-defined boundaries. We suggest that experience with LOSD models can help practitioners to develop an understanding of basic principles of system dynamics, giving them the ability to ‘see with new eyes’. Because efforts to build a set of LOSD models can help a transdisciplinary group to develop a shared, coherent view of the problems that they seek to tackle, such models can also become the foundations of ‘powerful ideas’. Powerful ideas are conceptual metaphors that provide the members of a policy-making group with the a priori shared context required for effective communication, the co-production of knowledge, and the collaborative development of effective public health policies. Keywords: Wicked problems, Transdisciplinary communication, Low-order models, Conceptual metaphor, Powerful ideas, Urban health policy

Executive summary: Over the past four decades, rapid urbanisation in China has brought unprecedented health benefits to its urban population, but has also created new challenges for protection of and promotion of health in cities. With the shift from rural to urban living, more people than ever enjoy the health advantages that cities can provide, such as better access to health services and improved sanitation. For example, the average life expectancy of male urban residents in 2010 was estimated to be 7·09 years longer than that of of their counterparts in rural China; urban females lived 6·64 years longer.1 Other changes associated with rapid urbanisation– including large-scale migration, ageing, pollution, shifts in diet and lifestyle, and social inequality–have created new health challenges.2 For example, about 52% of people over 60 years old lived in urban areas in 2015 compared with 34% in 2000,3 thus increasing the burden of senior care in Chinese cities. Non-communicable diseases have replaced infectious diseases as the leading cause of death among urban residents; the percentage of years of life lost because of such diseases as a fraction of all-cause years of life lost increased from 50·0% (95% CI 48·5–53·0) in 1990 to 77·3% (76·5–78·1) in 2015.4 Health inequality also increased in urban areas.5 China has acted to address urban health challenges by passing strict environmental regulations and investing heavily in urban infrastructure. Major reforms have been passed to increase the transparency of environmental governance to control pollution over the short term, while moving to reform whole industries and thus provide long-term solutions. Programmes like the Hygienic Cities movement have invested heavily in urban infrastructure to promote health, including major improvements in urban sanitation.6 China has also increased coverage of and accessibility to health services in urban areas. In 2016, around 93·8% of the urban population was covered by urban medical insurance programmes, a substantial increase from 4·1% in 1998 when the programmes started.7,8 Meanwhile, cities in China are also testing new strategies for urban health management, such as China’s pilot Healthy Cities project.9 Management of chronic diseases and mental disorders in cities has improved dramatically and major progress has been made regarding access to preventive and primary health services. All these efforts have contributed to the reduction of exposure to health risks and health improvement in urban China. However, despite these successes, major gaps remain, including but not limited to an over-reliance on a top-down-approach to environmental management, a narrow focus on health care in urban health management, and a scarcity of intersectoral action. Given that the urbanisation rate in China is predicted to reach 71% by 2030,10 urban health challenges will continue to emerge and expand. If innovative strategies are not used to address these issues, they will become major obstacles to the achievement of improved health and development for millions of people. It has also become clear that the health sector alone, with its traditional piecemeal approach, cannot effectively resolve the modern challenges to urban health in China. The country is now in a transitional period in which the pursuit of economic growth at any cost is being replaced by sustainable development. In 2013, President Xi Jinping declared China’s intention to develop a so-called ecological civilisation (ecocivilisation), the core principles of which involve balancing the relationship between humanity and nature. During this transition, health is recognised as the centrepiece of sustainable development in China, as highlighted in the Healthy China 2030 plan that was adopted in 2016.11 As a result, people-centred and health-oriented urban development will hopefully prevail in China; however, major efforts, political will, and investments will be needed to put this vision into practice. The Tsinghua–Lancet Commission on Healthy Cities in China aimed to characterise, understand, and address urban health challenges in the unique context of China’s rapid and dynamic urban development. Experts from a wide range of disciplines examined environmental and social determinants of health, identified key stakeholders,and assessed actions for the prevention, management, and control of adverse health outcomes associated with the country’s urban experience. We conclude that key efforts are needed to combat urban health challenges in China and these should be unified with the Healthy Cities movement, which uses a systems approach to urban health management and provides a clear path to the realisation of the Healthy China 2030 plan. Actions taken to build healthy cities in China have contributed to global knowledge on the development of healthy cities in other parts of the world. China’s strategic, simultaneous rollout of diverse trials in different cities— in areas such as health education and promotion—and its rapid adoption of effective approaches at the national scale is a valuable lesson for other countries facing rapid urbanisation. Despite such successes, we believe that there is room for substantial improvement and make the following five key recommendations. Integrate health into all policies China should take advantage of new, human-centred urbanisation strategies. For example, cities should integrate health into urban planning and design as a first step towards the integration of health into all policies. Increase participation Cities should increase participation by residents, the private sector, non-governmental organisations (NGOs), and community groups in health management. This increase can be achieved through investment in community capacity building and engagement with the private sector. Promote intersectoral action To motivate and sustain intersectoral action in the design, building, and management of healthy cities, cities should develop ways to assess the health effects of urban management by use of measures that span multiple and diverse sectors. Set local goals for 2030 and assess progress periodically Cities should view the health goals specified in the Healthy China 2030 plan as long-term goals that are achieved through the building of healthy cities. Indicator systems should be put in place to assess progress and inform the public. Enhance research and education on healthy cities To develop new theories and practical solutions, cities should increase investment and form partnerships with universities, research institutes, and the private sector to support research and education on the best ways to create healthy cities.

Background Laparoscopic lavage was proposed in the 1990s to treat purulent peritonitis in patients with perforated acute diverticulitis. Prospective randomized trials had mixed results. The aim of this study was to determine the success rate of laparoscopic lavage in sepsis control and to identify a group of patients that could potentially benefit from this treatment. Methods This retrospective multicentre international study included consecutive patients from 24 centres who underwent laparoscopic lavage from 2005 to 2015. Results A total of 404 patients were included, 231 of whom had Hinchey III acute diverticulitis. Sepsis control was achieved in 172 patients (74·5 per cent), and was associated with lower Mannheim Peritonitis Index score and ASA grade, no evidence of free perforation, absence of extensive adhesiolysis and previous episodes of diverticulitis. The operation was immediately converted to open surgery in 19 patients. Among 212 patients who underwent laparoscopic lavage, the morbidity rate was 33·0 per cent; the reoperation rate was 13·7 per cent and the 30-day mortality rate 1·9 per cent. Twenty-one patients required readmission for early complications, of whom 11 underwent further surgery and one died. Of the 172 patients discharged uneventfully after laparoscopic lavage, a recurrent episode of acute diverticulitis was registered in 46 (26·7 per cent), at a mean of 11 (range 2–108) months. Relapse was associated with younger age, female sex and previous episodes of acute diverticulitis. Conclusion Laparoscopic lavage showed a high rate of successful sepsis control in selected patients with perforated Hinchey III acute diverticulitis affected by peritonitis, with low rates of operative mortality, reoperation and stoma formation.

Dependence on air-conditioning (AC) for residential cooling and ventilation is a health and sustainability challenge. In hot temperatures, climate-sensitive buildings (CSB) can complement and/or substitute for AC usage in achieving thermal comfort. Many countries facing such conditions—particularly in tropical climates—are developing quickly, with rising populations and income creating demand for new housing and AC. This presents a window for adoption of CSB but could also result in long term lock-in of AC-dependent buildings. Here, a simple system dynamics model is used to explore the potential and limitations of subsidies to affect futures of housing stock and night-time AC usage in Malaysia. The effectiveness of subsidies in achieving high uptake of CSB and resulting health benefits is highly dependent on homebuyer willingness to pay (WTP). A detailed understanding of WTP in the Malaysian context and factors that can shift WTP is necessary to determine if CSB subsidies can be a good policy mechanism for achieving CSB uptake.

When we think of "climate change," we think of man-made global warming, caused by greenhouse gas emissions. But natural climate change has occurred throughout human history, and populations have had to adapt to the climate's vicissitudes. Anthony J. McMichael, a renowned epidemiologist and a pioneer in the field of how human health relates to climate change, is the ideal person to tell this story. Climate Change and the Health of Nations shows how the natural environment has vast direct and indirect repercussions for human health and welfare. McMichael takes us on a tour of human history through the lens of major transformations in climate. From the very beginning of our species some five million years ago, human biology has evolved in response to cooling temperatures, new food sources, and changing geography. As societies began to form, they too adapted in relation to their environments, most notably with the development of agriculture eleven thousand years ago. Agricultural civilization was a Faustian bargain, however: the prosperity and comfort that an agrarian society provides relies on the assumption that the environment will largely remain stable. Indeed, for agriculture to succeed, environmental conditions must be just right, which McMichael refers to as the "Goldilocks phenomenon." Global warming is disrupting this balance, just as other climate-related upheavals have tested human societies throughout history. As McMichael shows, the break-up of the Roman Empire, the bubonic Plague of Justinian, and the mysterious collapse of Mayan civilization all have roots in climate change. Why devote so much analysis to the past, when the daunting future of climate change is already here? Because the story of mankindâs previous survival in the face of an unpredictable and unstable climate, and of the terrible toll that climate change can take, could not be more important as we face the realities of a warming planet. This sweeping magnum opus is not only a rigorous, innovative, and fascinating exploration of how the climate affects the human condition, but also an urgent call to recognize our species' utter reliance on the earth as it is.

This paper revisits the emission scenarios of the European Commission's 2005 Thematic Strategy on Air Pollution (TSAP) in light of today's knowledge. We review assumptions made in the past on the main drivers of emission changes, i.e., demographic trends, economic growth, changes in the energy intensity of GDP, fuel-switching, and application of dedicated emission control measures. Our analysis shows that for most of these drivers, actual trends have not matched initial expectations. Observed ammonia and sulfur emissions in European Union in 2010 were 10% to 20% lower than projected, while emissions of nitrogen oxides and particulate matter exceeded estimates by 8% to 15%. In general, a higher efficiency of dedicated emission controls compensated for a lower-than-expected decline in total energy consumption as well as a delay in the phase-out of coal. For 2020, updated projections anticipate lower sulfur and nitrogen oxide emissions than those under the 2005 baseline, whereby the degree to which these emissions are lower depends on what assumptions are made for emission controls and new vehicle standards. Projected levels of particulates are about 10% higher, while smaller differences emerge for other pollutants. New emission projections suggest that environmental targets established by the TSAP for the protection of human health, eutrophication and forest acidification will not be met without additional measures.

This paper analyses factors that contributed to the evolution of SO2, NOx and CO2 emissions in Europe from 1960 to 2010. Historical energy balances, along with population and economic growth data, are used to quantify the impacts of major determinants of changing emission levels, including energy intensity, conversion efficiency, fuel mix, and pollution control. Time series of emission levels are compared for countries in Western and Eastern Europe, throwing light on differences in the importance of particular emissiondriving forces. Three quarters of the decline in SO2 emissions in Western Europe resulted from a combination of reduced energy intensity and improved fuel mix, while dedicated endof- pipe abatement measures played a dominant role in the reduction of NOx emissions. The increase in atmospheric emissions in Eastern Europe through the mid-1990s was associated with the growth of energy-intensive industries, which off-setted the positive impact of better fuel quality and changes in fuel mix. A continuous decrease in energy intensity and higher conversion efficiencies have been the main factors responsible for the moderate rate of growth of European CO2 emissions.

The world is undergoing a massive urban transition, which is now both the greatest driver of global environmental change and the most significant influence on human health. Cities offer real opportunities for improving health, but managed poorly, they can also create or reinforce significant health deficits while putting severe stresses on the natural systems which support human civilization. Management of urban problems is rarely straightforward, as complexity across scales and sectors, in causal structures, actors and incentives, can lead to ineffective policies and unintended consequences. Systems thinking offers a promising way forward in its ability to deal with non-linear relationships and simultaneous actions and outcomes. Encompassing, on the one hand, analytic frameworks and methods that can provide important causal insights and a test bed for urban policy, and on the other, broad processes of inter- and trans-disciplinary engagement to better define problems and feasible solutions, systems approaches are critical to the current and future design and management of sustainable healthy cities.

It has become evident that our planetary ecosystem is changing rapidly in response to human activities. This has led scientists to recognize the present-day era as a new geological epoch, the Anthropocene, in recognition of the substantial effect of man on the Earth’s systems. Human health is better today than at any other time in history. Yet the flourishing of civilization has come at the cost of an unsustainable exploitation of nature’s resources. As we look toward the future, it has become clear that we now face substantial health risks from the degradation of the natural life support systems which is critical for human survival. Global environmental change, including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss, poses serious challenges to the global health gains of the past several decades.

This article describes the origins and characteristics of an interdisciplinary multinational collaboration aimed at promoting and disseminating actionable evidence on the drivers of health in cities in Latin America and the Caribbean: The Network for Urban Health in Latin America and the Caribbean and the Wellcome Trust funded SALURBAL (Salud Urbana en América Latina, or Urban Health in Latin America) Project. Both initiatives have the goals of supporting urban policies that promote health and health equity in cities of the region while at the same time generating generalizable knowledge for urban areas across the globe. The processes, challenges, as well as the lessons learned to date in launching and implementing these collaborations, are described. By leveraging the unique features of the Latin American region (one of the most urbanized areas of the world with some of the most innovative urban policies), the aim is to produce generalizable knowledge about the links between urbanization, health, and environments and to identify effective ways to organize, design, and govern cities to improve health, reduce health inequalities, and maximize environmental sustainability in cities all over the world.

El proceso de adopción de la siembra directa (SD) en Uruguay comenzó a fines de los 80. En el sector lechero, donde la degradación de los suelos ha sido producto principalmente del excesivo laboreo, la SD representa una ventaja para la conservación del potencial productivo. La encuesta realizada en el año 2000 detectó una fase decreciente en el proceso de adopción, proyectándose un máximo para el período 2000-2005. En el 2005, se realizó una nueva encuesta con el objetivo de elaborar un diagnóstico actualizado de la SD en los establecimientos lecheros. Los resultados muestran que un 46% han adoptado la SD, de los cuales el 58% la realiza sistemáticamente (nunca hacen laboreo). Los productores que realizan SD poseen mayor superficie lechera y productividad. El principal cambio detectado en los adoptantes de la SD fue la presencia de la maleza Poa annua, mientras que, por el contrario, se detectó una disminución del engramillamiento. Entre los productores que realizan SD, la falta de maquinaria y la huella por pastoreo fueron las razones más importantes para realizar laboreo ocasional. La falta de maquinaria fue la razón de mayor peso para no adoptar el sistema. De los productores que en el 2000 no realizaban siembra directa, el 48% la han comenzado, mientras que sólo un 8% de los que la realizaban la han abandonado.

Integrating livestock with cotton (Gossypium hirsutum L.) offers profitable alternatives for producers in the southeastern USA, but could result in soil water depletion and soil compaction. We conducted a 3-yr field study on a Dothan loamy sand (fine-loamy, kaolinitic, thermic Plinthic Kandiudult) in southern Alabama to develop a conservation tillage system for integrating cotton with winter-annual grazing of stocker cattle under rainfed conditions. Winter annual forages and tillage systems were evaluated in a strip-plot design where winter forages were oat (Avena sativa L.) and annual ryegrass (Lolium mutiflorum L.). Tillage systems included moldboard and chisel plowing and combinations of noninversion deep tillage (none, in-row subsoil, or paratill) with or without disking. We evaluated forage dry matter, N concentration, average daily gain, net returns from grazing, soil water content, and cotton leaf stomatal conductance, plant populations, and yield. Net returns from winter-annual grazing were between US$185 to US$200 ha - yr - . Soil water content was reduced by 15% with conventional tillage or deep tillage, suggesting that cotton rooting was increased by these systems. Oat increased cotton stands by 25% and seed-cotton yields by 7% compared with ryegrass. Strict no-till resulted in the lowest yields-30% less than the overall mean (3.69 Mg ha -1 ). Noninversion deep tillage in no-till (especially paratill) following oat was the best tillage system combination (3.97 Mg ha -1 ) but deep tillage did not increase cotton yields with conventional tillage. Integrating winter-annual grazing can be achieved using noninversion deep tillage following oat in a conservation tillage system, providing producers extra income while protecting the soil resource.

The term “co-benefits” refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities. Resumo “Co-benefícios” é um termo que se refere aos impactos positivos de uma política além do que se era esperado inicialmente. No contexto urbano, políticas executadas em um setor específico (como transporte, energia ou resíduos) frequentemente podem gerar múltiplos co-benefícios em outras áreas, como redução dos impactos ambientais globais e locais, e se extendendo à saúde pública. Um ponto chave para se poder identificar e gerar co-benefícios é adotar a abordagem por sistemas para entender as ligações inter-setoriais. Esta abordagem também pode ajudar no entendimento de como podemos melhorar um setor específico e a governança urbana em geral. Assim, este artigo faz uma revisão da literatura de várias políticas que geram co-benefícios climáticos e de saúde em diversos setores e ilustra através de uma série de casos como a abordagem por sistemas pode levar a inovações em governança urbana que levem ao desenvolvimento de cidades mais sustentaveis e saudáveis. Resumen “Co-beneficios” es un término que se refiere a los impactos positivos de una política que van más allá de los resultados esperados, con frecuencia en sectores distintos. En el contexto urbano, las políticas en determinados sectores (como el transporte, la energía o la gestión de residuos) muchas veces generan co-beneficios múltiples en otros sectores. Entre dichos beneficios se incluye la reducción de los impactos ambientales a nivel local o mundial e incluso en el ámbito de la salud pública. Entre las acciones claves para la identificación y realización de co-beneficios se incluye la adopción de un enfoque sistémico-analítico para entender los vínculos intersectoriales y, en particular, la traducción de este entendimiento en mejor gobernanza a nivel de sectores específicos y municipalidades. Este artículo repasa una serie de políticas que puedan generar co-beneficios para la salud y el clima a través de distintos sectores urbanos. Por medio de casos ejemplares, ilustra cómo un abordaje por sistemas puede producir innovaciones en la gobernanza urbana que faciliten el desarrollo de ciudades sanas y sostenibles.

Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.

Measuring and mapping apparent soil electrical conductivity (ECa) is a potentially useful tool for delineating soil variability. The “Old Rotation,” the world's oldest continuous cotton (Gossypium hirsutum L.) experiment (ca. 1896), provides a valuable resource for evaluating soil spatial variability. The objectives of this study were to determine the relationship between soil chemical and physical properties and ECa in the Old Rotation, to determine spatial differences in these properties, and to relate differences in these properties to long‐term management effects. Soils at the site classified as fine, kaolinitic, thermic Typic Kanhapludults. Soil ECa was measured at 0–30‐ and 0–90‐cm depths (ECa‐30 and ECa‐90) using a Veris® 3100 direct contact sensor with georeferencing. Soils were grid sampled (288 points) at close intervals (1.5×3.0 m) for chemical properties and grid sampled (65 cells, 7.5×6.9 m) for soil texture. Soil organic carbon (SOC) and total nitrogen (N), extractable phosphorus (P...

Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children (OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other covariates, increasing child’s age and household size category were positively correlated with infection, and sleeping under an insecticidetreated bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of supporting the development of human capital.

Both anatomically modern humans and the gastric pathogen Helicobacter pylori originated in Africa, and both species have been associated for at least 100,000 years. Seven geographically distinct H. pylori populations exist, three of which are indigenous to Africa: hpAfrica1, hpAfrica2, and hpNEAfrica. The oldest and most divergent population, hpAfrica2, evolved within San hunter-gatherers, who represent one of the deepest branches of the human population tree. Anticipating the presence of ancient H. pylori lineages within all hunter-gatherer populations, we investigated the prevalence and population structure of H. pylori within Baka Pygmies in Cameroon. Gastric biopsies were obtained by esophagogastroduodenoscopy from 77 Baka from two geographically separated populations, and from 101 non-Baka individuals from neighboring agriculturalist populations, and subsequently cultured for H. pylori. Unexpectedly, Baka Pygmies showed a significantly lower H. pylori infection rate (20.8%) than non-Baka (80.2%). We generated multilocus haplotypes for each H. pylori isolate by DNA sequencing, but were not able to identify Baka-specific lineages, and most isolates in our sample were assigned to hpNEAfrica or hpAfrica1. The population hpNEAfrica, a marker for the expansion of the Nilo-Saharan language family, was divided into East African and Central West African subpopulations. Similarly, a new hpAfrica1 subpopulation, identified mainly among Cameroonians, supports eastern and western expansions of Bantu languages. An age-structured transmission model shows that the low H. pylori prevalence among Baka Pygmies is achievable within the timeframe of a few hundred years and suggests that demographic factors such as small population size and unusually low life expectancy can lead to the eradication of H. pylori from individual human populations. The Baka were thus either H. pylori-free or lost their ancient lineages during past demographic fluctuations. Using coalescent simulations and phylogenetic inference, we show that Baka almost certainly acquired their extant H. pylori through secondary contact with their agriculturalist neighbors., Author Summary Genetic analyses of Helicobacter pylori have illuminated human migrations and the history of human infection by these bacteria. Both humans and H. pylori originated in Africa, and have been intimately associated for at least 100,000 years. We hypothesized that communities who still live in relative isolation might provide further details about the evolutionary history of H. pylori in Africa. We therefore investigated H. pylori within Baka Pygmies of southeast Cameroon, who live as hunter-gatherers in the tropical rainforest, and compared those bacteria to H. pylori from neighboring farming populations of non-Baka ethnicities. Unexpectedly, Baka Pygmies were much less commonly infected (20.8%) than the non-Baka (80.2%). H. pylori from hunter-gatherers and agriculturalists were genetically very similar and ancient H. pylori lineages were not identified in Baka. We used an epidemiological model to show that demographic factors including small population size and low life expectancy can account for the low infection rate among Baka Pygmies, and that this low rate could have been attained within a few hundred years of secondary contact with their neighbors. We also suggest that the ancestors of the Baka Pygmies were initially H. pylori-free or that their ancestral bacteria have been lost through past demographic fluctuations.

SummaryThe genetic structure of Sicily was analysed through the distribution of surnames of 758,793 users registered in the Italian Telephone Company, corresponding to 371 communes of the island. Estimates of the coefficient of consanguinity due to random isonymy, of Fisher'sa, an indicator of abundance of surnames, and of Karlin–McGregor'sv, an indicator of immigration rates, were obtained for each commune. Four different estimates of genetic distance between all possible pairs of communes within each province were also obtained, and their relationship with geographic distance was studied. The logarithmic transformation of Lasker's coefficient of relationship showed correlations with the log of geographic distance which range between −0·78 and −0·40; the strongest, for the province of Catania, was attributed to the presence of Mount Etna, and the weakest, for Palermo, to the high population density of this province.

Malaria occurrence is lower in urban versus rural areas of sub-Saharan Africa for a variety of reasons, including limitation of suitable mosquito habitat, generally improved housing standards and access to prevention and treatment, and a relative decrease in the ratio of vectors to humans. Nonetheless, empirical observation confirms that malaria cases, whether locally transmitted or imported, are frequently observed in cities in endemic areas. Theoretical considerations imply that local transmission will decrease as a city grows, transitioning from a relatively malaria-permissive state to one that encourages reduction or extinction. Using a simple deterministic systems dynamic model based on traditional malaria models, we simulate scenarios for the evolution of local transmission rates and acquired immunity in a homogenous urban area with respect to population size, growth rate, and level of suppression of mosquito breeding. In particular, we consider how the timing and extent of decreases in local transmission are mitigated by travel by city dwellers to endemic rural areas and their resulting exposure to infected mosquitoes. We explore the generalizability and sensitivity to assumptions of our results using microsimulation and analytic methods to account for various aspects of environmental (urban/rural) and demographic heterogeneity. The results of these simulation models should inform projections for long-term urban malaria trends, and have implications for the targeting of malaria prevention efforts in urban and peri-urban areas of sub-Saharan Africa.

1 Severe malarial anemia (SMA) is the most frequently observed severe outcome, with an estimated 1.42-5.66 million cases and 0.19-0.97 million fatalities annu- ally in children less than five years of age and a case fatal- ity rate greater than 13%. 2 During the past decade, research has suggested a multi-organ pathology for severe malaria, in which multiple pathways can produce similar syndromes. 3 , 4 Abstract. The epidemiology of malaria in urban environments is poorly characterized, yet increasingly problem- atic. We conducted an unmatched case-control study of risk factors for malarial anemia with high parasitemia in urban Kisumu, Kenya, from June 2002 through February 2003. Cases (n = 80) were hospital patients with a hemoglobin level £ 8 g/dL and a Plasmodium parasite density ≥ 10,000/μL. Controls (n = 826) were healthy respondents to a concurrent citywide knowledge, attitude, and practice survey. Children who reported spending at least one night per month in a rural area were especially at risk (35% of cases; odds ratio = 9.3, 95% confidence interval (CI) = 4.4-19.7, P < 0.0001), and use of mosquito coils, bed net ownership, and house construction were non-significant, potentially indicating that malaria exposure during rural travel comprises an important element of risk. Control of severe malaria in an urban setting may be complicated by Plasmodium infections acquired elsewhere. Epidemiologic studies of urban malaria in low transmission settings should take travel history into account.

Cephalic vein (CV) approach is preferable to subclavian vein when technically feasible. Aim of the study was to describe a technique to extend the use of CV for lead implantation. This technique was applied every time the lead didn't proceed through the CV. Methods After the isolation of the CV as usual a Terumo straight wire was advanced under fluoroscopy control through the subclavian vein up to the right atrium. Then an appropriate-size dilator and sheath with a peel-away system was slipped over the wire. In case of dual-chamber pacemaker the wire was kept in place for the second lead. Results All patients (Pts) (77±8 years) were implanted with tined bipolar atrial and ventricular leads. Our technique was applied in 64 pts (9% single-lead VDD, 55% dual-chamber and 36% single-chamber). No complications were reported in these pts neither in acute nor at follow-up (1 and 3 months). The subclavian approach was used only in 11% pts, when both the standard cephalic approach and this technique failed. Conclusion Our technique is feasible in the majority of patients and always safe.

A clinical case of splenosis recently observed in a young man subjected at the age of 8 to splenectomy for rupture of the spleen and operated at 19 for intestinal occlusion is reported. The pathogenetic aspects of the condition, characterised by the presence of nodules of splenic tissue in the abdominal cavity, are examined through a review of the literature.

A case of cystic neoplasia with a cephalopancreatic localization, arising in a young woman aged 26 and derived from the beta-insular elements, is presented. The tumour had invaded the porto-mesenteric tract, and hence duodenopancreatic demolition had to be followed by venous repair by prosthesis. On the basis of the literature the biological complexity of this exceptional tumour is disscussed (especially in relation to prognosis), as well as the surgical treatment adopted in this patient, who is in excellent conditions more than three years later.