Adverse Socio-economic Consequences Research Articles

Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies.

Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.

COVID-19 Infection in Academic Dental Hospital Personnel; A Cross-Sectional Survey in Saudi Arabia.

Background: Close patient contact is an essential component of clinical dental education, which can expose students and faculty to risk of COVID-19 and its sequelae. Methods: The study was a cross-sectional survey conducted among faculty and clinical students at an academic dental hospital in Al Madinah western Saudi Arabia. An online questionnaire was distributed to collect data on prevalence, risk factors, clinical manifestations, and long-term health and socioeconomic complications of COVID-19 infection. Results: Prevalence of COVID-19 was 19.6% among a total of 316 students and faculty. Participants cited family and friends as the primary source of infection (40.3%). Among cross-infection control practices, they cited failure to practice distancing as the primary reason for infection transmission (61.3%). The disease was symptomatic in 85.5% of infected personnel. Most frequently reported clinical manifestations were: fever, cough, malaise, and diarrhoea (74.1%, 56.5%, 40.3%, 32.3%, respectively). A proportion of 37.1% of infected personnel stated that they had long COVID-19, and 58.3% of infected students reported deteriorated academic achievement. Conclusions: One in five of clinical dental students and their faculty had COVID-19. Most cases were symptomatic, and a large proportion developed long COVID or adverse socioeconomic consequences. Regardless of the severity of symptoms encountered during the acute stage of COVID-19 infection, all infected dental healthcare personnel should be followed, especially those who report long COVID. Continuous follow-up and assistance for infected students may be warranted to mitigate the potential academic and mental drawbacks caused by the pandemic. Dental schools should adopt clear policies regarding COVID-19 transmission and prevention and should implement them in their infection-control education and training.

Assessment of vulnerability reduction policies: Integration of economic and cognitive models of decision-making

Earthquakes can cause significant damage to vulnerable residential buildings and cause irreversible adverse economic, social, and socioeconomic consequences. Implementing hazard mitigation policies can enhance homeowners' willingness to adopt hazard mitigation measures such as seismic retrofits or insurance. Several past studies have proposed models that aimed to explain individuals' hazard mitigation behavior. Despite their advantages, these decision-making models are subject to limitations. This manuscript proposes a new decision-making model that addresses the shortcomings of previous models. The proposed decision-making model is then incorporated at the core of an agent-based model to evaluate owners' responses to candidate hazard mitigation policies. The proposed decision-making model considers the characteristics of the buildings, the owners' attitude, and their condition-dependent response to proposed incentives. Hence, it can effectively explain homeowners' behavior when presented with various alternatives for mitigating the seismic risk. It can be applied to measure the impact of marginal changes in government subsidies to minimize community losses, as demonstrated in the illustrative example. Practitioners and policymakers can use the outcomes of the proposed model to select appropriate policies to enhance communities' resilience based on physical infrastructure characteristics.

Application of nanomaterials decorated with cyclodextrins as sensing elements for environment analysis.

Environmental pollution has brought adverse socio-economic consequences. Organic pollutants and heavy metals are the main culprits of environmental pollution. It is of great importance to develop novel, simple, rapid, sensitive, and low-cost detection approaches for sensing trace pollutants in environmental samples. A lot of detection strategies which are based on varieties of nanomaterials have been developed for environmental analysis in past decades. In this review, we retrospect a variety of nanomaterials decorated with cyclodextrins (CDs), including carbon nanomaterials decorated with CDs, noble metal nanomaterials decorated with CDs and other nanomaterials decorated with CDs, and their application in environmental analysis. CDs is a type of ideal modifying molecules which could recognize targets, improve the solubility and dispersibility of corresponding functionalized materials, and enhance the detecting performance of designed sensors. CDs have been widely immobilized to carbon nanomaterials, noble metal nanomaterials, phosphorene (BP) nanocomposites, metal organic framework (MOF), and magnetic nanomaterials, and these nanocomposites have been utilized as the sensing elements for different target analytes. Immobilizing CDs on different nanomaterials could extremely expand the development of new sensing systems for environmental analysis based on these materials, greatly broaden the species of sensing targets, and apparently improve their sensing performance. Herein, the nanomaterials decorated with CDs, as sensing elements for environmental analysis, were reviewed including the types of nanomaterials decorated with CDs and their applications in various sensing strategies for environmental analysis. Finally, the perspectives of the nanomaterials decorated with CDs used as sensing elements were also discussed.

Occupational Rhinitis

There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.

Vulnerability of rangeland beef cattle production to climate-induced NPP fluctuations in the US Great Plains.

The vulnerability of rangeland beef cattle production to increasing climate variability in the US Great Plains has received minimal attention in spite of potentially adverse socioeconomic and ecological consequences. Vulnerability was assessed as the frequency and magnitude of years in which net primary production (NPP) deviated >±25% from mean values, to represent major forage surplus and deficit years, for a historic reference period (1981-2010), mid-century (2041-2065), and late-century (2075-2099) periods. NPP was simulated by MC2, a dynamic global vegetation model, driven by five climate projections for representative concentration pathway (RCP) 4.5 and 8.5. Historically, 4-4.7years per decade showed either NPP surpluses or deficits. The future number of extreme years increased to 5.4-6.4 and 5.9-6.9 per decade for RCP 4.5 and 8.5, respectively, which represents an increase of 33%-56% and 38%-73%, respectively. Future simulations exhibited increases in surplus years to between 3 and 5years in the Northern Plains and 3-3.5 in the Southern Plains. The number of deficit years remained near historic values of 2 in the Northern Plains, but increased in the Southern Plains from 2.5 to 3.3 per decade. Historically, NPP in extreme surplus and deficit years both deviated 40% from mean NPP in all three regions. The magnitude of deficit years increased by 6%-17% in future simulations for all three regions, while the magnitude of surplus years decreased 16% in the Northern Plains and increased 16% in the Southern Plains. The Southern Plains was the only region to exhibit an increase in the magnitude of both surplus and deficit years. Unprecedented future variability of NPP may surpass the existing adaptive capacity of beef producers and adversely impact the economic viability of rangeland cattle production and ecological sustainability of rangeland resources.

Prevalence and Predictors of Harmful Alcohol use in a Sub-urban Community in North-Central Nigeria

Alcohol is a commonly used beverage with adverse health and socio-economic consequences when consumed in excessive amounts. This study determined the prevalence and predictors of hazardous alcohol use in a sub-urban community in Plateau state, Nigeria. Consenting adults aged 18 years and above were selected using multi stage sampling technique. They completed a semi–structured interviewer administered questionnaire adapted from Short Michigan Alcoholism Screening Test–Geriatric Version (SMAST-G) and the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT) tools. Majority 154 (55) of the 280 respondents were males and about half were farmers. About 150 (53.6) of respondents had ever consumed alcohol as at the time of data collection and112 (77.4) of them were currently using alcohol. Harmful use was prevalent in 93 (83) of current users. Being male, belonging to age group 38-45years, and being a civil servant or a business person positively predicted harmful use of alcohol while consuming burukutu, was a negative predictor of harmful use. Control efforts need to target these groups to reduce the negative health and socio-economic consequences of alcohol use in the community.

Childhood cancer: Survival, treatment modalities, late effects and improvements over time

Since the 1960s, paediatric oncologists have gradually become better organised in large study groups and participation in clinical trials is today considered as the standard of care, with most children with cancer in Europe and North America being enrolled on available treatment protocols. Chemotherapy is nowadays the main element of therapy, but irradiation is still required for some patients. With the advent of multimodality therapy and supportive care, five-year cancer survival exceeds 80 % in most European and North American countries today. The substantial improvements in survival led to a constantly growing population of childhood cancer survivors. Concerns regarding the risk of late effects of the intensive cancer treatment at a young age, together with increasing numbers of survivors, have directed attention towards survivorship research. Survivors of childhood cancer are at longstanding risk of various severe somatic and mental health conditions attributable to the cancer and its treatment, as well as adverse social and socioeconomic consequences, and diminished psychological well-being and quality of life. It is, however, important to stress that some survivors have no or very mild adverse health conditions. Nevertheless, joint efforts are warranted for the care and long-term follow-up of childhood cancer patients.With this article, we provide a comprehensive overview of improvements in survival and treatment modalities over time, as well as the related somatic and mental late effects, and social and socioeconomic difficulties that these children might encounter later in life.

Analysis of past and future multi-temporal land use and land cover changes in the semi-arid Upper-Mzingwane sub-catchment in the Matabeleland south province of Zimbabwe

ABSTRACT In this study, we analyse past spatio-temporal land use and land cover (LULC) change dynamics in the Upper-Mzingwane sub-catchment (UMS) located in the semi-arid Matabeleland south region of Zimbabwe using Landsat 5 Thematic Mapper (L5-TM) and Landsat 8 Operational Land Imager (L8-OLI) imagery for the periods of 1989, 2004, 2013, and 2018. We also model plausible future LULC scenarios for UMS. We distinguished five LULC classes, i.e. water, bareland, dense woodland, shrubland, and grassland using a hybrid approach entailing image classification in R-software using the Random Forest (RF) and Support Vector Machine (SVM) algorithms. Accuracy assessment and Kappa statistics revealed better performance of the SVM hence its outputs were used in the change analysis (i.e. to quantify LULC transitions and trends statistically). We then utilized the TerrSet Land Change Modeller (LCM) (using the Markov Chain algorithm with Multi-Layer Perceptron) to model future LULC scenarios up to 2038 at 5-year intervals. Results revealed that the grass, shrub, and woody vegetation are predominant land covers covering 48.5%, 31.5%, and 18.8% in 1989 and 54.4%, 28.8%, and 15.8%, respectively, in 2018. Dense woodland cover was projected to experience the greatest net loss of 43.57% while shrubland, grassland, water, and bareland increase by 10.73%, 4.5%, 26.85%, and 15.09%, respectively, between 2023 and 2038. We concluded that the UMS has since 1989, been losing and will continue to lose dense woodland cover into the future possibly due to increased human activities such as small scale and illegal gold mining in the area. As such, immediate remedial action needs to be taken to reverse the observed and possible future negative LULC change trends especially for woodland cover so as to avert likely adverse socio-economic, hydrological, and ecological consequences within and beyond the UMS.

The impact of childhood cancer on parents' socio-economic situation-A systematic review.

Taking care of children diagnosed with cancer may have considerable consequences on parents' socio-economic situation. Our systematic review aimed to evaluate and synthesise the evidence on the impact of childhood cancer on parents' socio-economic situation. Systematic literature searches for articles published between January 2000 and January 2019 were performed in PubMed, Scopus, and PsycINFO. Findings of eligible articles were narratively synthesised and quality appraised. Our systematic review included 35 eligible articles. Childhood cancer had a substantial impact on parents' socio-economic situation across all studies. This impact varied largely by geographical region. We observed a high prevalence of disruptions in parental employment such as job quitting or job loss, particularly among mothers. The associated income losses further contributed to families' perceived financial burden in addition to increased cancer-related expenses. Adverse socio-economic consequences were most pronounced shortly after diagnosis, however, persisted into early survivorship for certain groups of parents. We identified families of children diagnosed with haematological cancers, younger age at diagnosis, and lower parental socio-economic position to be at particular risk for adverse socio-economic consequences. Following the child's cancer diagnosis, parents experience a broad range of adverse socio-economic consequences. Further effort is needed to systematically implement an assessment of financial hardship in paediatric oncology together with appropriate support services along the cancer trajectory.

Impact of Khat (Catha edulis) Chewing on Carotid Intima-media Thickness.

Khat has severe adverse socio-economic consequences. It causes serious cardiovascular, neurological and psychiatric problems. The study aimed to evaluate the effect of chewing khat on intima-media thickness (IMT) of the common carotid arteries. This was a descriptive case-control cross-sectional study. A total of 50 participants of chronic regular khat chewers were investigated. B-mode ultrasound 7-10 MHz linear transducers used for assessment of common carotid arteries according to the standard carotid sonography protocol. The IMT was measured and the presence of plaques was assessed. The carotid IMT was significantly increased in regular khat chewers more than the controls (p-value = 0.016). The common carotid IMT increased in smokers more than non-smokers among khat chewers (0.6710±0.20687 vs. 0.5789±0.16859 mm). Significant correlations existed between the duration of chewing khat and age with the presence of plaque (p-values = 0.013 and 0.002, respectively). There is a significant correlation between carotid plaque and longtime khat chewing. Khat is a contributory factor for increasing carotid intima-media thickness and formation of carotid plaques. A combination of khat and smoking produce more thickening of carotid intima-media.

Economic and Social Impacts of Khat (<i>Catha edulis Forsk</i>) Chewing Among Youth in Sebeta Town, Oromia Ethiopia

Khat (<i>Catha edulis Forsk</i>) is a large green shrub grown in Eastern to Southern Africa and extends to Arabian Peninsula. The leaf of Khat comes from a small evergreen shrub that can grow to the size of a tree. Both young buds and tender leaves are chewed to attain a state of euphoria and stimulation. Khat leaves contain Cathinone which it’s an active brain stimulant and Khat ingestion in low doses results in decreased appetite, euphoria, increased intellectual efficiency, and hyper-alertness.High doses and chronic use of Khat can cause more serious adverse neurological, psychiatric, cardiovascular, dental, gastrointestinal and genitourinary effects. Besides damaging health, Khat chewing has adverse socio-economic consequences effects on many other aspects of life. It has its own impact on mental and physical health of the chewers. This study was conducted from September to June 2017 using both quantitative and qualitative methods of data collection. A total of 250 samples were included in the study. Structured questionnaire were employed during data collection with the main objectives of to assess the socio-economic effects of Khat chewing among youth of Sebeta town, Oromia, Ethiopia. The studies revealed that Khat chewing was associated with carelessness, frequent absenteeism from working place, poor academic performance of chewer students, poor interaction with the societies, depression and anxiety, poor confidence, exposed for economic problem, health problems, conflict in the family. Generally,the current Khat chewing practices in the study area are relatively high. So efforts like creating awareness about negative effects, making different recreation methods available, addressing the underlying social problems of unemployment, poor housing, and cultural alienation and promote positive measures for community development and develop a health education program to raise awareness and formulating common conventions regarding Khat use mainly by young generations are necessary to decrease the magnitude of chewing practices and thereby its associated consequences.

The Impact of Brexit on the Transport Industry

By referendum on 23 June 2016, voters in the United Kingdom of Great Britain and Northern Ireland voted narrowly to leave the EU. The vote was called for party political reasons, as the ruling Conservative party was divided on the issue of continued EU membership, and the Government expected that a national pro-EU popular vote would silence those who wanted to leave. When the result turned out to be the opposite of what the Government expected, the Prime Minister resigned, despite an earlier pledge that he would abide by and implement the result. The new Prime Minister – who had voted to remain in the EU – repeated the pledge, even though the referendum had been an advisory, not a binding, one. The subsequent period has been spent in trying to achieve an agreement that minimises the adverse socio-economic consequences, to both sides, of a UK departure from the EU, prior to the declared leaving date of 29 March 2019. This paper examines likely effects of Brexit on the transport industry. It starts by explaining the meaning of Brexit, the timetable for UK exit, and some of the possible reasons why the referendum vote turned out as it did. (There has been a surprising lack of research into this subject, and none was undertaken by the UK Government in the aftermath of the vote.) The paper then considers the possible trade and commercial alternatives that the UK has to EU membership. ‘Norway’ or ‘Canada’ (or Canada Plus) arrangements were part of the internal discussion in the UK in the period after the referendum (which had not included a question on alternatives). A UK Government insistence (‘red line’) that the UK would no longer be subject to the jurisdiction of the European Court of Justice, which interprets EU law, limited the options available to the UK. The possible consequences to the UK, if it leaves the EU without a mutually acceptable withdrawal agreement, are then considered. Having set the background to this possible event, the paper then looks at how it may affect the transport industry. All modes of transport, other than inland waterway transport which has no direct connection between the UK and other EU countries, are examined. In each case new agreements will be needed to avoid serious disruption in the event of a ‘no-deal’ Brexit that removes the UK from the single market and customs union, with the UK then being regarded as a third country for trade and transport links. The final part of the paper examines the likely effect of Brexit on the economies of the UK and the remainder of the EU (and hence transport demand). It finds that Ireland may be the most affected EU country, but that the economy of the remaining EU-27 as a whole will suffer as a result of Brexit. After Ireland, the UK economy will be hit hardest, and we may never know if that is a result that the ‘leave’ voters in 2016 expected or not.

Exploring the environmental impact assessment commissioners' perspectives on the development of the seawater desalination project

In recent years, extreme climate conditions have resulted in uneven precipitations in Taiwan. The development of traditional water resources frequently suffers from protests of environmental groups, potential dam sites being hard-to-find, and other factors. The development of new water sources has been increasingly difficult. Sea water desalination has the advantages of a short construction time and easy expansion flexibility, making it an important alternative as a new water resource. In this study, the current proposal of Tainan's desalination plant was used as an example. Qualitative interviews and Analytic Hierarchy Process (AHP) were used to explore the environmental impact assessment (EIA) commissioner's perceptions of the impact from the development of the desalination project. The results of the qualitative interview indicate that the main concerns of the EIA commissioners are whether the development could damage the marine ecological environment and its fishery resources, which may have adverse socioeconomic consequences. The AHP results show that the commissioners' priority of environmental impact is ecological environmental impact 36.9%, social impact 29.7%, economic impact 23.7%, and physical and chemical environmental impact 9.7%. The main concerns in each impact category are, respectively, marine ecological environment, land and ocean utilisation, fisheries, and air quality.

Magnitude and associated factors of anemia among pregnant women in Dera District: a cross-sectional study in northwest Ethiopia

BackgroundAnemia is associated with adverse health and socio-economic consequences among pregnant women. Particularly, severe anemia increases the risk of maternal mortality by 20%. However, literatures are scarce in the northwest Ethiopia. Therefore, this study aimed to determine the magnitude and associated factors of anemia among pregnant women attending antenatal care in Dera District, South Gondar Zone, northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted in Dera District health centers from June 27 to September 2, 2015. Capillary blood samples were taken from 348 pregnant women. The raw measured values of hemoglobin were obtained using the portable Hb301 instrument and adjusted for altitude. Besides, nutritional status of the women was assessed by the mid upper arm circumference (MUAC) taken on non-dominant upper limb, mostly of the left hand. Socio-demographic factors, obstetric history, environmental related factors and dietary intake were collected by interviewing the pregnant women. A multivariate logistic regression analysis was employed to identify factors associated with anemia. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was computed to show the strength of association. In multivariable analysis, a P value of <0.05 was used to declare statistical significance.ResultsThe overall prevalence of anemia among pregnant women was 30.5% [95% CI 21.0, 40.0]. The result of multivariable analysis revealed that the likelihood of anemia was higher among pregnant women living in rural areas [AOR = 3.03, 95% CI 1.17, 7.82], had no latrine [AOR = 4.75, 95% CI 1.15, 16.60], low monthly income: <Eth. Birr 1200 (US dollar 52.22) [AOR = 2.56, 95% CI 1.17, 5.60], five or above parity [AOR = 4.17; 95% CI 1.62, 10.69], MUAC < 23 cm [AOR = 4.97; 95% CI 2.61, 9.43] and did not prenatal take iron supplementation [AOR = 5.63; 95% 2.21, 14.32].ConclusionSo far in the district, the magnitude of anemia existed as a moderate public health concern. Thus, improved socio-economic status, latrine and maternal iron supplementation coverage are essential to mitigate the high burden of anemia. In addition, nutritional counseling and education on the consumption of extra meals and iron-rich foods should be intensified.

Urban development, environmental vulnerability and CRZ violations in India: impacts on fishing communities and sustainability implications in Mumbai coast

Coastal Regulations in India are traced back to the UN Conference on Human Environment, held in Stockholm in 1972. The Environment Protection Act (EPA) 1986 was enacted to implement India’s commitments as a signatory. The Coastal Regulation Zone (CRZ) Notification of 1991 was made under the provisions of the EPA in order to protect coastal environments and social and livelihood security of fishing community. This paper assesses the effects of CRZ rules and violations in the Mumbai Metropolitan Region, which has experienced tremendous growth due to the rapid industrialization and urbanization. This process has led to the destruction of mangroves and other important species of fish which play a crucial role in sustaining the coastal ecology and urban biodiversity; high population density and uneven growth have exacerbated adverse environmental and socioeconomic consequences. The Koli (fishing community) in this region faces huge problems of survival and sustenance in small-scale fishing, due to the rampant commercial fishing by big trawlers and large-scale dumping of waste materials by the industries surrounding the vicinity into the sea. In small but significant ways, the fishing communities through their traditional commons-based resource management and livelihood systems protect the coastal ecology and help the cities in reducing their carbon footprints. On the basis of primary field research in Thane–Mulund Creek Bhandup, Chimbai, and Sewri, this paper attempts to assess CRZ violations taking place on coastal areas and is causing damage to the coastal ecology. The research specifically has focused on the particular fishing-related activities and spaces—such as: jetties, parking of boats, access to sea, weaving and drying of nets, landing grounds, drying and cleaning of fish that are more affected by encroachment of seashore area and by CRZ rules violations. It evaluates the actions taken by Maharashtra Coastal Zone Management Authority and Bombay Municipal Corporation while implementing rules and making Integrated Coastal Zone Management plan for management of marine environment. It raises broader issues relating to the contradictions and complementarities involved in ICZM plans vis-a-vis management of biodiversity, within a larger context of rapid urbanization and demands for real estate growth. The paper argues that urban biodiversity management requires clear valuation of the long-term ecological and socioeconomic benefits of sustenance of coastal ecology and related livelihoods.

Managing opioid-induced constipation.

in depth. Nursing professionals are critical for identifying constipation in patients using opioids and ensuring that these simple measures to alleviate distress and improve quality of life are implemented effectively. Where simple laxatives are insufficient to relieve OIC, a newer, more-expensive laxative approved for treating chronic constipation (i.e., lubiprostone or prucalopride) or an opioid antagonist should be considered. Lubiprostone stimulates intestinal fluid and electrolyte secretion by activating type 2 chloride channels. While lubiprostone is approved for treating refractory constipation in the USA and EU, it is only licensed for treating OIC in noncancer pain in the former. Prucalopride, a selective 5-HT4 agonist, is approved for treating refractory constipation in the UK, but not in the USA. These agents are modestly effective in treating OIC associated with non-cancer pain. The endpoints varied across studies precluding a comparison of their efficacy. Because the studies compared these drugs to placebo, the incremental benefit of these drugs over simple laxatives is unknown. Finally, their efficacy in OIC related to cancer pain is unknown. Of the μ-opioid-receptor antagonists used to treat OIC, some (i.e., naloxegol, methylnaltrexone) have peripheral effects only. Others (i.e., naloxone) also have central effects. The central effects may predispose to opioid withdrawal and reduce analgesia in some patients. Naloxegol comprises naloxone conjugated with polyethylene glycol, reducing its ability to cross the blood–brain barrier. Compared with placebo, the number needed to treat (NNT) for treating OIC with oral naloxegol (25 mg) in adults with chronic noncancer pain is approximately 7. In the USA, the approved indication for naloxegol use is OIC in non-cancer pain. In the EU, the approved indication is OIC in adult patients who have had an inadequate response to laxatives. In contrast to naloxegol, methylnaltrexone, is available only as a subcutaneous injection, and is essentially approved for treating OIC in patients with chronic non-cancer pain or advanced illness receiving palliative care in the USA and EU. In the pivotal study (Thomas et al, 2008) conducted in patients with an advanced illness (60% had cancer), 48% treated with a single dose of methylnaltrexone (0.15 mg/kg) versus 15% of placebo-treated U p to one third of the population in the western world report chronic pain. Pain causes distress and disability and has adverse socioeconomic consequences. Opioids are effective and have a favourable risk–benefit profile in conditions associated with acute pain or end-of-life pain. However, the widespread use of opioids, particularly newer semi-synthetic and synthetic opioids, for chronic non-cancer pain, has fuelled a crisis of iatrogenic opioid abuse, addiction, side effects, overdoses, and deaths, with no demonstrable reduction in the burden of chronic pain (Ballantyne and Sullivan, 2015). In the context of these opioid prescribing patterns, opioid-induced constipation (OIC) is common, does not decrease over time, compromises patient satisfaction with analgesic treatment, and limits opioid use (Camilleri et al, 2014). In a population-based survey (Cook et al, 2008), 57% of individuals with chronic non-cancer pain using opioids experienced constipation that they associated with opioid treatment. Moreover, 33% reported constipation as their most bothersome symptom. It is therefore crucial to ask patients on opioids about their bowel habits—not only stool frequency, but also other symptoms of constipation—and elicit changes in bowel patterns. When dealing with OIC, it is prudent to assess whether it is appropriate to use opioids to manage pain, and to discontinue them if not. The long-term use of opioids in patients with non-cancer non-palliative pain (e.g. chronic abdominal pain, fibromyalgia) should be strongly discouraged. Alternatives to opioids —nonopioid analgesics, antidepressant or antiepileptic medications in patients with neuropathic pain, and non-pharmacological adjuncts (e.g. meditation, cognitive behavioural therapy, and neurostimulators)—should be considered. If opioids are essential, anecdotal experience

Using Massive Parallel Sequencing for the development, validation, and application of population genetics markers in the invasive bivalve zebra mussel (Dreissena polymorpha).

The zebra mussel (Dreissena polymorpha, Pallas, 1771) is one of the most invasive species of freshwater bivalves, due to a combination of biological and anthropogenic factors. Once this species has been introduced to a new area, individuals form dense aggregations that are very difficult to remove, leading to many adverse socioeconomic and ecological consequences. In this study, we identified, tested, and validated a new set of polymorphic microsatellite loci (also known as SSRs, Single Sequence Repeats) using a Massive Parallel Sequencing (MPS) platform. After several pruning steps, 93 SSRs could potentially be amplified. Out of these SSRs, 14 were polymorphic, producing a polymorphic yield of 15.05%. These 14 polymorphic microsatellites were fully validated in a first approximation of the genetic population structure of D. polymorpha in the Iberian Peninsula. Based on this polymorphic yield, we propose a criterion for establishing the number of SSRs that require validation in similar species, depending on the final use of the markers. These results could be used to optimize MPS approaches in the development of microsatellites as genetic markers, which would reduce the cost of this process.

Breaking Ships in the World-System: An Analysis of Two Ship Breaking Capitals, Alang-Sosiya, India and Chittagong, Bangladesh

Centrality in the world-system allows countries to externalize their hazards or environmental harms on others. Core countries, for instance, dump heavy metals and greenhouse gases into the global sinks, and some of the core's hazardous products, production processes and wastes are displaced to the (semi) peripheral zones of the world-system. Since few (semi) peripheral countries have the ability to assess and manage the risks associated with such hazards, the transfer of core hazards to the (semi) periphery has adverse environmental and socio-economic consequences for many of these countries and it has spawned conflict and resistance, as well as a variety of other responses. Most discussions of this risk globalization problem have failed to situate it firmly in the world-system frame emphasizing the process of ecological unequal exchange. Using secondary sources, I begin such a discussion by examining the specific problem of ship breaking (recycling core-based ocean going vessels for steel and other materials) at the yards in Alang-Sosiya, India and Chittagong, Bangladesh. Attention centers on the nature and scope of ship breaking in these two locations, major drivers operating in the world-system, adverse consequences, the unequal mix of costs and benefits, and the failure of existing political responses at the domestic and international levels to reduce adequately the adverse consequences of ship breaking.

The Economic Impacts of Climate Change on Agriculture in Africa

The African continent is projected to suffer adverse impacts from climate change, which are disproportionate to its contribution to global carbon dioxide emissions. Africa is particularly vulnerable because it is among the hottest places on the Earth and therefore any further warming will likely have adverse socioeconomic consequences; and most of the economies in this region rely mainly on natural resources and rain-fed agriculture, which are very sensitive to climate change and variability. This article investigates the impacts of climate change on African agriculture and discusses the policy implications for managing these impacts. The modelling results show that Africa will experience the largest impacts from climate change in terms of decline in economic growth and welfare losses. The disaggregated results show that Southern Africa will be the hardest hit region, followed by the Rest of sub-Saharan Africa, North Africa and East Africa, in that order. There is therefore need for concerted efforts at adaptation, which should include introduction of temperature-sensitive varieties, diversification of production systems and livelihoods, shift to sustainable agricultural intensification, shift to irrigation agriculture, addressing institutional challenges such as poor physical and social infrastructure, market imperfections, lack of access to credit, and lack of crop insurance, etc. In the long run, emphasis should be placed on diversifying away from agriculture to industry and services.