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1.  Domestic water and sanitation as water security: monitoring, concepts and strategy 
Domestic water and sanitation provide examples of a situation where long-term, target-driven efforts have been launched with the objective of reducing the proportion of people who are water-insecure, most recently through the millennium development goals (MDGs) framework. Impacts of these efforts have been monitored by an increasingly evidence-based system, and plans for the next period of international policy, which are likely to aim at universal coverage with basic water and sanitation, are being currently developed. As distinct from many other domains to which the concept of water security is applied, domestic or personal water security requires a perspective that incorporates the reciprocal notions of provision and risk, as the current status of domestic water and sanitation security is dominated by deficiency This paper reviews the interaction of science and technology with policies, practice and monitoring, and explores how far domestic water can helpfully fit into the proposed concept of water security, how that is best defined, and how far the human right to water affects the situation. It is considered that they fit well together in terms both of practical planning of targets and indicators and as a conceptual framework to help development. The focus needs to be broad, to extend beyond households, to emphasize maintenance as well as construction and to increase equity of access. International and subnational monitoring need to interact, and monitoring results need to be meaningful to service providers as well as users.
doi:10.1098/rsta.2012.0420
PMCID: PMC3785949  PMID: 24080628
water; sanitation; water security; millennium development goals; water monitoring; human right
2.  Inequities in neonatal survival interventions: evidence from national surveys 
Background
Nearly four million children die during the first four weeks of life every year, yet known and effective interventions exist. Neonatal mortality has to be addressed to reach the millennium development goal for child survival.
Aims
To determine the extent of within‐country inequities in neonatal mortality and effective intervention coverage.
Methods
Neonatal, infant and child (under 2 years) mortality rates were calculated from empirical data from Demographic and Health Surveys for eight countries using direct estimation techniques. Wealth groups were constructed using the World Bank wealth index; neonatal mortality inequities were evaluated by comparing low:high quintile ratios; concentration indices were calculated for intervention coverage rates.
Results
The proportion of under‐2 deaths occurring in the neonatal period ranged from 24.3% (Malawi) to 49.4% (Bangladesh). In all countries (excluding Haiti) inequities in neonatal mortality and intervention coverage were evident across wealth groups with more deaths and less coverage in the poorest, compared with the richest, quintile; the largest mortality differential was 2.1 (Nicaragua) and the smallest was 1.2 (Eritrea). In Nicaragua 33% of the poorest women had a skilled delivery compared with 98% of the richest; in Cambodia for antenatal care this was 18% (poorest) and 71% (richest). Low coverage of interventions tended to show top inequity patterns whereas high coverage tended to show bottom inequity patterns.
Conclusions
Reducing inequity is a necessary step in reducing neonatal deaths and also total child deaths. Intervention efforts need to begin to integrate approaches relevant to equity in programme design, implementation, monitoring and evaluation.
doi:10.1136/adc.2006.104836
PMCID: PMC2675357  PMID: 17379739
inequity; intervention coverage; neonatal mortality; DHS surveys; Millennium Development Goals (MDGs)
3.  Genetic testing for long QT syndrome and the category of cardiac ion channelopathies 
PLoS Currents  2012;4:e4f9995f69e6c7.
Cardiac ion channel mutational analysis is a category of genetic testing used in clinical practice for determining the status of long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome genes in blood, saliva, or tissue from patients and family members at risk for cardiac events such as syncope and sudden death. Such testing is most informative following careful phenotypic characterization. Individuals with ion channelopathies may benefit from prevention (avoidance of triggers and predisposing drugs) and treatment (e.g., beta blocker therapy, implantable cardioverter-defibrillator (ICD) placement) modalities.
doi:10.1371/4f9995f69e6c7
PMCID: PMC3392134  PMID: 22872816
4.  Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies 
Mayo Clinic Proceedings  2009;84(7):643-662.
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Its increasing prevalence, particularly among the elderly, renders it one of the most serious current medical epidemics. Several management questions confront the clinician treating a patient with AF: Should the condition be treated? Is the patient at risk of death or serious morbidity as a result of this diagnosis? If treatment is necessary, is rate control or rhythm control superior? Which patients need anticoagulation therapy, and for how long? This review of articles obtained by a search of the PubMed and MEDLINE databases presents the available evidence that can guide the clinician in answering these questions. After discussing the merits of available therapy, including medications aimed at controlling rate, rhythm, or both, we focus on the present status of ablative therapy for AF. Catheter ablation, particularly targeting the pulmonary veins, is being increasingly performed, although the precise indications for this approach and its effectiveness and safety are being actively investigated. We briefly discuss other invasive options that are less frequently used, such as pacemakers, defibrillators, left atrial appendage closure devices, and the surgical maze procedure.
PMCID: PMC2704137  PMID: 19567719
5.  Functional Status, Heart Rate, and Rhythm Abnormalities in 521 Fontan Patients 6-18 Years of Age 
Objectives
To determine the relationship between functional outcome and abnormalities of heart rate & rhythm after the Fontan operation.
Methods
The NHBLI Pediatric Heart Network conducted a cross sectional analysis of patients who had undergone a Fontan procedure at the 7 network centers. Analysis was based on 521 patients with an ECG (n=509) and/or bicycle exercise test (n=404). The Child Health Questionnaire parent report and the O2 consumption at the anaerobic threshold were used as markers of functional outcome.
Results
Various Fontan procedures had been performed: intracardiac lateral tunnel (59%), atrio-pulmonary connection (14%), extracardiac later tunnel (13%), and extracardiac conduit (11%). Prior volume unloading surgery was performed in 389 patients; Bi-directional Glenn (70%) and Hemi-Fontan (26%). A history of atrial tachycardia was noted in 9.6% of patients and 13.1% of patients had a pacemaker. Lower resting heart rate and higher peak heart rate were each weakly associated with better functional status, as defined by higher anaerobic threshold (R = -0.18, p=0.004 and R = 0.16, p=0.007, respectively) and higher Child Health scores for physical functioning (R = -0.18, p<0.001 and R = 0.17, p=0.002, respectively). Higher anaerobic threshold was also independently associated with younger age and an abnormal P-axis. Resting bradycardia was not associated with anaerobic threshold or Child Health scores.
Conclusions
In pediatric patients (6-18 yrs) following the Fontan procedure, a lower resting heart rate and a higher peak heart rate are each independently associated with better physical function as measured by anaerobic threshold and Child Health scores. However, these correlations are weak suggesting that other, non-rhythm and non-rate, factors may have a greater impact on the functional outcome of pediatric Fontan patients.
doi:10.1016/j.jtcvs.2007.12.024
PMCID: PMC2525868  PMID: 18603061
6.  Malaria’s Indirect Contribution to All-Cause Mortality in the Andaman Islands during the Colonial Era 
The Lancet infectious diseases  2008;8(9):564-570.
Malaria appears to have a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands Penal Colony were initiated by the brackish swamp breeding malaria vector Anopheles sundaicus and fueled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r2=0.60, n=68, p< 0.0001) from 1872 to 1939. Directly attributed malaria mortality based on postmortem examinations rarely exceeded one fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery and diarrhea, which combined with malaria made up a majority of all-cause mortality, were positively correlated to malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections.
doi:10.1016/S1473-3099(08)70130-0
PMCID: PMC2657868  PMID: 18599354
malaria; epidemic; Andaman Islands; mortality
7.  Imported malaria and high risk groups: observational study using UK surveillance data 1987-2006 
BMJ : British Medical Journal  2008;337(7661):103-106.
Objective To examine temporal, geographic, and sociodemographic trends in case reporting and case fatality of malaria in the United Kingdom.
Setting National malaria reference laboratory surveillance data in the UK.
Design Observational study using prospectively gathered surveillance data and data on destinations from the international passenger survey.
Participants 39 300 cases of proved malaria in the UK between 1987 and 2006.
Main outcome measures Plasmodium species; sociodemographic details (including age, sex, and country of birth and residence); mortality; destination, duration, and purpose of international travel; and use of chemoprophylaxis.
Results Reported cases of imported malaria increased significantly over the 20 years of the study; an increasing proportion was attributable to Plasmodium falciparum (P falciparum/P vivax reporting ratio 1.3:1 in 1987-91 and 5.4:1 in 2002-6). P vivax reports declined from 3954 in 1987-91 to 1244 in 2002-6. Case fatality of reported P falciparum malaria did not change over this period (7.4 deaths per 1000 reported cases). Travellers visiting friends and relatives, usually in a country in Africa or Asia from which members of their family migrated, accounted for 13 215/20 488 (64.5%) of all malaria reported, and reports were geographically concentrated in areas where migrants from Africa and South Asia to the UK have settled. People travelling for this purpose were at significantly higher risk of malaria than other travellers and were less likely to report the use of any chemoprophylaxis (odds ratio of reported chemoprophylaxis use 0.23, 95% confidence interval 0.21 to 0.25).
Conclusions Despite the availability of highly effective preventive measures, the preventable burden from falciparum malaria has steadily increased in the UK while vivax malaria has decreased. Provision of targeted and appropriately delivered preventive messages and services for travellers from migrant families visiting friends and relatives should be a priority.
doi:10.1136/bmj.a120
PMCID: PMC2453297  PMID: 18599471
8.  Imported malaria and high risk groups: observational study using UK surveillance data 1987-2006 
Objective To examine temporal, geographic, and sociodemographic trends in case reporting and case fatality of malaria in the United Kingdom.
Setting National malaria reference laboratory surveillance data in the UK.
Design Observational study using prospectively gathered surveillance data and data on destinations from the international passenger survey.
Participants 39 300 cases of proved malaria in the UK between 1987 and 2006.
Main outcome measures Plasmodium species; sociodemographic details (including age, sex, and country of birth and residence); mortality; destination, duration, and purpose of international travel; and use of chemoprophylaxis.
Results Reported cases of imported malaria increased significantly over the 20 years of the study; an increasing proportion was attributable to Plasmodium falciparum (P falciparum/P vivax reporting ratio 1.3:1 in 1987-91 and 5.4:1 in 2002-6). P vivax reports declined from 3954 in 1987-91 to 1244 in 2002-6. Case fatality of reported P falciparum malaria did not change over this period (7.4 deaths per 1000 reported cases). Travellers visiting friends and relatives, usually in a country in Africa or Asia from which members of their family migrated, accounted for 13 215/20 488 (64.5%) of all malaria reported, and reports were geographically concentrated in areas where migrants from Africa and South Asia to the UK have settled. People travelling for this purpose were at significantly higher risk of malaria than other travellers and were less likely to report the use of any chemoprophylaxis (odds ratio of reported chemoprophylaxis use 0.23, 95% confidence interval 0.21 to 0.25).
Conclusions Despite the availability of highly effective preventive measures, the preventable burden from falciparum malaria has steadily increased in the UK while vivax malaria has decreased. Provision of targeted and appropriately delivered preventive messages and services for travellers from migrant families visiting friends and relatives should be a priority.
doi:10.1136/bmj.a120
PMCID: PMC2453297  PMID: 18599471
9.  Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence 
Environmental Health Perspectives  2004;112(10):1092-1098.
Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers’ objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.
doi:10.1289/ehp.6877
PMCID: PMC1247383  PMID: 15238283
biodiversity; deforestation; ecosystems; emerging infectious diseases; land use; Lyme disease; malaria; urban sprawl; wildlife; zoonosis

Results 1-9 (9)