Comprehending the multiple 'values' of green infrastructure - Valuing nature-based solutions for urban water management from multiple perspectives.

The valuation of urban water management practices and associated nature-based solutions (NBS) is highly contested, and is becoming increasingly important to cities seeking to increase their resilience to climate change whilst at the same time facing budgetary pressures. Different conceptions of 'values' exist, each being accompanied by a set of potential measures ranging from calculative practices (closely linked to established market valuation techniques) - through to holistic assessments that seek to address wider concerns of sustainability. Each has the potential to offer important insights that often go well beyond questions of balancing the costs and benefits of the schemes concerned. However, the need to address - and go beyond - economic considerations presents policy-makers, practitioners and researchers with difficult methodological, ethical and practical challenges, especially when considered without the benefit of a broader theoretical framework or in the absence of well-established tools (as might apply within more traditional infrastructural planning contexts, such as the analysis of transport interventions). Drawing on empirical studies undertaken in Sheffield over a period of 10 years, and delivered in partnership with several other European cities and regions, we compare and examine different attempts to evaluate the benefits of urban greening options and future development scenarios. Comparing these different approaches to the valuation of nature-based solutions alongside other, more conventional forms of infrastructure - and indeed integrating both 'green and grey' interventions within a broader framework of infrastructures - throws up some surprising results and conclusions, as well as providing important sign-posts for future research in this rapidly emerging field.

Addition of carbohydrate side chains at novel sites on influenza virus hemagglutinin can modulate the folding, transport, and activity of the molecule.

We have constructed and expressed a series of mutant influenza virus hemagglutinins, each containing a new consensus site for glycosylation in addition to the seven sites found on the wild-type protein. Oligosaccharide side chains were added with high efficiency at four of the five novel sites, located on areas of the protein's surface that are not normally shielded by carbohydrate. Investigations of the structure, intracellular transport, and biological activities of the mutant hemagglutinin molecules indicated that (a) supernumerary carbohydrate side chains can be used to shield or disrupt functional epitopes on the surface of hemagglutinin, and (b) the presence of an additional oligosaccharide may cause temperature-dependent defects in the transport of the glycoprotein. We discuss the addition of supernumerary oligosaccharides as a general tool for shielding chosen areas of the surface of proteins that enter or traverse the secretory pathway.

The significance of intraluminal crystalloids in benign prostatic glands on needle biopsy.

Based on data from autopsy, radical prostatectomy, and cystoprostatectomy specimens, it has been suggested that the finding of intraluminal crystalloids in benign glands on needle biopsy may indicate a concurrent carcinoma; therefore, repeat biopsy is recommended. We studied data from 56 consecutive needle biopsies from the Johns Hopkins Hospital and Dianon Systems in which the diagnosis of intraluminal crystalloids in benign glands was rendered and follow-up data were subsequently obtained. Cases in which crystalloids were present in glands suspicious for cancer, in glands of high-grade prostatic intraepithelial neoplasia, or in adenosis were excluded from the study. Follow-up data included repeat biopsy results and serum prostatic specific antigen levels. Of the 56 men, 31 (55%) had repeat biopsy (two underwent transurethral resection of the prostate [TURP]); the remaining men were either noncompliant or had medical conditions precluding subsequent biopsy. Of the 31 men who underwent repeat biopsies, 23 (74%) had benign diagnoses, one (3%) had high-grade prostatic intraepithelial neoplasia, and seven (23%) had adenocarcinoma. There was no difference in serum prostate-specific antigen values between those with and without cancer on repeat biopsy. In a control population of men with a benign first biopsy not showing crystalloids, the incidence of cancer on repeat biopsy was 16.2%, which was not statistically significantly different from the incidence found in our study group. We conclude that men with prostate biopsy results showing benign glands with crystalloids are at no significantly higher risk of having cancer on repeat biopsy than if crystalloids were not present.

Atypical mole syndrome: a brief overview for the primary care physician.

Early detection of melanoma and identification of potential markers or precursor lesions can substantially improve survival. Several risk factors have been identified in the pathogenesis of this potentially lethal cancer. Numerous reports in the literature have confirmed a subset of persons with an increased risk of developing melanoma. These patients are identified by a distinctive clinical phenotype depicted by unusually appearing melanocytic nevi (moles) in association with an increased number of total body nevi. They may have a family history of atypical moles or melanoma. In order to facilitate the recognition of such individuals by the non-dermatologist, a brief overview and salient features of the atypical mole syndrome are presented.

Fun in the sun: an outdoor program in a health care setting.

The Children's Hospital of Eastern Ontario in Ottawa, Ontario, has had a supervised playground program for the past 6 years, which is available to inpatients, outpatients, and their visitors. This paper describes playground staff and volunteer prerequisites, the role of interdisciplinary involvement, equipment and materials, factors to consider when planning outdoor activities, and the activities found to be most useful. The authors' purpose is not to give the recipe for an ideal playground program, but rather to stimulate interest in the desirability of playground programs in health care settings through the description of one such facility.

Surveillance of family planning services at Title X clinics and characteristics of women receiving these services, 1991.

PROBLEM/CONDITION: Public health surveillance data describing family planning services at Title X clinics and characteristics of women receiving these services during 1991 are contained in this report. These data update previously published information concerning characteristics of women and services at such clinics during 1981. REPORTING PERIOD COVERED: 1991. DESCRIPTION OF SYSTEM: Data characterizing patients and services were reported by family planning clinics to Title X grantees. These data for 1991 were provided by all 75 grantees to CDC's Family Planning Services Surveillance (FPSS) project. RESULTS: In 1991, 4.2 million women received services at Title X clinics. Overall, 69.5% of family planning patients had chosen oral contraceptives as their method of contraception, and 64.7% of patients were at or below the federal poverty level. In addition to information characterizing patients and services at Title X clinics, this report also evaluated current data-collection methods used by Title X grantees. Complexities in the analysis reflected variations in the quality and availability of data, including differences in definitions, data-collection instruments at the clinic level, and data categories. INTERPRETATION: The number and characteristics of family planning patients receiving services at Title X clinics during 1991 were similar to the number and characteristics during 1981. Furthermore, these results underscore the need to improve the quality and timeliness of family planning data and to facilitate program planning and operations at the grantee level. ACTIONS TAKEN: These surveillance findings have been communicated to state family planning administrators and to national Title X program administrators. This information will be used to assess how publicly funded family planning clinics currently contribute to health-care delivery and how these clinics might contribute to a national system of reproductive health-care services in the future.

Variant influenza virus hemagglutinin that induces fusion at elevated pH.

The hemagglutinin (HA) glycoprotein of influenza virus performs two critical roles during infection: it binds virus to cell surface sialic acids, and under mildly acidic conditions it induces fusion of the virion with intracellular membranes, liberating the genome into the cytoplasm. The pH dependence of fusion varies for different influenza virus strains. Here we report the isolation and characterization of a naturally occurring variant of the X31 strain that fuses at a pH 0.2 units higher than the parent strain does and that is less sensitive to the effects of ammonium chloride, a compound known to elevate endosomal pH. The bromelain-solubilized ectodomain of the variant HA displayed a corresponding shift in the pH at which it changed conformation and bound to liposomes. Cloning and sequencing of the variant HA gene revealed amino acid substitutions at three positions in the polypeptide. Two substitutions were in antigenic determinants in the globular region of HA1, and the third occurred in HA2 near the base of the molecule. By using chimeric HA molecules expressed in CV-1 cells from simian virus 40-based vectors, we demonstrated that the change in HA2 was solely responsible for the altered fusion phenotype. This substitution, asparagine for aspartic acid at position 132, disrupted a highly conserved interchain salt bridge between adjacent HA2 subunits. The apparent role of this residue in stabilizing the HA trimer is consistent with the idea that the trimer dissociates at low pH. Furthermore, the results demonstrate that influenza virus populations contain fusion variants, raising the possibility that such variants may play a role in the evolution of the virus.

The social costs of inadequate contraception.

This study examines, on a per-case basis, the social costs associated with contraceptive failures and resulting term pregnancies. To combat unintended pregnancy and escalating health care costs, the public sector needs to provide greater access to highly effective methods of contraception.

PIP: This study measures the social costs resulting when specific contraceptives fail women who are eligible for federal entitlement programs and pregnancy is carried to term. Social costs were calculated for selected contraceptive methods (the copper-T IUD, the diaphragm, contraceptive implants, injectables, the male condom, oral contraceptives, and tubal ligation), which were then compared with each other and with nonuse. The three-part analysis begins with the design of an economic model to measure the social costs of a single unplanned pregnancy brought to term (state and federal government payments) per person over a five-year term. Next these data were combined with data on specific contraceptive failure rates, and, finally, the data on social cost per method were combined with data from a previous study of direct health care costs to evaluate the total costs associated with the various methods. This analysis revealed that highly effective contraceptive methods are highly cost-effective, and that the initial expenditure to provide these methods to low-income women is overwhelmingly offset by savings in medical and social programs. This finding raises the question of why those qualifying for entitlement programs have so many unintended pregnancies, and it is suggested that the answer can be found in the fact that the fiscal resources that pay for (or fail to pay for) effective contraception are different from those bearing the social and medical costs once an unplanned baby is born. It is concluded that all women should be assured of access to highly effective contraceptive methods.

Glycosylation requirements for intracellular transport and function of the hemagglutinin of influenza virus.

The contribution of each of the seven asparagine-linked oligosaccharide side chains on the hemagglutinin of the A/Aichi/68 (X31) strain of influenza virus was assessed with respect to its effect on the folding, intracellular transport, and biological activities of the molecule. Twenty mutant influenza virus hemagglutinins were constructed and expressed, each of which had one or more of the seven glycosylation sites removed. Investigations of these mutant hemagglutinins indicated that (i) no individual oligosaccharide side chain is necessary or sufficient for the folding, intracellular transport, or function of the molecule, (ii) at least five oligosaccharide side chains are required for the X31 hemagglutinin molecule to move along the exocytic pathway to the plasma membrane, and (iii) mutant hemagglutinins having less than five oligosaccharide side chains form intracellular aggregates and are retained in the endoplasmic reticulum.

Cost-benefit analysis of selective screening criteria for Chlamydia trachomatis infection in women attending Colorado family planning clinics.

Women attending family planning clinics in Colorado during 1988 were screened for Chlamydia trachomatis infection by enzyme immunoassay (EIA, Chlamydiazyme, Abbott Laboratories; Abbott Park, IL). Cervical specimens from 11,793 women attending 22 family planning clinics were analyzed. Patient history and physical exams were used to assess risk factors for infection. A total of 913 individuals (7.7%) had positive culture results for C. trachomatis. Multivariate analysis showed that infection was significantly related to endocervical bleeding, cervical mucopurulent discharge, a new sexual partner in the last 3 months or multiple previous sexual partners (greater than 3) in the last year, pregnancy, the use of oral contraceptives, and age. Increased odd ratios were observed for the combination of endocervical bleeding and mucopurulent discharge and sexual history that included partners over the previous year as well as the most recent 3 months. A combination of these criteria was used to selectively screen women attending Colorado family planning clinics on an ongoing basis. A cost-benefit analysis employing a model reported previously showed a significant financial benefit associated with universal screening over either selective screening or no screening for C. trachomatis in this population.

Angiosarcoma of the small intestine: a case report and literature review.

A case of primary intestinal angiosarcoma in a 59-yr-old man is reported. The patient had recurrent gastrointestinal bleeding with normal upper and lower gastrointestinal endoscopies, technetium-99m-labeled erythrocyte scan, and angiography. Barium small bowel series and abdominal computerized tomography showed an ileal mass. Pathological examination was consistent with hemangiosarcoma with both solid and vasoformative patterns. Metastatic disease was also identified in the small bowel mesentery, liver, spleen, lungs, and brain. No identifiable underlying or epidemiologic factors have previously been reported to be associated with this rare type of tumor of the gastrointestinal tract. The pertinent literature on gastrointestinal angiosarcoma also is reviewed.

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES: The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS: Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS: All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS: Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.