Water scarcity alleviation through water footprint reduction in agriculture: The effect of soil mulching and drip irrigation.

Water scarcity has received global attention in the last decade as it challenges food security in arid and semi-arid regions, particularly in the Middle East and North Africa. This research assesses the possible alleviation of water scarcity by reducing the water footprint in crop production through the application of soil mulching and drip irrigation. The study is the first to do so at catchment scale, taking into account various crops, multi-cropping, cropping patterns, and spatial differences in climate, soil, and field management factors, using field survey and local data. The AquaCrop-OS model and the global water footprint assessment (WFA) standard were used to assess the green and blue water footprint (WF) of ten major crops in the Upper Litani Basin (ULB) in Lebanon. The blue water saving and blue water scarcity reduction under these two alternative practices were compared to the current situation. The results show that the WF of crop production is more sensitive to climate than soil type. The annual blue WF of summer crops was largest when water availability was lowest. Mulching reduced the blue WF by 3.6% and mulching combined with drip irrigation reduced it by 4.7%. The blue water saving from mulching was estimated about 6.3 million m3/y and from mulching combined with drip irrigation about 8.3 million m3/y. This is substantial but by far not sufficient to reduce the overall blue WF in summer to a sustainable level at catchment scale.

A risk score to predict need for treatment for upper-gastrointestinal haemorrhage.

BACKGROUND: Current risk-stratification systems for patients with acute upper-gastrointestinal bleeding discriminate between patients at high or low risks of dying or rebleeding. We therefore developed and prospectively validated a risk score to identify a patient's need for treatment. METHODS: Our first study used data from 1748 patients admitted for upper-gastrointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients' risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second study, we prospectively validated this score using receiver operating characteristic (ROC) curves--a measure of the validity of a scoring system--and chi2 goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. FINDINGS: We calculated risk scores from patients' admission haemoglobin, blood urea, pulse, and systolic blood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0.92 (95% CI 0.88-0.95). The score was well calibrated for patients needing treatment (p=0.84). INTERPRETATION: Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.

Infectious health care workers: should patients be told?

The risk of transmission of HIV or hepatitis B from infectious health care workers to patients is low. However, inadvertent exposure causes great concern amongst patients of an infected health care worker. The patients of a Scottish dentist diagnosed hepatitis B e antigen positive were informed by letter of their exposure. A sample of patients was sent a postal questionnaire. Most (56%) respondents reported feeling anxious on receiving the letter but almost all (93%) thought patients should always be informed following treatment by an infectious health care worker, although the risk was very small. We discuss clinical and ethical factors relating to informing patients following exposure to an infectious health care worker. We suggest that a balance should be struck between patients' wishes to know of risks to which they have been exposed, however small, and the professional view that when risks are negligible, patients need not be informed.

Emergency medical admissions in Glasgow: general practices vary despite adjustment for age, sex, and deprivation.

BACKGROUND: Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying factors are needed. AIM: To determine the principal diagnoses, demographic, and socioeconomic factors associated with emergency medical admissions. METHOD: Cohort study based on the Greater Glasgow Health Board population of 810,423 adults. A fully anonymized dataset linkage of 43,247 adult emergency admissions to Glasgow medical beds in 1997 was obtained. Emergency admission rates were analysed by diagnosis, age, sex, Carstairs' deprivation category, and by individual general practices (after adjustment for other factors). RESULTS: The commonest principal diagnoses were chest pain (9.6%), chronic obstructive airways disease (5.6%), angina (5.4%), heart failure (4.1%), and acute myocardial infarction (3.9%). Twenty-one per cent of patients were coded as having 'ill-defined signs or symptoms'. Emergency medical admission rates rose with the age of the patient, doubling with every two decades' age increase. Admission rates for patients from deprived areas were twice those from affluent areas. Males were more frequently admitted than females (adjusted odds ratio = 1.19). After adjustment for age, sex, and deprivation, the general practices' emergency medical admission rates showed an almost twofold difference between the top and bottom deciles. CONCLUSION: Emergency medical admission rates are higher among the elderly, males, and deprived populations. This has implications for equitable resource distribution in the National Health Service. Admissions for exclusion of myocardial disease were common; however, myocardial infarction was not the final diagnosis in two-thirds of these patients. The large variation between the general practices' admission rates requires further investigation.

Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.