Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.     

All Hands on Deck: Transdisciplinary Approaches to Emerging Infectious Disease

The increasing burden of emerging infectious diseases worldwide confronts us with numerous challenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on “transdisciplinary approaches” to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases. We describe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social–ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them. The views expressed here by Marian McDonald and Josh Rosenthal are those of the authors and do not represent official views or policies of the U.S. Centers for Disease Control and Prevention or the National Institutes of Health.     

Reconstruction of the Terminal of an Abandoned Fractured Unipolar Coronary Sinus Lead: a Feasible Solution to Restore Effective Cardiac Resynchronization Therapy

Complications related to coronary sinus lead are not infrequent in recipients of cardiac resynchronization devices. We describe the case of a patient with a biventricular implantable cardioverter defibrillator with persistent phrenic nerve stimulation, previous coronary sinus lead fracture, and severe left subclavian vein stenosis. The reimplantation of a new coronary sinus lead on the left side, ipsilateral to the original implant, was unsuccessful. In order to avoid more complex and risky procedures, we performed the repair of the fractured abandoned lead with the reconstruction of the unipolar lead terminal. Effective biventricular pacing was obtained with satisfactory electrical parameters and it was maintained at twelve months follow-up.     

Evidence of High Tolerance to Ecologically Relevant Lead Shot Pellet Exposures by an Upland Bird

Upland birds that display grit ingestion behavior are potentially at risk of detrimental effects and death from lead poisoning at trap and skeet ranges and other areas where vast quantities of spent lead shot pellets abound. Because commonly cited force-feeding pellet exposure studies deviate from true field conditions, their results may not reflect true risks faced by upland birds. In particular, studies that use new shot pellets and administer more pellets than would be reasonably ingested, critically interfere with the understanding of actualized pellet exposures. In this study, northern bobwhites (Colinus virginianus), a frequent test species in shot pellet research, were dosed in an ecologically-relevant manner (i.e., with spent shot and with no more than three pellets). Notably, the 56-day post-dosing observation period, during which a battery of physiological measures were recorded, exceeded that of related studies. Despite a sustained suppression of a lead poisoning indicator, the data suggest upland birds can withstand spent shot pellet exposures. Data detected a survivorship ≥95%, absence of illness, demonstrated tolerance for extremely high blood lead concentrations, and unaffected blood parameters. In conjunction with ecological considerations (e.g., spatial scale and animal behavior), concern about bird population losses from the incidental ingestion of spent shot pellets is potentially overstated.     

Postgraduate Veterinary Training in Conservation Medicine: An Interdisciplinary Program at Murdoch University, Australia

Although many veterinarians in Australia have been interested in wildlife conservation, the concept of active and worthwhile involvement in biodiversity conservation has often seemed difficult to achieve. There are many boundaries which may hinder the ability of veterinarians to contribute effectively to wildlife conservation initiatives. This article discusses postgraduate veterinary educational initiatives at Murdoch University, Perth, Western Australia, which aim to train veterinarians to effectively participate in biodiversity conservation programs. The Master of Veterinary Studies (Conservation Medicine) and the Postgraduate Certificate in Veterinary Conservation Medicine have a flexible program structure and can be undertaken entirely by distance education. Their establishment required the removal of disciplinary, institutional, cultural, experiential, and professional development boundaries, which have traditionally impeded veterinary involvement in wildlife conservation projects. The programs have proven to be very successful and have attracted students across Australia and internationally. The strong commitment of Murdoch University to interdisciplinary study and distance education, the goodwill of staff from other divisions within the university, and enthusiastic support from collaborating institutions were critical for the development and establishment of the programs.     

Lead accumulation and distribution in maize seedlings: Relevance to biomass production and metal phytoextraction

Among trace metals, lead is a highly toxic contaminant, being hazardous to humans and animals. Application of maize plants for phytoremediation of polluted soils and waters has recently been of particular interest. The aim of this work is to investigate the Pb-phytoextraction potential of the maize cv. Tzariza used widely in Eastern European agriculture. Maize seedlings were exposed in a nutrient solution to 1–10000 µM of Pb²⁺ for 21 days. Lead accumulated mostly in conductive tissues and shoots at 0.1 mM and higher concentrations of Pb in growth medium. Pb at concentrations of 1 and 10 mM caused an increase in the superoxide anion level and the catalase activity in maize leaves. Lead ions were tolerable to maize seedlings within a concentration range up to 1000 µM of Pb^2+. The levels of lead in the nutrient solution above 1 mM resulted in inhibition of the growth of axial organs, decrease in leaf area, inhibition of water absorption, and reduction in accumulation of biomass. Theoretical considerations indicate that in the temperate climates of the phytoremediation with maize may allow annual removal up to 90 kg of Pb per km², depending on the initial level of soil contamination.     

Situating Suicide as an Anthropological Problem: Ethnographic Approaches to Understanding Self-Harm and Self-Inflicted Death

More than a century after Durkheim's sociological classic placed the subject of suicide as a concern at the heart of social science, ethnographic, cross-cultural analyses of what lie behind people's attempts to take their own lives remain few in number. But by highlighting how the ethnographic method privileges a certain view of suicidal behaviour, we can go beyond the limited sociological and psychological approaches that define the field of 'suicidology' in terms of social and psychological 'pathology' to engage with suicide from our informants' own points of view-and in so doing cast the problem in a new light and new terms. In particular, suicide can be understood as a kind of sociality, as a special kind of social relationship, through which people create meaning in their own lives. In this introductory essay we offer an overview of the papers that make up this special issue and map out the theoretical opportunities and challenges they present.     

Adsorption Optimization of Lead (II) Using Saccharum Bengalense as a Non-Conventional Low Cost Biosorbent: Isotherm and Thermodynamics Modeling

In the present study a novel biomass, derived from the pulp of Saccharum bengalense, was used as an adsorbent material for the removal of Pb (II) ions from aqueous solution. After 50 minutes contact time, almost 92% lead removal was possible at pH 6.0 under batch test conditions. The experimental data was analyzed using Langmuir, Freundlich, Timken and Dubinin-Radushkevich two parameters isotherm model, three parameters Redlich—Peterson, Sip and Toth models and four parameters Fritz Schlunder isotherm models. Langmuir, Redlich—Peterson and Fritz-Schlunder models were found to be the best fit models. Kinetic studies revealed that the sorption process was well explained with pseudo second-order kinetic model. Thermodynamic parameters including free energy change (ΔG°), enthalpy change (ΔH°) and entropy change (ΔS°) have been calculated and reveal the spontaneous, endothermic and feasible nature of the adsorption process. The thermodynamic parameters of activation (ΔG ^#, ΔH ^#and ΔS ^#) were calculated from the pseudo-second order rate constant by using the Eyring equation. Results showed that Pb (II) adsorption onto SB is an associated mechanism and the reorientation step is entropy controlled.     

Masking in Humans: The Problem and Some Attempts to Solve IT

Different types of masking are discussed together with an account of the masking effect that the sleep-wake cycle exerts upon the circadian rhythms of body temperature and urinary excretion. The relative importance to masking of the several components of differences between sleeping and wakefulness are then assessed.

Means to deal with the problem of masking fall into two major categories. These attempt to minimise masking effects by protocols such as constant routines or control days, and mathematical models which separate results obtained in the presence of masking influences into endogenous and exogenous components. (The problem of the extent to which masking influences can render the endogenous component of a rhythm an impure reflection of the internal oscillator is considered also.) These different techniques are compared with respect to their usefulness and assumptions.

Finally, a brief speculation is given of the usefulness of masking.     

Approaches to assessing and managing cumulative ecosystem change,with the Bay of Quinte as a case study: an essay

Rising concern for the future of humans and the earth's ecosystems provides the backdrop for an essay on approaches to assessing and managing ecosystem health. A review and critique of two rival metaphors of human health, illness and wellness, provide the staring point for evaluation of parallel approaches to the assessment and management of ecosystems. The limitations of the metaphors are noted for humans and ecosystems. The impact assessment and ecosystem approach concepts of ecosystem assessment and management are contrasted. As a case history, the nature and pace of change in the Bay of Quinte ecosystem are reviewed, spanning from colonization by the Empire Loyalists at the end of the 18th century through the current development of a remedial action plan for the ecosystem. The review includes the long-term scientific study of the Bay's response to point-source phosphorus control (Project Quinte) and the recent efforts to develop and implement a coordinated clean-up program (Remedial Action Plan). From the lessons of the Quinte experience, a framework is derived, combining the illness and wellness approaches to health. The framework deals with five topics: uncertainty and the precautionary principle; an ecosystem health scale; indicators of ecosystem health; maximum allowable change; and, regulation and planning. Uncertainty should not be used to justify inaction. A precautionary principle assumes that impacts will occur and places the burden of proof on the proponents of ecosystem disturbance. An ecosystem health scale is defined using current, original, and potential conditions. Restoration to the original condition is unlikely but provides a justifiable direction for actions to establish sustainability. Indicators of ecosystem health with sustainable ranges are preferred over end-points and thresholds. The concept of maximum allowable change is promoted with a tentative suggestion that a fifty percent rule might be used. Finally, an argument for the combined use of regulation and planning. Regulatory approaches tend to perpetuate confrontation. Planning can be used to lengthen the time-horizon from quarterly reports to generations and identify self-regulating codes of behaviour. The framework is briefly discussed and placed in a broader context linking humans and ecosystem, illness and wellness.Based on the text of a talk presented at the Cumulative Impact Assessment Workshop held in Toronto, Ontario, December 1992, and sponsored by the North Central Division of the American Fisheries Society.     

Tackling the threat of antimicrobial resistance: from policy to sustainable action

Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of antimicrobial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors. Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.     

Review. Lessons of kuru research: background to recent studies with some personal reflections

The widespread exposure of the UK population to bovine spongiform encephalopathy prions, and the potential consequences for public health, led to a renewed interest in kuru, the principal example of epidemic human prion disease. Kuru research in Papua New Guinea was expanded to study the range of incubation periods possible in human prion infection, to investigate maternal and other possible natural routes of transmission, to characterize genetic susceptibility and resistance factors and to gain insights into the peripheral pathogenesis of orally acquired prion disease in humans. Although now essentially over, the kuru epidemic continues to provide important lessons.     

Including Ethnic Minorities in Mental Health Intervention Research: A Practical Approach to a Long-Standing Problem

This paper examines a controversy that arose while developing a supplement to Mental Health: A Report of the Surgeon General that was focused on ethnic minority mental health. The controversy involved whether and how to make recommendations about ethnic minorities seeking mental health care. We found that few studies provided information on outcomes of mental health care for ethnic minorities. In this paper, we discuss outcomes of mental health care for ethnic minorities and how to proceed in developing an evidence base for understanding mental health care and minorities. We conclude that entering representative (based on population) numbers of ethnic minorities in efficacy trials is unlikely to produce useful information on outcomes of care because the numbers will be too small to produce reliable findings. We also conclude that while conducting randomized efficacy trials for all mental health interventions for each ethnic group would be impractical, innovative and theoretically informed studies that focus on specific cultural groups are needed to advance the knowledge base. We call for theory-driven research focused on mental health disparities that has the potential for understanding disparities and improving outcomes for ethnic minority populations.     

Short- and Long-Term Exposure of Lumbriculus variegatus (Oligochaete) to Metal Lead: Ecotoxicological and Behavioral Effects

Metals are naturally occurring constituents of the environment and although many are essential nutrients for living organisms, at higher concentrations they can be toxic. Some aquatic species can help understand and even predict the impact of those contaminants. Lumbriculus variegatus is a recommended species for use in sediment toxicity tests and is known to have a remarkable ability of segmental regeneration. Short- (10-day) and long-term (28-day) toxicity tests were used to test the effects of a metal on the survival, growth, and behavior of L. variegatus. This work aims to investigate and validate the use of behavior as a new parameter in standard toxicity tests. Worms were exposed to sediments contaminated with different levels of lead and the results indicated a positive relation between lead concentrations and mortality and growth: higher lead concentrations resulted in higher mortalities and strong inhibition of growth. An inhibition of behavior was observed and results suggested that although behavior could not be used in sediment toxicity tests, it proved useful as an addition to short-term tests and helps select sediments. Thus, exposure to sediments contaminated with lead affects the presence of this species in nature, because it interferes with growth and survival.     

Leptospirosis: an emerging global public health problem

Leptospirosis has been recognized as an emerging global public health problem because of its increasing incidence in both developing and developed countries. A number of leptospirosis outbreaks have occurred in the past few years in various places such as Nicaragua, Brazil and India. Some of these resulted due to natural calamities such as cyclone and floods. It is a direct zoonotic disease caused by spirochetes belonging to different pathogenic species of the genus Leptospira. Large number of animals acts as carriers or vectors. Human infection results from accidental contact with carrier animals or environment contaminated with leptospires. The primary source of leptospires is the excretor animal, from whose renal tubules leptospires are excreted into the environment with the animal urine. Majority of leptospiral infections are either sub clinical or result in very mild illness and recover without any complications. However, a small proportion develops various complications due to involvement of multiple organ systems. In such patients, the clinical presentation depends upon the predominant organs involved and the case fatality ratio could be about 40% or more. Febrile illness with icterus, splenomegaly and nephritis (known as Weil’s disease), acute febrile illness with severe muscle pain, febrile illness with pulmonary haemorrhages in the form of haemoptysis, jaundice with pulmonary haemorrhages, jaundice with heamaturea, meningitis with haemorrhages including sub conjunctival haemorrhage or febrile illness with cardiac arrhythmias with or without haemorrhages are some of the syndromes. Because of the protean manifestations of leptospirosis it is often misdiagnosed and under-reported. Although the basic principles of prevention such as source reduction, environmental sanitation, more hygienic work-related and personal practices etc., are same everywhere, there is no universal control method applicable to all epidemiological settings. Comprehensive understanding of the eco- epidemiological and cultural characteristics of a community that faces the problem of leptospirosis is an essential prerequisite for evolving an effective and acceptable control measure.     

Desert fishes: an interdisciplinary approach to endangered species conservation in North America

The habitat degradation and species endangerment that preceded and accompanied the North American environmental movement in the late 1960s and early 1970s found the conservation community ill-prepared. Protective legislation and basic research necessary for structuring recovery efforts did not exist. Desert aquatic communities were among the first to need attention, and an interdisciplinary effort was mounted in an early application of conservation biology. The history and evolution of desert ecosystem preservation are discussed, and case histories are presented that may prove helpful in other parts of the world as habitats are inexorably reduced. The role of the Desert Fishes Council in co-ordinating efforts of research scientists and resource managers to achieve common objectives is emphasized.     

Comparison of Contaminated Site Human Health Risk Assessment Approaches in Canada: Application of Provincial Methods to a Hypothetical Site

Human health risk assessment, whether at the screening level or more complex phase, is not an exact science. A wide variety of advice and direction is offered by international, national, and provincial/state environmental agencies regarding the conduct of risk assessment, and different risk assessors access and rely on the available regulatory advice and direction differently. This may result in wide variability in the estimates of chemical exposure and risk. A comparison of human health risk assessment approaches practiced at the provincial level in Canada was undertaken, wherein each jurisdiction's approach was applied to a hypothetical contaminated site. Approaches were found to vary both in terms of methodological considerations, and in matters of policy. The exercise yielded results in terms of estimated exposures and predicted hazard quotients/indexes and incremental lifetime cancer risks that were in some cases quite consistent (varying by a factor of less than 1.5 times), and in other cases remarkably different (varying by orders of magnitude). This article reviews the various approaches/frameworks applied and discusses the results of the hypothetical risk assessments, in terms of both the observed variation and the source of this variability.     

A bacteriological survey of an oyster-growing area: The Oualidia Lagoon,Morocco

A 3-year bacteriological survey of an oyster-growing area in Morocco, where the Japanese oyster (Crassostrea gigas) is grown, showed that the contamination of this lagunar ecosystem was not continuous but intermittent and that animal manure and human recreational activities were important sources of pollution. The major source of contamination was of animal origin, except during the summer, when human contamination prevailed.