Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA.     

Prenatal diagnosis and outcomes of five cases of mosaicism for an isochromosome of 20q

Five cases of mosaicism for an isochromosome of 20q have been detected from a total of 50 000 cases analysed for prenatal diagnosis by amniocentesis. Karyotypes were designated mos 46,X_/46,X_,i(20q). In all cases, the abnormal cell line was detected in more than one primary culture, thus fulfilling the criterion for true (level III) mosaicism. Indications for prenatal diagnosis were parental anxiety (two cases), low maternal serum alpha-fetoprotein (AFP) (two cases), and high maternal serum AFP (one case). Level II ultrasounds on all five fetuses were normal, and the abnormal cell line was never detected in fetal blood and/or cord blood. All five pregnancies were continued and had normal outcomes, with birth weights ranging from 2.4 to 3.8 kg. The development of all five children has been normal, with the oldest child in the study now 4 years of age. We suggest that the abnormal cell line in each case was of extrafetal origin, and that this may be one of the more common examples of this phenomenon, occurring in approximately 1/10000 prenatal diagnoses. Mosaicism i(20q) may have been missed in the past because of the higher resolution necessary to detect this subtle change.     

Prenatal diagnosis of a fetus with terminal deletion of chromosome 1 (q41)

Many authors have suggested that individuals affected by a terminal 1q deletion display a phenotypically definable and recognizable syndrome. In all of the 27 cases reported to date, the breakpoints were at band q42 or distally to it. To our knowledge, we report the first case of a terminal 1q41 deletion. Diagnosis was made prenatally by amniocentesis, following ultrasonographic diagnosis of omphalocele, cerebral ventriculomegaly, and increased nuchal fold thickness in a 19-week female fetus. Multiple facial and extremity features were consistent with the proposed distal 1q deletion syndrome; omphalocele, however, has not been reported previously. The absence of liver herniation into the omphalocele sac in this case supports the previously reported association of this finding with chromosomal anomalies.     

Backwater Confluences of the Ohio River: Organic and Inorganic Fingerprints Explain Sediment Dynamics in Wetlands and Marinas

In the Ohio River (OR), backwater confluence sedimentation dynamics are understudied, however, these river features are expected to be influential on the system’s ecological and economic function when integrated along the river’s length. In the following paper, we test the efficacy of organic and inorganic tracers for sediment fingerprinting in backwater confluences; we use fingerprinting results to evidence sediment dynamics controlling deposition patterns in confluences used for wetland and marina functions; and we quantify the spatial extent of tributary drainages with wetland and marina features in OR confluences. Both organic and inorganic tracers statistically differentiate sediment from stream and river end‐members. Carbon and nitrogen stable isotopes produce greater uncertainty in fingerprinting results than inorganic elemental tracers. Uncertainty analysis of the nonconservative tracer term in the organic matter fingerprinting application estimates an apparent enrichment of the carbon stable isotopes during instream residence, and the nonconservativeness is quantified with a statistical approach unique to the fingerprinting literature. Wetland and marina features in OR confluences impact 42% and 11% of tributary drainage areas, respectively. Sediment dynamics show wetland and marina confluences experience deposition from river backwaters with longitudinally linear and nonlinear patterns, respectively, from sediment sources.     

Listing for change? Exploring the politics of relief lists in Bangladesh after Cyclone Sidr

Ideal notions of efficient aid are challenged continuously by realities on the ground in the wake of major disasters, such as dire needs, limited resources, and opportunism. This paper demonstrates how ‘relief lists’ can be productive entry points for a systematic inquiry into the pervasive politics of disaster assistance. Through an analysis of qualitative data collected during the five years after Cyclone Sidr struck Bangladesh on 15 November 2007, it examines how relief lists featured in both physical and phantom forms and then developed beyond their transparency-making aims, becoming elevated sites of struggle for post-disaster resources. Three list processes, selected to indicate the temporal, material, and spatial dynamics of relief encounters, are assessed in depth. Although recipients of cyclone relief appreciated its value, the paper argues that list politics also stimulated structures of vulnerability, including inequality. Gradually, relief, as governed after Sidr, also served to restore the differential vulnerability of the country's coastal poor.     

Petrophysical analysis to investigate the effects of carbon dioxide storage in a subsurface saline aquifer at Ketzin, Germany (CO2SINK)

To test the injection behaviour of CO₂ into brine-saturated rock and to evaluate the dependence of geophysical properties on CO₂ injection, flow and exposure experiments with brine and CO₂ were performed on sandstone samples of the Stuttgart Formation representing potential reservoir rocks for CO₂ storage. The sandstone samples studied are generally fine-grained with porosities between 17 and 32% and permeabilities between 1 and 100 mD.Additional batch experiments were performed to predict the long-term behaviour of geological CO₂ storage. Reservoir rock samples were exposed over a period of several months to CO₂-saturated reservoir fluid in high-pressure vessels under in situ temperature and pressure conditions. Petrophysical parameters, porosity and the pore radius distribution were investigated before and after the experiments by NMR (Nuclear Magnetic Resonance) relaxation and mercury injection. Most of the NMR measurements of the tested samples showed a slight increase of porosity and a higher proportion of large pores.     

Hypoxia in the Baltic Sea: Biogeochemical Cycles, Benthic Fauna, and Management

Hypoxia has occurred intermittently over the Holocene in the Baltic Sea, but the recent expansion from less than 10 000 km² before 1950 to >60 000 km² since 2000 is mainly caused by enhanced nutrient inputs from land and atmosphere. With worsening hypoxia, the role of sediments changes from nitrogen removal to nitrogen release as ammonium. At present, denitrification in the water column and sediments is equally important. Phosphorus is currently buried in sediments mainly in organic form, with an additional contribution of reduced Fe-phosphate minerals in the deep anoxic basins. Upon the transition to oxic conditions, a significant proportion of the organic phosphorus will be remineralized, with the phosphorus then being bound to iron oxides. This iron-oxide bound phosphorus is readily released to the water column upon the onset of hypoxia again. Important ecosystems services carried out by the benthic fauna, including biogeochemical feedback-loops and biomass production, are also lost with hypoxia. The results provide quantitative knowledge of nutrient release and recycling processes under various environmental conditions in support of decision support tools underlying the Baltic Sea Action Plan.     

Quantifying carbon dioxide and methane emissions and carbon dynamics from flooded boreal forest soil

The boreal forest is subject to natural and anthropogenic disturbances, but the production of greenhouse gases as a result of flooding for hydroelectric power generation has received little attention. It was hypothesized that flooded soil would result in greater CO(2) and CH(4) emissions and carbon (C) fractionation compared with non-flooded soil. To evaluate this hypothesis, soil C and nitrogen (N) dynamics, CO(2) and CH(4) mean production rates, and (13)C fractionation in laboratory incubations at 14 and 21 degrees C under non-flooded and flooded conditions and its effect on labile and recalcitrant C sources were determined. A ferro-humic Podzol was collected at three different sites at the Experimental Lakes Area, Canada, with a high (19,834 g C m(-2)), medium (18,066 g C m(-2)), and low (11,060 g C m(-2)) soil organic C (SOC) stock. Soil organic C and total N stocks (g m(-2)) and concentrations (g kg(-1)) were significantly different (p < 0.05) among soil horizons within each of the three sites. Stable isotope analysis showed a significant enrichment in delta(13)C and delta(15)N with depth and an enrichment in delta(13)C and delta(15)N with decreasing SOC and N concentration. The mean CO(2) and CH(4) production rates were greatest in soil horizons with the highest SOC stock and were significantly higher at 21 degrees C and in flooded treatments. The delta(13)C of the evolved CO(2) (delta(13)C-CO(2)) became significantly enriched with time during decomposition, and the greatest degree of fractionation occurred in the organic Litter, Fungal, and Humic forest soil horizons and in soil with a high SOC stock compared with the mineral horizon and soil with a lower SOC stock. The delta(13)C-CO(2) was significantly depleted in flooded treatments compared with non-flooded treatments.