A coupled human–natural system analysis of freshwater security under climate and population change

Limited water availability, population growth, and climate change have resulted in freshwater crises in many countries. Jordan’s situation is emblematic, compounded by conflict-induced population shocks. Integrating knowledge across hydrology, climatology, agriculture, political science, geography, and economics, we present the Jordan Water Model, a nationwide coupled human–natural-engineered systems model that is used to evaluate Jordan’s freshwater security under climate and socioeconomic changes. The complex systems model simulates the trajectory of Jordan’s water system, representing dynamic interactions between a hierarchy of actors and the natural and engineered water environment. A multiagent modeling approach enables the quantification of impacts at the level of thousands of representative agents across sectors, allowing for the evaluation of both systemwide and distributional outcomes translated into a suite of water-security metrics (vulnerability, equity, shortage duration, and economic well-being). Model results indicate severe, potentially destabilizing, declines in freshwater security. Per capita water availability decreases by approximately 50% by the end of the century. Without intervening measures, >90% of the low-income household population experiences critical insecurity by the end of the century, receiving <40 L per capita per day. Widening disparity in freshwater use, lengthening shortage durations, and declining economic welfare are prevalent across narratives. To gain a foothold on its freshwater future, Jordan must enact a sweeping portfolio of ambitious interventions that include large-scale desalinization and comprehensive water sector reform, with model results revealing exponential improvements in water security through the coordination of supply- and demand-side measures.

Jordan, a nearly land-locked nation, has a tenuous freshwater future. The country’s water challenges stem from having extremely limited natural water availability with few alternatives for generating new supply and dependence on transboundary rivers and groundwater (Fig. 1A). Flows in the lower Jordan River, which marks Jordan’s western border with Israel and the West Bank, are estimated to have declined by nearly 90% since predevelopment conditions (1), mostly due to the diversion of the upper Jordan River into the National Water Carrier by Israel (2). The Yarmouk River tributary, currently Jordan’s primary surface-water source, is also largely captured by upstream Syria (3–6). Throughout the country, groundwater is being rapidly depleted, with observed groundwater-level declines of 0.9 to 3.5 m/y since 1995 in the country’s most highly productive aquifer (7, 8). To the south, Jordan competes with Saudi Arabia for shared groundwater from the fossil Disi regional aquifer (9). Jordan has long sought construction of the Red Sea–Dead Sea conveyance project, which would desalinate Red Sea water, transport the freshwater north to Amman, and dispose of the saline brine to the Dead Sea. Although first conceived of in the 1960s, project costs and fragile international cooperation have stood in the way.Open in a separate windowFig. 1.Map of Jordan and conceptual model. (A) Jordan relies on surface-water sources (primarily the Yarmouk River) and groundwater wells for water supply. The most recent record of total freshwater use from Jordan’s MWI is 1,054 MCM for 2017, with groundwater contributing 59% of the total supply, surface water 27%, and treated wastewater 14%. The domestic sector uses 45% of all water, agriculture 52%, and industry 3%. Groundwater is the primary source for the domestic sector, constituting over 70% of its supply. For the agricultural sector, groundwater constitutes 46% of the supply for irrigation, surface water 28%, and treated wastewater 26%. (B) The JWM consists of two types of modules: human modules (white rectangles) and biophysical modules (gray rectangles) of natural and engineered physical phenomena. The systems model includes interactions between modules, distinguished by endogenous human decisions (blue lines), endogenous physical flows and production (green lines), and exogenous scenarios (pink lines) and human interventions (yellow lines).Climate change and population growth further threaten Jordan’s tenuous situation (10). Rainfall decline in Jordan is already evident over the past century (11, 12), while climate models predict further increased temperatures with doubling in the frequency, duration, and intensity of droughts by 2100 (13). Jordan’s growing population has been punctuated by sudden, large refugee influxes (10, 14). In 2010, Jordan’s population was 7.2 million, growing to over 10.8 million by 2020, a period when at least 1.1 million Syrian refugees fled Syria’s 2011 war to Jordan (2, 15). In response to water shortage, Jordan has implemented significant water-supply efficiencies. In Amman, the largest city and capital, over 95% of wastewater is treated and recycled. However, Jordan’s water-distribution system is inefficient and intermittent. Approximately 50% of Jordan’s piped supply is lost as “nonrevenue water” (NRW), due to either physical factors (e.g., pipeline leaks) or administrative issues (e.g., water theft, incorrect meter readings, or underbilling). On average, households in the capital of Amman receive piped water for only 36 h per week (16), with lower-income neighborhoods receiving as low as 24 h of municipal supply, while higher-income households receive up to 5 d of uninterrupted supply per week (17). As a result, urban users purchase expensive water delivered by tanker trucks that obtain water from private agricultural wells through both formal and informal tanker-water markets (17, 18). Ecological impacts related to both groundwater and surface-water withdrawals by Jordan and upstream riparian nations in the Jordan River Basin have been severe, with notable examples including the drying of the Azraq Oasis, a Ramsar wetland (19, 20), and the shrinking of the Dead Sea, whose shoreline is receding by ∼1 m/y (21).The situation in Jordan is emblematic of water crises around the world, in which rapid population growth, intensifying water use, sudden demographic shocks, climate change, transboundary water competition, and institutional challenges pose serious threats to freshwater security (22–28). In the face of such global changes, an overarching sustainability goal is the long-term provision of freshwater as formalized in the 2015 Sustainable Development Goals (29). Given the complex and interacting physical and socioeconomic facets of such a challenge, there has been a growing call for analytic frameworks to evaluate freshwater systems that account for both the physical processes that govern freshwater supply and the human institutions and behaviors that influence the management, allocation, and consumption of water (30–36). Here, we present such a coupled human–natural-engineered system framework to explore the long-term impacts of a suite of policy interventions aimed at achieving freshwater security in Jordan in the face of anticipated changes in climate, population, and the economy.     

Effects of Spray and Stretch on Postneedling Soreness and Sensitivity After Dry Needling of a Latent Myofascial Trigger Point

Objectives

To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity.

Design

A 72-hour follow-up, single-blind randomized controlled trial.

Setting

University community.

Participants

Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle.

Intervention

All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention.

Main Outcome Measures

Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised.

Results

Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F_3,204.8=3.19; P<.05; η_p²=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F_2.6,175=1.9; P=.131; η_p²=.02).

Conclusions

The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.     

Lactobacillus fermentum,a pathogen in documented cholecystitis

INTRODUCTIONLactobacillus species are probiotics proven to exhibit various preventative as well as therapeutic properties. While lactobacillus species have been implicated in the formation of dental caries, endocarditis and bacteremia, their role as pathogens in cholecystitis has not been reported. We present a rare case of Lactobacillus fermentum working as a pathogen in cholecystitis.PRESENTATION OF CASEAn 81-year old male was admitted with right upper quadrant abdominal pain. His signs, symptoms, laboratory values and imaging were consistent with a diagnosis of cholecystitis with ascending cholangitis. In view of his co-morbidity and severe sepsis, the patient was treated non-operatively with antibiotics and cholecystostomy. L. fermentum, which was vancomycin resistant, was identified from the cholecystostomy aspirate and from anaerobic blood culture. The patient went into septic shock, developed multi-organ dysfunction syndrome and eventually died.DISCUSSIONCommensal bacteria such as L. fermentum are known to modulate immunity, reduce the pathogenicity of gastrointestinal organisms and play a therapeutic role in various disease processes. We isolated L. fermentum as a pathogen in a documented case of cholecystitis with ascending cholangitis.CONCLUSIONWhile the routine use lactobacillus species as a probiotic is supported in the literature, understanding its potential role as a pathogen may allow more judicious use of these bacteria and encourage research to elucidate the pathogenicity of lactobacillus species.     

Differential binding between volatile ligands and major urinary proteins due to genetic variation in mice

Two different structural classes of chemical signals in mouse urine, i.e., volatile organic compounds (VOCs) and the major urinary proteins (MUPs), interact closely because MUPs sequester VOCs. Although qualitative and/or quantitative differences in each chemical class have been reported, previous studies have examined only one of the classes at a time. No study has analyzed these two sets simultaneously, and consequently binding interactions between volatile ligands and proteins in urines of different strains have not been compared. Here, we compared the release of VOCs in male urines of three different inbred strains (C57BL/6J, BALB/b and AKR) before and after denaturation of urinary proteins, mainly MUPs. Both MUP and VOC profiles were distinctive in the intact urine of each strain. Upon denaturation, each of the VOC profiles changed due to the release of ligands previously bound to MUPs. The results indicate that large amounts of numerous ligands are bound to MUPs and that these ligands represent a variety of different structural classes of VOCs. Furthermore, the degree of release in each ligand was different in each strain, indicating that different ligands are differentially bound to proteins in the urines of different strains. Therefore, these data suggest that binding interactions in ligands and MUPs differ between strains, adding yet another layer of complexity to chemical communication in mice.     

Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial

Objectives

The purpose of this study was to compare the effects of a cervical vs thoracic spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE).

Methods

A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended 1 experimental session. Participants were randomized to receive either a cervical or thoracic spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and 5 minutes postintervention by an examiner blind to group assignment. A 3-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip.

Results

The analysis of variance detected a significant interaction between group and time (F = 31.7, P < .000) for PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic spine manipulation (P < .001). For pain-free grip strength, no interaction between group and time (F = .66, P = .42) existed.

Conclusions

Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions.     

Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial

Villafañe JH, Silva GB, Bishop MD, Fernandez-Carnero J. Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial.ObjectiveTo examine the effects of radial nerve mobilization on pain sensitivity and motor performance in subjects with secondary thumb carpometacarpal osteoarthritis.DesignRandomized controlled trial. Treatment and placebo were given for 4 weeks. Measurements were taken before intervention, after 1 month (first follow-up), and after 2 months (second follow-up).SettingPatients from the Department of Physical Therapy, Azienda Sanitaria Locale 3, Collegno (Italy).ParticipantsParticipants (N=60; age range, 70–90y) with right-dominant hand secondary thumb carpometacarpal osteoarthritis without other motor-related pathology. All patients completed the study. No patients were withdrawn from the study.InterventionsSliding mobilization of the proximal-distal radial nerve or intermittent ultrasound therapy, used as placebo.Main Outcome MeasuresWe hypothesized that radial nerve mobilization induces hypoalgesia and increases strength in secondary thumb carpometacarpal osteoarthritis. We measured pressure pain threshold (PPT) at the trapeziometacarpal joint, the tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone by algometry. Tip pinch strength and tripod pinch strength were measured by a mechanical pinch gauge.ResultsTreatment increased PPT by 3.33±.24kg/cm² (P<.001) in the trapeziometacarpal joint and was maintained until first follow-up and second follow-up. Also, PPT in the scaphoid bone and hamate bone was increased (P<.001 and P<.02, respectively). Variables in the placebo group remained unchanged. Tip pinch strength increased by 2.22±.22kg (P<.04) and tripod pinch strength by 2.83±.24kg (P<.019).ConclusionsRadial nerve mobilization decreases pain sensitivity in the trapeziometacarpal joint and increases tip pinch strength.     

Associations of pain catastrophizing with pain-related brain structure in individuals with or at risk for knee osteoarthritis: Sociodemographic considerations

Compelling evidence exists that non-Hispanic blacks (NHB) engage in pain catastrophizing (negatively evaluate one’s ability to cope with pain) more often than non-Hispanic whites (NHW). Functional neuroimaging studies revealed that individuals with high levels of trait pain catastrophizing show increased cerebral responses to pain in several pain-related brain regions (e.g., insula, primary somatosensory cortex [S1]), but associations between brain structure and catastrophizing remain largely unexplored. The current investigation was conducted at the University of Florida and the University of Alabama at Birmingham. Participants were 129 community-dwelling adults with or at risk of knee osteoarthritis (OA). Participants completed the pain catastrophizing subscale of the Coping Strategies Questionnaire-Revised and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain intensity subscale. Magnetic Resonance Imaging data were obtained. MANOVA and Chi-Square analyses assessed sociodemographic/clinical differences stratified by ethnicity/race. Multivariate regression analyses with insula and somatosensory cortical thickness entered as dependent variables with catastrophizing and the interaction between catastrophizing and ethnicity/race as the independent variables. Covariates include education, body mass index, study site, and WOMAC pain (ethnicity/race was an additional covariate in non-stratified analyses). There were significant interactions between ethnicity/race, pain catastrophizing, and brain structure. Higher pain catastrophizing was associated with thinner S1 bilaterally (ps < .05) in NHW, but not NHB participants with or at risk for knee OA. These results suggest that pain catastrophizing might have differing effects on pain-related central pathways and may contribute to ethnic/race group differences in individuals with or at risk for knee OA.