Arbuscular Mycorrhizal Fungi (AMF) constitute a group of root obligate biotrophs that exchange mutual benefits with about 80% of plants. They are considered natural biofertilizers, since they provide the host with water, nutrients, and pathogen protection, in exchange for photosynthetic products. Thus, AMF are primary biotic soil components which, when missing or impoverished, can lead to a less efficient ecosystem functioning. The process of re-establishing the natural level of AMF richness can represent a valid alternative to conventional fertilization practices, with a view to sustainable agriculture. The main strategy that can be adopted to achieve this goal is the direct re-introduction of AMF propagules (inoculum) into a target soil. Originally, AMF were described to generally lack host- and niche-specificity, and therefore suggested as agriculturally suitable for a wide range of plants and environmental conditions. Unfortunately, the assumptions that have been made and the results that have been obtained so far are often worlds apart. The problem is that success is unpredictable since different plant species vary their response to the same AMF species mix. Many factors can affect the success of inoculation and AMF persistence in soil, including species compatibility with the target environment, the degree of spatial competition with other soil organisms in the target niche and the timing of inoculation. Thus, it is preferable to take these factors into account when “tuning” an inoculum to a target environment in order to avoid failure of the inoculation process. Genomics and transcriptomics have led to a giant step forward in the research field of AMF, with consequent major advances in the current knowledge on the processes involved in their interaction with the host-plant and other soil organisms. The history of AMF applications in controlled and open-field conditions is now long. A review of biofertilization experiments, based on the use of AMF, has here been proposed, focusing on a few important factors that could increase the odds or jeopardize the success of the inoculation process. Soil microorganisms such as arbuscular mycorrhizal fungi (AMF or AM fungi) represent a key link between plants and soil mineral nutrients. Thus, they are collecting growing interest as natural fertilizers. AMF are obligate symbionts, belonging to the phylum Glomeromycota   genome  and consumption (nosZ) and AM fungal abundance suggests that the regulation of N2O emissions is caused by changes induced by AM fungi in the soil microbial biomass and in the community composition. AM fungi could have an indirect influence on GHG emissions, and also change the physical conditions of soil, i.e., moisture, aggregation, and aeration, all of which influence the production and transport of GHG in soil. Lazcano et al.  into a target soil. However, the exploitation of these fungi in applicative programs requires the knowledge of how AMF adapt and react to the target ecosystem and soil management and of the events that lead to the establishment of a functional symbiosis, including the mechanisms involved in nutrient transfer. In this review, after a brief mention of the most recent results on the nutritional aspects of AM symbiosis and a quick overview of the challenges involved in AMF inoculum production, examples of AM fungi application, in controlled and open-field conditions, are reported and discussed, with particular attention being paid to identifying the factors that led to successful outcomes in the biofertilization experiments.via the AM fungus and directly through the root transport system, and have revealed that the fungus can transfer the Pi to the plant even without an evident growth effect   in an AM fungus  for the plant cell machinery, the contribution of AM symbiosis to plant K+ nutrition has rarely been studied  can also be transferred to plants through AM fungi  into a target soil. Unfortunately, AMF are obligate symbionts and cannot be cultivated in pure cultures, away from their host plants. This constraining feature makes the large-scale production of AMF inocula very challenging and complex. There are three main types of AMF inocula. First, soil from the root zone of a plant hosting AMF can be used as inoculum as it normally contains colonized root fragments, AMF spores, and hyphae. However, unless precise information about the propagule abundance, diversity, and infectivity are available, soil inocula can be unreliable and carry the possible risk of transferring weed seeds and pathogens. Spores extracted from soil can instead be used as starters for crude inoculum production. Crude inoculum can be obtained after a known isolate of AMF and a host trap plant  are grown together in an inert medium optimized for AMF propagation. This is the most commonly used type of inoculum for large-scale crop inoculation as it usually contains a more concentrated set of the same kind of propagules found in soil inocula. Finally, infected root fragments alone of a known AMF host that have been separated from a trap plant culture can also serve as a source of inoculum.The production of AMF crude inoculum on a large-scale remains very challenging even though new methods for massive production  and sample sizes , the z-test is able to return a p-value that can be used to either accept or reject the null hypothesis that the sample proportions are equal.In an effort to define whether some of the most important factors considered in the reviewed studies have the potential to determine the success or the failure of inoculated AMF on plant productivity, the proportions of experiments showing a significant increase in colonization, biomass, yield, and nutrition following AMF inoculation was calculated for three important factors . This is probably due to the fact that containerized roots stop growing because of constraints imposed by pot boundaries at a certain point in time during cultivation. In addition, the inoculated plants might sometimes be less prone to invest in root growth in pots. This could be due to the fact that containerized inoculated plants are likely to rely massively on fungal-mediated uptake  were carried out in greenhouses, while 24% were conducted in open-field conditions Figure . As expeAgrobacterium rhizogenes , and, interestingly, only marginal use is made of other methods. A few other alternatives to the use of potted trap plants are in fact available. Soilless culture systems, such as aeroponics and hydroponics, lead to the production of pure clean spores and the maximization of growing conditions for the host plant . Most manufacturers advertise their commercial inocula by pointing out their suitability for a wide range of plants and environmental conditions. Unfortunately, the promises made about these products and the obtained results are sometimes far apart. Examples of ineffective or badly formulated inocula can be found in the literature , as seen in 60% of the reviewed experiments. Single species inoculation experiments tend to be more successful for a shoot biomass increase (s Figure , and cans Figure . This suIt is currently estimated that the world's population will exceed nine billion by 2050 (Rodriguez and Sanders, In this review, it has been pointed out that AMF inoculation overall produces positive outcomes on plant production in both controlled and open-field conditions, mainly due to the several nutrition-related benefits that this class of soil fungal symbionts is able to provide to their host-plant. In particular, AMF inoculation in the field has proven to be as effective as inoculation in the greenhouse, where non-inoculated controls are normally free of AMF, unlike in open-field conditions. For these reasons, the next significant step toward the stable use of AMF in agriculture is to carry out large-scale multi-location field trials and conduct cost-benefit analyses, such as that presented in Ceballos et al. , in ordeAB, EL, RB, and VB contributed to the conception and drafting of the review. All the authors critically revised and approved the manuscript before submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Community-based participatory research builds partnerships between communities and academic researchers to engage in research design, decision making, data collection, and dissemination of health promotion initiatives. Community-based participatory projects often have formal agreements or defined roles for community and academic partners. Our project (November 2012–November 2014) was designed to document life narratives of urban American Indian elders as a foundation for developing a resilience-based health promotion curriculum for urban American Indian adolescents aged 12 to 18. We used a flexible method for engaging community partners that honored the individual strengths of elders, encouraged them to describe how they wanted to contribute to the project, and provided multiple ways for elders to engage with university partners. We invited elders to participate in one or more of the following roles: as members of consensus panels to develop interview questions, as members of a community advisory board, or as participants in individual qualitative interviews. The flexibility of roles gave elders the opportunity to serve as advisors, co-developers, interviewees, or reviewers during 2 years of curriculum development. Engaging American Indian elders in the research process acknowledged the multiple layers of expertise they had as traditional leaders in the community while promoting trust in and ownership of the project. This flexible technique can be used by other communities that may not be comfortable with structured processes of engagement. Community-based participatory research (CBPR) can be used to promote health and conduct prevention research that fits the needs and culture of the community by engaging community members, community organizations, and researchers in all aspects of the research process ,2. CBPR Trust is an essential component in a successful collaboration, but it can be difficult to obtain because of negative perceptions about research in communities that were marginalized or received few direct benefits from research findings ,6. DurinIn American Indian cultures, elders are valued as protectors, mentors, teachers, keepers of wisdom, and intergenerational transmitters of cultural knowledge . AmericaIn a departure from CBPR best practices ,14, our The Tucson Indian Center provides monthly luncheons for American Indians elders aged 55 or older; these luncheons bring elders together to socialize with their peers and listen to presentations from various local organizations and programs. We used this natural platform to recruit elders for participation in consensus panels and interviews. Recruitment through verbal announcements at the monthly luncheons allowed the team of investigators to answer questions about the purpose of the project, to develop a relationship with the elders, and to form a purposeful sample of participants .To generate discussion on the design of the interview guide and the content of the curriculum, we facilitated 4 consensus panels . Each paThe absence of defined roles and formal agreements, such as time or participation commitments, contributed to the flexibility of the consensus panels. Included in this flexibility was the opportunity for the American Indian elders to choose to participate regardless of their experience or level of familiarity with the project. To acknowledge their time and show our appreciation for their participation, each time a community member participated in a consensus panel he or she was given a $20 gift card. Participation in the consensus panels provided elders with a chance to embrace the role of a co-developer in a community health initiative.The first consensus panel. This panel reviewed a draft of our qualitative interview guide for cultural sensitivity, word selection, and clarity of the questions. Additionally, the elders requested that we follow cultural protocol and add an introduction for both the interviewer and the interviewee to establish rapport. After reaching a final consensus on its cultural appropriateness, the resulting interview guide was expanded from 11 questions to 25 questions to obtain information from interviewees on their experiences of historical trauma and resilience.The second consensus panel. The goal of this panel was to review proposed lesson plans before the development of the curriculum. During this panel, elders were provided with a hard copy of proposed lesson plans. The investigators facilitated discussion about the plans and associated activities until the elders reached consensus.The third and fourth consensus panels. These panels reviewed a draft of the resilience-based curriculum with particular attention to cultural sensitivity, missing information, and areas to strengthen. The elders critiqued compilations of video-recorded interviews and reviewed content of the individual lesson plans and the final curriculum. During the curriculum design and dissemination phases, elders members of these consensus panels bridged the gap between our usual methods of gathering qualitative data and the methods that are best suited to the American Indian community, thus increasing the likelihood of relevance of the curriculum for urban American Indian adolescents .During CAB meetings, CAB members were updated on the status of the project and also reviewed our research project outline and methods and provided feedback. Communication between the community and academic partners was emphasized by following cultural protocol and opening each meeting with a proper introduction to build trust. As CAB members, elders contributed to the cultural humility of our project by informing respectful and culturally sensitive research protocols . To retaWe engaged 13 American Indian elders as participants in one-on-one interviews to document their life narratives. American Indian elders were asked to share their life narratives or personal stories of historical trauma, personal challenges, and strategies of resilience. Unlike the consensus panels, this aspect of elder project engagement had several eligibility criteria. Participants had to be self-identified as American Indian elders, aged 55 or older, living in Tucson, and willing to provide verbal and written consent to being interviewed. Elders who expressed interest in participating in the interviews were asked for their contact information, were contacted to set up interview times and location, and were provided with a $20 gift card at the completion of each interview. Through their storytelling, elders offered ideas for key themes for the curriculum. After being interviewed, elders were eligible to shift into being CAB members or consensus panel participants, or they could opt out of the process at any time.Reviews of personal interviews. Shortly after providing their life narratives, the 13 elders were given an edited copy of their full interview and were asked to review it for additional editing. Two to three weeks later, elders met with a researcher, who used a semistructured interview guide, to discuss what they liked or disliked about their interview. Although most elders approved of their interviews and asked for no changes, one elder requested to redo his interview and another elder asked to change or remove pieces of his interview before they were incorporated into the final curriculum. Reviewing their recorded personal interviews offered the elders the opportunity to reflect on their own experiences of historical trauma and resilience. Sharing their own lived experiences for translation into a health promotion curriculum for adolescents helped promote ownership in the project ( project .During our 2-year project, we provided multiple opportunities for American Indian elders to participate without having to adhere to the formalized rules and operational procedures that are often recommended for CBPR projects to control the effectiveness and mixture of participants and to ensure that knowledge is transferred from the research to the field ,4,14. ThOur flexible approach to CBPR had several benefits, including various levels of elder involvement throughout the phases of the project; enhanced sense of elder ownership in the project; feedback from each consensus panel, the CAB, and the interviews on the interview process and curriculum development. We identified 2 major challenges: fluctuating attendance of participants at CAB meetings and lack of participation by some quiet elders at the consensus panels and CAB meetings.Privacy concerns. Because all recruitment took place at the Tucson Indian Center, our research protocol addressed privacy concerns. Any elder who wished to participate in an interview was provided the option to be video recorded, audio recorded, or be completely anonymous. During an anonymous interview, notes were taken, but the elder’s voice was not captured and any markers indicating identity, such as names, were removed.Methods for active engagement. To increase engagement, we offered gift cards as compensation for participating in consensus panels and interviews. However, other methods for active engagement were also used, including offering snacks and beverages at every meeting and offering nonmonetary gifts such as socks and puzzles. We also found it helpful to schedule consensus panels and CAB meetings directly after monthly elder luncheons because it relieved participants of any extra travel. Sufficient representation. Throughout this project, we recruited elders to participate in consensus panels and CAB meetings from the monthly elders’ luncheons. To ensure sufficient representation in the absence of regularly engaged elders, we provided frequent and thorough updates at every consensus panel and CAB meeting and occasionally at the elders’ luncheons. We also supported sufficient representation by directly asking quiet elders to share their input when we noticed that the most outspoken elders were the ones who volunteered the most feedback.Informal CAB. Although best practices suggest formal agreement to support efficiency during the research process, we did not ask elders to sign a written commitment to attend regular CAB meetings. Although we did ask for verbal commitment at the beginning of the research process, we decided that it was not appropriate to enforce a signed commitment. The elders chose to participate according to their personal schedules, family engagements, and transportation needs. Because the CAB was flexible, elders could join at any time; this policy allowed for better representation but presented a challenge in interpreting feedback.Interpreting feedback. Because we had no formal agreements for attendance or participation in any of the consensus panels or CAB meetings, attendance fluctuated. This fluctuation in attendance made consistent feedback difficult because one elder would suggest a particular change at one meeting, the change would be incorporated into the program, but at a later meeting, the change would be challenged by an elder not present at the earlier meeting. To ensure that we interpreted the feedback correctly, we provided a thorough update and progress report at the beginning of every meeting. Although the process was repetitive, it helped all participants, even those attending regularly.The involvement of self-selected American Indian elders in every aspect of our research may provide evidence that using flexible techniques without defined roles for engagement and not having formal agreements benefitted this project. Engaging American Indian elders in this project acknowledged the traditional role of the American Indian elders as leaders, mentors, and teachers, which facilitated transparency that formed trust and gained community buy-in . This fl


As a researcher with several affiliations and commitments, I am often asked to assess clinical research studies, and approve student dissertation proposals prior to their initiation. One of the most common issues of concern which I often come across, is an unethical research methodology, that if conducted, would breach medical ethics in one way or another. This issue goes to show that the subject of medical ethics is often either misconstrued, downplayed, or ignored by students contemplating research in the medical field. We as physicians, are obligated to abide by and uphold ethical values and to relay them to our students. It is imperative that students contemplating clinical research, consider all aspects of medical ethics, both in their proposals and study design. They should be aware of what medical ethics is and what exactly constitutes a breach of medical ethics.Medical ethics is defined as a system of moral principles that bring values and judgement to the practice of medicine. As a scholarly discipline, medical ethics encompasses practical application in clinical settings. Historically, Western medical ethics may be traced to guidelines relating to the duty of physicians that were formulated in antiquity, such as the Hippocratic Oath, and early religious teachings. The first code of medical ethics, ‘Formula Comitis Archiatrorum’, was published in the 5th century during the reign of the Ostrogothic king, Theodoric the Great. In the medieval and early modern period the issue of ethics is attributed to scholars of Muslim medicine, such as Ishaq ibn Ali al-Ruhawi , and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), as well as other philosophers, such as Maimonides, Roman Catholic scholastic thinkers like Thomas Aquinas and case-oriented analysts (casuistry) of Catholic moral theology. These intellectual traditions were propagated and incorporated in Catholic, Islamic and Jewish medical ethics. By the 18th and 19th centuries, medical ethics had emerged as a more self-conscious discourse. In England, Thomas Percival, a physician and author, established the first modern code of medical ethics. He drafted a pamphlet with the medical code in 1794 and wrote an expanded version in 1803; he also coined the terms, ‘medical ethics’ and ‘medical jurisprudence’ (The human rights era started with the formation of the United Nations (UN) in 1945. The UN pursued the global promotion of human rights and the Universal Declaration of Human Rights (1948) was the first major document published to define human rights. Medical doctors have an ethical duty to protect the patients’ human rights and dignity in research as well as treatment. Most codes of medical ethics also require respect for the patient’s human rights in publishing. In Europe, the Council of Europe promotes the rule of law and observance of human rights. In 1997, the Council of Europe adopted the European Convention on Human Rights and Biomedicine in order to create a uniform code of medical ethics for its 47 member-states. The convention applies international human rights laws to medical ethics. In addition, it also provides special protection for the physical integrity of those who are unable to consent, which includes children . In DeceThe United Nations Educational, Scientific and Cultural Organization (UNESCO) also promotes the protection of dignity and human rights. According to UNESCO, ‘Declarations are another means of defining norms, which are not subject to ratification’. Similar to recommendations, they set forth universal principles to which the community of States wished to attribute the greatest possible authority and to afford the broadest possible support. UNESCO adopted the Universal Declaration on Human Rights and Biomedicine to advance the application of international human rights laws in medical ethics. This Declaration provides special protection of human rights for incompetent persons.The Declaration of Helsinki is a set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association (WMA). It is widely regarded as the cornerstone document of human research ethics , 5. AbidAny procedure or intervention conducted on a patient that is not performed in the accepted routine management of that disorder, or which is unnecessary and/or potentially harmful.Administration of a drug or medication that is not given in the normal management of a disorder, or which is unnecessary, potentially harmful or its effects are unknown.Obtaining a signed consent in an attempt to justify an unethical procedure or immoral methodology. Exposure of the patient to an invasive clinical procedure or a potentially harmful noninvasive procedure, in the interests of a study.Exposure of the patient to undue radiation, no matter how small the dose, for the purposes of study, analysis, comparison, etc. Attempting a new invasive human clinical procedure without prior successful animal studies and without institutional review board approval.Testing new medications without prior successful animal studies, FDA approval, or well-documented indications for prescription.Harvesting an organ or tissue from one who does not have the capacity to give consent.Attempting paraclinical procedures deemed unnecessary by current documented studies.Use of an inferior procedure when a better procedure is available and has been proven more effective, less invasive or with less complications, etc., for the sake of comparison.To conclude, in the light of the aforementioned issues, students must check to ensure that the methodology of their study does not violate these basic ethical principles. They should also note that in applying and advancing scientific knowledge, medical practices and associated technologies, human weakness must be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals must be respected . All med


Biosimilars that were not compared in clinical trials with the compound innovator are not true biosimilars (biocopies) and are associated with risks that the clinical rheumatologist should be aware of before generalized use. This article comments on various aspects surrounding the use of such biocopies in clinical rheumatology. The introduction of targeted biologic therapies has revolutionized the treatment of immune inflammatory arthritis . The useThe European Medicine Agency (EMA) has already approved the first biosimilar version of infliximab from Celltrion  and Hospira  for rheumatoid arthritis, paving the road for less expensive medications when they finally reach the market in 2015. Also important was the EMA recommendation for approval of the infliximab biosimilar for ankylosing spondylitis, psoriatic arthritis, psoriasis, and, surprisingly, inflammatory bowel disease, in which the pathogenetic role of TNF is still not fully understood -11. WhetIn some countries in Latin America, non-innovator biologics have been approved by using legislation in place for synthetic copies of brand compounds . Therefore, these products cannot be considered biosimilars; rather, they are biocopies, also known as intended copies or non-regulated biologics ,13. The In Brazil, the risk of registration of biocopies is null since the current legislation is similar to the recommendations from the WHO and the EMA. The Brazilian national agency (ANVISA) requests that a complete pre-analytical dossier and a rigorous comparison with the reference product be available. To stimulate the advent of biosimilars, the Ministry of Health is sponsoring an initiative known as Productive Partnership for Development, which will lead to domestic production of biosimilars through a transfer of technology agreement with international companies that are developing production of biosimilars, such as Sandoz , Samsung , Samsung Bioepis , and Epirus Biopharmaceuticals, Inc. . Merck Serono  has recently signed a partnership with a new Brazilian company  to ensure transfer of technology for the production of biosimilars during the next 5 years. The rituximab product from Merck Serono has yet to produce data of comparability in arthritis, a reason for concern since the products available at present are biocopies instead of true biosimilars. Orygen , another biotechnology company, has signed a production partnership with Pfizer Inc.  for technology transfer of adalimumab, infliximab, and rituximab.In Europe, only biosimilars are expected to be approved and the risks of biocopies are avoided. How rheumatologists will deal with the fact that approval of a biosimilar was extended to all indications of Remicade  although Celltrion and Hospira undertook phase 1 and 3 studies in only rheumatoid arthritis and ankylosing spondylitis remains to be seen.The use of biocopies does not lead to the necessary safety that is associated with the prescription of the innovator or a true biosimilar when they become licensed for use in clinical practice. Owing to the absence of rigorous clinical testing, biocopies should not be expected to have almost identical efficacy. Another issue that can generate confusion in clinical practice is the heterogeneity present in various countries in post-marketing surveillance programs by the health agencies when biocopies are exchanged with the innovator in an uncontrolled manner. In addition, nomenclature terminology regarding the use of the innovator versus biocopies is still an open issue ,7. The lFinally, the gradual acceptance of the first true biosimilar by rheumatologists will depend on real-life exposure. Norwegian authorities plan to address this issue this year by funding a head-to-head study of Inflectra (Hospira) (a biosimilar) versus Remicade in a bid to convince rheumatologists to prescribe the biosimilar because of its similarities in efficacy and safety and cost savings. The stimulation of switching back and forth by the Norwegian health authorities has yet to be adopted by any other country in Europe, and how this interchangeability approach will develop in the near future remains to be seen .


Local food-production crises, having social, economic or environmental origin, propagate in this network, modifying the virtual water trade and perturbing local and global food availability, quantified in terms of virtual water. We analyze here the possible effects of local crises by developing a new propagation model, parsimonious but grounded on data-based and statistically-verified assumptions, whose effectiveness is proved on the Argentinean crisis in 2008–09. The model serves as the basis to propose indicators of crisis impact and country vulnerability to external food-production crises, which highlight that countries with largest water resources have the highest impact on the international trade, and that not only water-scarce but also wealthy and globalized countries are among the most vulnerable to external crises. The temporal analysis reveals that global average vulnerability has increased over time and that stronger effects of crises are now found in countries with low food (and water) availability.By importing food and agricultural goods, countries cope with the heterogeneous global water distribution and often rely on water resources available abroad. The virtual displacement of the water used to produce such goods (known as  The international trade of agricultural goods causes a virtual displacement of the water used to produce such goods, “embedded” in trade as a factor of production1virtual water trade has relevant environmental and socio-economic implications, the most important one being that water-scarce countries can rely on water resources available abroad. In fact, in semi-arid countries, water scarcity limits the local agricultural production posing a key challenge to food security79Virtual water exchanged between producing and consuming countries defines flows across an international network associated to the commodity trade. This 3 per year and represented about one fifth of the total volume embedded in consumed goods1516In recent years, the international VW trade underwent marked modifications, following the expansion and evolution of commodity trade1112Globalization of commodity trade contributes to improve food availability and to sustain population by reducing the dependence on local resources202125262832A different approach to the analysis of trade dynamics, with specific reference to its effects on water endowments, is represented by agro-economic models, such as GTAP-WPursuing a different approach, we propose here an analysis of the effects of local food-production crises at the annual scale, which bases on a simple and novel mechanistic model. Building on data-based rules, statistically verified assumptions and very few parameters, the model mimics the propagation of crises taking advantage of the observed network structure and VW flows. The model is then tested on a real case to confirm the correctness of the propagation mechanism, and it is then applied to the assessment of countries’ impact and vulnerability to local crises.c, at any year, A national annual virtual water balance, following from a food balance expressed in terms of virtual water equivalent, can be stated for each country, c, respectively; water footprint of production), and internal availability of agricultural goods which includes food consumption, stock variation and other minor terms, such as waste. A decrease of where β, of the initial water footprint of production. The VW loss induced by the crisis is partitioned into a reduction of internal availability and a reduction of export, according to the relative weight of the two terms in the country VW balance (1). The country-specific export weight, a, identifies the so-called export propensity of the country.A crisis is identified by a marked decrease of agricultural production, expressed in terms of equivalent virtual water volume. This reduction can be triggered by environmental, social or economic events such as droughts, floods, pests, conflicts or economic crises, disregarding the few cases in which the decrease in agricultural production is counterpoised by an increased use of water resources. When a country undergoes a local crisis, the VW embedded in its agricultural production is decreased by a fraction, et al.The reduction of export propagates to all direct trading partners proportionally to the initial VW flows towards each of them, and all trading partners find themselves with a reduced volume of VW in the balance. The rule of proportional propagation is strongly supported by data, as detailed in the Method section. The reduced volume is again partitioned between internal availability and export in each country and propagated towards their trading partners. Calculations proceed iteratively until a prescribed level of accuracy is reached. At the end of the simulation, the reduction in production occurred in the first country reflects into modified VW flows in the trade network and reductions of virtual water availability worldwide, with a geographic distribution that depends on the network structure (topology and node-to-node trade). The proposed propagation model is similar to the one developed by Lee The model bases on assumptions that are statistically validated on real data of VW embedded in food production and trade (see the Method section): in particular, we found that (i) a decrease of agricultural production in a country is associated to a decrease of export in the same country, (ii) a decrease of import is associated to a decrease of export, and (iii) a decrease of production does not generally imply an increase of import. There is no clear evidence, from our dataset, of compensatory mechanisms by which countries suffering a reduction of VW import from one partner increase the VW import from elsewhere (new or existing links), nor that occasional compensation is related to country wealth. The use of global rules and local coefficients represents a compromise which, although not considering some specific policies , allows one to mimic the core dynamics of crisis propagation. The use of annual data does not enable the investigation of sub-annual consequences of food-production crisis, but the propagation model could be adapted to different time scales if suitable data were available.In 2008–09 Argentina underwent a crisis which markedly affected its economy and agricultural production. Triggered by the international financial crisis and by the local political economy . Marked impacts are also suffered by South Africa, India, Malaysia, France and Chile, with a real and modeled decrease of 1–2 km3, again corresponding to 30–50% of initial VW fluxes. Also countries with intermediate and negligible variations of VW trade show a good matching with the model results. The marked decrease of import observed in Morocco and Algeria is likely due to the initial phase of the Arab Spring rather than to the Argentinean crisisThe model results compare very well with data. Most impacted countries are correctly identified by the model and are Brazil, China and Spain, where the VW fluxes have decreased by more than 2 kmHaving shown the capability of the proposed model to mimic real dynamics, we use it to infer the propagation of possible crises hitting four different countries: USA, Italy, Japan and South Africa. Crises are quantified by a decrease of 30% of the water footprint of agricultural production in 2011, 3 of VW); the same also occurs to possible crises hitting some large exporting countries, such as France and Indonesia, as well as minor countries (crises not shown).The most impacted country in these crises is not necessarily the one receiving the largest share of export from the hit country. In fact, the model mimics the cascade dynamics on the network and reproduces the superimposition of disturbances reaching a country directly and indirectly, through different trade connections. This leads, for example, to the case of Japan, whose major trading partner in 2011 was Hong Kong, but the country modeled as having the overall largest reduction of import is China  of the per-capita VW internal availability are highlighted in Marked differences in the results are due to the different hit strengths, in that greater VW losses occur in hit countries with greater agricultural production; however, the spreading of the crisis depends on the (weighted) network of country connections and the characteristics of the hit node. In fact, although Italy and South Africa undergo a similar VW loss, the resulting picture of highly impacted countries (dark grey) is quite different and ranges from most part of Europe in the case of Italy, to only few African countries in the case of South Africa. Also the extension of the crisis propagation is different and affects (with a variation greater than 0.1%) 54 countries with 510 total million people in the case of Italy, and 21 countries with 292 total million people in the case of South Africa.unweighted degree), by the sum of incoming and outgoing VW fluxes (weighted degree), and by the eigenvector centrality, i.e. an influence score dependent on the links and fluxes of connected nodesComparing the four possible crises, the network-based differences among hit nodes should be taken into account. Hit-node characteristics can be described, for example, by the sum of incoming and outgoing links , one can compare the different impacts of countries on the network, as shown in where Px, plays a role, in that VW volumes losses are defined as a fraction of it. To overcome such dependency on the crises entity and to highlight the role of the network, which is otherwise partially masked by the VW export of the hit country, a different indicator is required.A strong correlation emerges between the absolute impact and the VW export fluxes of countries. In fact, large exporters of VW, such as the USA and Brazil have the largest impact on the network, European countries have an intermediate impact, while African and Middle Eastern countries have the smallest one. This correlation confirms the intuitive fact that crises with the largest impact are those hitting countries with larger VW fluxes towards the network. However, also the agricultural production of the hit country, A normalized impact, β and it is invariant with the entity of the crises, thus enabling a more even comparison among different crises and countries.This normalized impact does not depend on the parameter proportional to the existing VW availability of countries. On the contrary, values distant from the unit indicate the tendency of a crisis to generate modifications of VW availability that are more than (or less than) proportional to the existing VW availability of countries. Taking the VW availability as a proxy of the VW embedded in food consumption in a country  and on the country reliance on internal agricultural production. International economic dynamics are not accounted for in our evaluation of country vulnerability whereas the focus lies in the country dependency on food (and VW) supply through the trade network.Country vulnerabilities are shown in In the MENA region, the large vulnerability is justified by the large VW import, a close second to Europe in per-capita termsOther cases of medium-to-large vulnerabilities can be explained by large VW net imports despite the abundant agricultural production (such as Mexico and Turkey), or by low agricultural productions , or a mix of large imports and low internal production . Malaysia is a peculiar case, in that it shows large agricultural production and negative VW net import, suggesting a low vulnerability; however, its intense trading with large VW exporters such as Indonesia, India and Thailand, induces a great exposure to the risk of their failure, which in turn increases the overall vulnerability of the country.Worldwide, low vulnerabilities (green colors) are found (i) in countries having large agricultural productions , which are self-sufficient in terms of virtual water (and food) even when external crises reach the country through trade, and (ii) in countries having low VW imports , which are peripheral in the VW trade network and thus not much “exposed” to external crises propagating in the VW trade network.Quantitative metrics have been introduced to evaluate the impact and vulnerability of countries in the global water system, represented by the ensemble of national VW balances connected through the VW trade networkIn general, two key features emerge from Central European countries have high impact and high vulnerability, due to their intense international trading. Agricultural production does not cover the internal VW demand, and these countries have to rely on foreign water resources, balancing trade openness and globalization with the exposure to external crises. Given that most of Europe is characterized by high agricultural efficiency, favorable climate and availability of freshwater resources, there is a potential for improving such condition. Pursuing an increase of agricultural production in these countries, although challenged by a sustainable land management , would decrease the reliance on VW trade and lead to more affordable levels of vulnerability.MENA countries are known to be markedly dependent on VW imports and, wherever local water resources are lacking, the vulnerability becomes very high . Egypt is one of the most vulnerable countries, due to its dependency of VW imports, but it also has non-negligible impact, thanks to its export of greenhouse and irrigated-agriculture products which, however, pose a marked pressure on its limited freshwater resources. In the case of MENA countries, vulnerability is dictated by water scarcity and can hardly be managed through agricultural policies and planning.A high vulnerability is also found in Japan and South Korea, i.e., in countries dependent on the VW trade despite their water abundance, while at the other edge one finds Argentina, having a marked impact on the VW trade network, and a very low vulnerability although its water resources are not as abundant as for other large producers. The low vulnerability of Argentina is not disproved by the crisis in 2008 which, in fact, was not triggered by a decrease of food imports from other countries see ; rather,Among the countries with the largest impact on the global water system, critical situations emerge where crises are more likely. For example, countries having limited freshwater resources have a higher probability to undergo an environmental crisis or being negatively affected by a drought; among them, those having largest impact include  Argentinequitable crises As a final remark, we analyze the water system globalization through the temporal evolution of world-scale indexes of impact and vulnerability, obtained as population-weighted averages . The traThe world-average vulnerability also shows a clear evolution. It has been rather stable in the first decade of the study period, followed by a marked increase, only minimally affected by the world economical crisis in 2008–09. Driven by countries facing a fast growth, in population and wealth, the increase of vulnerability follows from the intensification of virtual water trade and the increase of global interconnectedness. On a country basis  a decreai traded in year a to country b. Trade data are converted into virtual water flows by multiplying traded quantities by the crop virtual water content, Data of virtual water trade are based on the commodity trade dataset of the Food and Agricultural Organization of the United Nations (Faostat)The considered crop virtual water content is the sum of green and blue water, i.e. rainfall and surface-/groundwater, contributing to crop evapotranspiration and data are provided by the global assessment of the Water Footprint Network45i produced by country a in year mi, in order to avoid for double-counting of water volumes involved in secondary productsAgricultural production data are available from the same Faostat databaseThe Faostat database has also provided the population data for all countries over the period 1986–2011c  and choice of a prescribed year of data, enable the establishment of initial virtual water balances in all countries. The VW internal availability in each country is derived from Equation being x, which can be caused by environmental or socio-economic events. The decrease of production is expressed as a fraction, β, of the initial production value and readsThe network perturbation is represented by a local crisis inducing a decrease of the VW used for agricultural production in country τ is an iterative index and β may vary from 0, identifying an absence of perturbation, to 1, identifying an interruption of the country agricultural production (see the following assessments).where x, expressed in VW volume, will affect partly the national availability and partly the country exports. The partition between the two terms is chosen to be proportional to the relative weight of availability and export in the country, and the modified terms of the country VW balance readThe decreased production of agricultural commodities in country export propensity of each country and tunes the impact of the perturbation Where x proportionally to the existing flows towards each of these countries. Following Eq. x to all partners, k, thus becomesThe reduction of export Eq.  is propax but due to a reduced import rather than a reduced production. The disturbance affecting each importing country is thenAll trading partners will find themselves with a reduced volume of VW in the balance, similarly to country x. The recursive expression of the VW balance terms for country c at the n-th iteration which, assuming that production does not change, will have to be partitioned between internal availability and export according to Eqs ε of the previous values, i.e.Iterations are interrupted when results reach a prescribed precision, that is when all terms in the trade matrix change less than a fraction ε is here taken equal to x reflects into a reduction of VW availability in all countries, satisfying the relationwhere with a geographic distribution of reductions that depends on the trade network. The total iteration time P is considered) in all world countries with population greater than 1 million people.The propagation model bases on some assumptions and calibrations which are here supported by specific statistical analyses. These analyses are based on the variations of VW import, p-value equal to The model assumes that a decrease of agricultural production in a country induces a decrease of export in the same country. Such hypothesis has been verified with a sign test considering the sample of p-value equal to Similarly, the model assumes that a decrease of import in a country is related, to different extents, to a decrease of export in the same country. The sign test is thus applied to the sample of p-value equal to 0.84. This supports the model assumption that a decrease of production is not generally associated to an increase of import.Implicitly, the model assumes that a decrease of production induces a decrease of export, rather than an increase of import. A sign test is then applied to the sample of β parameter represents the entity of a crisis and equals the percentage variation of the VW in agricultural production of the hit country. An empirical distribution function is built for the negative percentage variations of the VW production recorded in all countries and all years from 1961 to 2011 (time span of production data) to guarantee a better definition of the curve tail  and of VW import  determine a decrease of VW volume in the balance of the country Eq. . This deisis Eqs ,10), i.eα values. Points are depicted with different grey levels according to the population of countries they refer to, to differentiate between large and small countries.Points are rather scattered due to the variety of country conditions and behaviors. The 1:1 line represents the model assumption that the partition of crises within countries depends on their export propensity Eqs ,10). AltIt may also be noticed that several cases exist in which countries increase their exports despite a reduction of summed internal availability and export . In such cases, losses are compensated by the reduction of VW availability and likely by stocks alone, which are mainly devoted to compensate for variable/uncertain food availability.3 from one year to the following, provided that such decrease represented at least 10% of the initial export. This identified 20 cases in 26 years. In each case, initial fluxes towards the trading partners were normalized by the total VW export and the variations of flux were normalized with respect to the total variation of export. These values are then plotted in 3) identifies 226 cases; the model fitting is still very good The model assumes that VW export variations of a country are propagated towards trading partners proportionally to the virtual water flows exchanged before the crisis. This has been assessed on a sample of cases identified by a decrease of country VW export larger than 10 kmThe propagation of an export decrease among trade partners has been investigated using also other variables than the initial VW export flux. Both direct and inverse relationships have been sought with destination-country per-capita GDP, total GDP and population; however, none of these variables explained globally or locally more than 10% of the variance of flux variations N countries, obtaining a matrix of resulting internal availability in country c, x. Notice the addition of the apex x to identify the country hit by the crisis.The proposed propagation model allows one to distribute an initial local perturbation to the whole network accounting for the network topology and virtual water flows. The procedure can be repeated applying the same initial perturbation to each of the x can be expressed through Eq. Some indicators are then useful to investigate the effects of local crises in the virtual water trade network. The absolute impact of a perturbation occurring in country igin Eq. . Such noc by the perturbations triggered in all other countries, , in a given year, areN, that are active in the considered year.where How to cite this article: Tamea, S. et al. Global effects of local food-production crises: a virtual water perspective. Sci. Rep.6, 18803; doi: 10.1038/srep18803 (2016).


Floods are a devastating kind of natural disaster. About half of the population in China lives in rural areas. Therefore, it is necessary to assess the flood disaster risk of rural housings. The results are valuable for guiding the rescue and relief goods layout. In this study, we take the severe flood disaster that happened at Kouqian Town in Jilin, China in 2010 as an example to build an risk assessment system for flood disaster on rural housings. Based on the theory of natural disaster risk formation and “3S” technology , taking the rural housing as the bearing body, we assess the flood disaster risk from three aspects: hazard, exposure and vulnerability. The hazard presented as the flood submerging range and depth. The exposure presented as the values of the housing and the property in it. The vulnerability presented as the relationship between the losses caused by flood and flood depth. We validate the model by the field survey after the flood disaster. The risk assessment results highly coincide with the field survey losses. This model can be used to assess the risk of other flood events in this area. China is a developing country with a large population. About half of the population lives in rural areas. Previous studies have mainly focused on the influences of flood disasters on cities and agriculture, and there are seldom studies on the impacts of flood disasters on rural houses, which are much more vulnerable to disasters because of the weak building structure, and lack of sufficient attention in disaster prevention and mitigation. Therefore, it is very necessary to assess the flood disaster risk of rural housing.There is no doubt that global climate change has increased the frequency of extreme precipitation events and may cause many more floods. This brings great human life and property losses by flooding fields, washing away housings, infectious diseases, et al. who assessed the waterlogging disaster risk of the Jing’an District in Shanghai by creating a GIS raster-based urban water-logging model to simulate the water depth and inundation areas, using vulnerability curves to evaluate the possible losses [et al. took downtown Ha-Erbin (Daoli District) as an example to study the trip difficulty for urban residents in various depths of water after urban rainstorm waterlogging, and scenario simulation was used to build the waterlogging model [et al., and Liu et al. analyzed the flood pressure and the flood resistance of rural housing under different flood hydraulic and wave conditions by physics experiments and models, and a flood resistance capacity evaluation system of rural housing was developed based on this research [According to the statistics, the flood disaster that happened in Jilin Province in 2010 caused a total of 118,000 houses to collapse and damaged 301,000 houses, among which rural housing accounted for 75% or even over 95% in some areas, Kouqian Town suffered an even larger flood with a return period of 1,600 years. As mentioned, flood disaster risk assessment studies are mainly focused on the cities, such as Yin ng model . Yin et The definition of risk varies with the applications for which they are used and it can be seen graphically as a function of these three elements, hazard, exposure and vulnerability as illustrated in the risk triangle proposed by Crichton ,9. In th2. There are seven communities and fifteen administrative villages in Kouqian Town, and the total population is 37,621 households. Kouqian Town is located in the transition zone of the Songnen plain to the Changbai Mountain, and the Wuli River and Sijian River join together in the north of Kouqian Town. The town is located in the northeast monsoon region, with hot, rainy summers and cold, dry winters. Precipitation is concentrated in summer. More than 10 serious flood events have happened in this area since 1950, such as in the years 1951, 1953, 1986 and 2010. They caused many houses to be washed away, casualties, and property losses.Kouqian Town is located in the northeastern of Yongji city of Jilin Province , with anRemote sensing image interpretation is the process of obtaining target object information from remote sensing images. There are many methods of remote sensing interpretation used to identify flood range. This study based on the characteristics of the study area and the parameters characteristic of the remote sensing image, choosing normalized differential water index (NDWI) , the comGrid GIS method is the inheritance and development of grid map taking the information grid as the basic study unit, which is different with traditional administrative boundaries basis data collection and editing. In this study, the methods of spatial interpolation, remote sensing retrieval and multivariate analysis were used to distribute the data into each grid cell.The fieldwork activities consisted of three major processes: indoor preparation, interviews with households and data processing. During indoor preparation, relevant data and information about the study area were collected to develop a detailed plan. In the second stage, GPS was used to locate each sampling point, and data was obtained by actual measurement and questionnaire. In the final data processing stage, fieldwork data was classified to establish the database.The remote sensing image data was obtained from the Chinese Resources Satellite Application Center and Google Earth, the sensing image taken by CCD sensor on Environmental disaster mitigation satellite. Terrain data was gained from 1:10,000 scale topographic maps made by the National Mapping Office. Meteorological data was gained from the Meteorological Data Sharing Service of China. The number of households in each community was obtained from the government of Kouqian Town. The flood disaster housing losses were determined using field surveys.This research extracted the flood submerged area and flood depth by using the remote sensing images of the flood and DEM data. Based on the conceptual framework of housing exposure the assessment model for the value of housing structure and indoor property was built, and the property distributed in grids by using grid GIS technology. The flood depth and losses regression models were built for housing structures and indoor property based on the fieldwork data. Finally, we got the flood disaster losses fast assessment model. The flow chart is seen in The division of the grid includes the definition of grid size and determination of the shape. Determine the grid size must guarantee the accuracy and efficiency of flood depth calculation, and take into account the size and spatial distribution of disaster bearing body. The determination of grid shape is mainly according to the spatial pattern of the disaster bearing body. The bearing body of this study is mainly housing, so the shape of the grid is rectangular. The grid size was defined as 80 m by analyzing the high-resolution remote sensing images of Kouqian Town and measuring the size of houses in Kouqian Town.Rectangular grids were generated by using the HawthsTools of arcGIS software, and the length of grid edge is 80 m. Adjusting the auto-generated grid cells by comparing the high-resolution remote sensing image to make sure one house will not be divided into different grid cells, and combining the small cells at the edge. Finally, we got the grid cells of Kouqian Town .The hazard of flood disaster means the intensity and frequency of flood threatened areas be affected by the flood. It is common to use submerged area, flood depth, duration and frequency to portray this. Flood submerged area and flood depth are the key factors that affect flood disaster risk and residential losses. In this study, flood submerged area and flood depth were selected as the assessment factors of hazard of flood disaster. Flood submerged area was identified from remote sensing images by using NDWI and density segmentation methods. Flood depth was calculated by using the Voronoi Map and Grid GIS methods.The main feature type in the study area includes the water body , vegetation and residential areas. Using the 4, 3, 2 band of environmental disaster reduction satellite CCD data to make standard false color composite, the interpretation keys was established through field investigation using GPS to locate the typical objects of the study area combined with the corresponding points of the image features for visual interpretation . Flood wBecause vegetation has a unique reflection peak in the near infrared, vegetation had been extracted from remote sensing images by band 2 and 4 of satellite CCD data using the NDWI method based on ENVI software and contrast standard false-color image to set the threshold value . The claFlood depth could presented as water surface elevation minus land surface elevation. Water surface elevation could be extracted by spatial interpolation of flood boundary elevation. In this study, the flood boundary elevations were extracted by using the Mask tools of ArcGIS software and abnormal flood boundary elevation values should be excluded, using neighborhood statistical analysis of ArcGIS software, 90 m radius of the window and the mean function were chosen to smooth the elevation value of the submerged border. Voronoi Map is one of the boundary interpolation methods, it assumes that the spatial properties change occurs on the boundary, and the boundary within the value is determined by the nearest boundary value. Because this assumption is consistent with the actual situation, the Voronoi Map method is used to obtain the flood water surface elevation in this study. The elevation raster of flood submerged border was transferred into vector points using spatial analysis of ARCGIS software, and Thiessen polygons were generated by re-used statistical analysis module of ARCGIS software in order to obtain the flood water surface elevation .DEM with a resolution of 5 m was generated by digitalized the topographical features elements such as contour lines and elevation points in 1:10,000 topographic map made by the State Bureau. Flood depth of each grids were calculated by water surface elevation subtracted the land surface elevation in each grid cell using ArcGIS software .From Exposure is often used to describe all persons and property that would be subjected to the threat of floods, such as personnel, buildings, crops and lifelines . In thisThere are mainly two types of residential housing and they are buildings and bungalows. Residential buildings and cottage housing can be roughly identified based on external morphological differences on Google Earth: the building body is wider and its shadow is longer, the spacing between buildings is also larger compared with bungalow. Field survey had been used to verify the classification results, and public buildings, such as schools, hospitals, administrative offices were verified during the fieldwork .Residential property value (RP) in each grid cell is determined by the value of the external structure and internal value (IV) of the property according to the conceptual framework for assessing residential exposure. The value of external structure is calculated by the following function:ij is the value of external housing value in grid cell , HAij is the housing area in grid cell , and PVij is the external housing value in per unit area. The internal property value is obtained by field investigation. Residential property value of each grid in Kouqian Town had been distributed by ArcGIS software  PD is the potential losses, PVbs is the property value of external structural, VVbs is the loss rate; PVbc is the property value of internal property, VVbc is the loss rate of it. By using the above formula, the potential flood losses in each grid cell was calculated This study used remote sensing images, DEM data and GIS technology to extract flood submerged area and depth. The results coincide with the real fieldwork results. This method could replace fieldwork, so as to save human, physical and financial resources.(2)For housing structures, buildings (multi-story) will not be destroyed under 4.5 m flood depth with a bit of losses; bungalows will not be destroyed under 1 m flood depth. The bungalows will be totally submerged if the flood depth is higher than 3 m and cause collapses. The higher the flood depth is, the larger the losses of housing structure are. When the flood depth is the same, the older the house is the larger the losses of the house are.(3)For indoor properties, when the flood depth is higher than 2 m, all the indoor property will be destroyed. There also has a positive relationship between flood depth and indoor property losses.(4)Based on the assessment of hazard, exposure and vulnerability of flood disaster, this study built s flood disaster losses fast assessment model. In different areas the disaster losses may be caused by different reasons, some may caused by large flood depth, some may caused by high housing values. The assessment result could be used in disaster management and emergence rescue.As soon as a flood disaster happened, this assessment method can be used to assess the flood disaster losses from remote sensing images to get the flood submerged area and flood depth, then the depth-loss rate curves can be used to calculate the flood losses. It is rapid and can save human financial and material resources. In addition, from the perspective of other impact characteristics, flow rate and duration also impact the loss rate of housing; from a residential structure point of view, building foundation and construction materials also affect the flood loss rate of housing. These factors will be considered in a future study in order to improve the accuracy of the vulnerability curves and potential flood loss evaluation.


Inability to solve complex problems or errors in decision making is often attributed to poor brain processing, and raises the issue of brain augmentation. Investigation of neuronal activity in the cerebral cortex in the sleep-wake cycle offers insights into the mechanisms underlying the reduction in mental abilities for complex problem solving. Some cortical areas may transit into a sleep state while an organism is still awake. Such local sleep would reduce behavioral ability in the tasks for which the sleeping areas are crucial. The studies of this phenomenon have indicated that local sleep develops in high order cortical areas. This is why complex problem solving is mostly affected by local sleep, and prevention of local sleep might be a potential way of augmentation of brain function. For this approach to brain augmentation not to entail negative consequences for the organism, it is necessary to understand the functional role of sleep. Our studies have given an unexpected answer to this question. It was shown that cortical areas that process signals from extero- and proprioreceptors during wakefulness, switch to the processing of interoceptive information during sleep. It became clear that during sleep all “computational power” of the brain is directed to the restoration of the vital functions of internal organs. These results explain the logic behind the initiation of total and local sleep. Indeed, a mismatch between the current parameters of any visceral system and the genetically determined normal range would provide the feeling of tiredness, or sleep pressure. If an environmental situation allows falling asleep, the organism would transit to a normal total sleep in all cortical areas. However, if it is impossible to go to sleep immediately, partial sleep may develop in some cortical areas in the still behaviorally awake organism. This local sleep may reduce both the “intellectual power” and the restorative function of sleep for visceral organs. The modern industrial style of life and necessity to live in non-natural environments often leads to dramatic errors in human behavior. Usually these errors are included in the general term “human factor” and are attributed to reduced attention, inability to predict consequences of an action in complex conditions and, finally, to reduced brain ability. Thus, the intention to augment the brain function can be considered a challenging goal for Neuroscience.It was noticed that industrial anthropogenic disasters, traffic accidents, and medical errors often occur during the night, suggesting a probable link between sleepiness and reduced quality of brain functioning  played a particular role in these processes  from visual Figure  and somaThe presented observations supported an idea that patterns of the cortical afferentation, rather than the state of vigilance, determine the pattern of cortical activity. All above-mentioned considerations inclined us to conclude that switching to analysis of another flow of incoming information would be able to better explain the phenomenology of transition from wakefulness to sleep. The temporal organization of these incoming signals, specific for the state of sleep, will define the pattern of cortical activity during sleep.Animal physiology offered the answer on this question; that it can be periodic activity of various visceral systems, e.g., gastro-intestinal peristalsis, heart and respiratory activities. We proposed that during sleep the same brain neurons that in wakefulness process exteroceptive information of various modalities switch over to the analysis of interoceptive information coming from visceral systems. Rhythmic activities of different visceral systems define this periodic afferent flow towards the cortical areas, which is reflected in cortical SWS activity. Thus, the central nervous system during sleep might be involved in the process of visceral regulation Pigarev, .According to this proposal, periods of local sleep are not the periods when “tired” brain areas stop processing of exteroceptive information in favor of self-recuperation. During periods of local sleep, normally working brain areas respond to warning messages from the internal organs and switch to the processing of the alarming visceral afferentation. Within the frame of this hypothesis, we should “think differently” about the nature of sleep and local sleep.This suggestion may be too fantastic for the brain paradigm generally accepted at present. This paradigm was established mainly on the basis of data collected for the state of wakefulness. On the other hand, our “fantastic” proposal opened the way for its experimental validation in simple experiments, which could not be conducted without this theoretical background. Below, we offer a short review of the experiments performed to investigate such nontrivial predictions of the visceral hypothesis of sleep.First of all, to check this hypothesis responses of different cortical regions to extero- and interoceptive stimulation during sleep and wakefulness were compared. These experiments were started from the visual cortical areas. Visual areas were selected for these experiments because they were well studied, and it was generally recognized that in behaviorally awake animals neurons of these areas were responding exclusively to visual stimulation. In addition, one of us (Ivan N. Pigarev) had considerable experience in investigation of various visual areas in behaviorally awake animals. Later, similar experiments were conducted with neurons not only in occipital, but also in frontal and parietal cortical areas.panel A) and somatosensory area 5 (panel B) of cats to electrical intraperitoneal stimulation delivered in SWS and in wakefulness. These neurons in the state of wakefulness responded to visual and somatosensory stimuli respectively. During SWS both neurons responded to electrical stimulation of the area of the small intestine, and these apparent responses immediately disappeared in REM sleep and after awakening.In Figure Similar experiments were conducted with monkeys, where evoked responses to intraperitoneal electrical stimulation were recorded above the cortical visual area V1 , prof. V. A. Bagaev and I. I. Busigina. Recording electrodes were implanted in the walls of the small intestine and stomach of cats, together with stomach fistula. With this approach, in addition to cortical neuronal activity, EEG, and ocular movements we could record myoelectrical activity of small intestine and stomach, and to change intragastric contents.In Figure More impressive were results of those experiments where we have studied interaction of the neuronal activity in various cortical visual areas and myoelectrical activity from the wall of the duodenum  performed in the period of SWS lead to changes in the EEG pattern and temporal reorganization of the background neuronal spiking, revealed by Fano factor analysis , retinal synaptic terminals form only one third of all synaptic terminals. Another third of terminals belong to backward cortico-thalamic projections. The remaining one third of terminals is of non-visual origin, and come from the pontine and the brain stem regions  sleep pressure. For humans this might happen during work at the time of the maximal sleepiness. For rats, local sleep can accompany experiments during the light phase of the day, if the rats are caged in animal houses with non-inverted conditions of illumination.People with habitual or forced short length of night sleep are at permanent risk of partial sleep development. For some professions partial sleep provoked by such chronic sleep deprivation may not cause any troubles. However, for professions connected with responsible and complex decision making, especially during night shifts, the dangerous consequences of local sleep are very high. For these professions, any visceral disorders, especially in the gastro-intestinal system, may dramatically increase the risk of wrong decisions.Besides the negative effects of partial sleep for mental ability due to the disengagement of some cortical areas from the intellectual work, one should also not neglect the possible negative consequences of this phenomenon for the visceral health of an organism. As participation of all cortical areas in information processing is essential for the efficient solution of complex problems in wakefulness, for efficient management of visceral systems, all cortical areas should be involved into the processing of visceral information. Appearance of local sleep during wakefulness means that the length of total sleep during the nighttime was not sufficient, and may indicate hidden problems in some visceral systems.The detailed investigation of brain involvement in the regulation of the various visceral systems during sleep is a goal for further studies. At present, following the visceral theory of sleep, we can state that efficient and sufficient sleep, together with visceral health, might be the cheapest, safest and most pleasant way to augment brain function.Both co-authors have equal contribution to all steps of preparation of this article and both approved the version to be published.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Under-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected.The aims of this study were threefold: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors’ level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror.M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4–5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors’ level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed.Three hundred and twenty five survivors (Most participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services.In accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care. On 22 July 2011, Norway experienced two consecutive terrorist attacks against the government, the civilian population, and an island summer camp hosting members from the governing Labour Party's youth organization. In the first attack, a car bomb was detonated outside the executive government quarter in Oslo, the capital of Norway. The second attack occurred less than 2 hours later at a summer camp on the island of Utøya, with 564 participants. The perpetrator shot, killed, and wounded those he came across. When he was apprehended by the police, 68 had been killed, and one died later in the hospital. Many more were injured, and 56 were hospitalized  was asked by the Secretary of Health to develop a national outreach strategy. On 28 July, the recommendations developed by NKVTS were approved as the governmental strategy and implemented in the affected municipalities. The outreach program was based on three main principles: proactivity in early outreach, continuity in responses, and targeted interventions for individuals in need. The main features of the program were as follows: The crisis teams in the municipalities were queried to establish early contact with the survivors and their families. A designated individual in the municipality was appointed the role of “contact person” for the survivors and their families for at least the first year. The contact person was responsible for monitoring the survivors’ needs and for providing further contact with relevant primary care and mental health services. To aid the contact person in identifying individuals with clinical needs, a simple screening instrument was developed =0.99, p=.32], gender , or where they lived .In total, 495 survivors were registered by the police after the terrorist attack on the island of Utøya. In this study, four individuals were excluded because of an age below 13 years, and one individual was living abroad and could not be reached for an interview. Thus, postal invitations were sent out to 490 survivors. Three survivors opted out by sending a text message to the research team. The remaining 487 were contacted by phone. Of them, 135 declined to participate, whereof 55 provided a reason ; 27 could not be reached by phone. The remaining 325 (66.3%) survivors were interviewed. There were no significant differences between participants and non-responders in age  and reported higher levels of exposure , posttraumatic stress , depression/anxiety , and somatic health problems , compared to survivors reporting no unmet needs of services.At the end of the interview, the survivors were asked to evaluate if they were currently receiving sufficient help and assistance; 13.7%  of the survivors had seen a psychologist or a psychiatrist at least once may indicate that the needs were very high, or that the selection procedure was not very strict. As reported elsewhere  of survivors reported that the help they received following the terror attack was sufficient. However, the 43 survivors with unmet needs reported more distress and other health problems than the majority of survivors and were more often of non-Norwegian origin. Hence, this group seemed to be in a particularly vulnerable situation despite the outreach program provided. Unmeasured factors, such as the quality of services provided, the survivors’ life situations, the lack of progress in treatment, secondary adversities due to the event, and relationship problems, may have affected the level of needs. The interviewers had instructions to follow-up on unmet needs and arrange for assistance. Currently, we have no systematic data on the outcome of these follow-up procedures. However, the intention was that the research interview would also serve as a safety net for the survivors who had various problems that would benefit from treatment. Interviewers have described a variety of follow-up procedures to meet the needs of the survivors. It is our impression that the use of clinical interviewers who were familiar with local resources was a strength for the intervention strategy and for the acceptability of the study by the survivors, the Norwegian Labour Youth organization, the post-terror self-help organization, and the health authorities.The data from the interview study 5 months after the terror attack provided an overall positive evaluation of the intervention strategy for those who participated. However, we must not forget that we do not have information on the 34% of the survivors who did not participate in the study, and that an important minority of those who did participate was not reached as planned: Some individuals with a heavy burden of symptoms were not offered treatment, some survivors felt that therapy was not useful to them, and 14% reported unmet needs. We know from other studies that perceived social support tends to decrease with time, and as time goes by, it may not be as easy to mobilize municipalities and specialized services. We may also speculate that the early phases of therapy may be associated with hope and expectations for change and relief. Later measurements may be more characterized by disappointment and resignation for individuals who do not experience the expected changes.This study adds significantly to the limited knowledge of early outreach programs by systematically describing the national response program implemented in Norway after the 22nd of July terrorist attack; it describes how the strategy worked on certain key areas. The strengths of this study included the relatively high response rate and the very low levels of missing data. Furthermore, the interviewers were trained professionals, the interviews were performed face-to-face, and the interviewers were provided supervision from the research team throughout the data collection. Survivors in need of professional help were given advice and help in contacting health and social services.Despite these strengths, our findings must be considered in light of several limitations. The results presented here were correlational; thus, the study was not able to provide conclusions of causality. Also, health services may have been provided to participants for several reasons, not only trauma specific health problems. The experiences of this specific population may provide useful information on the implementation of proactive outreach in countries with similar health care systems, but may not be comparable to the situation in countries with other levels of health services.It is important to underline that the evaluation of implementation of the outreach program in this paper is based on the experiences reported by those who chose to participate in the study. We do not know what kind of help those who did not participate received or missed. Finally, this study did not measure treatment efficacy or the quality of services provided.In sum, in accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach, and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned.The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care.