BACKGROUND: It is generally unknown to what extent organ transplant recipients can be physically challenged. During an expedition to Mount Kilimanjaro, the tolerance for strenuous physical activity and high-altitude of organ transplant recipients after various types of transplantation was compared to non-transplanted controls.METHODS: Twelve organ transplant recipients were selected to participate (2 heart-, 2 lung-, 2 kidney-, 4 liver-, 1 allogeneic stem cell- and 1 small bowel-transplantation). Controls comprised the members of the medical team and accompanying family members (n = 14). During the climb, cardiopulmonary parameters and symptoms of acute mountain sickness were recorded twice daily. Capillary blood analyses were performed three times during the climb and once following return.RESULTS: Eleven of the transplant participants and all controls began the final ascent from 4700 meters and reached over 5000 meters. Eight transplant participants (73%) and thirteen controls (93%) reached the summit (5895m). Cardiopulmonary parameters and altitude sickness scores demonstrated no differences between transplant participants and controls. Signs of hyperventilation were more pronounced in transplant participants and adaptation to high-altitude was less effective, which was related to a decreased renal function. This resulted in reduced metabolic compensation.CONCLUSION: Overall, tolerance to strenuous physical activity and feasibility of a high-altitude expedition in carefully selected organ transplant recipients is comparable to non-transplanted controls.
Designers have grown increasingly interested in social consequences of new technologies. As social impacts become increasingly important it might be fruitful to understand how social impacts develop and how a designer can anticipate these consequences. In health care practices, for instance, it is important to control unintended social impacts at forehand. Social impact is an outcome of the mediating effect of a technology with its social environment. Human behaviour in a social environment can be analysed from the perspective of a social ecological system. To anticipate social impacts simulations of social practices are needed. To simulate practices the persona approach has been adapted to a screenplay approach in which the elements of a social ecology are used to gain a rich description of a social environment. This has been applied for a 'Heart Managers' case. It was concluded that the screenplay approach can be used for a systematic simulation of future social impacts.
In this article, Isaac argues that since 1948, Israel's control of water resources has been the result of military actions that forced between 700,000 and 800,000 Palestinians into exile and claimed the most fertile part of the disputed territory for the state. It thereby paved the way for subsequent military occupation. Isaac maintains that the Israeli occupation has violated the Palestinian right to the equitable and reasonable utilization of shared water resources. In his view, from the end of the 1967 war, Israel initiated its occupation of the territories of Palestine and quickly imposed military order with a view to achieving full control over land and water resources. To Isaac, these military orders served to dissolve the pre-1967 legal systems and which consisted of Ottoman, British, Jordanian (West Bank) and Egyptian (Gaza Strip) laws. This critical review article concentrates on the concept of justice tourism as a response to these assumed Israeli violations of Palestinian rights to equitable and reasonable utilization of shared water resources. The article sheds light on why and how justice tourism conceivably contributes to the Palestine host communities' transformation and hence to the development of higher level self-consciousness about their rights as "a sovereign nation".
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