Fluorosis in IndiaFluoride is a vital compound for the growth and development of the human body. Not only does it promote the strengthening of tooth enamel, helping to protect teeth from cavities, but it is also thought to aid in the development of the bones. However, when consumed in any more than minute quantities, the same compound can lead to a myriad of health issues ranging from the browning of the teeth to severe developmental issues leading to the deformation of the skeleton. Fluorosis in India is an issue raising concerns for the health of the country’s people.

India’s Water Supply

These health problems are among those faced by people who rely on India’s heavily fluoridated groundwater, or roughly 80% of the nation’s 1.35 billion people. Water is often sourced directly from the ground by wells, hand pumps or water plants with little to no filtration, leaving dangerous levels of naturally occurring fluoride to be consumed. In fact, fluoride levels have been recorded as high as 15 parts per million, far above the World Health Organization’s maximum recommendation of 1.5 parts per million.

Fluorosis and Other Health Problems

Today, skeletal fluorosis, or the build-up of fluoride in the bones, remains the leading side effect of excessive fluoride consumption and can occur in concentrations as small as 1 part per million. Effects of the disease range from joint pain and stiffness, to the calcification of the ligaments and permanent skeletal deformation. Of India’s 32 states, 17 have been identified as areas of endemic fluorosis, leaving 25 million people impacted and 66 million at risk.

Fluorosis in India is most concerning in children, as excess fluoride can have permanent harmful effects on developing bones, leaving some children bedridden and unable to walk. Additionally, local doctors are often unaware of the disease and do not have the means to treat it, leaving families to spend hundreds of dollars on ‘witch doctors’ offering magical cures.

Organizational Efforts

In response to the prevalence of fluorosis in India, rural villages and urban areas have been the subject of a variety of efforts by local governments and humanitarian organizations alike to purify groundwater and treat those affected.

Since the 1990s, UNICEF, alongside the Satya Sai Organization, has been working to implement defluoridation into the regular process of water collection. The organizations donated a total of 24,000 self-sustaining defluoridation units to five provinces across India and implemented rainwater collection systems in 50 schools throughout the country, providing students with safe drinking water. Likewise, defluoridation units were delivered directly to households, giving families easy access to safe water.

SARITA’s Efforts for Defluoridation

Similarly, the Society Affiliated to Research and Improvement of Tribal Areas (SARITA), has been working since 2005 to provide households with effective defluoridation units in some of the most rural and underserved areas of the country. Alongside community activities to raise awareness about the often unheard of condition, SARITA provided defluoridation filters at little to no cost to villages across 12 states.

The organization was unique in its outreach methods as it deliberately sought to serve the most ostracized members of society, such as the ‘untouchables’ or the lowest and most collectively shamed demographic in India’s social caste system. As SARITA puts it, it is “unusual for government programs to start assistance in isolated hamlets”, meaning the wellbeing of this demographic is rarely of concern in government assistance efforts.

Fluoride Mitigation Support Centre

Doctors and health centers across the nation are also making efforts towards the treatment and cure of fluorosis in India. Although a cure has yet to become widely available, the Fluoride Mitigation Support Centre worked with a group of 20 children in 2013 in an attempt to reverse advanced skeletal fluorosis through calcium, Vitamin C and Vitamin D supplements. Over the course of a year, “dramatic changes were observed in the children”, with one previously bedridden child able to walk again.

The positive effects of widely available defluoridation and fluorosis treatment are quite evident. Increased government support for these existing efforts is needed to put an end to fluorosis in India.

– Jane Dangel
Photo: Flickr

Water Crisis in South Sudan
South Sudan, the world’s youngest country, has faced adversity and troubled times since its founding. Its separation from Sudan was accompanied by significant conflict, beginning with the advent of civil war in December 2013. The widespread conflict led to many humanitarian crises and the country did not see peace until a cease-fire was issued in August of 2018. Five years later, the effects of this conflict persist and can be seen in the nation’s water crisis. Here are six facts about the water crisis in South Sudan.

6 Facts About the Water Crisis in South Sudan

  1. Only 41 percent of people in South Sudan had access to clean drinking water in 2019. In urban areas, residents often live too far from water sources to walk and are forced to rely on deliveries, driving up the cost of water. This forces many lower-income families to go without. Outside the metropolitan areas, water wells are not reliable either. During the conflict, armed groups destroyed the wells of many communities, hoping to defeat them. Now that the fighting is over, these wells remain destroyed, and even if they are within walking distance, people may not have access.
  2. Having to travel long distances to obtain clean drinking water also creates health and safety concerns for women and children in South Sudan. Walking long distances every day to access water increases the risk of severe dehydration as well as violence and kidnappings.
  3. The conflict has also displaced more than two million people, driving them into other countries or away from their available water sources. People settled in rural areas are heading to the cities, putting further pressure on already strained water sources and worsening the water crisis in South Sudan.
  4. According to data from 2016, one in three people use contaminated water daily. This water may come from the Nile or from swamp areas, both of which present immense risks of bacterial infections. When the choices are either to be thirsty or drink dirty water, people have to choose the water. As a result of the contaminated water, there were 20,000 reported cases of cholera in South Sudan between June 2016 and the start of 2018.
  5. Most water in South Sudan is not put towards domestic use. 97 percent goes to the agricultural industry, and in these strenuous times, a lack of water presents challenges for their main industry. 80 percent of the South Sudanese support themselves through farming, and without enough water to grow crops, their nutrition and economy suffer.
  6. A total of 871 million dollars has been given to South Sudan so far, but this only meets half of the goal to solve the crisis. Still, significant work is being done by humanitarian organizations, including Oxfam, which is working on the ground to improve access to clean drinking water. Its goal is to make long-lasting, sustainable changes to how water is accessed in order to end the water crisis in South Sudan.

While there is still progress to be made, there have been decreases in the percentage of people without drinkable water, especially in urban areas. Moving forward, as clean water reaches more remote areas, water accessibility in South Sudan will become more stable, greatly improving livelihoods.

Anna Sarah Langlois
Photo: Flickr

Water resources in GabonWater quality in Gabon is abundant, but unevenly distributed and strained by high rates of urbanization. Gabon has one of the highest levels of water availability in the world, at 127,825 cubic meters per capita, per year.

Eighty-seven percent of Gabon’s 1.8 million people live in urban areas, such as Libreville and Port-Gentil. As the urban population increases, so does the demand for a fixed water supply. Gabon’s low capacity for drinking water production and lack of storage and maintenance facilities leads to frequent water shortages in Libreville and other urban areas.

Water quality in Gabon is different in urban and rural areas. In 2015, 92 percent of urban areas and 59 percent of rural areas had access to improved water resources. ‘Improved’ drinking sources include piped water on property and other improved sources of drinking water, according to the World Health Organization.

Despite its status as an upper middle-income country, 34 percent of the population lives in poverty. Rural, poverty stricken areas suffer deprivation from drinking water resources in Gabon, and 58 percent of the population does not have access to improved sanitation facilities. In 2015, sanitation rates in urban and rural areas were 43 and 32 percent, respectively.

Access to sanitation facilities is very low in Gabon. Inadequate wastewater and rainwater networks and deficient solid waste management explain the disparity.

Inadequate sewage and waste management led to negative health outcomes. Insufficient sanitation and lack of access to improved water sources are associated with the increased risk of neglected tropical diseases (NTDs), a class of infectious bacterial and parasitic diseases. In Gabon, a large proportion of the population is at risk of infection from soil-transmitted helminthiasis, lymphatic filariasis and schistosomiasis.

The infrastructure for drinking water and sanitation were identified as priority areas for reform in the Gabonese government’s 2016–2020 Country Strategy Paper. Long-term success for water and waste management requires understanding how wealth distribution and social gradients affect water quality in Gabon. The CSP addresses social and infrastructural issues and broadened the scope of the development plan. It plans to build a sustainable water and sanitation infrastructure.

Gabrielle Doran

Photo: Flickr

Drinking Water
Despite having the largest freshwater resources in Africa, the Democratic Republic of the Congo (DRC) has long faced significant challenges in maintaining and furnishing potable drinking water to its citizens. More than 50 million Congolese face the daily trial of acquiring clean water, due to issues ranging from inadequate infrastructure to poor sanitation.

According to a 2015 UNICEF and World Health Organization study, almost 700 million people worldwide did not have access to clean drinking water — most of them in sub-Saharan Africa.

Much of this water quality problem falls within the spectrum of sanitation. The DRC’s rate of urban expanse far outstrips its ability to furnish infrastructure that would deliver clean drinking water to those living in developing areas. In more rural communities, however, the opposite is true — water-furnishing infrastructure is almost non-existent, which puts these Congolese at a higher risk of consuming contaminated drinking water.

Many living in these areas use water from local streams and rivers, unaware that the same water source has been contaminated upstream with chemicals, bacteria and parasites. The people of the DRC share the experience of 2.4 billion people worldwide who do not have access to sanitary toilets.

However, many communities have addressed the water quality problem head-on, developing resourceful solutions to provide this necessity. Hand-drilled wells, for instance, are a much cheaper (although laborious) method of accessing fresh water in rural Congolese villages. UNICEF, via its Water, Sanitation and Hygiene program (WASH), has been working tirelessly with the Congolese government to spread these solutions. They aspire to provide clean water to 4 million people by the end of 2017.

Large-scale efforts have positively impacted the water quality in the DRC. The U.N.’s Environment Program (UNEP) helped to complete a community-led catchment management project on the Lukaya River basin in 2016. These projects work with the natural processes of the local ecosystem, providing drinking water to 400,000 people living in the Congolese capital of Kinshasa.

Despite a history of instability and conflict, the people of the DRC have made great strides in improving their water quality. Organizations such as UNICEF and UNEP bring great support to this cause, and if global interest continues, general health and welfare in these areas will drastically improve as well.

Emily Marshall

Photo: Flickr

In 2010, a trip to Cambodia changed the lives of four young girls. As two girls witnessed the health problems caused in Cambodia due to unsanitary drinking water, they both decided to start a mission to help families protect their health. Four Girls for Families began when sisters Rae (11 years old) and Emmy (eight years old) Specht traveled to Cambodia with their family during the winter of 2010.

While in Cambodia, both sisters were introduced to the harsh living standards of the local people. The two sisters decided to make a difference when they discovered that 75 percent of deaths in Cambodia were the results of drinking unsanitary water. Once they arrived in the United States, the Specht sisters began to brainstorm with their friends Clara Walker (10 years old) and Maddie Joinnides (11 years old). Four Girls for Families was born.

With the aid and support of their parents, the four girls began to create homemade jewelry, crafts and T-shirts to raise awareness about unsanitary drinking water in developing countries. The money the girls raised during their sells was used to buy water filters that would be delivered to Cambodians in need.

The water filters used by Four Girls for Families are designed to kill 99.9 percent of bacteria and are given to individual families. In a country where 65 percent of the population does not have access to clean drinking water, water filters play a vital role in protecting the health of families.

Nearly five years later, Four Girls for Families has become a non-profit organization that still continues to provide water filters to rural places in Cambodia. From 2011 to 2014 Rae and Emmy Specht, Clara Walker and Maddie Joinnides have raised nearly $40,000 and supplied 2,000 water filters to families.

This past year, the organization has gained more support in its hometown of Bellport, New York, which has allowed Four Girls for Families to provide 300 water filters to families this past spring. Four Girls for Families relies on fundraisers and profits from their online shop. As the organization gains more acknowledgement and support, all four girls continue to think of ways to provide more water filters to Cambodia.

Erendira Jimenez

Sources: Four Girls for Families, YouTube, Bellport
Photo: Four Girls for Families

FRANK-water-saves-livesjpgKatie Alcott, young social entrepreneur and founder of FRANK Water, started the charity and social enterprise by producing and selling her own brand of bottled spring water and using the profits to afford clean drinking water worldwide.

After being diagnosed with dysentery, Alcott launched FRANK Water, creating it as both a registered charity (No. 1121273) under the name “FRANK Water Projects” and as a social enterprise that donates all its net proceeds to FRANK’s Projects.

FRANK Water has impacted more than 200,000 people in more than 128 communities. The goal is to provide clean, accessible drinking water to the 748 million worldwide who need it the most.

FRANK is working in Uttar Pradesh, Madhya Pradesh, Chhattisgarh Odisha and Andhra Pradesh, various states in India. In 2014, nearly 95 communities totaling to 176,063 people received safe water and sanitation. By 2015, 80 new communities will welcome FRANK, which will serve 17,800 people.

Much of FRANK’s work is teamed with local community-based organizations. Currently, FRANK’s India partners are SAMERTH, CURE India, People Science Instirute, Bala Vikasa, VJNNS and Gram Vikas.

In Chhattisgarh, India, FRANK Water is working with tribal Baiga communities so that they can access clean drinking water in the Kabirdham District. Since Chhattisgarh’s formation as a state in 2000, its local people have been severely exploited for their minerals and forests. They are without basic services, so FRANK Water works with them to develop advocacy methods, plans and roads for change. For two years, FRANK and its local partner SAMERTH have worked with 12,000 people across 36 communities.

In eastern Andhra Pradesh, the remote tribal regions of the eastern Ghats are left without basic water services. This lack of water devastates health, agricultural dependencies and other activities, causing the tribal people to develop at much slower rates. FRANK and one of its partners, VJNNS, are working to establish 10 gravity-fed water systems that will give 10 communities safe water through the earth’s natural gravitational pull. This will serve nearly 3,000 people.

FRANK Water also works in Madhya Pradesh, where fluoride is rampant in its natural water sources. Too much fluoride can lead to yellowing teeth and fluorosis, an incurable disease. FRANK is helping to establish projects to reduce the fluoride concentrations in the Dhar district of Madhya Pradesh, which is currently at 1.0 to 1.5 mg/l. These projects work with the communities to build lasting solutions such as low-tech rainwater harvesting. In three years, FRANK and PSI’s work will have provided safe drinking water to 3,000 people, while also training local communities on how to monitor water quality.

FRANK Water’s Odisha, Telangana and Uttar Pradesh projects similarly combat the issue of inaccessible clean water in rural and slum areas.

Improving access to water and better sanitation are FRANK’s main objectives. FRANK has worked in India for nearly 10 years, securing water access and sanitation with its local partners. The programs focus on its projects, advocacy and research and development, aiming to improve poor water, sanitation and hygiene conditions.

FRANK is frank. The safe water proponent is transparent and self-reflective. While small, it “packs a punch.”

Lin Sabones

Sources: FRANK Water 1, FRANK Water 2, FRANK Water 3, Vimeo
Photo: Trendhunter

Katya Cherukumilli Takes On Poverty in India

Living in poverty often means consuming contaminated drinking water. Assembled by the Blum Center for Global Engagement, Katya Cherukumilli earned recognition in June 2015 at the University of California Irvine’s Designing Solutions for Poverty challenge. She has been addressing and innovating ways to cheaply eradicate fluoride from drinking water by using a remediation solution in groundwater. In doing so, she is helping to protect those without any other source for cleaner water.

Katya Cherukumilli developed a cheap way to use bauxite, a material that produces alumina and aluminum, in order to filter out fluoride in drinking water. She is a PhD student at the University of California, Berkley, set to complete an Environmental Engineering Degree in 2017. Her work with the Gadgil Lab for Energy and Water Research found a cheap solution to the problem concerning fluorosis.

The Gadgil Lab is located at the University of California, Berkley. Its mission is to alleviate poverty using research and engineering studies. Katya Cherukumilli is working specifically with fluoride removal. Having been born near the district of interest, Nalgonda, she feels, according to Alex Chan with Daily Pilot, “This is something that is very close to my heart. Access to clean water does not seem like something people should die for.”

According to Gadgil Lab, drinking excessive levels of fluoride, above 1.5 mg/L, can cause anemia, discolored enamel and bone deformities, also known as skeletal fluorosis. Affected groundwater exists on a global scale in places like Sri Lanka, China, Est African Rift Valley, northern Mexico and Argentina.

With 200 million people drinking toxic water, 66 million in India are at risk. A site is open for examining the water in Telegana, where contamination is the most acute and fixated. Ten percent of this district has been affected and 10,000 are permanently deformed.

Groundwater in the Nalgonda District in India has a toxic amount of fluoride that causes deformities with excess intake. Skeletal fluorosis patients reside here. Granite rocks underground are breaking apart and contaminating drinking water with fluoride.

A toxic level of fluoride in drinking water is a problem that has been known for six decades. When rural areas cannot reach safer alternatives, the problem continues. Responding to this issue takes time and manpower. Areas where innovations are costly, difficult to set up or culturally ineffective make it difficult to introduce defluoridation. Gadgil Lab lists a few requirement guidelines addressing the issues.

Any technology useful to the cause must be local, affordable, and appropriate for the culture. It should require minimal maintenance and must function very successfully in the rural area.

To satisfy these requirements, Cherukumilli has been researching bauxite ore. She found that remediating groundwater fluoride needs to be more cost-effective. Cherukumilli is refining bauxite in order to minimize expenditure per person per year from $50 to $1.

Her method to reduce cost includes improving sustainability, so less material is required. Also less energy and carbon costs are needed to solve the issue.

Forty community leaders, scientists, business partners and investors at the competition agreed her progress in this field of study has absolute potential. It will protect the less fortunate from further disfigurement that affects them socially, economically and medically. Her presentation at the Irvine’s Designing Solutions for Poverty challenge received the popular vote among three others.

– Katie Groe

Sources: GADGIL Lab 1, GADGIL Lab 2, The Orange County Register, The Daily Pilot, GADGIL Lab 3
Photo: Daily Pilot

Receiving only a half-inch of precipitation annually, the 7.6 million residents of Lima, Peru are in the midst of a serious water shortage. One point two million Limans do not have running water at all, and 700,000 people have no access to clean water for drinking or bathing. With advanced climate change affecting the natural water sources of the Andes, engineers from Peru’s University of Engineering and Technology (UTEC) have turned to science, and specifically water billboards, for an answer.

Like a magician pulls a rabbit from a hat, they’ve figured out a way to pull water from thin air.

The process of scientific magic occurs inside a billboard in Lima’s Bujama District, erected by a group of UTEC engineers in partnership with marketers from the Mayo Publicidad ad agency. The billboard takes advantage of Lima’s high degree of humidity, nearly 90 percent in the summer months, and transforms this moisture into usable water.

When moist air hits the billboard, five condensers cool it and convert it into liquid form. The newly created water goes through reverse-osmosis purification and then flows into a 20-liner storage tank at the billboard’s base. The filtration system is simple and straightforward, though not entirely self-sufficient, because it uses electricity from Lima’s power lines.

Active for 3 months, the billboard has had a significant effect. It has produced nearly 2,500 gallons of water, averaging 26 gallons a day. According to the UTEC engineers involved, this is equivalent to the water consumption of hundreds of families per month.

Efforts have been made in the past to magically pull water from the air. Most notably Eole, a French company, installed a wind turbine in Abu Dhabi that was said to generate more than 370 gallons of water a day. The commercial launch of this technology, however, came at too high of a price.

That’s the genius of UTEC’s water billboard – if the technology expands, it will be inexpensive to install thanks to funding from advertisers. The inaugural billboard costs only $1,200 to construct, and advertises both UTEC and the technology itself. UTEC has not gone unrewarded, since the erection of the billboard enrollment has substantially increased. It hopes that companies will see UTEC’s own results and seek to advertise on water billboards themselves.

It is unclear whether more billboards like this one will be installed throughout Lima, but UTEC’s water billboard has successfully started new discussions about providing clean water. Advertising can be more than a commercial tool; it has potential as an effective method of helping those in need.

– Katie Pickle

Sources: Popular Mechanics, Time
Photo: Fast Coexist

people_are_hungryIn 2013, Equatorial Guinea donated $30 million to fight hunger in Africa. Truthfully though, that donation may have been partly inspired by self-interest. Located west of Central Africa itself, the tiny nation is dwarfed in reputation by its northern compatriot Guinea. Below are five other reasons people are hungry in large swaths of its population.

1. Ignorance

Many Americans are culturally illiterate when it comes to Africa as a whole. They do not know how many countries there are, much less the individual distinctions between those countries. When casually asked about the location of the 2010 World Cup, most of them shrug and reply, “Africa.” What follows is a fair amount of “voluntourism,” our second reason.

2. Voluntourism

“An act carried out by … hoards of … the great unwashed backpacker brigade descend on a place to do have a jolly nice holiday—usually at precious little cost to themselves—and do the occasional bit of good work.” The Urban Dictionary definition says it all. Voluntourists seldom go to Africa because they are dedicated to ending the suffering of African women or children. Instead, it’s become a social rite of passage and a booster for résumés and college applications.

Lauren Kascak—a three-time, self-admitted voluntourist herself—asserts, “Voluntourism is ultimately about the fulfillment of the volunteers themselves, not necessarily what they bring to the communities they visit … In Ghana … local people weren’t purchasing health insurance, since they knew there would be free foreign health care and medications available every few months. This left them vulnerable in the intervening times, not to mention when the organization would leave the community.”

3. Misplaced priorities

Closely related to voluntourism, many people who do come to Equatorial Guinea with a helpful mindset end up not helping in ways that have lasting impacts. It is said that if a man is given fish, he will only have food for one day. Many altruists are, sometimes literally, the fish-givers. For this reason, it cannot be stressed enough the importance of diversifying aid beyond handouts and freebies. Otherwise, the very “Others” whom altruists try to help become dependent upon the latter’s aid, eventually stunting economic growth on a grand scale.

4. The Paradox of Plenty

Equatorial Guinea is not a poster child nation of poverty; it struck oil in 1995 and is now perceived as relatively wealthy. However, its people remain stuck in poverty because the government also has misplaced priorities. While it has increased the annual amount spent on public works, less than half of Equatorial Guinea’s population has access to clean drinking water. Its child mortality rate remains near 10 percent. Why? That brings us to point five.

5. Corruption

Ahh, the old C-word is back. The leaders of Equatorial Guinea, since its independence in 1968, have ruled over the small country with a dictatorial, terroristic mindset. Its first leader following independence was Francisco Macias Nguema: a dictator who ordered the deaths of thousands of opponents, including some of his own family members. He remains known as “one of the most kleptocratic, corrupt, and dictatorial leaders in post-colonial African history.” His successor and nephew, Teodoro Mbasogo, may not be much better. Mbasogo may not be connected to a possible Bubi genocide, but Human Rights Watch maintains that he has used the oil boom to carry on the kleptocracy that his predecessor instituted.

– Leah Zazofsky

Sources: BBC,  Urban Dictionary,  The Society Pages,  The Ottawa Citizen
Photo: Human Rights Watch

If you think back to your days as a kindergartner, you may remember the first time you learned the water cycle. Equipped with a blue crayon, you replicated what your teacher described in a simple picture: rain falls, people drink it, the water evaporates and the whole thing repeats. You learned that water is renewable.

But renewable does not mean unlimited, a fact constantly recognized by the 780 million people who lack access to clean drinking water.

Freshwater, the largest source of our drinking water, makes up only 2.5 percent of the planet’s water. Only 1 percent of freshwater is actually available, as most of it is frozen. This leaves 0.007 percent of the Earth’s water left for an ever-growing population that exceeds 7 billion. This is a water crisis.

“Why can’t we use ocean water?” one might ask. The answer is, well, we can.

Desalination, the removal of salt from saltwater, makes the use of ocean water possible. But breaking the strong bonds that salt forms with water molecules requires a lot of energy, and this energy is expensive.

As Peter Gleick, president of the environmental think-tank Pacific Institute, says, “It can cost from just under $1 to well over $2 to produce one cubic meter (264 gallons) of desalted water from the ocean.”

Considering that 99 percent of water-related illnesses occur in developing countries, desalination is simply an unrealistic option for most who suffer from the water crisis.

But what if there were some way to desalinate without such steep energy requirements?

A team of scientists believe they know how to do so.

Martin Bazant and Daosheng Deng of the Massachusetts Institute of Technology (MIT) have developed a process that they believe will more efficiently and effectively desalinate water. They call it “shock electrodialysis.”

Today, the two cheapest methods of desalination are reverse osmosis and electrodialysis.

Reverse osmosis works by pumping water through a membrane that does not allow salts to pass. Although it requires less energy than older methods, it works too slowly.

Building on reverse osmosis, electrodialysis tried the opposite: pumping salts through an electrified membrane until only pure water is left. This process is significantly cheaper than reverse osmosis but is not without shortcomings. It fails to decontaminate water of dirt and bacteria without additional filtration methods.

Bazant and Deng say that shock electrodialysis can produce clean, bacteria-free drinking water in one step. How? They placed an additional filter made of porous glass near the electrified membrane. Based on Bazant and Deng’s observations, dirt particles and bacteria are unable to fit through the tiny pores in the glass material.

If it turns out that this MIT development can be produced at a low cost on a large scale, shock electrodialysis could provide millions of people with access to drinking water.

– Shehrose Mian

Sources: UNICEF, National Geographic, Scientific American, Technology Review
Photo: Technology Review