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Inland distribution is becoming a very important dimension of the globalisation / maritime transportation / freight distribution paradigm. Observed logistics integration and network orientation in the port and maritime industry have redefined the functional role of ports in value chains and have generated new patterns of freight distribution and new approaches to port hierarchy. Existing models on the spatial and functional evolution of ports and port systems only partially fit into the new freight distribution paradigm. This paper aims to add to existing literature by introducing a port regionalization phase in port and port system development. It is demonstrated that the regionalization phase and associated hinterland concepts demand new approaches to port governance and a functional focus that goes beyond the traditional port perimeter.

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Emerging infectious diseases may be contributing to the global decline of amphibian populations. In particular, chytridiomycosis, a cutaneous fungal infection of amphibians caused by the chytrid Batrachochytrium dendrobatidis, gained attention in the 1990s as an apparently new pathogen. This fungus has been implicated as the causative agent of widespread mortalities among wild amphibians in geographically disparate parts of the world. To investigate the global distribution, historical occurrence, and infectiousness of this pathogen, we examined 3371 postmetamorphic and adult amphibians collected between 1895 and 2001 from 25 countries for the presence of chytrid fungi in the epidermis. Cutaneous chytrid infection was diagnosed in 383 of 2931 (13.1%) specimens of 12 common amphibian species from five Canadian provinces and seven American states, including 30 of 69 locations examined in the St. Lawrence River Valley of Québec. Chytrids were observed in 7.0% (46/655) of the adults collected in the 1960s, the earliest cases being two green frogs ( Rana clamitans) collected in 1961 from Saint-Pierre-de-Wakefield, Québec. In recent studies, morbidity and mortality attributable to chytridiomycosis were not observed in infected amphibians from Québec despite a 17.8% (302/1698) prevalence of chytrid infection during the period 1990-2001. The prevalence of infection during this latter period was not statistically different when compared with the period 1960-1969. Epidermal chytrid infections were not observed in 440 amphibians examined from 23 other countries. In light of the fact that infection by B. dendrobatidis is widely distributed and apparently enzootic in seemingly healthy amphibians from eastern North America, lethal outbreaks of chytridiomycosis among amphibian populations appear to have complex causes and may be the result of underlying predisposing factors. Resumen: Las enfermedades infecciosas emergentes pueden estar contribuyendo a la declinación global de poblaciones de anfibios. En particular, la quitridiomicosis, una infección fungosa cutánea en anfibios provocada por el quitridio Batrachochytrium dendrobatidis, atrajo la atención en la década de 1990 como un patógeno aparentemente nuevo. Este hongo ha sido implicado como el agente causal de extensas mortalidades en anfibios silvestres en sitios geográficamente dispares en el mundo. Para investigar la distribución global, la ocurrencia histórica y el nivel infeccioso de este patógeno, examinamos a 3371 anfibios postmetamórficos y adultos, recolectados entre 1895 y 2001 en 25 países, para detectar la presencia de hongos quitridios en la epidermis. Diagnosticamos quitridiomicosis cutánea en 383 de 2931 (13.1%) de especimenes de especies comunes de anfibios de cinco provincias Canadienses y siete estados de E. U. A., incluyendo 30 de 69 1432 Chytrid Infection in Wild Amphibians Ouellet et al. examinadas en el Valle del Río San Lorenzo de Québec. Observamos quitridios en 7.0% (46/655) de los adultos recolectados en la década de 1960, los primeros casos corresp...

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PURPOSE On the eve of major primary health care reforms, we conducted a multilevel survey of primary health care clinics to identify attributes of clinic organization and physician practice that predict accessibility, continuity, and coordination of care as experienced by patients.METHODS Primary health care clinics were selected by stratifi ed random sampling in urban, suburban, rural, and remote locations in Quebec, Canada. Up to 4 family or general physicians were selected in each clinic, and 20 patients seeing each physician used the Primary Care Assessment Tool to report on fi rst-contact accessibility (being able to obtain care promptly for sudden illness), relational continuity (having an ongoing relationship with a physician who knew their particulars), and coordination continuity (having coordination between their physician and specialists). Physicians reported on aspects of their practice, and secretaries and directors reported on organizational features of the clinic. We used hierarchical regression modeling on the subsample of regular patients at the clinic. RESULTSOne hundred clinics participated (61% response rate), for a total of 221 physicians and 2,725 regular patients (87% response and completion rate). Firstcontact accessibility was most problematic. Such accessibility was better in clinics with 10 or fewer physicians, a nurse, telephone access 24 hours a day and 7 days a week, operational agreements to facilitate care with other health care establishments, and evening walk-in services. Operational agreements and evening care also positively affected relational continuity. Physicians who valued continuity and felt attached to the community fostered better relational continuity, whereas an accessibility-oriented style (as indicated by a high proportion of walk-in care and high patient volume) hindered it. Coordination continuity was also associated with more operational agreements and continuous telephone access, and was better when physicians practiced part time in hospitals and performed a larger range of medical procedures in their offi ce. CONCLUSIONSThe way a clinic is organized allows physicians to achieve both accessibility and continuity rather than one or the other. Features that achieve both are offering care in the evenings and access to telephone advice, and having operational agreements with other health care establishments.

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