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Minor Problems (minor + problem)
Selected AbstractsOptimizing in-kind drug donations for Tanzania,a case studyINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 4 2008Gaby Gehler Mariacher Abstract A questionnaire survey (QS) among stakeholders in Tanzania had shown that in-kind drug donations (DDs) are important to boost the drug supply system. Major problems were their insufficient quantity for sustainable treatment and the discrepancy between the needs of the recipients and the donors' supply. Objectives in this study were to discuss these findings and to learn from key informants (KIs) how to improve the DD process. Data were collected through KI interviews in 2001/2002. A 30% gap in drug supply has to be bridged by DDs. KIs confirmed the importance of the World Health Organisation and Tanzanian DD guidelines as a tool for good donation practice and emphasized the role of the government in their implementation. They requested that donors meet the recipient country's regulatory requirements. In contrast to QS respondents, KIs did not view DD quality as a minor problem, and proposed that DD quality should be adapted to the national quality assurance procedures. DD processes could be improved through (a) effective implementation of DD guidelines as an aid for decision-making and for quality assurance, (b) availability of data to improve communication between donors and recipients, (c) transparency between recipients and donors and (d) clearly defined accountability. Copyright © 2007 John Wiley & Sons, Ltd. [source] Teretrius nigrescens against larger grain borer Prostephanus truncatus in African maize stores: biological control at work?JOURNAL OF APPLIED ECOLOGY, Issue 2 2003Niels Holst Summary 1Following the accidental introduction of the bostrichid beetle Prostephanus truncatus into East and West Africa around 1980, a classical biological control campaign was launched in 1991; the histerid beetle Teretrius nigrescens was released as a biocontrol agent to prevent the destructive outbreak of the pest in small-farm maize stores. However, while the campaign has been ongoing, so has discussion in the scientific community about the merits of this campaign and its chances of success. 2From published and unpublished data from experimental maize stores in Benin, West Africa, we derived statistical models describing the in-store insect population dynamics, and were thus able to point out significant biological interactions and to explain the observed lack of biological control. 3We found that (i) T. nigrescens reduced significantly the population growth rate of both P. truncatus and the non-target pest, the weevil Sitophilus zeamais; (ii) T. nigrescens displayed a positive numerical response to both prey species, P. truncatus and S. zeamais; (iii) asymmetric competition existed between the two prey species, S. zeamais was negatively affected by P. truncatus but not vice versa; (iv) T. nigrescens and S. zeamais displayed negative intraspecific density-dependence whereas P. truncatus was resource-limited. 4We conclude that classical biological control with T. nigrescens is not likely to become successful, mainly due to the predator's intraspecific density-dependence and its low population growth rate compared with its prey. We recommend that further research on P. truncatus integrated pest management takes into account the farmer as an active agent managing the store. 5Synthesis and applications. When biocontrol does not result in satisfactory pest control, as in the case of P. truncatus, farmers should learn how to scout for the pest and take action when a need is detected. In areas where the pest is usually only a minor problem, the agricultural extension service should consider setting up a simple early warning system for their region. When attempts at classical biological control remain unsuccessful, as in the case of P. truncatus now for 10 years, policy-makers should prioritize training of extension service and farmers in integrated pest management techniques (e.g. need-based use of insecticides) as a necessary supplement to biocontrol. [source] Exomphalos , a major or minor problem?PEDIATRIC ANESTHESIA, Issue 9 2002T. O'Neill Introduction The mortality and morbidity statistics associated with exomphalos major remain discouraging despite advances in management techniques (1). Congenital lung pathology, in particular pulmonary hypoplasia, and thoracic maldevelopment, have been strongly allied to this condition, accounting for the high incidence of pulmonary insufficiency necessitating prolonged ventilatory support in these infants (2). We discuss the respiratory issues in an infant with a particularly severe form of exomphalos major, and the impact of a comprehensive parental website devoted to the infants' management and progress. Case Report A female infant, born at 38 weeks' gestation, was referred for management of exomphalos major. Due to the extensive nature of the abdominal wall defect, primary surgical closure was impossible and initial management consisted of staged reduction by external compression of the exomphalos. This resulted in escalating cardiovascular and respiratory embarrassment, and was abandoned in favour of conservative treatment, whereby the sac was dressed and allowed to epithelialise. Thereafter the clinical course was characterised by chronic pulmonary insufficiency requiring prolonged ventilatory support. Ventilator dependence did not significantly decrease until lung growth occurred and the sitting position was adopted, enabling weaning from conventional ventilation to genuine BIPAP at 6 months. Currently, after 11 months, we are preparing her for entry into a home ventilation programme. Throughout this period, progress and realistic goals were discussed at multidisciplinary case conferences involving the parents. The interpreted medical management has subsequently been displayed by the parents on an elaborate, up-to-date website, which is part of a larger ,Mother Of Omphalocele' network. Although innovative, this highlights the fact that we the medical profession, should be vigilant with regard to potential public exposure of patient management. Whilst the Internet has become an integral part of our own continuing education, this case highlights a new aspect of how it may be used by our patients and their relatives to compare and contrast management policies in various institutions. [source] Hermit crabs, humans and Mozambique mangrovesAFRICAN JOURNAL OF ECOLOGY, Issue 3 2001David K. A. Barnes Abstract There is a complex interrelationship between upper shore hermit crabs (such as Coenobita sp. and Clibanarius sp.), coastal human populations and mangrove forests in Mozambique. The abundance, activity, shell selection and behaviour of three species of hermit crab are related to the level of mangrove cover. With increased density of mangrove trees, the study species of hermit crab changed in abundance, tended to become diurnal, spent more time feeding and were clustered in larger groups when doing so, and selected longer spired shells. All five of the same variables are also linked to the proximity and activity of humans through both direct and indirect actions. Direct effects included a tendency to nocturnal activity with proximity to human activity; indirect effects included increased and more clumped food supplies, and shell middens from intertidal harvesting and deforestation. Mangroves are important to local human populations as well as to hermit crabs, for a wide variety of (similar) reasons. Mangroves provide storm shelter, fisheries and fishery nursery grounds for adjacent human settlements, but they also harbour mosquito populations and their removal provides valuable building materials and fuel. Hermit crabs may be useful (indirectly) to coastal human populations by being a source of food to certain commercial species, and by quickly consuming rotting/discarded food and faeces (thereby reducing disease and pests). They can also cause minor problems to coastal human populations because they use shells of (fisheries) target mollusc species and can be more abundant than the living molluscs, thereby slowing down effective hand collection through confusion over identification. The mixture of positive and negative attributes that the three groups impart to each other in the Quirimba Archipelago, northern Mozambique, is discussed. Résumé Il existe des interrelations complexes entre les Bernard-l'Ermite du haut littoral (tels que Coenobita sp. Et Clibanarius sp.), les populations humaines côtières et les forêts de mangroves au Mozambique. L'abondance, l'activité, le choix de la coquille et le comportement de trois espèces de Bernard-l'Ermite sont liés au degré de couverture de la mangrove. Lorsque la densité des arbres de la mangrove augmente, l'abondance des espèces étudiées de Bernard-l'Ermite change, ils ont tendance à devenir diurnes, passent plus de temps à se nourrir et se rassemblent à ces moments-là en plus grands groupes, et ils choisissent aussi de plus longues coquilles. Les cinq mêmes variables sont aussi liées à la proximité et à l'activité des hommes, directement et indirectement. Parmi les effets directs, on compte une tendance à une activité nocturne lorsque les activités humaines sont proches ; les effets indirects incluent des apports de nourriture et de débris de coquilles accrus et plus regroupés résultant des marées et de la déforestation. Les mangroves sont aussi importantes pour les populations locales que pour les Bernard-l'Ermite, pour toute une série de raisons (semblables). Les mangroves constituent un abri en cas de tempête, un terrain de pêche et de frai dont bénéficient les populations humaines voisines, mais elles renferment aussi beaucoup de moustiques, et leur bois fournit un bon matériau de construction et du combustible. Les Bernard-l'Ermite peuvent être (indirectement) utiles aux populations côtières car certaines espèces commerciales sont comestibles et que tous consomment rapidement les restes de nourriture en décomposition et les excréments (réduisant ainsi les risques de maladie et d'animaux nuisibles). Ils peuvent aussi causer des problèmes mineurs aux populations côtières parce qu'ils utilisent la coquille d'espèces de mollusques qui font l'objet de la pêche et qu'ils peuvent être plus abondants que les mollusques eux-mêmes, ce qui ralentit la pêche manuelle à cause du besoin d'identification. On discute le mélange de qualités négatives et positives que les trois groupes représentent les uns pour les autres dans l'Archipel de Quirimba, au nord du Mozambique. [source] HyBAR: hybrid bone-attached robot for joint arthroplastyTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2009S. Song Abstract Background A number of small bone-attached surgical robots have been introduced to overcome some disadvantages of large stand-alone surgical robots. In orthopaedics, increasing demand on minimally invasive joint replacement surgery has also been encouraging small surgical robot developments. Among various technical aspects of such an approach, optimal miniaturization that maintains structural strength for high speed bone removal was investigated. Methods By observing advantages and disadvantages from serial and parallel robot structures, a new hybrid kinematic configuration was designed for a bone-attached robot to perform precision bone removal for cutting the femoral implant cavity during patellofemoral joint arthroplasty surgery. A series of experimental tests were conducted in order to evaluate the performance of the new robot, especially with respect to accuracy of bone preparation. Results A miniaturized and rigidly-structured robot prototype was developed for minimally invasive bone-attached robotic surgery. A new minimally invasive modular clamping system was also introduced to enhance the robotic procedure. Foam and pig bone experimental results demonstrated a successful implementation of the new robot that eliminated a number of major design problems of a previous prototype. Conclusions For small bone-attached surgical robots that utilize high speed orthopaedic tools, structural rigidity and clamping mechanism are major design issues. The new kinematic configuration using hinged prismatic joints enabled an effective miniaturization with good structural rigidity. Although minor problems still exist at the prototype stage, the new development would be a significant step towards the practical use of such a robot. Copyright © 2009 John Wiley & Sons, Ltd. [source] Observer Variability and Optimal Criteria of Transient Ischemia During ST Monitoring with Continuous 12-lead ECGANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2002Ph.D., Tomas Jernberg M.D. Background: ST monitoring with continuous 12-lead ECG is a well-established method in patients with unstable coronary artery disease (CAD). However, the method lacks documentation on optimal criteria for episodes of transient ischemia and on observer variability. Methods: Observer variability was evaluated in 24-hour recordings from 100 patients with unstable CAD with monitoring in the coronary care unit. Influence on ST changes by variations in body position were evaluated by monitoring 50 patients in different body positions. Different criteria of transient ischemia and their predictive importance were evaluated in 630 patients with unstable CAD who underwent 12 hours of monitoring and thereafter were followed for 1 to 13 months. Two sets of criteria were tested: (1) ST deviation , 0.1 mV for at least 1 minute, and (2) ST depression , 0.05 mV or elevation , 0.1 mV for at least 1 minute. Results: When the first set of criteria were used, the interobserver agreement was good (kappa = 0.72) and 8 (16%) had significant ST changes in at least one body position. Out of 100 patients with symptoms suggestive of unstable CAD and such ischemia, 24 (24%) had a cardiac event during follow-up. When the second set of criteria were used, the interobserver agreement was poor (kappa = 0.32) and 21(42%) had significant ST changes in at least one body position. Patients fulfilling the second but not the first set of criteria did not have a higher risk of cardiac event than those without transient ischemia (5.3 vs 4.3%). Conclusions: During 12-lead ECG monitoring, transient ischemic episodes should be defined as ST deviations , 0.1 mV for at least 1 minute, based on a low observer variability, minor problems with postural ST changes and an important predictive value. A.N.E. 2002;7(3):181,190 [source] Diabetic mothers and their newborn infants , rooming-in and neonatal morbidityACTA PAEDIATRICA, Issue 7 2010E Stage Abstract Aim:, As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity. Methods:, The records of an old cohort of 103 infants routinely admitted to the NSCU, and a new cohort (N = 102), offered rooming-in were assessed for neonatal morbidity. Results:, Eighty-four (82%) of the new cohort infants followed their mothers to the maternity ward; whereas 19 (18%) were transferred to the NSCU chiefly because of prematurity. Ten infants were later transferred to the NSCU for minor problems. Neonatal morbidity and neonatal hypoglycaemia were significantly less common in the new cohort than in the old cohort [27 (26%) vs. 55 (54%), p < 0.001 and 42 (41%) vs. 64 (63%), p = 0.0027 respectively]. Maternal HbA1c in late pregnancy was significantly lower in the new cohort, but the only independent predictors of neonatal morbidity were belonging to the old cohort and preterm delivery. Conclusion:, Neonatal care with rooming-in mothers with type 1 diabetes and their newborn infants seems safe and is associated with reduced neonatal morbidity, when compared with routine separation of infants from their mothers. [source] Solifenacin treatment for overactive bladder in Hispanic patients: patient-reported symptom bother and quality of life outcomes from the VESIcare® Open-Label TrialINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2008J. P. Capo' Jr Summary Objective:, The primary goal of overactive bladder (OAB) treatment is to reduce symptoms and improve health-related quality of life (HRQoL). Although trials open enrolment to everyone, most OAB studies feature Caucasians. Here we present Hispanic data. Methods:, VESIcare® Open-Label Trial was a 12-week, open-label, flexible-dosing study in patients with OAB symptoms for , 3 months. All patients started on solifenacin 5 mg/day, with a dosing option of 5 or 10 mg/day at weeks 4 and 8. Three patient-reported outcome (PRO) measures assessed symptom improvement and treatment satisfaction: the Patient Perception of Bladder Condition (PPBC) scale, a Visual Analogue Scale (VAS), the Overactive Bladder Questionnaire (OAB-q). Results:, 94/2205 patients in the full population were Hispanic. Urgency was most frequently reported at baseline (93.6%), followed by frequency (91.5%), nocturia (84.0%) and urge incontinence (UI) (67.0%). Frequency was reported as the most bothersome symptom (MBS) by a higher proportion of Hispanics than the full population (40.4% vs. 28.1%). UI was reported as the MBS by a smaller proportion of Hispanics (18.1% vs. 27.3%). Patients reporting moderate-to-severe problems related to bladder condition at baseline reported improvement to ,some minor problems' at week 12. Over 72.0% of patients experienced PPBC score improvement. Both groups reported significant improvements in urgency, UI, frequency and nocturia on the VAS (all p < 0.001) and all OAB-q domains (all p < 0.001) at week 12. Conclusion:, Although numbers were small, Hispanics receiving solifenacin for OAB reported improvement from baseline in symptom bother and HRQoL, as assessed by three independent PRO measures. [source] | |||||||||||||