Short-term recurrence rate of male urethral stricture and its predictors after treatment with optical internal urethrotomy: Prospective Cohort Study at a tertiary center in Ethiopia.

Background: Although optical internal urethrotomy is popular among the urologists due to its simplicity and safety, urethroplasty is considered the gold standard treatment for urethral strictures. This study aims to determine the 1-year recurrence rate of urethral strictures after optical urethrotomy and identify predictors of recurrence in a tertiary center in Ethiopia. Methods: A prospective observational cohort study was conducted on 80 male patients who underwent optical urethrotomy from November 2019 to August 2020 in a tertiary center in Ethiopia. Logistic regression was used to analyze the association between dependent and independent variables, with a P-value of <0.05 considered statistically significant. Results: The mean and median age (±SD) of patients at the time of the procedure were 54.76 (±14.74) and 58 years with a range [20-78], respectively. Urethral discharge was the most common etiology identified in 39 (48.75%) of patients. Eleven (13.75%) patients had no identifiable etiology for their urethral stricture disease.The majority of patients presented with at least one voiding lower urinary tract symptoms.Sixty-eight (85%) patients out of the total had a single stricture and 12 (15%) had multiple strictures. The location of the stricture was in the bulbar urethra on cystourethrography in 83% of the patients. The 1-year recurrence rate of urethral stricture after optical urethrotomy was 35% in our study.The number of strictures and the presence of hypertension were independent predictors of recurrence of urethral stricture within 1-year after treatment with optical urethrotomy (AOR=15.35, 95% CI: 2.92-80.61, P=0.00; AOR=19.47, 95% CI: 2.11-178.98, P=0.01, respectively). Conclusions: Our study identified that multiple strictures, and the presence of hypertension are associated with an increased recurrence rate in the first postoperative year.

Unilateral Giant Hydronephrosis Secondary to Ureteropelvic Junction Obstruction in a Middle-Aged Woman.

BACKGROUND: Giant hydronephrosis is a rare urologic problem defined as a collection of more than one liter of urine in the collecting system. The radiologic appearance may mimic benign cystic disease of the kidney. We report a case of giant hydronephrosis in a 32-year-old female who presented with progressive abdominal swelling of two-year duration, caused by ureteropelvic junction obstruction with more than nine liters of urine in the collecting system. CONCLUSION: Giant hydronephrosis is a rare differential diagnosis for cystic intra-abdominal mass in adults with progressively increasing abdominal swelling. CT and MRI are important in confirming the diagnosis by localizing the origin of the swelling. Management depends on the underlying cause and appearance of the diseased kidney.

Prevalence of Schistosoma mansoni-Salmonella coinfection among patients in southern Ethiopia.

Concurrent infection with Schistosoma mansoni and Salmonella species is not uncommon in the endemic area of sub-Saharan Africa, although its prevalence may have regional variations. We discuss such coinfection and associated factors in an Ethiopian context. We assessed the prevalence of S. mansoni and Salmonella coinfections among patients attending two hospitals in southern Ethiopia. A facility-based cross-sectional study was carried out between 1 October and 30 November 2019. In total 271 participants with gastrointestinal complaints were selected through a systematic sampling technique. S. mansoni was detected using direct microscopy and formalin-ether concentration techniques, whereas Salmonella was identified by conventional culture methods and the Widal test. Antibiotic susceptibility test for Salmonella isolates was performed. The prevalence rates of S. mansoni and Salmonella infections were 17.30% and 7.70% respectively. The prevalence of S. mansoni-Salmonella coinfection was 7.7%. Of the factors analysed in connection with coinfection, male sex, age and frequency of exposure to contaminated water bodies were found to be statistically significant. S. mansoni-Salmonella coinfections pose a grave health problem in the study area, especially among children. Our conclusions can be used by the medical community to frame and implement intervention strategies for the management of S. mansoni-Salmonella coinfections.

Prevalence of enteric bacteria and enteroparasites in human immunodeficiency virus-infected individuals with diarrhoea attending antiretroviral treatment clinic, Arba Minch General Hospital, southern Ethiopia.

In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and enteroparasites in human immunodeficiency virus (HIV) -infected individuals with diarrhoea. Hence, this study aims to assess the prevalence of enteric bacteria and enteroparasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhoea, who visited the Anti-Retroviral Therapy Clinic of the Arba Minch General Hospital between 1 March and 31 August 2019. Data pertaining to sociodemographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV-infected individuals with diarrhoea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analysed using SPSS software. A total of 180 individuals were included in the stool collection process. The prevalence rates of enteric bacteria and enteroparasites were 8.3% and 36.1%, respectively. Parasitic infections were more frequent than bacterial infections in these HIV-infected individuals; commonly identified enteroparasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Campylobacter sp. was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella (1.1%) species. CD4 counts <200 cells/µL was significantly associated with both bacterial infections (adjusted OR 9.55, 95% CI 1.54-59.3, p 0.015) and parasitic infections (adjusted OR 3.53, 95% CI 1.3-17.9, p 0.03). Multidrug resistance was also detected in 100%, 75% and 60% of Shigella, Campylobacter and Salmonella sp., respectively. We found that enteroparasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T-cell counts <200 cells/µL, quality of drinking water sources, hand washing habits after toilet and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.

Understanding adolescent and parent acceptability and feasibility experience in a large Type 1 diabetes mellitus behavioural trial.

AIMS: Using an 18-month, multisite randomized control trial as an exemplar, the aim of this study was to identify themes related to adolescent and parental feasibility and acceptability for participation in large behavioural trials designed to improve adolescents' Type 1 diabetes self-management. METHODS: Thematic analysis methodology was used to develop themes describing factors related to acceptability and feasibility. RESULTS: Based on a sample of interviews (N = 72), factors contributing to intervention acceptability and feasibility were identified. Aspects of acceptability included: a framework for goal-setting, the coach as a non-judgemental listener, perception of an ongoing benefit to participation and the delivery mode. Aspects of feasibility included: participants' altruism to help adolescents with Type 1 diabetes; pre-enrolment preparation for intervention content and duration; and the option of remote intervention delivery via telephone or video, which minimized travel time and costs. In addition, participants described positive outcomes including improvements in behaviour, Type 1 diabetes self-management behaviours and parent-adolescent communication, and emotion-attitude changes. Participants also described potential revisions that may inform future trials. CONCLUSIONS: Acceptability and feasibility of behavioural interventions with adolescents with chronic illness have multifactorial dimensions. While empowering adolescent self-management, parental support is also an under-appreciated aspect to consider. Potential revisions were identified for subsequent behavioural trials.

The impact of pastoralist mobility on tuberculosis control in Ethiopia: a systematic review and meta-synthesis.

BACKGROUND: Directly observed treatment, short-course (DOTS) is the current mainstay to control tuberculosis (TB) worldwide. Context-specific adaptations of DOTS have impending implications in the fight against TB. In Ethiopia, there is a national TB control programme with the goal to eliminate TB, but uneven distribution across lifestyle gradients remains a challenge. Notably, the mobile pastoralist communities in the country are disproportionately left uncovered. The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia. MAIN TEXT: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically reviewed articles in seven electronic databases: Excerptra Medical Database, African Journal Online, PubMed, Google Scholar, Centre for Agriculture and Bioscience International Direct, Cochrane Library and Web of Science. The databases were searched from inception to December 31, 2018, with no language restriction. We screened 692 items of which 19 met our inclusion criteria. Using a meta-ethnographic method, we identified six themes: (i) pastoralism in Ethiopia; (ii) pastoralists' livelihood profile; (iii) pastoralists' service utilisation; (iv) pastoralists' knowledge and awareness on TB control services; (v) challenges of TB control in pastoral settings; and (vi) equity disparities affecting pastoralists. Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country. CONCLUSIONS: This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle. Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision. Targeting these two parameters holds promise to enhance effectiveness of an intervention.

Comparison of radiofrequency electromagnetic field exposure levels in different everyday microenvironments in an international context.

BACKGROUND: The aim of this study was to quantify RF-EMF exposure applying a tested protocol of RF-EMF exposure measurements using portable devices with a high sampling rate in different microenvironments of Switzerland, Ethiopia, Nepal, South Africa, Australia and the United States of America. METHOD: We used portable measurement devices for assessing RF-EMF exposure in 94 outdoor microenvironments and 18 public transport vehicles. The measurements were taken either by walking with a backpack with the devices at the height of the head and a distance of 20-30 cm from the body, or driving a car with the devices mounted on its roof, which was 170-180 cm above the ground. The measurements were taken for about 30 min while walking and about 15-20 min while driving in each microenvironment, with a sampling rate of once every 4 s (ExpoM-RF) and 5 s (EME Spy 201). RESULTS: Mean total RF-EMF exposure in various outdoor microenvironments varied between 0.23 V/m (non-central residential area in Switzerland) and 1.85 V/m (university area in Australia), and across modes of public transport between 0.32 V/m (bus in rural area in Switzerland) and 0.86 V/m (Auto rickshaw in urban area in Nepal). For most outdoor areas the major exposure contribution was from mobile phone base stations. Otherwise broadcasting was dominant. Uplink from mobile phone handsets was generally very small, except in Swiss trains and some Swiss buses. CONCLUSIONS: This study demonstrates high RF-EMF variability between the 94 selected microenvironments from all over the world. Exposure levels tended to increase with increasing urbanity. In most microenvironments downlink from mobile phone base stations is the most relevant contributor.

A vision for the future of pastoralism.

Pastoral regions are challenged by social and ecological changes. Yet, there is increasingly robust evidence that pastoralism is a viable and sustainable livelihood and that pastoralists play a role in attaining the United Nations Sustainable Development Goals (SDGs). In this issue of the Scientific and Technical Review of the World Organisation for Animal Health (OIE), the authors take a broad view of pastoralism and pastoral livestock production from a number of different perspectives, taking into account societal and ecological viewpoints as well as issues of animal and human health. Thematic reviews are complemented by regional perspectives from Central Asia, China, Europe, East, Central and West Africa, and Latin America. The broader issues of pastoral livestock production and its potential for improving and sustaining animal health are of great interest to the OIE. Summarising the diverse contributions, it appears that pastoral socialecological systems are hotspots of cultural and biological diversity. They are multifunctional in that they generate diversified sources of income and contribute to sustained natural resource management. Pastoral populations require favourable institutional and legal frameworks, so governance structures must be improved and reformed through effective participation and the empowerment of pastoralists. To sustain functional pastoral production systems, the key ingredients are decentralised governance of natural resources, better locally adapted social services, and high flexibility for maintaining mobility. Young people should be actively encouraged to engage in pastoral livelihoods, which should be supported by improved legal systems for land use by all interested parties. There is still untapped potential to optimise extensive livestock production through adapted genetic improvement and better transformation, stocking and marketing of animal-source food. Modern concepts of disease surveillance and response, combining human and animal health as 'One Health', are particularly suited to pastoral systems. The OIE's interest in pastoralism is highly justified given its economic and environmental importance and its significance for livelihoods. Sustainable improvements require understanding and discussion of diverse social and ecological interactions, and it is to this discussion which the authors and editors of this issue of the Review have endeavoured to contribute.

Les régions d'élevage pastoral sont confrontées à des mutations tant sociales qu'écologiques. En même temps, des éléments factuels chaque fois plus nombreux démontrent que le pastoralisme constitue un moyen de subsistance viable et durable et que les pasteurs participent à la réalisation des Objectifs de développement durable fixés par les Nations Unies. Ce numéro de la Revue scientifique et technique de l'Organisation mondiale de la santé animale (OIE) propose une large vue d'ensemble sur le pastoralisme et l'élevage pastoral, examinés sous différents angles et en prenant en considération divers points de vue, tant sociétaux qu'écologiques, sans oublier les problématiques de la santé animale et publique. Les examens thématiques sont complétés par des études régionales portant sur l'Asie centrale, la Chine, l'Europe, l'Afrique de l'Est, centrale et de l'Ouest et l'Amérique latine. Les questions plus générales liées à l'élevage pastoral et à sa capacité potentielle d'améliorer et de promouvoir la santé animale présentent un grand intérêt pour l'OIE. Les diverses contributions réunies dans ce numéro font apparaître que les systèmes socio-écologiques pastoraux constituent des zones sensibles en termes de diversité biologique et culturelle. Ils exercent de multiples fonctions, dans la mesure où ils génèrent des sources de revenus diversifiées et contribuent à une gestion durable des ressources naturelles. Les populations pastorales doivent être soutenues par des cadres juridiques et institutionnels favorables, ce qui suppose d'améliorer et de moderniser les structures de gouvernance au moyen d'une participation effective des pasteurs eux-mêmes et de la prise en main de leur destin. Les ingrédients majeurs pour soutenir le bon fonctionnement des systèmes de production pastoraux sont la gouvernance décentralisée des ressources naturelles, la fourniture de services sociaux spécifiquement adaptés aux besoins des pasteurs et une grande flexibilité afin de préserver le nomadisme. Les jeunes devraient être activement encouragés à participer à l'économie pastorale, et celle-ci devrait bénéficier d'un soutien juridique afin que l'utilisation des terres par toutes les parties intéressées soit mieux encadrée. La production animale extensive présente une grande marge d'amélioration encore inexploitée, grâce à l'amélioration génétique et à des méthodes plus efficaces de transformation, de stockage et de commercialisation des denrées alimentaires d'origine animale. Les concepts modernes de surveillance des maladies et de réaction aux évènements sanitaires en faisant appel à une approche intégrée de la santé animale et humaine selon le concept « Une seule santé ¼ sont particulièrement adaptés aux systèmes pastoraux. L'intérêt que suscite le pastoralisme pour l'OIE se justifie pleinement par l'importance économique et environnementale du pastoralisme et par sa valeur en tant que moyen de subsistance. La mise en place d'améliorations durables passe par une connaissance et un examen approfondis des nombreuses interactions sociales et écologiques à l'oeuvre dans le pastoralisme ; c'est à cet examen que les auteurs et coordinateurs de ce numéro de la Revue se sont attachés à contribuer.

Las regiones pastorales están viviendo difíciles transformaciones sociales y ecológicas. Aun así, hay pruebas cada vez más concluyentes de que el pastoreo constituye un medio de sustento viable y sostenible y de que las sociedades que viven de él contribuyen al cumplimiento de los Objetivos de Desarrollo Sostenible (ODS) fijados por las Naciones Unidas. En este número de la Revista científica y técnica de la Organización Mundial de Sanidad Animal (OIE) los autores ofrecen una vasta panorámica del pastoreo y de la producción ganadera que le es propia, abordando el tema desde múltiples ángulos y teniendo en cuenta tanto aspectos ligados a la sociedad y la ecología como las cuestiones zoosanitarias y sanitarias. El tratamiento temático se complementa con estudios de ámbito regional, dedicados a Asia Central, China, Europa, África Oriental, Central y Occidental y América Latina. Las cuestiones más generales ligadas a la producción ganadera por pastoreo y a las posibilidades que esta ofrece para mejorar y preservar la sanidad animal revisten gran interés para la OIE. Las diversas contribuciones aquí reunidas evidencian, en resumen, que los sistemas socioecológicos pastorales encierran una enorme diversidad cultural y biológica. Revisten además carácter polivalente, en el sentido de que generan fuentes diversificadas de ingresos y contribuyen a una gestión duradera de los recursos naturales. Las poblaciones dedicadas al pastoreo necesitan regímenes institucionales y jurídicos favorables, para lo cual es indispensable mejorar y reformar las estructuras de gobierno instrumentando una participación efectiva de esas poblaciones y fórmulas que las doten de poder de decisión y actuación. Los ingredientes básicos para mantener duraderamente y en buen funcionamiento los sistemas de producción propios del pastoreo son: una gestión descentralizada de los recursos naturales; servicios sociales más eficaces y adaptados a las condiciones locales; y un elevado grado de flexibilidad para mantener la movilidad. Es preciso alentar activamente a los jóvenes a que abracen los modos y medios de vida del pastoreo, lo que debe acompañarse de mejores ordenamientos jurídicos sobre el uso de las tierras por todas las partes interesadas. Todavía queda margen para optimizar la producción ganadera extensiva mediante mejoras genéticas adaptadas y técnicas más eficaces de transformación, almacenamiento y comercialización de los alimentos de origen animal. Los conceptos modernos de la vigilancia y la respuesta sanitarias, que combinan la salud humana y la sanidad animal con arreglo a los principios de «Una sola salud¼, casan especialmente con los sistemas de pastoreo. El interés de la OIE por el pastoreo está sobradamente justificado por la importancia económica y ambiental de esta actividad y por la repercusión que tiene en los medios de sustento. Toda mejora duradera en este ámbito pasa por entender un conjunto de interacciones sociales y ecológicas y por debatir al respecto, proceso este de reflexión al que se han propuesto contribuir los autores y compiladores del presente número de la Revista.

Communication for the development of pastoralism.

Communication is vital for the socio-economic and cultural development of pastoralists. If used constructively, communication can help to create a favourable environment for change and modernisation. This paper tries to uncover trends in communication as part of pastoral development, emphasising both indigenous and current methods of communication and prevailing constraints. This study reveals that pastoral development interventions in the past have often failed to achieve their goals, due to the centralised, 'top-down' approaches adopted and to reliance on external strategies and channels which ignored the indigenous knowledge and communications systems of pastoralists. Pastoralists have their own well-established communications systems for sharing information on climatic conditions and ecology, as well as economic, social and political issues. Modern communication technologies, especially radio and mobile telephones, are increasingly being used by pastoralists to access current regional information. However, pastoral development in the communications area is currently constrained by the failure of various development agencies and stakeholders to use participatory approaches, and by poor infrastructure and weak capacity. The authors therefore call for the adoption of more participatory and integrated approaches towards communication, the expansion of infrastructure and building of capacity.

La communication est vitale pour le développement socio-économique et culturel des pasteurs. Utilisée de manière constructive, la communication peut contribuer à créer un environnement propice au changement et à la modernisation. Les auteurs s'efforcent de déceler les tendances de la communication en tant que soutien du développement pastoral, en soulignant les méthodes de communication tant traditionnelles que modernes et leurs principales contraintes. Cette étude révèle que l'échec fréquent des interventions du passé visant à développer le pastoralisme s'explique par le fait qu'elles adoptaient des méthodes de nature centralisée, « du haut vers le bas ¼, et qu'elles dépendaient de stratégies et de canaux extérieurs qui négligeaient les savoirs autochtones ainsi que les systèmes de communication des pasteurs. Les pasteurs utilisent leurs propres systèmes de communication bien établis pour partager les informations sur les conditions climatiques et écologiques ainsi que sur des questions économiques, sociales et politiques. Ils recourent de plus en plus aux technologies modernes de communication, en particulier la radio et la téléphonie mobile pour accéder aux informations et actualités régionales. Néanmoins, le développement pastoral dans le secteur des communications se heurte actuellement à l'incapacité de diverses agences de développement et parties prenantes à recourir à des méthodes participatives, ainsi qu'à une pénurie d'infrastructures et de capacités. Les auteurs préconisent de privilégier les méthodes de communication participatives et intégrées, d'améliorer les infrastructures et de renforcer les capacités.

La comunicación es vital para el desarrollo socioeconómico y cultural de las sociedades pastorales. Utilizada constructivamente, puede ayudar a crear condiciones propicias para el cambio y la modernización. Los autores tratan de desvelar una serie de tendencias en materia de comunicación como parte del desarrollo pastoral, haciendo hincapié en los métodos de comunicación tanto indígenas como modernos y en los factores que actualmente constriñen su buen funcionamiento. El estudio aquí descrito demuestra que en el pasado las intervenciones de desarrollo pastoral han sido a menudo poco fructuosas porque respondían a planteamientos centralizados y «descendentes¼ y reposaban en estrategias y canales externos que hacían caso omiso del conocimiento indígena y de los arraigados sistemas de comunicación propios de las sociedades pastorales que sirven para compartir información sobre condiciones climáticas y ecológicas u otras cuestiones de índole económica, social y política. Los pastores utilizan cada vez más las modernas tecnologías de comunicación, en especial la radio y el teléfono móvil, para mantenerse al corriente de la actualidad regional. No obstante, por lo que respecta a las comunicaciones, el desarrollo pastoral se ve lastrado actualmente por el hecho de que diversos interlocutores y organismos de desarrollo no apliquen métodos participativos, a lo que se añaden las deficiencias en materia de infraestructura y capacidades. Los autores propugnan por lo tanto la aplicación de planteamientos más participativos e integrados para abordar las cuestiones de comunicación, junto con la expansión de las infraestructuras y el fomento de las capacidades.

The role of pastoralism in regulating ecosystem services.

Pastoralism is rarely viewed as a major future form of land use, because of well-documented cases of rangeland degradation, attributed to irrational overstocking by pastoralists, and the subsequent losses of ecosystem services. However, pastoralists were actually encouraged to settle and adopt such strategies, copied from rangelands with higher and more reliable rainfall. This curtailed mobility resulted in a shift from opportunistic and extensive land use to more intensive and settled forms of use. The purpose of this review is to examine the link between pastoralism and the provision of ecosystem services by rangelands, focusing on biodiversity conservation and carbon sequestration. Pastoralists employ several techniques to manage rangeland resources, including mobility, herding, corralling, grazing reserves and the use of fire. With these strategies, pastoralists have contributed to the enhancement of rangeland biodiversity and the long-term conservation of important wildlife habitats. Pastoralists also possess detailed knowledge of rangeland plants and their uses, which could be valuable in the assessment, conservation and utilisation of rangeland biodiversity. Similarly, traditional pastoral rangeland management practices, such as the use of seasonal grassland reserves and livestock mobility, influence vegetation composition, coverage and abundance in rangelands and offer tools for biomass and soil carbon restoration, contributing to the mitigation of climate change. However, various internal and external factors have curtailed traditional management practices and livestock mobility, breaking the co-evolved balance of vegetation, wildlife and land use, thus exposing rangeland to continued livestock pressure, which often leads to degradation. Rather than abandoning pastoralism, the revitalisation of traditional practices and indigenous knowledge is vital to secure sustainable livelihoods for millions of pastoralists and to maintain rangeland biodiversity and ecosystem services.

Parmi les modalités d'utilisation des terres, le pastoralisme n'est guère considéré comme présentant un fort potentiel d'avenir, en raison d'exemples bien documentés de prairies dégradées suite à leur surexploitation irrationnelle par les pasteurs, entraînant une baisse des services écosystémiques qui leur étaient associés. Il faut toutefois rappeler que ces mêmes pasteurs avaient d'abord été encouragés à se sédentariser et à adopter ce type de stratégies, directement inspirées des pratiques d'élevage appliquées dans les prairies bénéficiant de précipitations plus importantes et plus fiables. Le déclin de la mobilité s'est traduit par le passage d'une utilisation opportuniste et extensive des terres à des formes d'exploitation plus intensives et sédentarisées. Les auteurs se sont attachés à faire apparaître les liens entre le pastoralisme et les services écosystémiques rendus par les prairies, en premier lieu la protection de la biodiversité et la séquestration de carbone. Les pasteurs recourent à diverses techniques pour gérer les ressources des prairies, dont la transhumance, la conduite des troupeaux, l'érection de clôtures, la rotation des pâtures et l'usage du feu. En déployant ces stratégies, les pasteurs ont contribué à améliorer la biodiversité des prairies et à assurer la conservation durable d'habitats importants pour la faune sauvage. Les pasteurs possèdent également une connaissance détaillée des espèces végétales poussant dans les prairies et de leur utilisation, qui s'avère précieuse pour évaluer, conserver et utiliser la biodiversité des prairies. De même, les pratiques pastorales traditionnelles de gestion des prairies telles que la rotation saisonnière des parcelles et les déplacements des troupeaux influent sur la répartition, la couverture et l'abondance de la végétation des prairies et constituent des outils permettant de réparer la biomasse et de séquestrer le carbone des sols, contribuant ainsi à atténuer le réchauffement climatique. Néanmoins, plusieurs facteurs internes et externes ont limité les pratiques de gestion traditionnelles et la mobilité des troupeaux, brisant l'équilibre d'une coévolution parallèle de la végétation, la faune sauvage et l'exploitation des terres, et exposant de ce fait les prairies à une pression permanente, souvent suivie de leur dégradation. Plutôt que de renoncer au pastoralisme, il est désormais crucial de revitaliser les pratiques traditionnelles et les savoirs autochtones afin de sécuriser les moyens de subsistance de millions de pasteurs et de préserver la biodiversité des prairies et les services écosystémiques.

Al pensar en las principales modalidades de usos del suelo de cara al futuro, rara vez se tiene en cuenta el pastoreo. Ello se debe a la existencia de casos probados de degradación de los pastos, atribuida a un acopio excesivo e irracional por parte de los pastores, y a la consiguiente pérdida de servicios ecosistémicos. La realidad, sin embargo, es que las comunidades de pastores fueron alentadas a asentarse y adoptar tales procederes, importados de zonas de pastizales con niveles más elevados y constantes de pluviosidad. La consiguiente limitación de la movilidad llevó a pasar de un uso oportunista y extensivo de las tierras a modalidades de explotación más intensivas y sedentarias. Los autores examinan aquí el vínculo entre el pastoreo y los servicios ecosistémicos ligados a los pastizales, centrándose sobre todo en la conservación de la diversidad biológica y el secuestro de carbono. Las sociedades de pastores emplean varias técnicas para gestionar los recursos que suponen las tierras de pasto, en particular la movilidad, el uso de rebaños, corrales y reservas de pastizales y el recurso al fuego. Con estas estrategias los pastores han contribuido a mejorar la diversidad biológica de los pastizales y a conservar duraderamente importantes hábitats de la fauna salvaje. Estas sociedades atesoran asimismo un detallado conocimiento de las plantas que forman los pastizales y de sus usos, lo que puede revestir gran utilidad para evaluar, preservar y utilizar la biodiversidad de los pastizales. Análogamente, las prácticas tradicionales de gestión de pastos que aplican los pastores (como el uso de reservas estacionales de tierras de pasto o la movilidad del ganado) influyen en la composición vegetal, la cobertura y la abundancia de los pastizales y brindan así herramientas para restaurar la biomasa y el carbono del suelo, ayudando con ello a mitigar el cambio climático. Sin embargo, hay una serie de factores internos y externos que han coartado las prácticas de gestión tradicionales y la movilidad del ganado, alterando el equilibrio entre vegetación, fauna salvaje y usos del suelo que se había alcanzado por coevolución y sometiendo así a los pastizales a una presión ganadera continua, que a menudo acaba por degradarlos. Más que de abandonar el pastoreo, se trata pues de revitalizar las prácticas tradicionales y el saber indígena como expediente crucial para procurar medios de sustento duraderos a los millones de personas que viven del pastoreo y a la vez mantener la diversidad biológica y los servicios ecosistémicos de los pastizales.

Highly stabilized, polymer-lipid membranes prepared on silica microparticles as stationary phases for capillary chromatography.

The ability to rapidly screen complex libraries of pharmacological modulators is paramount to modern drug discovery efforts. This task is particularly challenging for agents that interact with lipid bilayers or membrane proteins due to the limited chemical, physical, and temporal stability of conventional lipid-based chromatographic stationary phases. Here, we describe the preparation and characterization of a novel stationary phase material composed of highly stable, polymeric-phospholipid bilayers self-assembled onto silica microparticles. Polymer-lipid membranes were prepared by photochemical or redox initiated polymerization of 1,2-bis[10-(2',4'-hexadieoyloxy)decanoyl]-sn-glycero-2-phosphocholine (bis-SorbPC), a synthetic, polymerizable lipid. The resulting polymerized bis-SorbPC (poly(bis-SorbPC)) stationary phases exhibited enhanced stability compared to particles coated with 1,2-dioleoyl-sn-glycero-phosphocholine (unpolymerized) phospholipid bilayers when exposed to chemical (50 mM triton X-100 or 50% acetonitrile) and physical (15 min sonication) insults after 30 days of storage. Further, poly(bis-SorbPC)-coated particles survived slurry packing into fused silica capillaries, compared to unpolymerized lipid membranes, where the lipid bilayer was destroyed during packing. Frontal chromatographic analyses of the lipophilic small molecules acetylsalicylic acid, benzoic acid, and salicylic acid showed >44% increase in retention times (P<0.0001) for all analytes on poly(bis-SorbPC)-functionalized stationary phase compared to bare silica microspheres, suggesting a lipophilic retention mechanism. Phospholipid membrane-functionalized stationary phases that withstand the chemical and physical rigors of capillary LC conditions can substantially increase the efficacy of lipid membrane affinity chromatography, and represents a key advance toward the development of robust membrane protein-functionalized chromatographic stationary phases.

Flexible Lifestyles for Youth (FL3X) behavioural intervention for at-risk adolescents with Type 1 diabetes: a randomized pilot and feasibility trial.

AIM: To determine the potential effect sizes for the Flexible Lifestyle for Youth (FL3X) behavioural intervention to improve glycaemic control (HbA(1c)) and quality of life for at-risk adolescents with Type 1 diabetes. METHODS: Participants [n = 61; age 12-16 years, HbA(1c) 64-119 mmol/mol (8-13%)] were randomized to FL3X (minimum three sessions) or usual care. Effect sizes (Cohen's d), comparing the mean difference between the groups, were calculated. RESULTS: Study retention (95%), attendance at intervention sessions (87% attended all three sessions) and acceptability were high (100% of the adolescents and 91% of parents would recommend the programme to others). Overall, 41% of participants in the intervention group and 24% of participants in the control group were 'responders' [HbA(1c) decreased by > 6 mmol/mol (0.5%); d = 0.37]. HbA(1c) levels decreased (d = -0.18), diabetes-specific quality of life increased (d = 0.29), but generic quality of life decreased (d = -0.23) in the intervention compared with the control group. CONCLUSIONS: The FL3X programme merits further study for improving HbA(1c) and diabetes-specific quality of life in adolescents with Type 1 diabetes. (Clinical trials registry no.: NCT01286350).

Hybrid phospholipid bilayer coatings for separations of cationic proteins in capillary zone electrophoresis.

Protein separations in CZE suffer from nonspecific adsorption of analytes to the capillary surface. Semipermanent phospholipid bilayers have been used to minimize adsorption, but must be regenerated regularly to ensure reproducibility. We investigated the formation, characterization, and use of hybrid phospholipid bilayers (HPBs) as more stable biosurfactant capillary coatings for CZE protein separations. HPBs are formed by covalently modifying a support with a hydrophobic monolayer onto which a self-assembled lipid monolayer is deposited. Monolayers prepared in capillaries using 3-cyanopropyldimethylchlorosilane (CPDCS) or n-octyldimethylchlorosilane (ODCS) yielded hydrophobic surfaces with lowered surface free energies of 6.0 ± 0.3 or 0.2 ± 0.1 mJ m(-2) , respectively, compared to 17 ± 1 mJ m(-2) for bare silica capillaries. HPBs were formed by subsequently fusing vesicles comprised of 1,2-dilauroyl-sn-glycero-3-phosphocholine or 1,2-dioleoyl-sn-glycero-3-phosphocholine to CPDCS- or ODCS-modified capillaries. The resultant HPB coatings shielded the capillary surface and yielded reduced electroosmotic mobility (1.3-1.9 × 10(-4) cm(2) V(-1) s(-1) ) compared to CPDCS- and ODCS-modified or bare capillaries (3.6 ± 0.2 × 10(-4) cm(2) V(-1) s(-1) , 4.8 ± 0.4 × 10(-4) cm(2) V(-1) s(-1) , and 6.0 ± 0.2 × 10(-4) cm(2) V(-1) s(-1) , respectively), with increased stability compared to phospholipid bilayer coatings. HPB-coated capillaries yielded reproducible protein migration times (RSD ≤ 3.6%, n ≥ 6) with separation efficiencies as high as 200 000 plates/m.

Practical considerations for preparing polymerized phospholipid bilayer capillary coatings for protein separations.

Phosphorylcholine (PC) based phospholipid bilayers have proven useful as capillary coating materials due to their inherent resistance to non-specific protein adsorption. The primary limitation of this important class of capillary coatings remains the limited long-term chemical and physical stability of the coatings. Recently, a method for increasing phospholipid coating stability in fused silica capillaries via utilization of polymerized, synthetic phospholipids was reported. Here, we expand upon these studies by investigating polymerized lipid bilayer capillary coatings with respect to separation performance including run-to-run, day-to-day and column-to-column reproducibility and long-term stability. In addition, the effects of pH and capillary inner diameter on polymerized phospholipid coated capillaries were investigated to identify optimized coating conditions. The coatings are stabilized for protein separations across a wide range of pH values (4.0-9.3), a unique property for capillary coating materials. Additionally, smaller inner diameter capillaries (≤50 µm) were found to yield marked enhancements in coating stability and reproducibility compared to wider bore capillaries, demonstrating the importance of capillary size for separations employing polymerized phospholipid coatings.

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

OBJECTIVES: To describe how in-depth analysis of adverse events can reveal underlying causes. METHODS: Triggers for adverse events were developed using the hospital's computerised medical record (naloxone for opiate-related oversedation and administration of a glucose bolus while on insulin for insulin-related hypoglycaemia). Triggers were identified daily. Based on information from the medical record and interviews, a subject expert determined if an adverse drug event had occurred and then conducted a real-time analysis to identify event characteristics. Expert groups, consisting of frontline staff and specialist physicians, examined event characteristics and determined the apparent cause. RESULTS: 30 insulin-related hypoglycaemia events and 34 opiate-related oversedation events were identified by the triggers over 16 and 21 months, respectively. In the opinion of the experts, patients receiving continuous-infusion insulin and those receiving dextrose only via parenteral nutrition were at increased risk for insulin-related hypoglycaemia. Lack of standardisation in insulin-dosing decisions and variation regarding when and how much to adjust insulin doses in response to changing glucose levels were identified as common causes of the adverse events. Opiate-related oversedation events often occurred within 48 h of surgery. Variation in pain management in the operating room and post-anaesthesia care unit was identified by the experts as potential causes. Variations in practice, multiple services writing orders, multidrug regimens and variations in interpretation of patient assessments were also noted as potential contributing causes. CONCLUSIONS: Identification of adverse drug events through an automated trigger system, supplemented by in-depth analysis, can help identify targets for intervention and improvement.

A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections.

OBJECTIVE: The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for 'special cause' variation. STUDY DESIGN: Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods. RESULT: We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period. CONCLUSION: The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate.

Correlates of vaccination for hepatitis B among adolescents: results from a parent survey.

OBJECTIVE: To identify correlates of hepatitis B vaccination status in sixth-grade students in the year prior to implementation of a requirement mandating immunization for seventh-grade entry. METHODS: A survey of parents of sixth-graders in 5 schools in San Diego County. Two logistic regression models were tested to predict the outcome variables: initiation and completion of the vaccination series. RESULTS: Factors associated with initiating the series included a recent nonacute medical visit, white race, hearing about the vaccination law from a health care provider, and the availability of a school-based vaccination clinic. Factors associated with completing the series included English as the primary language spoken at home, hearing about the law from a health care provider, a school-based vaccination clinic, and higher socioeconomic status. Health insurance was not significantly related to either outcome. CONCLUSIONS: There was a clear benefit for hepatitis B immunization status to have had a recent nonacute medical visit, to have heard about the law from a health care provider, and to have a school-based vaccination clinic. The factors associated with starting vs completing the vaccination series were not identical. However, both health care provider and school characteristics were related to starting and completing the vaccination series. Thus, a multifaceted strategy may be most appropriate for successful coverage of an adolescent population with a vaccination series such as hepatitis B.

Parents' Perceptions of Primary Care: measuring parents' experiences of pediatric primary care quality.

OBJECTIVE: A measure of pediatric primary care quality that is brief, practical, reliable, and valid would be useful to patients and pediatricians, policymakers, and health system leaders. Parents have a unique perspective from which to report their experiences with their child's primary care, and these reports may be valid indicators of pediatric primary care quality. The research objective was to develop a brief parent report of their children's primary care, the Parent's Perceptions of Primary Care measure (P3C), and to test its reliability and validity as a measure of pediatric primary care quality. STUDY DESIGN: The P3C was based on the elements of primary care as defined by the Institute of Medicine. Pretesting of domain content and item clarity was accomplished via focus interviews. The P3C was developed in English and translated to Spanish, Vietnamese, and Tagalog. The 23-item P3C yields a total score, as well as subscale scores for continuity, access, contextual knowledge, communication, comprehensiveness, and coordination. The P3C was administered to 3371 parents of children in kindergarten through sixth grades in a large, urban school district. PRINCIPAL FINDINGS: The percentage of missing values for the overall sample was 1.88%, indicating acceptable feasibility. Range of measurement, assessed via floor and ceiling effects, was moderate to good. Cronbach's coefficient alpha, an indicator of scale internal consistency reliability, was 0.95 for the P3C total scale. Factor analysis supported the subscale structure, and P3C scores were higher for children with health insurance, whose parents completed the survey in English, and who had a regular physician. P3C scores were positively related to parent reports of the child's health-related quality of life. CONCLUSIONS: The P3C is a practical, reliable, and valid measure of parents' reports of pediatric primary care quality. This brief measure could be used alone, or in conjunction with other measures, to enhance outcomes and evaluate the impact of systems changes on the delivery of the main elements of primary care.