Provision of magnetic resonance imaging for patients with 'MR-conditional' cardiac implantable electronic devices: an unmet clinical need

Aims Increasing need for magnetic resonance imaging (MRI) has driven the development of MR-conditional cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators); however, patients still report difficulties obtaining scans. We sought to establish current provision for MRI scanning of patients with CIEDs in England. Methods and results A survey was distributed to all hospitals in England with MRI, to assess current practice. Information requested included whether hospitals currently offer MRI to this patient group, the number and type of scans acquired, local safety considerations, complications experienced and perceived obstacles to service provision in those departments not currently offering it. Responses were received from 195 of 227 (86%) of hospitals surveyed. Although 98% of departments were aware of MR-conditional devices, only 46% (n = 89) currently offer MRI scans to patients with CIED's; of these, 85% of departments perform ≤10 scans per year. No major complications were reported from MRI scanning in patients with MR-conditional devices. Current barriers to service expansion include perceived concerns regarding potential risk, lack of training, logistical difficulties, and lack of cardiology support. Conclusion Provision of MRI for patients with CIEDs is currently poor, despite increasing numbers of patients with MR-conditional devices and extremely low reported complication rates

The Possibility of a Maize Green Revolution in the Highlands of Kenya : An Assessment of Emerging Intensive Farming Systems

As population pressure on land grows rapidly in Kenya, rural farmers have started to intensify land use, which has led to the emergence of a new maize farming system. The new system is characterized by the adoption of high-yielding maize varieties, the application of chemical fertilizer and manure produced by stall-fed improved dairy cows, and intercropping, especially the combination of maize and legumes. This study aims to explore the determinants of the new maize farming system and its impact on land productivity and household income. We examine not only the impacts of new technologies and production practices but also the impact of the entire new maize farming system by generating an agricultural intensification index based on a principal component analysis. The estimation results show that an increase in sub-location level population density and a decrease in the land-labor ratio of an individual household accelerate farming intensification, and that the adoption of each new technology and production practice has positive and significant impacts on land productivity. These findings are further supported by the significantly positive impacts of the agriculture intensification index on land productivity