Production of Giant \u3cem\u3ePanicum\u3c/em\u3e in Contrasting Environments in Semi-Arid Kenya

Giant panicum (Panicum maximum Jacq.) is a tall, vigorous perennial grass that is native to tropical and sub-tropical Africa. It is drought tolerant due to its deep and dense fibrous roots system and grows in a wide range of soil types. It is an important livestock feed and has been extensively cultivated in Brazil (Santos et al. 2006). Despite its wide genetic diversity in East Africa, its potential for livestock feed has not been exploited there due to limited research. Our research was aimed at evaluating the production of several giant panicum ecotypes in contrasting environments in semi-arid areas of Kenya

ANTIINFLAMMATORY PROPERTIES OF DICHLOROMETHANE: METHANOLIC LEAF EXTRACTS OF CAESALPINIA VOLKENSII AND MAYTENUS OBSCURA IN ANIMAL MODELS

Objective: Inflammation is the reaction to injury of the living tissues. Conventional medication of inflammation is expensive and arguably associated with various severe adverse effects hence the need to develop herbal agents that are effective as alternative. Caesalpinia volkensii and Maytenus obscura are plants that grow in Mbeere County of Eastern region of Kenya. This study was designed to evaluate the anti-inflammatory activity of C. volkensii and M. obscura plants. Methods: Experimental animals were divided in to four groups; normal group, diseased negative control group, diseased reference group and diseased experimental groups. Inflammation was inducted into the mice using carrageenan. The experimental groups were treated with leaf extracts of the plants at concentration of 50 mg/kg, 100 mg/kg and 150 mg/kg. Anti-inflammatory activities in rats were compared with diclofenac (15 mg/kg) as the standard conventional drug. Results: The leaf extracts of C. volkensii reduced the paw edema by between 6.50%-13.42% while the extracts of M. obscura reduced it by between 4.94%-22.36%. Diclofenac reduced the paw edema by between 4.11%-10.47%. Conclusion: The phytochemical screening results showed that the extracts of C. volkensii had flavonoids, steroids and phenolics while the leaf extracts M. obscura had phenolics, terpenoids and saponins. Flavonoids, saponins and phenolics have been associated with anti-inflammatory activities. Therefore, the study has established that the DCM: methanolic leaf extracts of Caesalpinia volkensii and Maytenus obscura are effective in management of inflammation

Improved Land Management in the Lake Victoria Basin: Annual Technical Report, July 2000 to June 2001

ICRAF and the Kenyan Ministry of Agriculture and Rural Development (MOARD) are implementing a project on “Improved Land Management in the Lake Victoria Basin.” The project began in 1999 – 2000 with a one-year startup year of activities under the Sida-sponsored National Soil and Water Conservation Programme (NSWCP). The collaborative project of ICRAF and MOARD has now been continued for another three years under the National Agriculture and Livestock Extension Programme (NALEP). This paper summarizes achievements and findings for the project for the year 2000 / 2001. The Swedish International Development Agency (SIDA) supports “Improved Land Management in the Lake Victoria Basin” through NALEP. Additional financial support for the activities reported herein was also provided by the Rockefeller Foundation, ICRAF core funds, Danida, the University of Florida and the USAID. Research conducted during 2000 / 2001 addressed a range of issues across a large tract of Western Kenya. A coarse resolution assessment of soil erosion risk conducted for the entire Lake Victoria Basin identified the Nzoia / Yala and Kagera river basins as those with the greatest percentage of land at risk. Biophysical research on land management problem domains has quantified the widespread spatial extent of soil physical and chemical degradation in the Nyando river basin and illustrated four contrasting biophysical problem domains within the basin. District-level data on population density, poverty and agricultural production available from secondary sources have been complemented with baseline household and community survey data collected in 9 villages around the Nyando river basin. The overall picture that is emerging is that while much of the Nyando river basin has experienced some physical and chemical land degradation, there are pockets of severe poverty, severe environmental degradation and extremely low agricultural production. Different approaches to extension, investment and policy may be needed to address poverty – environment – agricultural problems in different parts of the river basin. Reversing trends in environmental deterioration will require interventions on farmers fields and in the many areas between farms that publicly-used, although usually privately-owned. Farmers have demonstrated their willingness to adopt recommended conservation practices on their individual family fields, but the intensity of adoption depends upon the potential returns to investments, their cultural grouping, and the approach that extension providers take to the provision of information and mobilization of community participation. Adoption of improved practices and investments on publicly-used areas between farms requires the mobilization of collective action among small, medium and large groups. Collective action in the Nyando River basin is most likely to be effective where it harnesses local institutional arrangements (e.g. sub-clan affiliations among the Luo) and advances common interests in the provision of high quality water and the generation of additional cash income. Among other opportunities, there appears to be good prospects for market-oriented agroforestry for production of fruit, fuelwood and timber. Changes in local and national policies would help to ensure good returns for smallholder farmers. This report begins with a presentation of a number of major findings, implications of those findings for extension and investment and implications for policy. A summary of progress by activity is then presented, followed by lists of personnel involved, presentations and publications. An annex presents detailed accomplishments by activity

A Randomized Trial to Compare a Tailored Web-Based Intervention and Tailored Phone Counseling to Usual Care for Increasing Colorectal Cancer Screening

Background: Colorectal cancer mortality could be decreased with risk-appropriate cancer screening. We examined the efficacy of three tailored interventions compared with usual care for increasing screening adherence. Methods: Women (n = 1,196) ages 51 to 74, from primary care networks and nonadherent to colorectal cancer guidelines, were randomized to (1) usual care, (2) tailored Web intervention, (3) tailored phone intervention, or (4) tailored Web + phone intervention. Average-risk women could select either stool test or colonoscopy, whereas women considered at higher than average risk received an intervention that supported colonoscopy. Outcome data were collected at 6 months by self-report, followed by medical record confirmation (attrition of 23%). Stage of change for colorectal cancer screening (precontemplation or contemplation) was assessed at baseline and 6 months. Results: The phone (41.7%, P < 0.0001) and combined Web + phone (35.8%, P < 0.001) interventions significantly increased colorectal cancer screening by stool test compared with usual care (11.1%), with ORs ranging from 5.4 to 6.8 in models adjusted for covariates. Colonoscopy completion did not differ between groups except that phone significantly increased colonoscopy completion compared with usual care for participants in the highest tertile of self-reported fear of cancer. Conclusions: A tailored phone with or without a Web component significantly increased colorectal cancer screening compared with usual care, primarily through stool testing, and phone significantly increased colonoscopy compared with usual care but only among those with the highest levels of baseline fear. Impact: This study supports tailored phone counseling with or without a Web program for increasing colorectal cancer screening in average-risk women

LHCb Upgraded RICH 1 Engineering Design Review Report

During the Long Shutdown 2 of the LHC, the LHCb collaboration will replace the upstream Ring Imaging Cherenkov detector (RICH 1). The magnetic shield of the current RICH 1 will be modified, new spherical and plane mirrors will be installed and a new gas enclosure will be manufactured. New photon detectors (multianode photomultiplier tubes) will be used and these, together with their readout electronics, require a new mechanical support system. This document describes the new optical arrangement of RICH 1, its engineering design, installation and alignment. A summary of the project schedule and institute responsibilities is provided

LHCb Upgraded RICH 1 Engineering Design Review Report

During the Long Shutdown 2 of the LHC, the LHCb collaboration will replace the upstream Ring Imaging Cherenkov detector (RICH 1). The magnetic shield of the current RICH 1 will be modified, new spherical and plane mirrors will be installed and a new gas enclosure will be manufactured. New photon detectors (multianode photomultiplier tubes) will be used and these, together with their readout electronics, require a new mechanical support system. This document describes the new optical arrangement of RICH 1, its engineering design, installation and alignment. A summary of the project schedule and institute responsibilities is provided

Clinical and Genetic Risk Factors for Adverse Metabolic Outcomes in North American Testicular Cancer Survivors

Background: Testicular cancer survivors (TCS) are at significantly increased risk for cardiovascular disease (CVD), with metabolic syndrome (MetS) an established risk factor. No study has addressed clinical and genetic MetS risk factors in North American TCS. Patients and Methods: TCS were aged <55 years at diagnosis and received first-line chemotherapy. Patients underwent physical examination, and had lipid panels, testosterone, and soluble cell adhesion molecule-1 (sICAM-1) evaluated. A single nucleotide polymorphism in rs523349 (5-α-reductase gene, SRD5A2), recently implicated in MetS risk, was genotyped. Using standard criteria, MetS was defined as ≥3 of the following: hypertension, abdominal obesity, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol level, and diabetes. Matched controls were derived from the National Health and Nutrition Examination Survey. Results: We evaluated 486 TCS (median age, 38.1 years). TCS had a higher prevalence of hypertension versus controls (43.2% vs 30.7%; P<.001) but were less likely to have decreased HDL levels (23.7% vs 34.8%; P<.001) or abdominal obesity (28.2% vs 40.1%; P<.001). Overall MetS frequency was similar in TCS and controls (21.0% vs 22.4%; P=.59), did not differ by treatment (P=.20), and was not related to rs523349 (P=.61). For other CVD risk factors, TCS were significantly more likely to have elevated low-density lipoprotein (LDL) cholesterol levels (17.7% vs 9.3%; P<.001), total cholesterol levels (26.3% vs 11.1%; P<.001), and body mass index ≥25 kg/m2 (75.1% vs 69.1%; P=.04). On multivariate analysis, age at evaluation (P<.001), testosterone level ≤3.0 ng/mL (odds ratio [OR], 2.06; P=.005), and elevated sICAM-1 level (ORhighest vs lowest quartile, 3.58; P=.001) were significantly associated with MetS. Conclusions and Recommendations: Metabolic abnormalities in TCS are characterized by hypertension and increased LDL and total cholesterol levels but lower rates of decreased HDL levels and abdominal obesity, signifying possible shifts in fat distribution and fat metabolism. These changes are accompanied by hypogonadism and inflammation. TCS have a high prevalence of CVD risk factors that may not be entirely captured by standard MetS criteria. Cancer treatment–associated MetS requires further characterization

An RCT to Increase Breast and Colorectal Cancer Screening

Introduction Adherence to breast and colorectal cancer screenings reduce mortality from these cancers, yet screening rates remain suboptimal. This 2 × 2 RCT compared 3 theory-based interventions to usual care to simultaneously increase breast and colon cancer screening in women who were nonadherent to both screenings at study entry. Design RCT. Setting/participants Women (n=692) who were nonadherent to both breast and colon cancer screenings and aged 51–75 years were recruited. Enrollment, intervention delivery, and data collection were completed between 2013 and 2017, and data analyzed in 2018. Intervention The randomized intervention included the following 4 groups: 3 intervention arms (personally tailored messages using a web-based intervention, phone delivery by a trained navigator, or both) compared with usual care. Women at an average risk for colon cancer were allowed to select either colonoscopy or stool test as their preferred colon cancer screening. Mammography was promoted for breast cancer screening. Main outcome measures Outcome data at 6 months included self-report and medical records for screening activity. Results All intervention arms significantly increased receipt of either a mammogram or stool test compared with control (web: p<0.0249, phone: p<0.0001, web + phone: p<0.0001). When considering receipt of both mammogram and stool test, all intervention arms were significantly different from usual care (web: p<0.0249, phone: p<0.0003, web + phone: p<0.0001). In addition, women who were adherent to mammography had a 4.5 times greater odds of becoming adherent to colonoscopy. Conclusions The tailored intervention simultaneously supporting both breast and colon cancer screenings significantly improved rates of obtaining one of the screenings and increased receipt of both tests

The state of hypertension care in 44 low-income and middle-income countries:a cross-sectional study of nationally representative individual-level data from 1·1 million adults

Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs-and its variation between countries and population groups-by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9-74·3) had ever had their blood pressure measured, 39·2% of participants (38·2-40·3) had been diagnosed with hypertension, 29·9% of participants (28·6-31·3) received treatment, and 10·3% of participants (9·6-11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Harvard McLennan Family Fund, Alexander von Humboldt Foundation

Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries:A multicountry analysis of survey data

BackgroundCardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.Methods and findingsWe did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p ConclusionIn this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care