Can guidelines improve referral to elective surgical specialties for adults? A systematic review

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects

Comparative studies on the structure of an upland African stream ecosystem

Upland stream systems have been extensively investigated in Europe, North America and Australasia and many of the central ideas concerning their function are based on these systems. One central paradigm, the river continuum concept is ultimately derived from those North American streams whose catchments remain forested with native vegetation. Streams of the tropics may or may not fit the model. They have been little studied. The Amani Nature Reserve in the East Usambara Mountains of north-eastern Tanzania offers an opportunity to bring these naturally forested systems to the attention of the ecological community. This article describes a comparison made between two lengths of the River Dodwe in this area. The work was carried out by a group of postgraduate students from eighteen European and African countries with advice from five staff members, as part of a course organised by the Tropical Biology Association. Rigorous efforts were made to standardise techniques, in a situation where equipment and laboratory facilities were very basic, through a management structure and deliberate allocation of work to specialists in each area.The article offers a summary of invertebrate communities found in the stream and its biomass. Crabs seem to be the key organism in both sections of the streams

Farmers' Perceptions of, and Preferred Traits in, Rice Varieties in the Coastal Region of Kenya and Their Implications for Breeding

The adoption rate of new rice varieties in the coastal region of Kenya has been negligible, possibly because the farmers’ special preferences are not taken into account during the breeding process. To bridge the gap between breeders and farmers, and to ensure the faster release and widespread adoption of new varieties, participatory research was undertaken in two major rain-fed rice-producing counties (Kwale and Kilifi) in coastal region of Kenya. The objectives were to determine what rice varieties were grown by the farmers and what their trait preferences were. Results showed that, over 90% of farmers grew landraces with preference differing between counties. The landrace Sigaye was preferred in Kilifi county while Kitumbo, Madevu and supa dominated in Kwale county. Preferred traits of new rice varieties were high-yield, short-duration, drought-tolerance, medium height, with white, long, bold grains of good baking quality. The good baking quality trait was found to be a unique requirement in the region, because rice is rarely bred for its baking properties especially in Sub-Saharan Africa. In this study, the role of farmers’ trait preferences were revealed in the adoption decisions when considering a new rice variety for the coastal region of Kenya. Future breeding programmes are encouraged to utilize farmer preferred landraces in their breeding programmes and incorporate farmer desired traits into new rice varieties for the region.departmental bulletin pape

Ambient noise crustal imaging of a heterogeneous rift linkage zone: Turkana Depression, East Africa

SUMMARY: The role of pre-existing lithospheric heterogeneities in rifting processes remains unclear. The Eastern and Main Ethiopian rifts lie within the same geodynamic province and are kinematically connected through the Turkana Depression, but they transect heterogeneous lithosphere: Pan-African accreted terranes, failed Mesozoic-Paleogene rift systems, zones of Eocene–Oligocene flood magmatism. Rifting in these pre-extension heterogeneities offers the opportunity to evaluate their relative importance in Oligo-Miocene to Recent stretching and magmatism. We use 3-D Rayleigh shear-wave speed (Vs) models inverted from ambient noise signals recorded on a temporary seismic network to image heterogeneities in lithospheric structure, and to evaluate their influence on syn-rift faulting and magmatism. Crustal feeder zones for Eocene–Oligocene flood magmatism in southwestern Ethiopia are marked by ≤50 km-wide, 10–15 km-thick mid-lower crustal fast wave speed (Vs ≥ 3.8 km s−1) anomalies that are localized rather than widespread. Evidence for active magma intrusions only occurs beneath aligned chains of Quaternary eruptive centres in Lake Turkana and ≤1 Ma shield volcanoes east of the Turkana rift having localized low Vs (≤3.4 km s−1) at 0–20 km depth. Evidence for widespread lower crustal intrusions, however, is lacking. Pan-African oceanic accreted terranes in southern Ethiopia have high Vs anomalies of 3.6 km s−1 throughout the crust and overlay previously imaged high-wave speed lithospheric mantle that has been interpreted as cold and strong Proterozoic accreted terrane. The integrated strength of this lithospheric-scale pre-existing mechanical heterogeneity resisted Oligocene–Miocene stretching and subsequently contributed to the unusual breadth of this East African rift sector lying north of the Turkana Depression

Rainfed Rice Farming Production Constrains and Prospects, the Kenyan Situation

Kenya experiences huge production-consumption deficit in relation to rice. This is due to changing eating habits that has adopted more rice in the menu and rapidly rising population. Rice production has remained low being unable to meet consumption. Rice ecosystems in Kenya include irrigated, rainfed lowland and rainfed upland. Irrigated ecosystem has over the years been given more emphasis despite rainfed rice farming having double the potential over irrigation system. Ecologically rice grows well in abundant water supply, warm to high temperatures and in Clay sandy to loamy soils with slightly acidic to neutral pH. Rice varieties grown in Kenya are mainly traditional, introduced improved, hybrids and landraces. Rainfed rice farming faces constraint’s key among them being; drought and erratic rainfall, weeds, pest and diseases, cheap imports, land ownership and poor infrastructure. Mitigating against drought and erratic rainfall, improving farm inputs and equipment, increasing germplasm production and distribution, credit support and marketing to farmers, improving farmers skills through technological transfers and infrastructural development are prospects that if adopted could increase rainfed rice productivity. More attention towards improvement of rainfed rice farming could greatly contribute to bridging the production-consumption deficit that is bridged through imports. It is with this, that this review updates our understanding of rain fed rice farming in Kenya in terms of ecological conditions, ecological systems, varieties, constraints and prospects

Body-wave tomographic imaging of the Turkana Depression: Implications for rift development and plume-lithosphere interactions

The Turkana Depression, a topographically-subdued, broadly-rifted zone between the elevated East African and Ethiopian plateaus, disrupts the N–S, fault-bounded rift basin morphology that characterizes most of the East African Rift. The unusual breadth of the Turkana Depression leaves unanswered questions about the initiation and evolution of rifting between the Main Ethiopian and Eastern rifts. Hypotheses explaining the unusually broad, low-lying area include superposed Mesozoic and Cenozoic rifting and a lack of mantle lithospheric thinning and dynamic support. To address these issues, we have carried out the first body-wave tomographic study of the Depression’s upper mantle. Seismically-derived temperatures at 100 km depth exceed petrological estimates, suggesting the presence of mantle melt, although not as voluminous as the Main Ethiopian Rift, contributes to velocity anomalies. A NW–SE-trending high wavespeed band in southern Ethiopia at urn:x-wiley:15252027:media:ggge22580:ggge22580-math-0001200 km depth is interpreted as refractory Proterozoic lithosphere which has likely influenced the localization of both Mesozoic and Cenozoic rifting. At urn:x-wiley:15252027:media:ggge22580:ggge22580-math-0002100 km depth below the central Depression, a single localized low wavespeed zone is lacking. Only in the northernmost Eastern Rift and southern Lake Turkana is there evidence for focused low wavespeeds resembling the Main Ethiopian Rift, that bifurcate below the Depression and broaden approaching southern Ethiopia further north. These low wavespeeds may be attributed to melt-intruded mantle lithosphere or ponded asthenospheric material below lithospheric thin-spots induced by the region's multiple rifting phases. Low wavespeeds persist to the mantle transition zone suggesting the Depression may not lack mantle dynamic support in comparison to the two plateaus

Genomics for public health and international surveillance of antimicrobial resistance.

Historically, epidemiological investigation and surveillance for bacterial antimicrobial resistance (AMR) has relied on low-resolution isolate-based phenotypic analyses undertaken at local and national reference laboratories. Genomic sequencing has the potential to provide a far more high-resolution picture of AMR evolution and transmission, and is already beginning to revolutionise how public health surveillance networks monitor and tackle bacterial AMR. However, the routine integration of genomics in surveillance pipelines still has considerable barriers to overcome. In 2022, a workshop series and online consultation brought together international experts in AMR and pathogen genomics to assess the status of genomic applications for AMR surveillance in a range of settings. Here we focus on discussions around the use of genomics for public health and international AMR surveillance, noting the potential advantages of, and barriers to, implementation, and proposing recommendations from the working group to help to drive the adoption of genomics in public health AMR surveillance. These recommendations include the need to build capacity for genome sequencing and analysis, harmonising and standardising surveillance systems, developing equitable data sharing and governance frameworks, and strengthening interactions and relationships among stakeholders at multiple levels