Five Years Experience of Ureterovaginal Fistulae Following Obstetric or Gynecological Intervention in Ethiopia

Objectives: To study the etiology, presentation and outcome of women presenting to the Addis Ababa Fistula Hospital with an ureterovaginal fistula.Patients and Methods: Women presenting with ureterovaginal fistulae following obstetric or gynecological intervention. The operating register from June 2004 to July 2009 was studied to identify women who had undergone ureteric re-implantation. Patient files were reviewed and onlywomen with fistulae resulting from iatrogenic injury were included.Results: Ureterovaginal fistulae were found in 89 women, 64 after Caesarean section, of which 43 were for a stillborn baby, 12 women have uterine rupture, 6 with instrumental delivery and only 7 with abdominal hysterectomy. The left ureter was most frequently injured (54). The number of patients seen has doubled over the past two years. Using one of four methods of repair, 88 women were continent at discharge from hospital. One died from a suspected pulmonary embolism.Conclusion: The incidence of iatrogenic ureteric injury is increasing in Ethiopia and most result from Caesarean section. The reasons should be studied. Using a variety of repair techniques, all patients can be cured. However, surgeons undertaking this surgery should have a wide range of urological training.Key Words : Ureter, vagina, fistula, latrogenic, caesarean section, hysterectomy, complicatio

Pastoralists do plan! Community-led land use planning in the pastoral areas of Ethiopia

This paper consolidates a set of case studies which document how pastoralists plan land and resource use in pastoral and agro-pastoral areas of Ethiopia. These case studies are drawn from the regional states of Afar, Somali, Southern Nations, Nationalities, and Peoples (SNNP), Oromia, and Gambella. They describe not only why, how, and when pastoralists plan, but also the management and governance structures that control planning processes and the later implementation of the plans. By doing this, the paper provides guidance on how best such planning processes can be supported, and how they can be integrated with and/or built on by other planning processes such as those led by government

Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator

Background: Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. Methods and Results: Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. Conclusions: ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component

Global governance approaches to addressing illegal logging: Uptake and lessons learned

One of the most challenging tasks facing development agencies, trade ministries, environmental groups, social activists and forest-focused business interests seeking to ameliorate illegal logging and related timber trade is to identify and nurture promising global governance interventions capable of helping improve compliance to governmental policies and laws at national, subnational and local levels. This question is especially acute for developing countries constrained by capacity challenges and “weak states” (Risse, 2011). This chapter seeks to shed light on this task by asking four related questions: How do we understand the emergence of illegal logging as a matter of global interest? What are the types of global interventions designed to improve domestic legal compliance? How have individual states responded to these global efforts? What are the prospects for future impacts and evolution? We proceed in the following steps. Following this introduction, step two reviews how the problem of “illegal logging” emerged on the international agenda. Step three reviews leading policy interventions that resulted from this policy framing. Step four reviews developments in selected countries/regions around the world according to their place on the global forest products supply chain: consumers (United States, Europe and Australia); middle of supply chain manufacturers (China and South Korea) and producers (Russia; Indonesia; Brazil and Peru; Ghana, Cameroon and the Republic of Congo). We conclude by reflecting on key trends that emerge from this review relevant for understanding the conditions through which legality might make a difference in addressing critical challenges

CAD Model and Visual Assisted Control System for NIF Target Area Positioners

The National Ignition Facility (NIF) target chamber contains precision motion control systems that reach up to 6 meters into the target chamber for handling targets and diagnostics. Systems include the target positioner, an alignment sensor, and diagnostic manipulators (collectively called positioners). Target chamber shot experiments require a variety of positioner arrangements near the chamber center to be aligned to an accuracy of 10 micrometers. Positioners are some of the largest devices in NIF, and they require careful monitoring and control in 3 dimensions to prevent interferences. The Integrated Computer Control System provides efficient and flexible multi-positioner controls. This is accomplished through advanced video-control integration incorporating remote position sensing and realtime analysis of a CAD model of target chamber devices. The control system design, the method used to integrate existing mechanical CAD models, and the offline test laboratory used to verify proper operation of the control system are described

Reactions of pyrrole, imidazole, and pyrazole with ozone:Kinetics and mechanisms

Five-membered nitrogen-containing heterocyclic compounds (azoles) belong to potential moieties in complex structures where transformations during ozonation can occur. This study focused on the azole-ozone chemistry of pyrrole, imidazole, and pyrazole as model compounds. Reaction kinetics and ozonation products were determined by kinetic and analytical methods including NMR, LC-HRMS/MS, HPLC-UV, and IC-MS. Analyses of reactive oxygen species (O-1(2), & x2d9;OH, H2O2), quantum chemical computations (Gibbs energies), and kinetic simulations were used to further support the proposed reaction mechanisms. The species-specific second-order rate constants for the reactions of ozone with pyrrole and imidazole were (1.4 +/- 1.1) x 10(6) M-1 s(-1) and (2.3 +/- 0.1) x 10(5) M-1 s(-1), respectively. Pyrazole reacted more slowly with ozone at pH 7 (k(app) = (5.6 +/- 0.9) x 10(1) M-1 s(-1)). Maleimide was an identified product of pyrrole with a 34% yield. Together with other products, formate, formamide, and glyoxal, C and N mass balances of similar to 50% were achieved. Imidazole reacted with ozone to cyanate, formamide, and formate (similar to 100% yields per transformed imidazole, respectively) with a closed mass balance. For pyrazole, a high ozone : pyrazole molar stoichiometry of 4.6 was found, suggesting that the transformation products contributed to the over-stoichiometric consumption of ozone (e.g., hydroxypyrazoles). Glyoxal and formate were the only identified transformation products (C mass balance of 65%). Overall, the identified major products are suspected to hydrolyze and/or be biodegraded and thereby abated by a biological post-treatment typically following ozonation. However, as substructures of more complex compounds (e.g., micropollutants), they might be more persistent during biological post-treatment

Visualization of membrane loss during the shrinkage of giant vesicles under electropulsation

We study the effect of permeabilizing electric fields applied to two different types of giant unilamellar vesicles, the first formed from EggPC lipids and the second formed from DOPC lipids. Experiments on vesicles of both lipid types show a decrease in vesicle radius which is interpreted as being due to lipid loss during the permeabilization process. We show that the decrease in size can be qualitatively explained as a loss of lipid area which is proportional to the area of the vesicle which is permeabilized. Three possible mechanisms responsible for lipid loss were directly observed: pore formation, vesicle formation and tubule formation.Comment: Final published versio

Projected Number of People With Onchocerciasis-Loiasis Coinfection in Africa, 1995 to 2025

BACKGROUND: Onchocerciasis elimination through mass drug administration (MDA) is hampered by coendemicity of Loa loa, as people with high L. loa microfilariae (mf) density can develop serious adverse events (SAEs) after ivermectin treatment. We assessed the geographical overlap of onchocerciasis and loiasis prevalence and estimated the number of coinfected individuals at risk of post-ivermectin SAEs in West and Central Africa from 1995 to 2025. METHODS: Focusing on regions with suspected loiasis transmission in 14 countries, we overlaid precontrol maps of loiasis and onchocerciasis prevalence to calculate precontrol prevalence of coinfection by 5 km2 × 5 km2 pixel, distinguishing different categories of L. loa mf intensity. Using statistical and mathematical models, we predicted prevalence of both infections and coinfection for 2015 and 2025, accounting for the impact of MDA with ivermectin. RESULTS: The number of people infected with onchocerciasis was predicted to decline from almost 19 million in 1995 to 4 million in 2025. Of these, 137 000 people were estimated to also have L. loa hypermicrofilaremia (≥20 000 L. loa mf/mL) in 1995, declining to 31 000 in 2025. In 2025, 92.8% of coinfecte