The Cerebro-placental Ratio as a Prognostic Factor of Foetal Outcome in Patients with Third Trimester Hypertension

Background: Hypertensive disorders of pregnancy can cause complications in both the maternal and fetal circulations resulting in poor fetal outcome. These circulations can be safely and non-invasively assessed using arterial Doppler indices of the umbilical and middle cerebral arteries to obtain the cerebro-placental ratio. The study objective was to determine the role of the cerebro-placental ratio as a prognostic factor of fetal outcome in patients with hypertensive states of pregnancy delivered at least 32 weeks of gestation by dates.Methods: This was a prospective cohort study undertaken at Kenyatta National Hospital, a tertiary referral hospital in Nairobi. A total of 160 gravid patients of median age 28 years and at least 32 weeks gestations were recruited from labor ward over a 9 month study period by consecutive sampling method. Doppler ultrasound analyses of the foetal umbilical and cerebral arteries were done and the cerebro-placental ratio calculated.Results: At sonography, the average ultrasound age was 31 weeks. The median gestation at admission was 34 weeks. Twenty nine percent had an abnormal Cerebro-placental ratio (<1.0).125/160 (78%) delivered via caesarean section and 35/160(22%) delivered vaginally.51/160(32%)  severe pre-eclamptic toxaemia out of which 39% had cerebroplacental ratio<1.0 109/160(68%) had mild pre-eclamptic toxaemia out of which 24% had cerebroplacental ratio <1.0 Still births were 12.5 times more likely in mothers with cerebroplacental ratio <1.0 than those with CPR 1.0 (p value 0.05). A foetal birth score < 7 was 66 times more often in  mothers with cerebro-placental ratio< 1.0 than mothers with CPR 1.0. (P 0.05). Low birth weight was 4.7 times more likely among mothers with cerebroplacental ratio < 1.0.as compared to those with mothers with CPR1.0 (95% CI 2, 11.1; p0.001). A foetal birth score < 7 was 66 times more likely among neonates delivered vaginally as compared to those born via caesarean section(95% CI 1.3, 23; p=0.02). Still births were 14.5 times more often than among neonates born vaginally as compared to those born via caesarean section (95% CI 3, 84; p0.001). The prognostic Odds Ratio for cerebro-placental ratio was 12.5 for live births (95% CI 2, 74; p=0.005), 66 for fetal birth score <7 (95% Confidence interval 13, 340; p< 0.001) and 4.7 for low birth weight (95% CI 2, 11.1; p< 0.001) and 1.1 (95% CI 0.9, 1.4; p=0.327).Conclusion: Cerebro-placental ratio is significantly predictive of adverse perinatal outcome when used to monitor mothers with hypertensive states of pregnancy. Cerebroplacental ratio.Key words: Cerebro-placental Ratio, Prognostic Factor, Foetal Outcome, Third Trimester, Hypertensio

Fodder Shrubs for Improving Incomes of Dairy Farmers in the East African Highlands

Smallholder dairying is an important enterprise in the highlands of E Africa. Farm sizes average 1-2ha and zero-grazing, cut-and-carry systems predominate. Inadequate protein reduces milk production and forces many farmers to spend scarce cash on commercial dairy meal supplements. In 1991, on-farm trials on fodder shrubs were started in Embu District as a collaborative venture of the Kenya Agricultural Research Institute, the Kenya Forestry Research Institute, and the World Agroforestry Centre. Calliandra calothyrsus was released to farmers in 1995 and was followed by Leucaena trichandra, mulberry (Morus alba), and Sesbania sesban. Farmers produce seedlings of calliandra and trichandra in nurseries; mulberry is planted using cuttings. Farmers plant the shrubs in hedges along field and farm boundaries, on contour bunds, and intercropped with Napier grass. Within 1 year after planting, shrubs are ready to be pruned for feeding livestock. Most farmers cut them at a height of about 1m to ensure that they do not shade the adjacent crops (Franzel et al., 2003)

Planning for Adaptation to Climate Change: Lessons from the US National Wildlife Refuge System

US national wildlife refuges have recent, detailed management plans illustrating the state of planning for climate-change adaptation in protected areas. Discussion of and prescriptions for addressing climate change increased in refuge plans between 2005 and 2010 but decreased in 2011. The plans respond to some climate-change impacts on biodiversity and call for monitoring but with little clarity regarding how to act on monitoring results and scant attention to future changes in phenology and community composition. The threats posed by sea-level rise generated the best-developed plan prescriptions. Examples of excellent prescriptions provide models for future planning. Some decision-support tools, such as vulnerability assessments, will improve future planning as they become more available. However, research better targeted at management information gaps is also needed. Region-level coordination, such as through landscape conservation design, offers opportunities for enlarging conservation footprints and improving information generation and sharing

Technology development and field testing: access to credit to allow smallholder dairy farmers in central Kenya to reallocate concentrates during lactation

A field trial with smallholder dairy farmers in central Kenya was carried out to study the feasibility of reallocating concentrates as a means of increasing the profitability of milk production. Researchers designed the trial with extension officers, dairy co-operative and feed company staff to ensure that all stakeholders and key players were involved. Central to the design was the provision of feed on credit from the dairy co-operative to its members, the volunteer farmers involved in the study. The role of the research team was to present the technology to the farmers and monitor the implementation and impact. Farmers were not constrained in the way they chose to implement the recommendations, but the research team monitored any modifications as well as recording production parameters and characteristics of the farm and feed management systems likely to explain underlying variation. The recommendation was to feed 8 kg/day in early lactation, withdrawing concentrates completely after twelve weeks so that during the course of lactation the amount fed would be equivalent to the most frequent farmer practice, a flat rate of 2 kg/day. Actual quantities offered by most farmers were reported to be higher than in previous lactations, but varied from 2-10 kg/day. Although some decreased the amount offered between 8-12 weeks post lactation most continued with the higher levels until a drop in milk yield was observed. Milk production increased as a result of the intervention with a large part of the variation in milk yield (r2 = 0.55) reflecting the amount of concentrate offered. Month of calving and sampling also influenced the production response For many smallholder dairy farmers one of the key constraints to making technological changes expected to improve production is the lack of credit to allow them to make investments. The results so far available from our study showed that farmers were able to increase their milk yield as a result of the intervention, and that, as expected, the response depended on the level of concentrate offered

Design of continuous circulation sub for gas drilling and the mechanical analysis on the sub body

AbstractGas drilling, as an important part of underbalanced drilling, can increase drilling speed. But in the process of conventional gas drilling, it tends to cause cutting settlement, borehole collapse, sticking and other safety hazards because gas circulation has to be interrupted. Therefore, this paper presents a continuous circulation sub which can be installed and removed easily. With this sub, gas circulation will not be interrupted when drilling tools are connected and removed. This sub is composed of body, main valve, bypass valve and side entry sub. The structure design of its key components (i.e. main and bypass valves) were fulfilled. Based on statics analysis on the sub body, its force situations under extension, torsion and internal pressure were simulated by using the ANSYS finite element analysis software. It is shown that its stress distribution trend is consistent with its elastic–plastic mechanics analysis results. Stress concentrates around the two round holes of the sub body, and the maximum deformation amount is still at the stage of elastic deformation. The analysis results are in line with the elastic–plastic mechanics analysis results, and the requirement of body strength is satisfied. This paper provides a new program to guarantee the drilling safety of extended-reach wells, underbalanced wells and narrow-density window wells

Countrywide roll-out of Xpert(®) MTB/RIF in Swaziland: the first three years of implementation.

SETTING: All 19 public health laboratories in Swaziland that had Xpert(®) MTB/RIF machines installed as part of a countrywide roll-out between June 2011 and June 2014. OBJECTIVE: To evaluate the utilisation and functionality of Xpert from 2011 to mid-2014. DESIGN: Descriptive study of Xpert implementation using routinely collected data. RESULTS: Of 48 829 Xpert tests conducted, 93% were successful: 14% detected Mycobacterium tuberculosis and 12% showed rifampicin resistance. The most common cause of unsuccessful tests was an 'Error' result (62%). Similar findings were obtained in government-supported and partner-supported laboratories. Annual utilisation of Xpert improved from 51% of maximum capacity in 2011 and 2012 to 74% in 2013 and 2014. A monitoring and supervision exercise of all Xpert testing sites in 2014 showed a generally good performance, with over 50% of laboratories achieving a ⩾80% score on most components. However, poor scores were obtained with equipment use and maintenance (6% achieving a score of ⩾80%), internal audit (19% achieving a score of ⩾80%) and process control (25% achieving a score of ⩾80%). CONCLUSION: Countrywide roll-out of Xpert in Swaziland has been successful, although operational issues have been identified and need to be resolved

Development of species diagnostic SNP markers for quality control genotyping in four rice (Oryza L.) species

Species misclassification (misidentification) and handling errors have been frequently reported in various plant species conserved at diverse gene banks, which could restrict use of germplasm for correct purpose. The objectives of the present study were to (i) determine the extent of genotyping error (reproducibility) on DArTseq-based single-nucleotide polymorphisms (SNPs); (ii) determine the proportion of misclassified accessions across 3134 samples representing three African rice species complex (Oryza glaberrima, O. barthii, and O. longistaminata) and an Asian rice (O. sativa), which are conserved at the AfricaRice gene bank; and (iii) develop species- and sub-species (ecotype)-specific diagnostic SNP markers for rapid and low-cost quality control (QC) analysis. Genotyping error estimated from 15 accessions, each replicated from 2 to 16 times, varied from 0.2 to 3.1%, with an overall average of 0.8%. Using a total of 3134 accessions genotyped with 31,739 SNPs, the proportion of misclassified samples was 3.1% (97 of the 3134 accessions). Excluding the 97 misclassified accessions, we identified a total of 332 diagnostic SNPs that clearly discriminated the three indigenous African species complex from Asian rice (156 SNPs), O. longistaminata accessions from both O. barthii and O. glaberrima (131 SNPs), and O. sativa spp. indica from O. sativa spp. japonica (45 SNPs). Using chromosomal position, minor allele frequency, and polymorphic information content as selection criteria, we recommended a subset of 24 to 36 of the 332 diagnostic SNPs for routine QC genotyping, which would be highly useful in determining the genetic identity of each species and correct human errors during routine gene bank operations

Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

BACKGROUND: Preventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts. METHODS: We used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey. RESULTS: Ninety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low. CONCLUSION: Youth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth