Competitive Strategy through Innovative Partnerships at the Regional Level: The Case of Tomatoes and Soybean Value Chains in Northern Togo.

Agricultural intensification is widely seen as a condition sine-qua-non for overall economic growth and food security in sub-Saharan Africa (SSA). Though attention is shifting from technology development to more market-oriented approaches, the best examples of agricultural intensification seem to happen relatively independent of interventions from the development circuit. This paper argues that agricultural intensification and market development may be stimulated through grassroots and regional-level efforts when care is taken not to substitute for responsibilities that belong to farmers, traders, and other stakeholders themselves. An approach is required that carefully addresses the factors influencing the competitiveness of agricultural enterprises. A major role of facilitating institutions may be to develop efficient relationships between farmers - and their complex multi-purpose farming systems and traders and processors - engaged in commodity specific trade and processing market segments. Finally, competitiveness is not something to win for today it crucially depends on innovation and continuous learning. The paper present cases from Northern Togo, where effective linkages have been established between farmers, traders, processors and rural bankers and NGOs. The paper concentrate on three cases: tomato production and marketing, soy bean processing, and the development of credit structures and interlocked contracts for input provisioning. The article is based on qualitative data interviews with the major stakeholders, and accounts in progress reports from the NGOs and farmer organizations. In conclusion, it gives some observations on the major lessons learnt, and the contribution that social scientists can make to strengthen dialogue between theory and practice.Agribusiness,

USAID TARGET project on fertilizer micro-dosing for the prosperity of small-scale farmers in the Sahel: Training Workshop on Large-scale Transfer (scaling-up) of Fertilizer Micro-dosing Technology, 20-24 January 2004, Ouahigouya, Burkina Faso

The USAID TARGET project on fertilizer micro-dosing for the prosperity of small-scale farmers in the Sahel was launched in three countries of West Africa, namely Burkina Faso, Mali and Niger. The goal of the project is to double the crop production and increase the farm incomes through the uptake of fertilizer micro-dosing technology and better farmer-based cooperative organizations. In all the three countries where the technology is being promoted, yields of sorghum and millet increased twofold in most cases, and the farmers have reported increase in incomes. To achieve the overall objective of the project, proven fertilizer micro-dosing technologies together with the "warrafitage " or inventory credit system should be transferred to a large number of end users in areas targeted by the project. It is essential to build the capacity of project partners. In this context, a workshop on "large-scale transfer of fertilizer micro-dosing technologies" was organized in Ouahigouya, Burkina Faso, from 20 to 23 January 2004. The training workshop provided the participants with tools that will enable them develop action plans for scaling up existing gains. A total of 19 participants from the national agricultural research systems, NGOs, IFDC and ICRISAT attended the workshop

Prediction of Ischemic Events after Percutaneous Coronary Intervention: Thrombelastography Profiles and Factor XIIIa Activity

Background: High plasma fibrin clot strength (MA) measured by thrombelastography (TEG) is associated with increased risk of cardiac events after percutaneous coronary interventions (PCIs). Factor XIIIa (FXIIIa) cross-links soluble fibrin, shortens clot formation time (TEG-K), and increases final clot strength (MA). Methods: We analyzed platelet-poor plasma from patients with previous PCI. Kaolin-activated TEG (R, K, MA) in citrate platelet-poor plasma and FXIIIa were measured (n = 257). Combined primary endpoint was defined as recurrent myocardial infarction (MI) or cardiovascular death (CVD). Relationship of FXIIIa and TEG measurements on cardiac risk was explored. Results: FXIIIa correlated with TEG-MA (p = 0.002) and inversely with TEG-K (p < 0.001). High MA (≥35.35 mm; p = 0.001), low K (<1.15 min; p = 0.038), and elevated FXIIIa (≥83.51%; p = 0.011) were associated with increased risk of CVD or MI. Inclusion of FXIIIa activity and low TEG-K in risk scores did not improve risk prediction as compared with high TEG-MA alone. Conclusion: FXIIIa is associated with higher plasma TEG-MA and low TEG-K. High FXIIIa activity is associated with a modest increase in cardiovascular risk after PCI, but is less sensitive and specific than TEG-MA. Addition of FXIIIa does not provide additional risk stratification beyond risk associated with high fibrin clot strength phenotype measured by TEG

Evolving treatment of necrotizing pancreatitis

Background Over the past decade, the treatment of necrotizing pancreatitis (NP) has incorporated greater use of minimally invasive techniques, including percutaneous drainage and endoscopic debridement. No study has yet compared outcomes of patients treated with all available techniques. We sought to evaluate the evolution of NP treatment at our high volume pancreas center. We hypothesized that minimally invasive techniques (medical only, percutaneous, and endoscopic) were used more frequently in later years. Methods Treatment strategy of NP patients at a single academic medical center between 2005 and 2014 was reviewed. Definitive management of pancreatic necrosis was categorized as: 1) medical treatment only; 2) surgical only; 3) percutaneous (interventional radiology – IR) only; 4) endoscopic only; and 5) combination (Surgery ± IR ± Endoscopy). Results 526 NP patients included biliary (45%), alcoholic (17%), and idiopathic (20%) etiology. Select patients were managed exclusively by medical, IR, or endoscopic treatment; use of these therapies remained relatively consistent over time. A combination of therapies was used in about 30% of patients. Over time, the percentage of NP patients managed without operation increased from 28% to 41%. 247 (47%) of patients had operation as the only NP treatment; an additional 143 (27%) required surgery as part of a multidisciplinary management. Conclusion Select NP patients may be managed exclusively by medical, IR, or endoscopic treatment. Combination treatment is necessary in many NP patients, and surgical treatment continues to play an important role in the definitive therapy of necrotizing pancreatitis patients

High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?

Background Necrotizing pancreatitis (NP) is a complex and heterogeneous disease with a protracted disease course. Hospital readmission is extremely common; however, few data exist regarding the cause of readmission in NP. Methods A retrospective review of NP patients treated between 2005 and 2017 identified patients readmitted both locally and to our hospital. All patients with unplanned hospital readmissions were evaluated to determine the cause for readmission. Clinical and demographic factors of all patients were recorded. As appropriate, two independent group t tests and Pearson’s correlation or Fisher’s exact tests were performed to analyze the relationship between index admission clinical factors and readmission. p values of < 0.05 were accepted as statistically significant. Results Six hundred one NP patients were reviewed. Median age was 52 years (13–96). Median index admission length of stay was 19 days (2–176). The most common etiology was biliary (49.9%) followed by alcohol (20.0%). Unplanned readmission occurred in 432 patients (72%) accounting for a total of 971 unique readmissions (mean readmissions/patient, 2.3). The most common readmission indications were symptomatic necrosis requiring supportive care and/or intervention (31.2%), infected necrosis requiring antibiotics and/or intervention (26.6%), failure to thrive (9.7%), and non-necrosis infection (6.6%). Patients requiring readmission had increased incidence of index admission renal failure (21.3% vs. 14.2%, p = 0.05) and cardiovascular failure (12.5% vs. 4.7%, p = 0.01). Discussion Readmission in NP is extremely common. Significant portions of readmissions are a result of the disease natural history; however, a percentage of readmissions appear to be preventable. Patients with organ failure are at increased risk for unplanned readmission and will benefit from close follow-up