The influence of body mass index on sensorimotor block and vasopressor requirement during spinal anaesthesia for elective caesarean section

Background: It has been suggested that the dose requirement for spinal anesthesia (SA) is lower in obese patients for cesarean delivery. In this prospective, observational, non-inferiority study we tested the hypothesis that obesity would not have a clinically important effect on vasopressor requirements or block height. Methods: Two groups of 25 parturients, Group O (BMI >40 kg/m²) and Group N (BMI <32 kg/m²) requiring elective cesarean delivery were recruited. All patients received 10 mg intrathecal hyperbaric bupivacaine co-administered with 10 μg fentanyl. Dermatomal levels were assessed at 5 and 25 minutes after SA, and at completion of surgery, using light touch and cold sensation in response to ethyl chloride. The primary outcomes were phenylephrine requirement in the first thirty minutes following spinal anesthesia, and maximum block height, measured by the sensation of touch and cold. Secondary outcomes were total phenylephrine dose required, changes in hand grip strength, and peak flow rate. Results: There were no significant between-group differences in median block height as assessed by touch at 5 or 25 minutes, or by temperature at 5 minutes. At 25 minutes, there was a two-dermatome difference in median block height for loss of temperature sensation between Group O and Group N (T2 vs. T4, 95% confidence interval (CI) of the difference in medians 0-2 dermatomes). No blocks extended to cervical dermatomes. The median (range) phenylephrine dose for the first 30 minutes was 150 μg (0-900 μg), and 100 μg (0-1250 μg) in Group N and O respectively. The 95% CI for the difference between the two median doses was -150 μg to 100 μg. There were no differences in median percentage reductions in peak flow rate or median hand grip strength after SA. Mean surgical time was longer in Group O than in Group N (49.1 vs 39.4 minutes, 95% CI difference 1.7 to 17.7 minutes). The mean time for recovery of touch sensation to T10 was longer in Group O (152 vs 132 minutes, 95% CI difference 3.8 to 36.2 minutes). No analgesic supplementation was required. Conclusion: Only a minor increase block height as assessed by temperature occurred in Group O at 25 minutes. Vasopressor requirements during the first 30 min of SA were equivalent. Time for regression of SA block level was longer in the Group O, which may be beneficial considering the longer surgical time. A dose of spinal bupivacaine 10 mg for single-shot SA should not be reduced in morbidly obese parturients

The role of partnerships in agricultural extension service delivery: a study conducted in provincial departments of agriculture in South Africa

There are different role players in the provision and support of extension in South Africa and the main one is the Government. This study seeks to report on the perceptions of advisors with regards to the role of partnerships in South African extension and advisory services. The study targeted a population of approximately 3 369 extension practitioners in South Africa from different occupational positions which included agricultural advisors, agricultural technicians, agricultural development technicians, senior advisors, and subject matter specialists. The findings indicate that partnerships are important in extension and advisory services. It can generally improve the provision of extension and advisory services in the sector. Provinces were differing in their state of awareness about partnerships, but when it comes to the usefulness of partnerships 50% of the respondents, agreed that partnership was important. Respondents identified six factors that are perceived to be critical for partnerships, namely capacity building, networking and learning, technical support, financial assistance, research, and new technology. Furthermore, three main strategies were identified to promote partnerships which include the use of formal agreements with partnerships, conducting needs analysis, and using invitation. The majority of respondents (72%) noted that the Free State Province was of the opinion that commodity organisations are very helpful in partnerships. The paper concludes with a recommendation of developing terms of reference (TOR) or operational guidelines for operationalising partnerships as well as the keeping of records to harmonise their contributions and reduction of possible duplications of service provision.Keywords: Partnership, Extension and Advisory Service

Factors Influencing Effective Use of Epicor Accounting System in Local Government Authorities: The Case of Kasulu Town Council.

Local Government Authorities (LGAs) in Tanzania are currently experiencing low performance in financial management despite adoption of computerised financial management system, Epicor. It appears Epicor is not effectively utilised. This study therefore explores the factors that influence the effective use of Epicor in LGAs. This study had three objectives; to examine the extent to which Epicor used in LGA’s financial activities; to identify factors influencing the effective use of Epicor in Local Government Authorities; and to determine the association between the use of Epicor and effectiveness of LGAs. The study was conducted in Kigoma region, Kisulu Town Council as a case study. This research was underpinned on interpretivism philosophy guided by cross-sectional design. A sample size of 100 respondents was used in data collection survey. Questionnaire was adopted as data collection tool. Quantitative analysis of the findings revealed that, Epicor was mostly used in executing high quality services (4.1), preparing financial report on a timely basis (3.8), audit management (3.6), preparing LGAs budget (3.6), and in the delivery of public service (3.5), where it maximized transparency. Results also indicated that, factors influencing effective use of Epicor system were mainly classified in three categories namely extent of usage of Epicor modules, acquisition of skills, and level of attitude. Further, findings yielded that, there is significant relationship between level of Epicor usage and performance of LGAs. Effective use of Epicor has significant (p<.05) powerful effect on performance of LGAs as it explained 80.4% of the model variation. Furthermore, policy framework needs to be strengthened to support effective use of Epicor. Keywords: Epicor Accounting System, Financial Performance and Staff Capacit

Pharmacology of Local Anaesthetics and Commonly Used Recipes in Clinical Practice

Local anaesthetics are commonly used drugs in clinical anaesthesia. The knowledge of their pharmacology is paramount for safe and optimal use of this group of drugs. This chapter consists of two sections. The first section will address the chemical and physical properties, pharmacokinetics and pharmacodynamics of the local anaesthetics. In the second section, examples of the commonly used doses and additives used for various peripheral and regional anaesthetics will be discussed. We will also address the treatment of toxicity as a result of inadvertent intravascular injection of the local anaesthetics

Community-based natural resource use and management of Bigodi Wetland Sanctuary, Uganda, for livelihood benefits

publisher versionConservation and sustainable management of wetlands requires participation of local stakeholders, including communities. The Bigodi Wetland is unusual because it is situated in a common property landscape but the local community has been running a successful community-based natural resource management programme (CBNRM) for the wetland for over a decade. Whilst external visitors to the wetland provide ecotourism revenues we sought to quantify community benefits through the use of wetland goods such as firewood, plant fibres, and the like, and costs associated with wild animals damaging farming activities. We interviewed 68 households living close to the wetland and valued their cash and non-cash incomes from farming and collection of non-timber forest products (NTFPs) and water. The majority of households collected a wide variety of plant and fish resources and water from the wetland for household use and livestock. Overall, 53% of total household cash and non-cash income was from collected products, mostly the wetland, 28% from arable agriculture, 12% from livestock and 7% from employment and cash transfers. Female-headed households had lower incomes than male-headed ones, and with a greater reliance on NTFPs. Annual losses due to wildlife damage were estimated at 4.2% of total gross income. Most respondents felt that the wetland was important for their livelihoods, with more than 80% identifying health, education, craft materials and firewood as key benefits. Ninety-five percent felt that the wetland was in a good condition and that most residents observed the agreed CBNRM rules regarding use of the wetland. This study confirms the success of the locally run CBNRM processes underlying the significant role that the wetland plays in local livelihoods

The role of learning networks in agricultural extension service delivery: a survey in the nine provinces of South Africa

This paper seeks to present the findings of a study based on learning networks conducted in nine provinces of South Africa during 2013. The aim of the study was to establish to what extent this tool is known or used in the provinces of South Africa. The information was important in order to assist decision makers in future planning to strengthen extension and advisory services. Both qualitative and quantitative paradigm were used to investigate the perceptions of the extensionists with regards to networks, the size of such networks in South Africa, and whether they are known or used by the extension advisors. The quota system was used to extract 10% from the total population of 3 368 which resulted in a sample of 315 extensionists. Data were collected through 315 questionnaires which were later captured and processed through SPSS, version 21. The results showed that: 34% of the respondents were above 20 years of work experience, 56 % were males who dominated the services, and 48 % of respondents were advisors as opposed to other professionals. Northern Cape was the only province which had the majority of advisors that show awareness and used Learning Networks. The study concludes by indicating positive aspects of personal learning networks such as a need for proper guidance and to increase the use of it due to its inherent potential in order to improve service delivery in future.Keywords: Learning networks, Service delivery, Agricultural extensio

Drought preparedness, impact and response: A case of the Eastern Cape and Free State provinces of South Africa

Drought is a major disaster in South Africa in terms of total economic loss and number of people affected. This study investigated and analysed the preparedness, impact of and response by the farming community to the 2007/2008 drought using the Eastern Cape and Free State provinces of South Africa as case studies. Both qualitative and quantitative approaches were used in this study. Primary data were collected through face-to-face interviews with sampled recipients of the 2007/2008 drought relief scheme. These were analysed using MedCalc® software and various statistical tests and correlations were performed to test for statistical differences on key variables. Major findings of this study included inadequacy of the extension support service, particularly as a vehicle for disseminating early-warning information. The most significant impact was livestock losses, and t-test results supported the hypothesis that there was a significant difference in terms of drought impact for the three categories of farmers (i.e. small, medium and large scale), particularly with regard to the proportion of livestock lost. A Logit analysis showed that the decision to reduce livestock during drought was influenced by access to land and race. The main constraint to the drought relief scheme, as perceived by the respondents, was the turnaround time − they felt that the relief was provided long after the disaster had occurred

UNDERSTANDING GOVERNANCE, ICT AND ORGANISATION SUSTAINABILITY: PERSPECTIVES FROM DONOR FUNDED SMALL AND MEDIUM ENTERPRISES (SMES) IN UGANDA.

UNDERSTANDING GOVERNANCE, ICT AND ORGANISATION SUSTAINABILITY: PERSPECTIVES FROM DONOR FUNDED SMALL AND MEDIUM ENTERPRISES (SMES) IN UGANDA