Towards a Regional Coastal Zone Management Program in the OECS

The Islands of the Lesser Antilles are described as truly archipelagic, enjoying the characteristic features of both oceanic and coastal islands. Once considered pristine and far removed from the influences of pollution from coastal areas, they are now faced with the realities of their own solid waste problems, resource degradation and over-exploitation, as well as human health impacts from contaminated rivers and coastal areas. Each of these territories can be considered packages of economic, political and cultural networks, attempting to provide for individual and nationwide needs while seeking economic growth and self-sufficiency. If developed properly and used in tandem with sustainable development principles, it is possible that increased use of the coastal zone might be possible without the obvious impacts that this normally implies. The closely linked islands of the Lesser Antilles have shared characteristics that are normally imperceptible such as current driven migrations of the pelagic larvae of some marine species, and similarly the sharing of pollution. This hidden dimension is only now being understood as research is stepped up and more data is provided on intra-regional linkages of marine resources

A multicenter, longitudinal, interventional, double blind randomized clinical trial in hematopoietic cell transplant recipients residing in remote areas: Lessons learned from the late cytomegalovirus prevention trial

AbstractPurposeThe logistics of conducting double-blinded phase III clinical trials with participants residing in remote locations are complex. Here we describe the implementation of an interventional trial for the prevention of late cytomegalovirus (CMV) disease in hematopoietic cell transplantation (HCT) subjects in a long-term follow-up environment.MethodsA total of 184 subjects at risk for late CMV disease surviving 80 days following allogeneic HCT were randomized to receive six months of valganciclovir or placebo. Subjects were followed through day 270 post-transplant at their local physician's office within the United States. Anti-viral treatment interventions were based on CMV DNAemia as measured by polymerase chain reaction (PCR) (>1000 copies/mL) and granulocyte colony stimulating factor (G-CSF) was prescribed for neutropenia (absolute neutrophil count (ANC < 1.0 × 109 cells/L). Blood samples for viral testing and safety monitoring were shipped to a central laboratory by overnight carrier. Real-time communication was established between the coordinating center and study sites, primary care physicians, and study participants to facilitate starting, stopping and dose adjustments of antiviral drugs and G-CSF. The time required to make these interventions was analyzed.ResultsOf the 4169 scheduled blood specimens, 3832 (92%) were received and analyzed; the majority (97%) arriving at the central site within 2 days. Among subjects with positive CMV DNAemia (N = 46), over 50% received open label antiviral medication within one day. The median time to start G-CSF for neutropenia was <1 day after posting of laboratory results (range 0–6; N = 38). Study drug dose adjustments for abnormal renal function were implemented 203 times; within one day for 48% of cases and within 2 days for 80% of cases.ConclusionComplex randomized, double-blind, multicenter interventional trials with treatment decisions made at a central coordinating site can be conducted safely and effectively according to Good Clinical Practice (GCP) guidelines over a large geographic area

1964: Abilene Christian College Bible Lectures - Full Text

LEADERSHIP IN THE CHURCH” Being the Abilene Christian College Annual Bible Lectures 1964 Price: $3.95 Published by ABILENE CHRISTIAN COLLEGE STUDENTS EXCHANGE ACC Station Abilene, Texa