Suchergebnisse

Abstract
ContextSeabirds were the most common taxa captured alive as part of the oiled wildlife response to the grounding of the container vessel MV Rena in the Bay of Plenty, New Zealand.
AimsTo describe the management of seabirds during the spill response, to outline the common problems encountered and to make recommendations for future responses.
MethodsSeabirds were collected from 7 October 2011 to 14 January 2012. They were stabilised and underwent pretreatment, washing and rinsing procedures to remove oil, followed by swimming physiotherapy to restore waterproofing and long-term housing in outdoor aviaries. The birds were released in batches close to the original sites of capture once the wild habitat was cleaned.
Key results428 live seabirds were admitted. There were two temporal peaks in admissions associated with the ship grounding and when the ship broke up. The majority of live birds were little penguins (Eudyptula minor; 394/428, 92%). Most seabirds admitted (393/428, 91.8%) were contaminated with heavy fuel oil, with the remainder (35/428, 8.2%) found unoiled but starving and/or exhausted or with injuries. Little penguins had lower mortality during rehabilitation (28/394, 7.1%) than other seabird species combined (27/34, 79.4%). Seabirds in poorer body condition on arrival had higher mortality, and unoiled birds were also more likely to die than oiled birds. In oiled little penguins, the degree of oiling on the plumage ranged from 1 to 100%, but mortality was not significantly associated with the degree of oiling (P=0.887). Pododermatitis affected 66% of little penguins. The most common causes of death (n=45) included weakness, anaemia and hypothermia in oiled seabirds (16/45, 35.6%), and starvation and weakness in unoiled seabirds (14/45, 31.1%).
ConclusionsTotal survival to release was 87.1%, primarily influenced by the species involved and the body condition of the birds on arrival. Unoiled seabirds had higher mortality rates than oiled seabirds.
ImplicationsOiled wildlife can be rehabilitated with good success, even when heavily oiled, or to a lesser extent, when found in poor body condition. More work is needed to refine species-specific rehabilitation protocols for seabirds, especially for those being admitted in emaciated body condition.

Context The risk of secondary poisoning to native fauna during pest control operations is an issue of global concern. In New Zealand, non-target impacts during sodium fluoroacetate (1080) operations are particularly contentious. 1080 is used extensively for pest control for conservation, bovine tuberculosis control, and in plantation forestry for seedling protection from herbivores. The endemic New Zealand falcon (Falco novaeseelandiae) breeds in Kaingaroa forest, an intensively managed pine plantation where regular 1080 poison operations are conducted; however, causes of mortality and risks of secondary poisoning by 1080 are not well documented. Aims We aimed to investigate mortality and survival of adult falcons with an emphasis on assessing the possible role of 1080 poisoning in annual mortality. Methods Using radio-telemetry and visual observations, we monitored 37 marked adult falcons before and after 1080 operations in 2013–14 (16 through carrot-bait and 21 through cereal-bait operations) and assessed mortality causes through post-mortem examinations. Using Program MARK, the annual survival rates for adults and independent juveniles were estimated from long-term banding data (2003–2014). Key results Survival of falcons was high through both cereal-bait (21/21) and carrot-bait (15/16) 1080 operations (overall 95% CI for survival = 84–100%). The exception was a radio-tagged male that died of unknown causes within a fortnight of an operation and tested negative for 1080 residues. Three falcons were depredated by introduced mammals. One falcon was found dead in an emaciated condition but evidently died from head injury through Australasian magpie (Cracticus tibicen) attack. The annual survival rate of falcons estimated from long-term banding was 80 ± 6.0% (mean ± s.e.) for adults and 29 ± 0.1% for juveniles. Conclusions No adult falcon death was attributable to 1080 poisoning in this study. Identifiable mortalities were attributable to depredation by introduced mammals and an injury from an Australasian magpie. The annual survival rate of Kaingaroa falcons was comparable to those of other raptor species worldwide. Implications The risk to adult falcons from 1080 secondary poisoning is likely low. Whether this is also true for juveniles requires further study.

Maternal and infant mortality rates are among the indicators present in the MDG's. In 2015 the Surabaya City Government seeks to reduce maternal mortality. Kalirungkut Puskesmas was one of puskesmas which become pilot project in one of pillar that was referral system. The purpose of this research was to arrange operational planning of referral as an effort to decrease maternal mortality in Kalirungkut Puskesmas. Methods of data retrieval was done by semi-open interview with indepth interview to midwives and cadre. Indepth interviews were conducted using structured interview guidelines. The results showed that the alternative problem solving for the priority of pregnant women problem referred to using taxi, among others: 1) the addition of emergency ambulance unit at Kalirungkut Puskesmas. 2) BPM and RB have Private Ambulances. 3) BPM, RB, Puskesmas and Hospital cooperate related to ambulance facilities. 4) The solution chosen to solve the problems of pregnant women, mothers, postpartum and babies in emergencies referred to by taxi was to cooperate with hospitals and some local health centers related to ambulance transportation facilities. Keywords : Delivery, Maternal Mortality, Plan of Action. ABSTRAK Angka kematian ibu dan dan bayi merupakan salah satu indikator yang ada dalam MDG's. Pada tahun 2015 ini Pemerintah Kota Surabaya berupaya untuk menurunkan angka kematian ibu. Puskesmas Kalirungkut merupakan salah satu puskesmas yang dijadikan pilot project dalam salah satu pilar yaitu sistem rujukan. Tujuan penelitian ini untuk menyusun perencanaan operasional rujukan terencana sebagai upaya penurunan kematian ibu di Puskesmas Kalirungkut. Metode pengambilan data dilakukan dengan cara wawancara semi terbuka dengan indepth interview kepada bidan dan kader. Indepth interview dilakukan dengan menggunakan pedoman wawancara terstruktur. Hasil penelitian menunjukkan bahwa alternatif pemecahan masalah untuk prioritas masalah ibu hamil dirujuk menggunakan taxi antara lain: 1)penambahan unit ambulan gawat darurat di puskesmas Kalirungkut. 2)BPM dan RB memiliki Ambulan Pribadi. 3)BPM, RB, Puskesmas dan Rumah Sakit bekerjasama terkait sarana ambulan. 4)Solusi yang dipilih untuk menyelesaikan masalah ibu hamil, ibu bersalin, ibu nifas dan bayi dalam keadaan darurat dirujuk menggunakan taxi adalah bekerjasama dengan rumah sakit dan beberapa puskesmas terdekat terkait sarana transportasi ambulan. Kata kunci : Rujukan Persalinan, Kematian Ibu, Plan of Action.

Solwayo Ngwenya1–3 1Department of Obstetrics & Gynaecology, Mpilo Central Hospital, 2Department of Obstetrics & Gynaecology, Royal Women's Clinic, 3National University of Science and Technology, Medical School, Bulawayo, Matabeleland, Zimbabwe Background: Severe preeclampsia is a disorder of pregnancy characterized by high blood pressure and significant proteinuria after 20 weeks gestation. Severe preeclampsia and eclampsia have considerable adverse impacts on maternal, fetal, and neonatal health especially in low-resource countries. Hypertensive disorders of pregnancy are the third leading cause of maternal deaths in Sub-Saharan Africa. Significant avoidable maternal and neonatal morbidity and mortality may result.Objectives: This study aimed 1) to determine the incidence of severe preeclampsia/eclampsia in a low-resource setting; 2) to determine the maternal complications of severe preeclampsia/eclampsia in a low-resource setting; 3) to determine the perinatal outcomes of severe preeclampsia/eclampsia in a low-resource setting.Methods: This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the birth registers in labor ward, intensive care unit, and neonatal intensive care unit of patients who had a diagnosis of severe preeclampsia or eclampsia for the period January 1, 2016, to December 31, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered.Results: There were 9,086 deliveries at the institution during the period January 1, 2016, to December 31, 2016. There were 121 cases of severe preeclampsia/eclampsia. The incidence of severe preeclampsia/eclampsia was 1.3% at Mpilo Central Hospital. The most common major complication was HELLP syndrome (9.1%). Maternal mortality was 1.7%. There were 127 babies born with six sets of twins, 49.6% of the babies were lost through stillbirths and early neonatal deaths.Conclusion: The incidence of severe preeclampsia/eclampsia at Mpilo Central Hospital was 1.3%. The most common maternal complication was hemolysis elevated liver enzymes low platelet syndrome. Maternal mortality was 1.7% due to acute renal failure. Nearly half (49.6%) of the babies born were lost to stillbirths and early neonatal deaths. Keywords: severe preeclampsia, eclampsia, mortality, morbidity, perinatal outcomes, low-resource settings, Mpilo Central Hospital

1. Plant quality (bottom-up effects) and natural enemies (top-down effects) affect herbivore performance. Furthermore, plant quality can also influence the impact of natural enemies. 2. Lower plant quality through reduced irrigation increased the abundance of the cryptic species from the Bemisia tabaci complex [hereafter B. tabaci Middle East Asia Minor 1 (MEAM1)], but not its natural enemies on cotton. It was therefore predicted that lower plant quality would diminish the impact of natural enemies in regulating this herbivore. 3. Over three cotton seasons, plant quality was manipulated via differential irrigation and natural enemy abundance with insecticides. Life tables were used to evaluate the impact of these factors on mortality of immature B. tabaci (MEAM1) over nine generations. 4. Mortality of B. tabaci (MEAM1) was consistently affected by natural enemies but not by plant quality. This pattern was driven by high levels of sucking predation, which was the primary (key) factor associated with changes in immature mortality across all irrigation and natural enemy treatments. Dislodgement (chewing predation and weather) and parasitism contributed as key factors in some cases. Analyses also showed that elimination of sucking predation and dislodgement would have the greatest effect on overall mortality. 5. The top-down effects of natural enemies had dominant effects on populations of B. tabaci (MEAM1) relative to the bottom-up effects of plant quality. Effects were primarily due to native generalist arthropod predators and not more host-specific aphelinid parasitoids. The findings of this study demonstrate the important role of arthropod predators in population suppression and validate the importance of conservation biological control in this system for effective pest control. ; Maricopa Agricultural Center; Arizona Pest Management Center; USDA-National Institute for Food and Agriculture Extension IPM program; USDA-ARS; Cotton Incorporated; Arizona Cotton Growers Association; Cotton Foundations ; This article is a U.S. Government work and is in the public domain in the USA. ; This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.

The paper presents results of a comprehensive analysis of the cardiovascular diseases (CVD) situation, both in the global and Russian contexts. It introduces original data illustrating the declining mortality rate from CVD, and the diminishing contribution of these diseases to overall mortality rate — globally and, to a larger extent, in developed countries. The paper also analyses the reasons for continuing CVD epidemic in Russia. Based on factual evidence, it argues that those include insufficient expenditures on treating CVD patients, and critically inadequate funding of prevention programmes. Unsatisfactory use of these funds to subsidise Russian regions (without taking into account their actual needs determined by the CVD mortality rate) only makes the problem worse. Through modelling, «average» efficiency of the Russian health care system in reducing CVD mortality was revealed. The paper describes various scenarios for future development of the Russian CVD situation. In the context of innovation-based scenario, the advantages of technological foresight are analysed; specifically, the authors summarise major ST development trends in the health sector (using data of the Russian ST Foresight 2030), which could significantly contribute to stopping the CVD epidemic in Russia. ; Приведены результаты широкого анализа ситуации с распространением сердечно-сосудистых заболеваний (ССЗ) как в глобальном контексте, так и в российских реалиях. Представлены оригинальные данные, свидетельствующие о снижение смертности от ССЗ и вклада болезней этой группы в общий показатель смертности в мире и, в большей мере, в развитых странах. Проанализированы системные причины продолжающейся в России эпидемии ССЗ. На основании объективных данных показано, что таковыми являются недостаточные затраты на лечение больных ССЗ и критически малое финансирование профилактических программ. Нерациональное субсидирование регионов с использованием этих средств (без учета потребности, определяемой уровнем смертности от ССЗ) лишь усугубляет проблему. Путем моделирования отмечена «средняя» эффективность российской системы здравоохранения по снижению смертности от ССЗ. Рассмотрены сценарии развития ситуации с ССЗ в России. В контексте инновационного сценария проанализированы преимущества технологического прогнозирования и, в частности, обобщены основные направления развития науки и технологий в сфере здравоохранения (по данным Прогноза научно-технологического развития Российской Федерации на период до 2030 г.), способные решить ряд задач, связанных с прекращением эпидемии ССЗ в России.

Background: The role of regional government in decentralization period is very important to the health sector particularly in financing. This is because health is one of the sectors that was decentralized. Minimum service standard is the obligatory responsibility for the region that is the right of every citizen at a minimum level, and one of many basic services is Maternal and Child Health programs. Objectives: To asses the financing sufficiency for Maternal and Child Health Programs based on Minimum Service Standard cost calculation and the effectivity of financing for Maternal and Child Health programs to achieve program's objectives and goals. Methods: This research is a descriptive study conducted in Nunukan in 2013 with quantitative data. Sufficiency analysis is done by calculating the cost of Maternal and Child Health program to the result of cost calculation based on Minimum Service Standard. Performance effectivity of the Maternal and Child Health Programs was analyzed by the achievement of Minimum Service Standard according to the national indicator target and Maternal Mortality and Infant Mortality to the target of RPJMN of 2010-2014. Results: The cost of Maternal and Child Health program that was available was Rp. 2.530.038.761, and the calculation result of the cost based on Minimum Service Standard at Rp. 3.707.719.364, thus there was fund deficit about Rp 1.177.680.603. The percentage of MCH programs financing by the central government was still hight that was about 75%. There are financing MCH programs for direct activities amounted to 74%, and indirect activities amounted to 26%. The financing performance of MCH program was not effective yet to achieve the target of national Minimum Service Standard indicator and maternal mortality was still high at 173 per 100.000 life birts and infant mortality at 14 per 1000 live births. Conclusion: The financing of MCH programs was not sufficient to perform activities in MCH programs, as there was fund deficit about Rp 1.177.680.603. There was high financing dependency to the central government at 75% because of the low regional government commitment to financing priority programs such as MCH programs.

Context
Changes in abundance following fire are commonly reported for vertebrate species, but the mechanisms causing these changes are rarely tested. Currently, many species of small mammals are declining in the savannas of northern Australia. These declines have been linked to intense and frequent fires in the late dry season; however, why such fires cause declines of small mammals is unknown.

Aims
We aimed to discover the mechanisms causing decline in abundance of two species of small mammals, the pale field rat, Rattus tunneyi, and the western chestnut mouse, Pseudomys nanus, in response to fire. Candidate mechanisms were (1) direct mortality because of fire itself, (2) mortality after fire because of removal of food by fire, (3) reduced reproductive success, (4) emigration, and (5) increased mortality because of predation following fire.

Methods
We used live trapping to monitor populations of these two species under the following three experimental fire treatments: high-intensity fire that removed all ground vegetation, low-intensity fire that produced a patchy burn, and an unburnt control. We also radio-tracked 38 R. tunneyi individuals to discover the fates of individual animals.

Key results
Abundance of both species declined after fire, and especially following the high-intensity burn. There was no support for any of the first four mechanisms of population decline, but mortality owing to predation increased after fire. This was related to loss of ground cover (which was greater in the high-intensity fire treatment), which evidently left animals exposed to predators. Also, local activity of two predators, feral cats and dingoes, increased after the burns, and we found direct evidence of predation by feral cats and snakes.

Conclusions
Fire in the northern savannas has little direct effect on populations of these small mammals, but it causes declines by amplifying the impacts of predators. These effects are most severe for high-intensity burns that remove a high proportion of vegetation cover.

Implications
To prevent further declines in northern Australia, fire should be managed in ways that limit the effects of increased predation. This could be achieved by setting cool fires that produce patchy burns, avoiding hot fires, and minimising the total area burnt.

Background: In high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown. Methods/Design: This multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women's and Children's Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18–22 and at 32–36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities. Discussion: In summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy outcomes in rural, low-resource settings. The intervention includes training for ultrasound-naïve providers in basic obstetric ultrasonography and then enabling these trainees to use ultrasound to screen for pregnancy complications in primary antenatal care clinics and to refer appropriately. Trial registration: Clinicaltrials.gov (NCT # 01990625)

BackgroundReduction in mortality and morbidity in HIV patients due to the introduction of HAART have resulted in changes in patterns of hospital admissions.ObjectiveTo examine trends of HIV patients hospital admissions.Design and methodSerial cross‐sectional analysis of HIV‐hospitalized patients from 1989 to 2011 in an HIV Care Unit. Each hospitalization was classified as major categories: opportunistic infections, other infections, drug‐related admissions, chronic hepatopathy, AIDS and non‐AIDS‐related tumours and chronic medical conditions (COPD, diabetes) and as specific diagnosis: tuberculosis, PCP, CMV, bacterial pneumonia and others. We considered 4 periods of time: pre‐HAART, 1989–1996; early HAART, 1997–2001; intermediate HAART, 2002–2006; and present HAART, 2007–2011.ResultsWe evaluated 2588 admissions. 20.7% of patients were unaware of HIV infection before first admission; this proportion did not change along the time (p=0.27). No previous outpatient follow‐up was seen in 34.9% of patients. There were differences in diagnosis, mortality, age and mean inpatient stay time (Table 1) between the analyzed periods of time.




















OI
HIV tumours
Non‐HIV tumours
Chronic diseases
Mortality
Mean age
Mean hospital stay
Pneumonia
Resp infect
TBC
CMV
PCP
PML




Pre‐HAART 682 adm.
51.7%*
5.1%*
0.8%*
3.2%*
10.1%*
36.1*
23.9*
12.1%*
14.1%*
14.1%
15%*
9.5%*
5.1%


Early HAART 632 adm.
34.5%
4%
2.2%
9%
4.6%
38.4
17.2*
21.1%
19.9%
11.7%
5%
8.2%
4.1%


Intermediate HAART 613 adm.
31.4%*
2.4%
2.8%
7.7%
4.4%
39.6
15.7
25.6%*
23.2%
11.4%
1.7%*
3.4%*
3%


Present HAART 661 adm.
21.8%*
0.8%*
4.1%*
15.9%*
3.8%*
42.9*
14.2
29.8%*
29.2%*
10.9%
1.9%*
4.2%*
2.2%





p<0.05

Conclusions(i) HAART and older age have changed the pattern of hospital admissions with a decrease of OI‐related admissions and an increase of chronic diseases and non‐AIDS‐related tumours and with a decrease in mortality and length of inpatient stay. (ii) Proportion of patients with unknown HIV serostatus before admission has not changed along the time. (iii) Pneumonia, respiratory tract infection and tuberculosis were the more common causes of admission.

BackgroundSince HIV‐1 RNA (viral load) testing is not routinely available in Haiti, HIV‐infected patients receiving antiretroviral therapy (ART) are monitored using the World Health Organization (WHO) clinical and/or immunologic criteria. Data on survival and treatment outcomes for HIV‐1 infected patients who meet criteria for ART failure are limited. We conducted a retrospective study to compare survival rates for patients who experienced failure on first‐line ART by clinical and/or immunologic criteria and switched to second‐line ART vs. those who failed but did not switch.MethodsPatients receiving first‐line ART at the GHESKIO Center in Port‐au‐Prince, Haiti, who met WHO clinical and immunologic criteria for failure were identified. Survival and treatment outcomes were compared in patients who switched their ART regimen and those who did not. Cox regression analysis was used to determine predictors of mortality after failure of first‐line ART.ResultsOf 3126 patients who initiated ART at the GHESKIO Center between 1 March 2003 and 31 July 2008, 482 (15%) met WHO immunologic and/or clinical criteria for failure. Among those, 195 (41%) switched to second‐line ART and 287 (59%) did not. According to Kaplan–Meier survival analysis, the probability of survival to 12 months after failure of first‐line ART was 93% for patients who switched to second‐line ART after failure and 88% for patients who did not switch. Predictors of mortality after failure of first‐line ART were weight in the lowest quartile for sex, CD4 T cell count ≤ 100, adherence < 90% at the time of failure and not switching to second‐line ART.ConclusionsPatients who failed first‐line ART based on clinical and/or immunologic criteria and did not switch to second‐line therapy faced a higher mortality than those who switched after failure. To decrease mortality, interventions to identify patients in whom ART may be failing earlier are needed urgently. In addition, there is a major need to optimize second‐line antiretroviral regimens for improved potency, lower toxicity and greater convenience for patients.

BACKGROUND: Prostate cancer is the second most common type of cancer among men but its aetiology is still largely unknown. Different studies have proposed several risk factors such as ethnic origin, age, genetic factors, hormonal factors, diet and insulin-like growth factor, but the spatial distribution of the disease suggests that other environmental factors are involved. This paper studies the spatial distribution of prostate cancer mortality in an industrialized area using distances from each of a number of industrial facilities as indirect measures of exposure to industrial pollution. MATERIALS AND METHODS: We studied the Gran Bilbao area (Spain) with a population of 791,519 inhabitants distributed in 657 census tracts. There were 20 industrial facilities within the area, 8 of them in the central axis of the region. We analysed prostate cancer mortality during the period 1996-2003. There were 883 deaths giving a crude rate of 14 per 100,000 inhabitants. We extended the standard Poisson regression model by the inclusion of a multiplicative non-linear function to model the effect of distance from an industrial facility. The function's shape combined an elevated risk close to the source with a neutral effect at large distance. We also included socio-demographic covariates in the model to control potential confounding. RESULTS: We aggregated the industrial facilities by sector: metal, mineral, chemical and other activities. Results relating to metal industries showed a significantly elevated risk by a factor of approximately 1.4 in the immediate vicinity, decaying with distance to a value of 1.08 at 12km. The remaining sectors did not show a statistically significant excess of risk at the source. DISCUSSION: Notwithstanding the limitations of this kind of study, we found evidence of association between the spatial distribution of prostate cancer mortality aggregated by census tracts and proximity to metal industrial facilities located within the area, after adjusting for socio-demographic characteristics at municipality level. ; We thank the Basque Government for providing census tract mortality and geographical data needed to carry out this study. This study was funded by Grant No. FIS: PI040041 from the Carlos III Institute of Health.

In the European context, the new legislation to avoid mineral contamination and the ban on antibiotics as growth promoters has led to the definition of new objectives in respect of nitrogen supply. The present study summarizes the state of nitrogen nutrition in rabbits and reviews the role of protein and amino acids in rabbit health and the new nitrogen value of protein sources based on true ileal digestibility (TID) for future recommendations. The main sources of nitrogen for microbial growth are ammonia, urea and protein (endogenous and dietary). The surplus of nitrogen flow to the caecum increases mortality rates during fattening by favouring the growth of potential pathogenic bacteria. Accordingly, feeding strategies to reduce ileal nitrogen flow have been reviewed. A large reduction of dietary protein level might have negative consequences on growth performances and mortality. In order to formulate balanced low protein diets, data on ileal and faecal amino acid digestibility of 14 raw materials is summarized. The use of this different unit for amino acid digestibility is also discussed. ; In the European context, the new legislation to avoid mineral contamination and the ban on antibiotics as growth promoters has led to the definition of new objectives in respect of nitrogen supply. The present study summarizes the state of nitrogen nutrition in rabbits and reviews the role of protein and amino acids in rabbit health and the new nitrogen value of protein sources based on true ileal digestibility (TID) for future recommendations. The main sources of nitrogen for microbial growth are ammonia, urea and protein (endogenous and dietary). The surplus of nitrogen flow to the caecum increases mortality rates during fattening by favouring the growth of potential pathogenic bacteria. Accordingly, feeding strategies to reduce ileal nitrogen flow have been reviewed. A large reduction of dietary protein level might have negative consequences on growth performances and mortality. In order to formulate balanced low protein diets, data on ileal and faecal amino acid digestibility of 14 raw materials is summarized. The use of this different unit for amino acid digestibility is also discussed.

Context. Invasive species are a growing global problem. Biological invasions can result in numerous harmful impacts on local ecologies, and non-native herpetofauna are frequently ignored. Nile monitor lizards (Varanus niloticus) and Burmese pythons (Python molurus bivittatus, recently reassessed as Python bivittatus bivittatus), have become established in southern Florida. Both are large, semi-aquatic predators that pose serious threats to a variety of threatened and endangered species, as well as to the unique ecology of the area.


Aims. Acetaminophen (CAS#103-90-2), a lethal oral toxicant for the invasive brown treesnake (Boiga irregularis) on Guam, was investigated as a possible toxicant in juvenile Burmese pythons and Nile monitors.


Methods. Dead neonatal mouse (DNM) baits containing 0, 10, 20, or 40 mg acetaminophen were force-fed to Nile monitors, whereas DNM containing doses of 0, 20, 40, or 80 mg were freely consumed by Burmese pythons. Subjects were frequently observed post-treatment for general condition and position, with special attention paid to activity (if any), behaviour, respiration, bleeding, emesis, ataxia, and mortality.


Key results. In Nile monitors, acetaminophen doses of 10, 20, or 40 mg resulted in 0, 50 and 100% mortality, respectively. In Burmese pythons, doses of 20, 40, or 80 mg resulted in 14.3, 85.7 and 100% mortality, respectively. No mortality was observed in control individuals of either species. A negative correlation between dosage (mg kg–1) and time-to-death was observed in both species. Dosages ranging from 522 to 2438 mg kg–1 and 263 to 703 mg kg–1 were uniformly lethal to monitors and pythons, respectively. Neither species exhibited signs of pain or discomfort following acetaminophen treatment.


Conclusions. Acetaminophen is an effective toxicant in juvenile Nile monitors and Burmese pythons. Further investigation into acetaminophen toxicity in adults of these species is merited.


Implications. Although further investigation into adult lethal dosages and strategies to optimise bait deployment while minimising secondary hazards is required, acetaminophen may have a role to play in the control of these invasive species in Florida.

Abstract A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made. In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. Whilst the focus of this paper is on maternal health, it is acknowledged that the interventions to reduce maternal mortality will also contribute to significantly reducing newborn mortality. Addressing each of the seven key areas of work – recommended by the first International Forum on 'Midwifery in the Community', Tunis, December 2006 – is essential for the success of any MDG5 programme. We hypothesize that a great deal of the stagnation of maternal health programmes has been the result of confusion and careless choices in scaling up between a limited number of truly skilled birth attendants and large quantities of multi-purpose workers with short training, fewer skills, limited authority and no career pathways. We conclude from the lessons learnt that no significant progress in maternal mortality reduction can be achieved without a strong political decision to empower midwives and others with midwifery skills, and a substantial strengthening of health systems with a focus on quality of care rather than on numbers, to give them the means to respond to the challenge.