This paper examined the technical efficiency of livestock in Eastern Cape Province, South Africa, to improve the understanding of the performance of livestock production of rural households in the communal rangelands. Surveys from 120 households were used to estimate a stochastic frontier model to assess livestock production's technical efficiency (TE) amongst households in a communal production environment where rangelands are the primary source of fodder. The estimated coefficients of the stochastic frontier model indicated that livestock units (LSU) and costs of additional feed supplements positively influenced livestock output per household. Management practices such as livestock kraaling and livestock herding influenced TE positively. An average technical efficiency score of 0.79 was estimated among households, suggesting that an improvement in efficiency could be achieved if proper interventions were employed. These interventions may include programmes such as the Extended Public Work Programmes to provide livestock herding support, gender-sensitive strategies that support the inclusion of women in livestock production, and other labour inputs related to animal husbandry. Lastly, this study provided essential information in understanding livestock production and informed policy about possible interventions that could potentially improve livestock production in rangelands.

RESUMEN Introducción: La administración organizacional en salud busca garantizar una atención efectiva y una gestión eficiente; evalúa la atención y satisfacción que a su vez guardan una estrecha y compleja relación. Objetivo: Estimar la asociación entre la calidad de atención y la satisfacción del usuario externo, del servicio de laboratorio clínico. Métodos: Estudio cuantitativo, correlacional, de diseño observacional transversal. La población estudiada fueron usuarios atendidos en el servicio de laboratorio clínico de un hospital privado, en Lima, Perú, a quienes se les aplicó un cuestionario de elaboración propia sobre calidad de atención y otro de satisfacción del usuario adaptado del modelo SERVPERF. La información obtenida fue analizada con el software IBM SPSS Statistics 23.0 y para la prueba de hipótesis se aplicó el coeficiente de correlación de Spearman. Resultados: De los 220 usuarios encuestados, el 69,1 % calificó como alta la calidad brindada, en la cual la dimensión mejor calificada fue la calidad humana (71,8 %); asimismo, el 73,6 % de los usuarios afirmaron estar satisfechos y dentro de ello, las dimensiones con mayor satisfacción fueron la empatía (73,2 %) y la seguridad (73,1 %). Conclusiones: La calidad de atención y sus dimensiones que la conforman se asocian con la satisfacción de los usuarios.

ABSTRACT Introduction: The healthcare management seeks to guarantee effective care and efficient management, assesses care and satisfaction, which in turn have a close and complex relationship. Objective: To estimate the association between the quality of care and the satisfaction of the external user of the clinical laboratory service. Methods: Quantitative, correlational study, with a cross-sectional observational design. The population studied were users treated in the clinical laboratory service of a private hospital in Lima, Peru, to whom a self-developed questionnaire was applied on quality of care and another on user satisfaction adapted from the SERVPERF model. The information obtained was analyzed with the IBM SPSS Statistics 23.0 software and Spearman's correlation coefficient was applied for the hypothesis test. Results: Of the 220 users surveyed, 69.1% rated the quality provided as high, in which the best rated dimension was human quality (71.8%); Likewise, 73.6% of the users stated that they were satisfied and within this, the dimensions with the greatest satisfaction were empathy (73.2%) and security (73.1%). Conclusions: The quality of care and its dimensions that make it up are associated with user satisfaction.

Resumo A frequência de parasitos gastrointestinais, com ênfase na pesquisa de Strongylus vulgaris, foi investigada entre os Pôneis Brasileiros criados em haras na cidade de Teresópolis, no estado do Rio de Janeiro. Amostras fecais foram coletadas em três haras: A (n=22 animais), B (n=3) e C (n=2). Amostras fecais foram submetidas à técnica quantitativa de Mini-FLOTAC utilizando três diferentes soluções e técnicas qualitativas. A prevalência de parasitos foi de 81,4%. Ovos de estrôngilos foram identificados em 74% dos pôneis. Ovos de Parascaris spp. foram detectados em 22,7% dos animais, sendo todos fêmeas do haras A. Nesta propriedade, as éguas eram mantidas com os pôneis em piquetes cercados durante todo o tempo. A solução de NaCl, com densidade de 1.200 g/ml, foi a que apresentou a maior frequência diagnóstica de ovos de nematoides e a maior contagem de ovos por grama de fezes. As amostras também foram submetidas à reação de polimerase em cadeia para amplificar DNA da região ITS2 de Strongylus vulgaris. Doze amostras fecais apresentaram sequências nucleotídicas de S. vulgaris. Ao final, este estudo demonstrou a alta frequência (96.3%) de S. vulgaris em pôneis mantidos em haras na cidade de Teresópolis, Rio de Janeiro, Brazil. gastrointestinais Teresópolis Janeiro n=22 n22 n 22 (n=2 animais , animais) n=3 n3 3 (n=3 n=2. n2 n=2 . 2 (n=2) MiniFLOTAC Mini FLOTAC qualitativas 814 81 4 81,4% 74 spp 227 7 22,7 propriedade tempo NaCl 1200 1 200 1.20 gml g ml g/ml fezes ITS S final 96.3% 963 96 (96.3% Brazil (n= n= 8 81,4 22, 120 20 1.2 96.3 9 (96.3 (n 81, 12 1. 96. (96. (96 (9 (

Abstract The frequency of gastrointestinal parasites with an emphasis on Strongylus vulgaris was investigated among the Brazilian Pony breed kept on farms in the municipality of Teresópolis, state of Rio de Janeiro. Fecal samples were collected in three stud farms: A (n= 22 animals), B (n= 3), and C (n= 2). Fecal samples were subjected to the quantitative Mini-FLOTAC technique, using three different solutions, and to qualitative techniques. The parasite prevalence was found to be 81.4%. Eggs from strongylids were identified in 74% of the ponies. Eggs of Parascaris spp. were detected in 22.7% of the animals, which were all females of farm A. At this locality, mares were kept with their foals in fenced paddocks all the time. The NaCl solution of d = 1.200 g/ml was generally the one that presented the highest frequency of diagnosis of nematode eggs and the highest mean of fecal eggs per gram. The fecal samples were also subjected to the polymerase chain reaction for amplification of DNA from the ITS2 region for Strongylus vulgaris. Twelve samples presented nucleotide sequences for S. vulgaris. In the end, this study revealed the high frequency (96.3%) of S. vulgaris among ponies on farms in Teresópolis, Rio de Janeiro, Brazil. Teresópolis Janeiro n= n (n 2 animals , animals) 3, 3 3) 2. . 2) MiniFLOTAC Mini FLOTAC technique solutions techniques 814 81 4 81.4% 74 spp 227 7 22.7 locality time 1200 1 200 1.20 gml g ml gram ITS S end 96.3% 963 96 (96.3% Brazil 8 81.4 22. 120 20 1.2 96.3 9 (96.3 81. 12 1. 96. (96. (96 (9 (

Accurately measuring evapotranspiration (ET) is important in the context of global atmospheric changes and for use with climate models. Direct ET measurement is costly to apply widely and local calibration and validation of ET models developed elsewhere improves confidence in ET derived from such models. This study sought to compare the performance of the Penman-Monteith-Leuning (PML) and Penman-Monteith-Palmer (PMP) ET models, over mesic grasslands in two study sites in South Africa. The study used routine meteorological data from a scientific-grade automatic weather station (AWS) to apply the PML and PMP models. The PML model was calibrated at one site and validated in both sites. On the other hand, the PMP model does not require calibration and hence it was validated in both sites. The models were validated using ET derived from a large aperture scintillometer (LAS). The PML model performed well at both sites with root mean square error (RMSE) within 20% of the mean daily observed ET (R² of 0.83 to 0.91). Routine meteorological data were able to reproduce fluxes calculated using micrometeorological techniques and this increased the confidence in the use of data from sparsely distributed AWSs to derive reasonable ET values. The PML model was better able to simulate observed ET compared to the PMP model, since the former models both transpiration and soil evaporation (E S), while the latter only models transpiration. Hence, the PMP model systematically underestimated ET in a context where the leaf area index (LAI) was < 2.5. Model predictions in the grasslands could be improved by incorporating the E S component in the PMP model while the PML model could be improved by careful choice of the number of days to be used in the determination of the fraction of E S.

Abstract: Background: To quantify the morphological changes in the surface of the back of adolescents with idiopathic scoliosis as a result of treatment with braces and to correlate them with radiographic changes. Material and methods: An analytical, cohort, prospective study on a sample of 31 adolescents with idiopathic scoliosis. We divided them into two groups: eleven treated with braces and twenty without them. Quantification of the deformity was performed on two separate occasions with an interval of one year using three systems: 1) angle of trunk rotation (scoliometer); 2) surface topography; 3) full spine X-rays. Results: No statistically significant differences were detected between the initial and final assessment of the topographic and radiographic variables in the group with braces. In the untreated group, only in measures with the scoliometer significant differences were registered. A positive correlation was found between the Cobb angle difference of the main curve with two topographic variables that quantify the asymmetry in the axial and coronal plane, respectively. Discussion: In following patients with scoliosis treated with braces, we should consider and evaluate not only radiographic parameters such as the Cobb angle, but also clinical and topographic parameters that quantify the external deformity of the back, as there is a clinical-radiographic discrepancy amply demonstrated in the literature. The improvement of the external shape of the back is a very important factor for the patient, and can influence a better completion of the orthopedic treatment. In our study, the scoliotic curve and external deformity of the back remained stable during the follow-up period in both treated and untreated patients.

Resumen: Antecedentes: Cuantificar los cambios morfológicos producidos en la superficie de la espalda de adolescentes con escoliosis idiopática como resultado del tratamiento mediante corsé y correlacionarlos con las variaciones radiográficas. Material y métodos: Estudio analítico, de cohortes, prospectivo, sobre una muestra de 31 adolescentes con escoliosis idiopática divididos en dos grupos: 11 con tratamiento mediante corsé y 20 sin corsé. Se realizó una cuantificación de la deformidad en dos ocasiones separadas entre sí por un intervalo de un año mediante tres sistemas: 1) ángulo de rotación del tronco (escoliómetro); 2) topografía de superficie; 3) radiografía simple de raquis completo. Resultados: No se detectaron diferencias estadísticamente significativas entre la valoración inicial y final de las variables topográficas y radiográficas en el grupo con corsé. En el grupo no tratado, sólo hubo diferencias significativas para las medidas del escoliómetro. Se encontró una correlación positiva entre la diferencia del ángulo de Cobb de la curva principal con la de dos variables topográficas que cuantifican la asimetría en el plano axial y en el coronal, respectivamente. Discusión: En el seguimiento de pacientes con escoliosis tratados con corsé, se deben tener en cuenta y valorar no sólo parámetros radiográficos como el ángulo de Cobb, sino también parámetros clínicos y topográficos que cuantifiquen la deformidad externa de la espalda, ya que existe una discrepancia clínico-radiográfica demostrada de manera amplia en la literatura. La mejoría de la forma externa de la espalda es un factor muy importante para el paciente y es lo que va a percibir fundamentalmente, lo que puede influir en una mejor cumplimentación del tratamiento ortopédico. En nuestro estudio, la curva escoliótica, así como la deformidad externa de la espalda, se mantuvo estable en el período de seguimiento tanto en los pacientes tratados con corsé como en los no tratados.

Contradictory findings have been reported from Africa with regard to the risk of developing Burkitt's lymphoma (BL) in sickle cell trait (AS) carriers. Haemoglobin electrophoresis was performed in 78 BL patients in the Northwest region of Cameroon, and in 78 nearest-neighbour controls of the same age, sex and tribe from the same village. AS was confirmed in 4 of 78 (5.13%) BL patients and in 11 of 78 (14.10%) controls (χ², p=0.052; Fisher's exact, one-tailed, p=0.050). Sickle cell trait carriers had a marginal statistically reduced risk of developing BL.

BACKGROUND: Paediatric and Perinatal HIV/AIDS remain significant health challenges in the Caribbean where the HIV seroprevalence is second only to Sub-Saharan Africa. METHOD: We describe a collaborative approach to the prevention, treatment and care of HIV in pregnant women, infants and children in Jamaica. A team of academic and government healthcare personnel collaborated to address the paediatric and perinatal HIV epidemic in Greater Kingston as a model for Jamaica (population 2.6 million, HIV seroprevalence 1.5%). A five-point plan was utilized and included leadership and training, preventing mother-to-child transmission (pMTCT), treatment and care of women, infants and children, outcomes-based research and local, regional and international outreach. RESULTS: A core group of paediatric/perinatal HIV professionals were trained, including paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data managers, information technology personnel and students to serve Greater Kingston (birth cohort 20 000). During September 2002 to August 2007, over 69 793 pregnant women presented for antenatal care. During these five years, significant improvements occurred in uptake of voluntary counselling (40% to 91%) and HIV-testing (53% to 102%). Eight hundred and eighty-three women tested HIV-positive with seroprevalence rates of 1-2% each year. The use of modified short course zidovudine or nevirapine in the first three years significantly reduced mother-to-child transmission (MTCT) of HIV from 29% to 6% (RR 0.27; 95% CI - 0.10, 0.68). During 2005 to 2007 using maternal highly active antiretroviral therapy (HAART) with zidovudine and lamivudine with either nevirapine, nelfinavir or lopinavir/ritonavir and infant zidovudine and nevirapine, MTCT was further reduced to an estimated 1.6% in Greater Kingston and 4.75% islandwide. In five years, we evaluated 1570 children in four-weekly paediatric infectious diseases clinics in Kingston, St Andrew and St Catherine and in six rural outreach sites throughout Jamaica; 24% (377) had HIV/AIDS and 76% (1193) were HIV-exposed. Among the infected children, 79% (299 of 377) initiated HAART, resulting in reduced HIV-attributable childhood morbidity and mortality islandwide. An outcomes-based research programme was successfully implemented. CONCLUSION: Working collaboratively, our mission of pMTCT of HIV and improving the quality of life for families living and affected by HIV/AIDS in Jamaica is being achieved.

ANTECEDENTES: El VIH/SIDA pediátrico y el perinatal continúan siendo retos significativos para la salud en el Caribe, donde la seroprevalencia de VIH ocupa el segundo lugar tras el África Subsahariana. MÉTODO: Se describe un enfoque colaborativo para tratamiento, prevención y cuidado de embarazadas, bebés y niños en Jamaica. Un equipo de personal académico y gubernamental vinculados a la salud, colaboraron para abordar la epidemia de VIH pediátrico y perinatal en Greater Kingston, como modelo para Jamaica (población de 2.6 millones, 1.5% seroprevalencia VIH). Se utilizó un plan de cinco puntos que incluyó liderazgo y entrenamiento, prevención de la transmisión madre a hijo (PTMAH), tratamiento y cuidado de mujeres, bebés y niños, investigaciones basadas en resultados, y outreach local, regional e internacional. RESULTADOS: Un grupo básico de profesionales del VIH pediátrico/perinatal, que incluía pediatras, obstetras, trabajadores de la salud, enfermeras, microbiólogos, administradores de datos, así como personal y estudiantes de la tecnología de la información, fue entrenado para servir en Greater Kingston (cohorte de nacimiento 20 000). De septiembre de 2002 hasta Agosto de 2007, más de 69 793 embarazadas se presentaron para recibir atención prenatal. Durante estos cinco años, tuvieron lugar mejoras significativos en cuanto a la recepción de asesoramiento (40% to 91%) y pruebas (53% to 102%) de VIH voluntarios. Ochocientos ochenta y tres mujeres resultaron VIH positivas en las pruebas, con tasas de seroprevalencia de 1-2% cada año. El uso de un ciclo corto modificado de zidovudina o nevirapina en los primeros tres años, redujo la transmisión madre a hijo (TMAH) de VIH significativamente de 29% a 6% (RR 0.27; 95% CI - 0.10, 0.68). Durante el 2005 hasta 2007, usando terapia antiretroviral altamente activa (TARAA) materna, con zidovudina y lamivudina con nevirapina, nelfinavir o lopinavir/ritonavir y nevirapina y zidovudina para niños, la TMAH se redujo a un estimado de 1.6 % en Greater Kingston y a .75% a lo largo de la isla. En cinco años, evaluamos 1570 niños en cuatro clínicas infecciosas pediátricas semanales en Kingston, Saint Andrew y Saint Catherine, así como en seis otros lugares destinados al servicio comunitario (outreach) por toda Jamaica; 24% (377) tenían VIH/SIDA y 76% (1193) estaba expuestos al VIH. Entre los niños infectados, 79% (299 de 377) iniciaron el TARAA, lo que trajo como resultado una reducción de la mortalidad y la morbilidad infantil atribuible al VIH, en todo el país. Se implementó exitosamente un programa de investigación basado en resultados. CONCLUSIÓN: Trabajando en colaboración, estamos logrando nuestra misión de prevenir la TMAH del VIH, y mejorar la calidad de vida de las familias que viven afectadas por el VIH/SIDA en Jamaica.

The Orange River, South Africa's largest river, is a critical water resource for the country. In spite of the clear economic benefits of regulating river flows through a series of impoundments, one of the significant undesirable ecological consequences of this regulation has been the regular outbreaks of the pest blackfly species Simulium chutteri and S. damnosum s.l. (Diptera: Simuliidae). The current control programme, carried out by the South African National Department of Agriculture, uses regular applications, by helicopter, of the target-specific bacterial larvicide Bacillus thuringiensis var. israelensis. While cost-benefit analyses show significant benefits to the control programme, benefits could potentially be further increased through applying smaller volumes of larvicide in an optimised manner, which incorporates upstream residual amounts of pesticide through downstream carry. Using an optimisation technique applied in the West African Onchocerciasis Control Programme, to a 136 km stretch of the Orange River which includes 31 blackfly breeding sites, we demonstrate that 28.5% less larvicide could be used to potentially achieve the same control of blackfly. This translates into potential annual savings of between R540 000 and R1 800 000. A comparison of larvicide volumes estimated using traditional vs. optimised approaches at different discharges, illustrates that the savings on optimisation decline linearly with increasing flow volumes. Larvicide applications at the lowest discharge considered (40 m³∙s-1) showed the greatest benefits from optimisations, with benefits remaining but decreasing to a theoretical 30% up to median flows of 100 m³∙s-1. Given that almost 70% of flows in July are less than 100 m³∙s-1, we suggest that an optimised approach is appropriate for the Orange River Blackfly Control Programme, particularly for flow volumes of less than 100 m³∙s-1. We recommend that trials be undertaken over two reaches of the Orange River, one using the traditional approach, and another using the optimised approach, to test the efficacy of using optimised volumes of B.t.i.

We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.

OBJECTIVE: In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority. WHO is working towards this objective by developing a surveillance and response system for chemical incidents. This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003. METHODS: Acute chemical incidents were actively identified through several informal (e.g. Internet-based resources) and formal (e.g. various networks of organizations) sources and assessed against criteria for public health emergencies of international concern using the then proposed revised International Health Regulations (IHR). WHO regional and country offices were contacted to obtain additional information regarding identified incidents. FINDINGS: Altogether, 35 chemical incidents from 26 countries met one or more of the IHR criteria. The WHO European Region accounted for 43% (15/35) of reports. The WHO Regions for Africa, Eastern Mediterranean and Western Pacific each accounted for 14% (5/35); South-East Asia and the Americas accounted for 9% (3/35) and 6% (2/35), respectively. Twenty-three (66%) events were identified within 24 hours of their occurrence. CONCLUSION: To our knowledge this is the first global surveillance system for chemical incidents of potential international concern. Limitations such as geographical and language bias associated with the current system are being addressed. Nevertheless, the system has shown that it can provide early detection of important events, as well as information on the magnitude and geographical distribution of such incidents. It can therefore contribute to improving global public health preparedness.

OBJETIVO: En diciembre de 2001, una reunión consultiva de expertos convocada por la OMS señaló que el fortalecimiento de la preparación y respuesta ante incidentes químicos nacionales y mundiales constituía una prioridad. Trabajando para lograr ese objetivo, la OMS está desarrollando un sistema de vigilancia y respuesta ante los incidentes químicos. En este informe se describen la frecuencia, la naturaleza y la ubicación geográfica de los incidentes químicos graves de posible impacto internacional ocurridos entre agosto de 2002 y diciembre de 2003. MÉTODOS: A partir de varias fuentes informales (p.ej., recursos de Internet) y formales (p.ej., diversas redes de organizaciones) se identificaron activamente los incidentes químicos graves para evaluarlos con los criterios empleados para las emergencias de salud pública de interés internacional, usando al efecto el proyecto de Reglamento Sanitario Internacional (RSI) revisado por entonces disponible. Se estableció contacto con las oficinas regionales y en los países de la OMS para obtener información adicional sobre los incidentes identificados. RESULTADOS: En total, 35 incidentes químicos de 26 países cumplían uno o más de los criterios estipulados en el RSI. El 43% (15/35) de los eventos correspondían a la Región de Europa de la OMS. Las regiones OMS de África, el Mediterráneo Oriental y el Pacífico Occidental concentraban cada una el 14% (5/35); y Asia Sudoriental y las Américas suponían el 9% (3/35) y el 6% (2/35) de los casos, respectivamente. Veintitrés (66%) eventos se descubrieron antes de transcurridas 24 horas. CONCLUSIÓN: Por lo que sabemos, éste es el primer sistema mundial de vigilancia de los incidentes químicos de posible impacto internacional. Se están abordando las limitaciones, por ejemplo de índole geográfica e idiomática, asociadas al sistema actual. No obstante, el sistema ha demostrado que puede detectar prontamente los eventos importantes, y aportar información sobre la magnitud y la distribución geográfica de tales incidentes. Por consiguiente, puede contribuir a mejorar la preparación de la salud pública mundial.

OBJECTIF: En décembre 2001, une consultation d'experts convoquée par l'OMS a jugé prioritaire de renfoncer la préparation aux interventions nationales et mondiales en cas d'incident chimique. L'OMS œ uvre en ce sens en mettant sur pied un système de surveillance et d'intervention en cas d'incident chimique. Le rapport décrit la fréquence, la nature et le lieu géographique des incidents chimiques aigus, susceptibles d'avoir une incidence internationale entre août 2002 et décembre 2003. MÉTHODES: Les incidents chimiques aigus ont été activement recensés à partir de plusieurs sources informelles (informations trouvées sur Internet, par exemple) et formelles (divers réseaux d'organisations, par exemple) et évalués en fonction de critères définissant les urgences de santé publique de portée internationale, en se référant à ce qui était alors le projet de révision du Règlement sanitaire international (RSI). Les bureaux régionaux de l'OMS et ses bureaux dans les pays ont été contactés afin d'obtenir des informations supplémentaires concernant les incidents recensés. RÉSULTATS: Au total, 35 incidents chimiques survenus dans 26 pays répondaient à un ou plusieurs critères du RSI. La Région européenne de l'OMS contribuait à hauteur de 43 % (15 sur 35) au nombre total d'incidents notifiés. Les Régions OMS de l'Afrique, de la Méditerranée orientale et du Pacifique occidental contribuaient chacune pour 14 % (5 sur 35) ; les Régions de l'Asie du Sud-Est et des Amériques pour 9 % (3 sur 35) et 6 % (2 sur 35) respectivement. Vingt-trois des événements (66 %) ont été signalés dans les 24 heures . CONCLUSIONS: A notre connaissance, il s'agit du premier système de surveillance mondial des incidents chimiques pouvant avoir une incidence dans plusieurs pays. On s'efforce actuellement de résoudre les problèmes posés par des biais géographiques ou linguistiques dans le système actuel. Néanmoins le système a fourni la preuve qu'il permettait de dépister précocement des événements importants et d'obtenir des informations sur l'ampleur et la répartition géographique de ces incidents. Il peut donc contribuer à améliorer la préparation aux interventions de santé publique.