Effect of combined use of supplementary irrigation, manure and P fertilization on grain yield and profitability of soybean in northern Nigeria

Declining soil fertility particularly phosphorus deficiency, low organic carbon, moisture stress and high cost of input are factors limiting soybean yield in the Nigeria savanna. Supplementary irrigation, nutrient application and inoculation with Bradyrhizobium could increase the grain yield of soybean. We evaluated the effects of Rhizobia inoculant, phosphorus fertilization, manure, and supplementary irrigation on the nodulation and productivity of a tropical soybean variety in two locations in northern Nigeria in the 2017 and 2018 cropping seasons. The treatments consisted of five input bundles: Supplementary irrigation +17.5 kg P ha-1 + 4 t ha-1 poultry manure + nodumax inoculant (S + P + M + I); 17.5 kg P ha-1 + 4 t ha-1 poultry manure + nodumax inoculant (P + M + I); 17.5 kg P ha-1 + nodumax inoculant (P + I); 17.5 kg PP ha-1 (P); and nodumax inoculant (I). Economic analysis was done to determine the benefit-cost ratio (BCR) for each input bundle. In Kano, the input bundle S + P + M + I produced mean number of nodules that were 38, 102, 200 and 352% higher than that of input bundles P + M + I, P + I, P and I, respectively. At Lere, the application of input bundle S + P + M + I increased mean number of nodules by 33, 81, 93 and 182% over that of input bundles P + M + I, P + I, P and I, respectively. Mean grain yield in Kano was greater for input bundle S + P + M + I over P + M + I, P + I, P and I bundles by 31, 50, 64 and 223%, respectively. In Lere, grain yield for input bundle S + P + M + I was higher than that of input bundles P + M + I, P + I, P and I only, by 27, 47, 41 and 184% respectively. The input bundle P + M + I produced the highest BCR (1.4) in Kano and application only of P produced the highest BCR (1.3) in Lere. Supplementary irrigation was not found to be profitable due to the high cost of supplementary irrigation.The application of P with or without manure/inoculant is recommeded for profitable soybean production in the savannas of Nigeria.

Evaluation and application of the CROPGRO-soybean model for determining optimum sowing windows of soybean in the Nigeria savannas

Soybean production is limited by poor soil fertility and unstable rainfall due to climate variability in the Nigeria savannas. There is a decline in the amount and duration of rainfall as one moves from the south to north of the savanna zones. The use of adapted soybean varieties and optimum sowing windows are avenues to increase productivity in the face of climate variability. Crop simulation models can be used as tools for the evaluation of alternative management options for a particular location, including fertilizer application rates, plant density, sowing dates and land use. In this study, we evaluated the performance of the Cropping System Model (CSM)-CROPGRO-Soybean to determine optimum sowing windows for three contrasting soybean varieties (TGX1835-10E, TGX1904-6F and TGX1951-3F) cultivated in the Nigeria savannas. The model was calibrated using data from ten field experiments conducted under optimal conditions at two sites (BUK and Dambatta) in Kano in the Sudan savanna (SS) agro-ecology over four growing seasons. Data for model evaluation were obtained from independent experiment for phosphorus (P) response trials conducted under rainfed conditions in two locations (Zaria and Doguwa) in the northern Guinea savanna (NGS) zone. The model calibration and evaluation results indicated good agreement between the simulated and observed values for the measured parameters. This suggests that the CROPGRO-Soybean model was able to accurately predict the performance of soybean in the Nigeria savannas. Results from long-term seasonal analysis showed significant differences among the agro-ecologies, sowing windows and the soybean varieties for grain yield. Higher yields are simulated among the soybean varieties in Zaria in the NGS than in Kano the SS and Jagiri in the southern Guinea savanna (SGS) agro-ecological zones. Sowing from June 1 to July 5 produced optimal yield of TGX1951-3F and TGX1835-10E beyond which yield declined in Kano. In Zaria and Jagiri the simulated results show that, sowing from June 1 to July 12 are appropriate for all the varieties. The variety TGX1951-3F performed better than TGX1904-6F and TGX1835-10E in all the agro-ecologies. The TGX1951-3F is, therefore, recommended for optimum grain yield in the savannas of northern Nigeria. However, the late maturing variety TGX1904-6F is not recommended for the SS due to the short growing season in this zone.

Effectiveness of a community-level social mobilization intervention in achieving the outcomes of polio vaccination campaigns during the post-polio-endemic period: Evidence from CORE Group polio project in Uttar Pradesh, India

BACKGROUND

A social mobilization (SM) initiative contributed to India's success in polio elimination. This was the CORE Group Polio Project (CGPP) India, a partner of the Uttar Pradesh (UP) SM Network and which continued its SM activities, even during the polio-free period through a network of multi-level social mobilizers. This paper assesses the effects of this community-level SM (CLSM) intervention on the extent of community engagement and performance of polio Supplementary Immunization Activity campaigns (SIAs) during the post-polio-endemic period (i.e., from March 2012 to September 2017).

METHODS

This study followed a quasi-experimental design. We used secondary, cluster-level data from CGPP India's Management Information System, including 52 SIAs held from January 2008 to September 2017, covering 56 blocks from 12 districts of UP. We computed various indicators and performed Generalized Estimating Equations based analysis to assess the statistical significance of differences between the outcomes of intervention and non-intervention areas. We then estimated the effects of the SM intervention using Interrupted time-series, Difference-in-Differences and Synthetic Control Methods. Finally, we estimated the population influenced by the intervention.

RESULTS

The performance of polio SIAs changed over time, with the intervention areas having better outcomes than non-intervention areas. The absence of CLSM intervention during the post-polio-endemic period would have negatively impacted the outcomes of polio SIAs. The percentage of children vaccinated at polio SIA booths, percentage of 'X' houses (i.e., households with unvaccinated children or households with out-of-home/out-of-village children or locked households) converted to 'P' (i.e., households with all vaccinated children or households without children eligible for vaccination), and percentage of resistant houses converted to polio acceptors would have gone down by 14.1 (Range: 12.7 to 15.5), 6.3 (Range: 5.2 to 7.3) and 7.4 percentage points, respectively. Community engagement would have reduced by 7.2 (Range: 6.6 to 7.7) percentage points.

CONCLUSIONS

The absence of CLSM intervention would have significantly decreased the level of community engagement and negatively impacted the performance of polio SIAs of the post-polio-endemic period. The study provides evidence of an added value of deploying additional human resource dedicated to social mobilization to achieve desired vaccination outcomes in hard-to-reach or programmatically challenging areas.

The Untold Story of Community Mobilizers Re-engaging a Disengaged Community During the Endemic Era of India's Polio Eradication Program

Although India's polio eradication program began with a flourish in 1995, gradually, the community disengaged from the program as misinformation about the vaccine spread. Vaccination teams faced abuse and even physical aggression. What caused this break in communication? CORE Group Polio Project's mobilizers had to delve deep to uncover untold stories of why communities were disengaged from the government's polio eradication efforts.

Significance of a social mobilization intervention for engaging communities in polio vaccination campaigns: Evidence from CORE Group Polio Project, Uttar Pradesh, India

Background

Globally, community engagement is an integral part of most public health programs and the social mobilization (SM) intervention of India’s polio eradication program is one such example that contributed to eliminating polio from the country. CORE Group Polio Project (CGPP), a partner of Uttar Pradesh (U.P.) SM Network executed its activities through a network of social mobilizers called Community Mobilization Coordinators (CMCs). These were deployed in polio high risk areas to perform awareness generation and trust-building activities with communities and achieved high coverage of polio vaccination during Supplementary Immunization Activity campaigns (SIAs). This paper measures the extent and outcomes of CMC community engagement in SM interventions and polio SIAs.

Methods

This study used secondary, cluster-level data from Management Information System of CGPP India, including 52 SIAs held between January 2008 to September 2017 in 56 blocks/polio planning units, covering 12 districts of U.P. We used five indicators that reflected community engagement in polio SIAs and constructed a Community Engagement Index (CEI). Further, we estimated the difference in the CEI between CMC and non-CMC areas, using Generalized Estimating Equations (GEE) and also estimated treatment effects through Difference-in-Differences (DID) method using STATA.

Results

Overall, 78.6% (95% confidence interval (CI) = 78.3, 78.8) of families from the study area were engaged in the polio SIAs and the extent of community engagement increased over time. The mean CEI of entire study period in CMC areas (85.8%; 95% CI = 85.6, 86.0) was significantly higher (P < 0.001) than that of non-CMC areas (71.3%; 95% CI = 71.1, 71.5). Over time, the SM intervention led to at least 11 percentage points increase in the CEI of CMC areas with about 17% of this achievement attributable to CGPP India’s SM efforts.

Conclusions

The study findings suggest that intensive social mobilization efforts can significantly increase the extent of community engagement. The community engagement learnings of polio SM Network may be useful to achieve the desired outcomes of public health programs such as the National Health Mission (NHM) of India, that serves communities for multiple health issues.

Why Communities Should Be the Focus to Reduce Stigma Attached to COVID-19

Since 1999, the CORE Group Polio Project (CGPP) has developed, refined, and deployed effective strategies to mobilize communities to improve vaccine uptake for polio (and other vaccine-preventable diseases such as measles) and conduct surveillance for infectious disease threats in high-risk, border, and hard-to-reach locations. CORE Group Polio Project teams have been called upon to address the COVID-19 pandemic, and, like with polio, the pandemic response is impacted by stigma in all areas of response, from health education, testing, contact tracing, and even treatment for infected individuals. The CGPP has reached back into its polio experience and is redeploying successful community engagement activities to address stigma as part of the COVID-19 response. Across country programs, community health volunteers communicate risk and behavior change at the household level by integrating health education and promotion activities with a focus on practical measures of COVID-19 prevention. Moreover, leveraging established and trusted partnerships with community networks and community leaders are providing lessons that can be adopted by the global community. The CGPP offers three overarching recommendations to curb stigma: 1) facilitating inclusive community engagement, 2) leveraging existing community networks and 3) cocreating with community leaders.

The Critical Role and Evaluation of Community Mobilizers in Polio Eradication in Remote Settings in Africa and Asia

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.

Effective Partnership Mechanisms: A Legacy of the Polio Eradication Initiative in India and Their Potential for Addressing Other Public Health Priorities

While many factors contributed to the successful elimination of polio from India, partnership and coordination mechanisms at multiple levels that have evolved over the years have been an important element. The lessons learned from these partnership and coordination mechanisms among various stakeholders involved in service delivery, surveillance, community mobilization, and governance deserve documentation as a legacy of the program. This article discusses the various processes and techniques adopted to build strong partnerships and coordination mechanisms among stakeholders by optimizing their strengths and using opportunities that lead toward the eradication of polio from India. Secondary data and literature review of relevant reports, papers and documents were adopted as the methodology for developing this research article. The article provides a model conceptual framework for partnerships and applies that framework to the CORE Group Polio Project (CGPP) partnerships in India and the partnerships among stakeholders for polio eradication in India. The learnings and expertise of the CGPP in developing, managing, and nurturing partnerships can be adapted and replicated for elimination or controlling other diseases (especially those that are vaccine-preventable as well as tuberculosis and vector-borne diseases) and for ending preventable child and maternal deaths.

Effectiveness of a Census-Based Management Information System for Guiding Polio Eradication and Routine Immunization Activities: Evidence from the CORE Group Polio Project in Uttar Pradesh, India

Census-based management information systems (CB-MISs) bring strength and power to public health programs by providing current information about everyone in the population covered by the program. Such a system has been developed by the CORE Group Polio Project (CGPP) in India. This article assesses the effectiveness of the CGPP CB-MIS in the management of social and behavioral change interventions. It also assesses the feasibility of the CB-MIS for vital events registration. We describe the procedures of the CB-MIS and measure the outcomes of the CGPP by observing the trends of vaccination coverage in CGPP catchment areas over time. We also compute vital statistics from births and deaths registered through the CGPP CB-MIS and compare them with the estimates from the Civil Registration System of India using statistics from India's Sample Registration System in Uttar Pradesh as the "gold standard." The CB-MIS has helped the CGPP to manage its social and behavior change communication interventions effectively, and it has contributed to the increase in polio vaccine coverage facilitated by the CGPP. We also estimate that the CGPP's CB-MIS has registered 86% of births and 98% of infant deaths, a much higher level of registration than has been achieved by the Civil Registration System for the entire state of Uttar Pradesh. The CB-MIS has helped to make it possible for community-based health workers to make behavioral diagnoses of barriers to immunization and to overcome them. The CB-MIS also provides a robust platform for community-based health workers to register vital events.

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative

The CORE Group Polio Project (CGPP) has contributed to polio eradication by successfully engaging civil society, particularly the non-governmental organization (NGO) community. This engagement, which began with a grant from the U.S. Agency for International Development in 1999, has contributed to improvements in routine immunization programs, polio campaign quality, and surveillance for acute flaccid paralysis in many challenging geographic areas. The CGPP has worked closely with polio eradication partners in a collaborative and supportive role. The CGPP has focused largely on high-risk areas with marginalized or hard-to-reach populations where health systems and immunization programs have also been weak and where transmission of poliovirus had not been stopped. The CGPP has engaged local civic leaders and communities in ways to complement top-down vertical efforts of ministries of health and other partners in the Global Polio Eradication Initiative. The CGPP has developed innovative strategies to detect cases using community-based surveillance, promoted independent campaign monitoring, established cross-border initiatives, and developed a strong and creative cadre of community mobilizers to track missed children and deliver behavior change education. Many of the innovations and approaches that the CGPP helped to develop are now being replicated by governments and international agencies to tackle other public health priorities in underserved and marginalized communities around the world. This article is the first in a series of articles describing the work of the CGPP. Because the article describes the work of more than 40 NGOs in 11 countries over 20 years, it provides only an overview, leaving many important details and variations of the CGPP's work to be described elsewhere, including in other articles included in this series.

Involvement of Civil Society in India's Polio Eradication Program: Lessons Learned

India achieved the title of a polio-free country in March 2014 after a prolonged battle with the poliovirus that threatened millions of children and paralyzed scores of them. Although there has been considerable documentation of the technical strategies applied over the years, not enough has been written on the other warfront that had opened, namely, the battle between the people and the polio eradication program. This article describes the immense people-driven challenges to the polio program and the need for tailor-made and novel responses. This is when the U.S. Agency for International Development-funded CORE Group Polio Project (CGPP)/India stepped in and started work in 1999. The project, a consortium of CORE Group member international non-governmental organizations (NGOs) and local NGOs, formed a bridge between communities and the government program. This article describes how CGPP/India listened to the families and communities who refused to participate in the polio eradication program and then strategically addressed their concerns. These lessons from India can benefit other public health priorities that require civil society involvement, as most public health efforts do.

Lessons Learned from the CORE Group Polio Project and Their Relevance for Other Global Health Priorities

Despite numerous setbacks, the Global Polio Eradication Initiative has implemented various community strategies with potential application for other global health issues. This article reviews strategies implemented by the CORE Group Polio Project (CGPP), including pursuit of the missed child, microplanning, independent campaign monitoring, using community health workers and community mobilizers to build community engagement, community-based surveillance, development of the capacity to respond to other health needs, targeting geographic areas at high risk, the secretariat model for non-governmental organization collaboration, and registration of vital events. These strategies have the potential for contributing to the reduction of child and maternal mortality in hard-to-reach, underserved populations around the world. Community-based surveillance as developed by the CGPP also has potential for improving global health security, now a global health priority.

A GIS - based method for assessment and mapping of noise pollution in Ota metropolis, Nigeria

A detailed method used for assessing and mapping noise pollution levels in Ota metropolis, Nigeria using ArcGIS 10.5 Software is presented in this paper. Noise readings were measured at a time interval of 30 min for each site considered using a precision grade sound level meter. The noise map developed was based on the computed values of average equivalent noise (LAeq) for the selected locations. Results of this study show that the A weighted sound level (LAeq), the background noise level (L10) and the peak noise level (L90) vary with location and period of the day due to traffic characteristics especially traffic volume, vehicle horns, vehicle mounted speakers, and unmuffled vehicles at road Junctions, major roads, motor parks and commercial centres. Based on the U.S. Department of Housing and Urban Development (HUD) recommendations and standards, only one (1) out of the 41 locations considered is under normally acceptable situation, while 12 locations are under normally unacceptable and the noise levels of the rest locations are clearly unacceptable. Results of this study are useful as reference and guideline for future planning and regulations on noise limit to be implemented for urban areas like Ota Metropolis. •Instrumentation used in this study for the environmental noise measurements consisted of a precision-grade sound-level meter - Model 8922 RS232.•The Geographical Positioning System (GPS) device (model: Magellan eXplorist 310) was used to obtain the exact coordinates of each location where noise level readings were recorded.•ArcGIS 10.5 software was used in this study to develop noise map for Ota Metropolis.

Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India

Background

Children who receive all doses of scheduled vaccines reduce their susceptibility to vaccine-preventable diseases. In India, full immunization coverage has increased significantly. However, only a small proportion of children are immunized on time. Globally, studies on factors affecting coverage of childhood immunization have found a significant impact by demand and supply-side determinants. This paper explores the demand-side determinants of timely immunization of the third dose of oral polio vaccine (OPV3) among children aged 6–11 months in the catchment areas of CORE Group Polio Project India.

Methods

We analyzed secondary de-identified data from a household level ‘Doers and Non-doers survey’ conducted in 2015. Determinants of timely OPV3 immunization were identified by modeling the characteristics of index children and survey respondents, surveyed households, respondents’ media habits, their exposure to immunization services and perceptions towards child immunization, through a multinomial regression analysis.

Results

The eight demand-side predictors based on the background characteristics and perceptions of caregivers determined timely vaccination of OPV3. The strongest predictor of timely OPV3 immunization was found to be the fathers’ educational level. Children of uneducated or lesser educated fathers had increased odds of not receiving the OPV1 vaccination, as compared to children of more educated fathers (OR > 10). Respondents who strongly perceived other (non-health) benefits of child immunization were three times more likely to timely vaccinate their children than those who do not. Furthermore, mothers who disagreed with the positive attributes of child immunization were 25 times more likely to delay or not to take their children for OPV immunization on time.

Conclusions

This study found eight essential factors that are responsible for timely OPV3. Despite limitations in data collection and analysis, immunization programs in India could use the eight identified demand-side determinants of timeliness and tailor communication strategies accordingly. We suggest that program communication efforts be directed at male community members; such messaging should address parents’ perceptions of non-health benefits and stress the positive attributes of child immunization. Further investigation would be helpful to assess the various risk factors of under-vaccination as well as vaccinators’ understating about timely immunization.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3129-2) contains supplementary material, which is available to authorized users.

Performance and determinants of routine immunization coverage within the context of intensive polio eradication activities in Uttar Pradesh, India: Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP)

BACKGROUND

Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services.

METHODS

We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children's receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents' exposure to CGPP, communication activities against their children's receipt of key vaccinations in order to identify determinants of routine immunization coverage.

RESULTS

Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children's receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers' exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT.

CONCLUSIONS

A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage.

Successful polio eradication in Uttar Pradesh, India: the pivotal contribution of the Social Mobilization Network, an NGO/UNICEF collaboration

In Uttar Pradesh, India, in response to low routine immunization coverage and ongoing poliovirus circulation, a network of U.S.-based CORE Group member and local nongovernmental organizations partnered with UNICEF, creating the Social Mobilization Network (SMNet). The SMNet's goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children's immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilize local opinion leaders. Creative behavior change activities and materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal-disease control, and breastfeeding. Program decision-makers at all levels used household-level data that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed innovative approaches to overcoming community concerns impacting immunization coverage. While the SMNet worked in the highest-risk, poorly served communities, data suggest that the immunization coverage in SMNet communities was often higher than overall coverage in the district. The partners' organizational and resource differences and complementary technical strengths posed both opportunities and challenges; overcoming them enhanced the partnership's success and contributions.

Determinants of performance of supplemental immunization activities for polio eradication in Uttar Pradesh, India: social mobilization activities of the Social mobilization Network (SM Net) and Core Group Polio Project (CGPP)

Background

The primary strategy to interrupt transmission of wild poliovirus in India is to improve supplemental immunization activities (SIAs) and routine immunization coverage in priority districts. The CORE Group, part of the Social Mobilization Network (SM Net), has been successful in improving SIA coverage in high-risk areas of Uttar Pradesh (UP). The SM Net works through community level mobilisers (from the CORE Group and UNICEF) and covers more than 2 million children under the age of five. In this paper, we examine the reasons the CORE Group had been successful through exploration of which social mobilization activities of the CORE Group predicted better performance of SIAs.

Methods

We carried out a secondary data analysis of routine monitoring information collected by the CORE Group and the Government of India for SIAs. These data included information about vaccination outcomes of SIAs in CORE Group areas and non-CORE Group areas within the districts where the CORE Group operates, along with information about the number of various social mobilization activities carried out for each SIA. We employed Generalized Linear Latent and Mixed Model (GLLAMM) statistical analysis methods to identify which social mobilization activities predicted SIA performance, and to account for the intra-class correlation (ICC) between multiple observations within the same geographic areas over time.

Results

The number of mosque announcements carried out was the most consistent determinant of improved SIA performance across various performance measures. The number of Bullawa Tollies carried out also appeared to be an important determinant of improved SIA performance. The number of times other social mobilization activities were carried out did not appear to determine better SIA performance.

Conclusions

Social mobilization activities can improve the performance of mass vaccination campaigns. In the CORE Group areas, the number of mosque announcements and Bullawa Tollies carried out were important determinants of desired SIA outcomes. The CORE Group and SM Net should conduct sufficient numbers of these activities in support of each SIA. It is likely, however, that the quality of social mobilization activities (not studied here) is as or more important than the quantity of activities; quality measures of social mobilization activities should be investigated in the future as to how they determine vaccination performance.

Outcomes of polio eradication activities in Uttar Pradesh, India: the Social Mobilization Network (SM Net) and Core Group Polio Project (CGPP)

BACKGROUND

The primary strategy to interrupt transmission of wild poliovirus in India is to improve supplemental immunization activities and routine immunization coverage in priority districts with a focus on 107 high-risk blocks of western Uttar Pradesh and central Bihar. Villages or urban areas with a history of wild poliovirus transmission, or hard-to-reach or resistant populations are categorized as high-risk areas within blocks. The Social Mobilization Network (SM Net) was formed in Uttar Pradesh in 2003 to support polio eradication efforts through improved planning, implementation and monitoring of social mobilization activities in those high-risk areas. In this paper, we examine the vaccination outcomes in districts of SM Net where the CORE Group works.

METHODS

We carried out a secondary data analysis of routine monitoring information collected by the SM Net and the Government of India. These data include information about vaccination outcomes in SM Net areas and non-SM Net areas within the districts where the CORE Group operates. Statistical analysis was used to compare, between SM Net and non-SM Net areas, vaccination outcomes considered sensitive to social mobilization efforts of the SM Net. We employed Generalized Estimating Equations (GEE) statistical method to account for Intra-cluster Correlation (ICC), and used 'Quasi-likelihood under the independence model criterion (QIC)' as the model selection method.

RESULTS

Vaccination outcomes in SM Net areas were as high as or higher than in non-SM Net areas. There was considerable variation in vaccination outcomes between districts.

CONCLUSIONS

While not conclusive, the results suggest that the social mobilization efforts of the SM Net and the CORE Group are helping to increase vaccination levels in high-risk areas of Uttar Pradesh. Vaccination outcomes in CORE Group areas were equal or higher than in non-CORE, non-SM Net areas. This occurred even though SM Net areas are those with more community resistance to polio vaccination and/or are have harder-to-reach populations than non-SM Net areas. Other likely explanations for the relatively good vaccination performance in SM Net areas are not apparent.

Random breath testing: a Canadian perspective

OBJECTIVE

The purpose of this article is to examine the case for and challenges to implementing random breath testing (RBT) in Canada, with a particular focus on the persistence of impaired driving under the current method of law enforcement. It seeks to place RBT within Canada's existing legal and social framework.

METHODS

This article reviews Canada's impaired driving record, charge and conviction rates, and law enforcement challenges. It then summarizes the impact that RBT programs have had in comparable countries. Finally, it examines whether the enactment of RBT would be upheld under Canada's Charter of Rights and Freedoms.

RESULTS

Canada has made little progress in reducing impaired driving since the late 1990s. Current enforcement methods fail to detect the majority of impaired drivers, even when stopped at sobriety checkpoints. This has reduced the perceived risk of apprehension and helps to explain the persistence of impaired driving in Canada. Faced with similar challenges, Australia, New Zealand, Ireland, and most EU countries have introduced comprehensive RBT programs. Comprehensive RBT has been shown to significantly reduce impaired driving deaths and injuries. Proposals to enact RBT in Canada will inevitably generate claims that it violates drivers' Charter rights. Similar arguments have been raised in opposition to RBT in other countries. This article demonstrates that RBT is compatible with the existing Charter case law involving traffic legislation and border, airline, and courtroom security.

CONCLUSION

Experience in other countries indicates that RBT is a minimally intrusive, cost-effective, and publicly accepted impaired driving countermeasure and that it would significantly improve the detection and deterrence of impaired drivers. Moreover, RBT is compatible with the Charter.

Vascular endothelial growth factor: a possible mediator of endothelial activation in acute respiratory distress syndrome

AIM

Vascular endothelial growth factor (VEGF) is a potent angiogenic and endothelial factor, which is abundantly found in the normal lung tissue. The objective of the study was to assess the VEGF levels in lung tissue and plasma in acute respiratory distress syndrome (ARDS) patients compared with controls who died from non-ARDS causes.

METHODS

Plasma and tissue samples were prospectively collected from 20 patients with ARDS within 6 hours after intubation (VEGF in plasma and tissue samples) and on the day of extubation (plasma VEGF) or postmortem (lung tissue). We used an ELISA to measure the VEGF level in plasma. Lung specimens were obtained by bronchoscopic biopsy or by open biopsy during autopsy. All lung samples were stained for standard histopathological analysis and for immunohistochemical methods. Biomarker levels were compared between survivors (N=12), non-survivors (N=8) and controls (N=10).

RESULTS

Compared with the levels in controls, in the early stages of ARDS, plasma VEGF levels rose and intrapulmonary levels fell, but during recovery, these levels went back to normal levels.

CONCLUSION

The initial phase of ARDS is associated with a decrease in VEGF in the lung and an increase in the plasma. This down-regulation may represent a protective mechanism aimed at limiting endothelial permeability and may participate in the decrease in the capillary number that is observed during early ARDS. A persistent elevation of plasma VEGF over time predicts poor outcome.

Feeding soyhulls to high-yielding dairy cows increased milk production, but not milking frequency, in an automatic milking system

To attract a cow into an automatic milking system (AMS), a certain amount of concentrate pellets is provided while the cow is being milked. If the milking frequency in an AMS is increased, the intake of concentrate pellets might increase accordingly. Replacing conventional starchy pellets with nonstarchy pellets increased milk yield, milk fat, and milk protein and decreased body weight. The hypothesis was that a nonroughage by-product rich in digestible neutral detergent fiber, such as soyhulls and gluten feed, could replace starchy grain in pellets fed in an AMS. Sixty cows were paired by age, milk yield, and days in milk, and were fed a basic mixture ad libitum [16.2 +/- 0.35 (mean +/- SE) kg of dry matter intake/d per cow] plus a pelleted additive (6 to 14 kg of dry matter/d per cow) that was consumed in the AMS and in a concentrate self-feeder, which could only be entered after passing through the AMS. The 2 feeding regimens differed only in the composition of the pelleted additives: the control group contained 52.9% starchy grain, whereas the experimental group contained 25% starchy grain, plus soyhulls and gluten feed as replacement for part of the grain. Wheat bran in the control ration, a source of fiber with low digestibility, was replaced with more digestible soyhulls and gluten. During the first 60 d in milk, a cow received 10 to 12 kg of concentrate pellets. After 60 DIM, concentrate feed was allocated by milk production: < or =25 kg/d of milk entitled a cow to 2 kg/d of concentrate feed; >25 kg/d of milk entitled a cow to receive 1 kg/d of additional concentrate feed per 5 kg/d of additional milk production, and >60 kg/d of milk entitled a cow to receive 9 kg of concentrate. The concentrate feed was split between the AMS and concentrate self-feeder. The 2 diets resulted in similar frequencies of voluntary milking (3.12 +/- 0.03 to 2.65 +/- 0.03 visits/d per cow vs. 3.16 +/- 0.00 to 2.60 +/- 0.01 visits/d per cow). Average milk yields were higher in the experimental group (42.7 +/- 0.76 to 39.09 +/- 0.33 kg/d per cow vs. 39.69 +/- 0.68 to 37.54 +/- 0.40 kg/d per cow) and percentages of milk protein (3.02 +/- 0.06 to 3.12 +/- 0.05% vs. 3.07 +/- 0.04 to 3.20 +/- 0.04%) and milk fat (3.42 +/- 0.17 to 3.44 +/- 0.08% vs. 3.38 +/- 0.13 to 3.55 +/- 0.06%) were similar in the 2 groups. The results suggest that the proposed pellets high in digestible neutral detergent fiber can be allocated via the AMS to selected high-yielding cows without a negative effect on appetite, milk yield, or milk composition while maintaining a high milking frequency.

The quality of commercial wheat silages in Israel

Wheat silages are the major roughage for high-producing lactating dairy cows in Israel; therefore, their quality is important. The main objective of the current study was to determine the preservation status and nutritional quality of commercial wheat silages in Israel. An additional objective was to develop predictive equations for dry matter digestibility (DMD) and neutral detergent fiber digestibility (NDFD) based on chemical composition of the silages, which would permit estimation of the digestibility from chemical composition. A total of 143 commercial wheat silages were sampled and analyzed for 3 yr. Fourteen random samples that were not included in the regression analysis were used to validate the equations by the bias and error of the model. Results revealed that wheat silages were quite sensitive to aerobic exposure; additives resulted in some improvement of the aerobic stability. After choosing the significant terms from ash, crude protein (CP), NDF, acid detergent fiber (ADF), and acid detergent lignin (ADL) by PROC STEPWISE of SAS, the following prediction equations were obtained from all 143 samples: DMD = 86.3 + (0. 70 x CP) - (0.46 x ADF) - (1.67 x ADL); and NDFD = 20.3 + (1.00 x CP) + (1.16 x NDF) - (0.88 x ADF) - (2.25 x ADL). The bias and the error of the prediction model for DMD were approximately 0.006 and 0.065, respectively; the bias and error for NDFD were approximately 0.007 and 0.118, respectively. It was concluded that the prediction model for DMD was quite adequate, whereas that for NDFD was less acceptable.

Predictors of variceal bleed among patients with liver cirrhosis in the era of sclerotherapy

INTRODUCTION

Variceal bleed is a common complication of portal hypertension. The bleed pattern has changed considerably with the introduction of variceal band ligation. The bleed pattern in developing countries where sclerotherapy continues to remain a viable option is not known. The aim of the study was to determine the predictors of first and subsequent bleed in individuals with liver cirrhosis.

METHODS

205 subjects with liver cirrhosis and portal hypertension registered in the liver clinic between January and June 2004, were followed-up for 18 months after registration. Bleeders already on pharmacotherapy or endotherapy were excluded. Patient details included age, gender, duration of illness, aetiology, Child-Pugh-Turcotte score and grades of oesophageal varices, details of index and subsequent variceal bleed, and complications during follow-up. Logistic regression multivariate analysis was applied to predict the factors influencing variceal bleed.

RESULTS

There were 95 variceal bleeders and 110 non-bleeders. Age at presentation and gender did not predict a variceal bleed. Grades III and IV oesophageal varices and fundal varices were the significant risk factors for an index bleed (p-value is 0.001). 27 of the 95 bleeders (28.3 percent) had a second bleed after a mean interval of 8 (+/- 7.7) months. Predictors of rebleed were similar to the index bleed. Predictors of index bleed were also similar to those who had bled for the first time after registration. Overall bleed-related mortality was low (2.1 percent).

CONCLUSION

Higher grades of varices, presence of cherry-red spots and fundal varices predicted variceal bleed in patients with liver cirrhosis. Variceal bleed-related mortality was low in the era of sclerotherapy.

Selection of contrast media

The pathophysiologic mechanisms of contrast-induced nephropathy (CIN) have been reviewed by Persson and Tepel. They focus on the renal response to contrast media (CM). In this section, we focus on the CM itself. Aspects of importance with regard to CIN include the route of administration, the volume of CM, the manner of X-ray attenuation, and the specific chemical structure of the CM.

Feeding of Pellets Rich in Digestible Neutral Detergent Fiber to Lactating Cows in an Automatic Milking System

If the milking frequency in an automatic milking system (AMS) is increased, the intake of concentrated pellets in the robot may be raised accordingly. Consumption of a large quantity of starchy grains within a short time can impair the appetite, decrease voluntary visits to the milking stall, and lower intakes of dry matter (DM) and neutral detergent fiber (NDF). Therefore, the hypothesis to be tested in this study was whether conventional starchy pellets fed in the AMS could be replaced with pellets rich in digestible NDF without impairing the cows' motivation to visit a milking stall voluntarily. Fifty-four cows were paired according to age, milk yield, and days in milk, and were fed a basic mixture along the feeding lane (19.9 kg of DM/cow per d), plus a pelleted additive (approximately 5.4 kg of DM/cow per d) that they obtained in the milking stall and in the concentrate self-feeder that they could enter only after passing through the milking stall. The 2 feeding regimens differed only in the composition of the pelleted additive, which, for the control group, contained 49% starchy grain, and for the experimental group contained 25% starchy grain plus soy hulls and gluten feed as replacement for part of the grain and other low-digestible, NDF-rich feeds. Both diets resulted in similar rates of voluntary milkings (3.31 vs. 3.39 visits/cow per d). Average yields of milk and percentages of milk protein were also similar in the 2 groups. The results suggest that an alternative pellet composition can be allocated in the AMS in conjunction with basic mixture in the feeding lane, without any negative effect on appetite, milk yield, milk composition, or milking frequency of the cows. It also opens the opportunity to increase yields of milk and milk solids by increasing the amount of pelleted concentrates that can be allocated to selected high-yielding cows via the AMS, because this can be done while maintaining a high frequency of voluntary milkings.

Follow-up of patients with contrast-induced nephropathy

In this chapter, we review the approach to following the patient after contrast is administered. We first discuss the clinical importance of renal injury for if there were no clinically significant consequences of this renal injury, we would have far less concern for the adequacy of follow-up. We next look at markers of renal injury and what tests are used in clinical practice to define contrast-induced nephropathy (CIN). Finally, we discuss the steps that should be taken in those who do develop CIN to limit the impact of the injury and protect them from future adverse events.

Digestibility in Lactating Cows of Diets Containing Whole Pima Treated with Sodium Hydroxide Versus Akala or Pima Cottonseed

This study examines the effect of NaOH treatment on the nutritive value of Pima cottonseed for lactating cows. Treatment of Pima cottonseed with NaOH increased the extent of dry matter (DM) and neutral detergent fiber in vitro digestibility. Three groups of cows were fed 3 similar total mixed rations (TMR) differing only in the type of cottonseed fed, either whole linted Akala, whole unlinted Pima, or whole Pima treated with 4% NaOH (T-Pima). Dry matter and organic matter (OM) intakes of Akala and Pima TMR were similar and tended to be lower compared with cows fed T-Pima. This was reflected in similar intake of crude protein and lipids by cows fed the 3 TMR. Digestibility of DM, OM, and crude protein were similar in cows fed Pima and T-Pima diets, and slightly higher in cows fed the Akala TMR. Lipid digestibility was highest in cows fed Akala TMR, whereas cellulose and NDF digestibility were lowest in Pima TMR. In the 3 TMR, there was a large gap between the high values of "digestibility of intact seeds" and actual in vivo digestion of DM and OM. Similar yields of milk and milk protein were obtained in cows fed the Akala and Pima TMR, whereas higher yields of milk, milk protein, milk fat, and 4% fat-corrected milk were found in the T-Pima cows. Similar efficiency of DM intake for fat-corrected milk production was achieved by cows fed the 3 TMR.

Interdigitating dendritic cell sarcoma: a report of four paediatric cases and review of the literature

AIMS

To report a series of four paediatric cases of interdigitating dendritic cell sarcoma (IDCS) and add to the known extranodal sites of occurrence for this tumour. Neoplasms derived from interdigitating dendritic cells are rare, with only 33 cases being reported in the literature (Medline search). These tumours usually occur in lymph nodes in the adult population.

METHODS AND RESULTS

The patients were a 10-year-old girl with a large soft tissue mass bulging into the left chest, a 12-year-old girl with a right paraspinal mass, a 21-month-old boy with generalized lymphadenopathy and hepatosplenomegaly and a 6-year-old girl with a large bladder mass. Paraffin blocks and haematoxylin and eosin slides were available in all cases. In addition, immunohistochemistry and electron microscopy were performed. A diagnosis of IDCS was made in all cases.

CONCLUSION

The diagnosis of IDCS can rarely be entertained on clinical information alone. Microscopically, there is a wide spectrum of features. Thus, immunohistochemistry and electron microscopy are crucial in making the diagnosis. The differential diagnosis includes inflammatory pseudotumour, follicular dendritic cell sarcoma, true histiocytic lymphoma, malignant Langerhans cell histiocytosis, anaplastic large-cell lymphoma, melanoma, and a range of sarcomas. IDCS displays aggressive behaviour and approximately half of the patients die of the disease.

Characterization of adhesion and differentiation markers of osteogenic marrow stromal cells

Marrow stroma cells (MSC) play a major role in osteogenesis. The potential of the MSC to differentiate to bone-forming cells relies upon molecular regulation. This study analyzed MBA-15 cells for the expression of genes and proteins that are key regulators of osteoblast differentiation. These cells express Cbfa1 and c-fos transcription factors (TF) of osteoprogenitor proliferating cells. RT-PCR and immunohistochemistry were used to demonstrate the message and protein expression of extracellular matrix proteins that are a prerequisite for matrix formation and mineralization, including alkaline phosphatase (ALP), osteocalcin, osteopontin, biglycan, and bone sialoprotein (BSP). The activity of ALP was correlated at various cell densities with co-expression of osteocalcin or osteopontin. Adhering cells must attach to the appropriate matrix to enable survival and differentiation. Using attachment assays, we demonstrated that MBA-15 cells adhered to collagenous matrix and the effect on survival measured by changes in intracellular calcium (Ca) levels. The cells' adhesion to matrix is mediated via cell surface molecules. We quantified the expression of cells surface molecules that are important players in mediating cell-matrix interaction. Flow cytometry analysis (FACS) was used to determine the expression of CD-31 (36%), and lower levels were identified for CD-62E and CD11b. In summary, the present study demonstrates the expression of molecular markers that are distinctive for the osteoblastic phenotype in MBA-15 marrow stroma cells and have crucial role in cell-matrix interaction, in establishing the cellular osteogenic phenotype and their survival.

Long segment Hirschsprung's disease in the Waardenburg-Shah syndrome

Presentation with signs of bowel obstruction in an infant with Waardenburg syndrome should raise the suspicion of aganglionosis. We report such a case of long segment Hirschsprung's disease associated with Waardenburg syndrome. Long term care of such children is fraught with high morbidity and mortality.

Digestibility by dairy cows of monosaccharide constituents in total mixed rations containing citrus pulp

Ten lactating cows were divided into two groups and individually fed ad libitum one of two experimental total mixed rations (TMR) as follows: 1) a TMR containing 20% corn grain and 10% dry citrus pulp (high corn); and 2) a TMR containing 21% citrus pulp and 9% corn grain (high citrus pulp). Both TMR also contained corn silage (28%), legume haylage (19.5%), extruded full fat soybeans (13.5 to 14%), soybean meal (6.5%), and minerals and vitamins. Voluntary dry matter intake of cows consuming the high corn ration tended to be higher than for cows in the high citrus pulp group (22.2 vs. 20.7 +/- 1.0 kg/cow per day, respectively). Digestibility of NDF was higher for the TMR with high citrus pulp compared with the TMR with higher corn. Across treatments, neutral detergent fiber (NDF) glucose was more digestible than NDF xylose and uronic acids and less digestible than NDF arabinose, galactose, and mannose. Digestibility of total neutral detergent soluble carbohydrates was also higher in the high citrus pulp group (86.8, high citrus pulp vs. 80.3 +/- 1.7%, high corn); with glucose and uronic acids accounting for most of that difference. Consequently, higher total carbohydrate digestibility was obtained in the TMR containing higher citrus pulp compared with the TMR with a higher percentage of corn (77.1 and 72.5 +/- 1.0%, respectively). Slightly lower carbohydrate intake in cows fed higher citrus pulp was compensated by higher digestibility of carbohydrates and protein. Thereby, partial replacement of corn by citrus pulp in TMR of high producing dairy cows improved feed efficiency.