"Generic baclofen 10mg amex, spasms in your back".

D. Rhobar, M.A., M.D., Ph.D.

Professor, Loyola University Chicago Stritch School of Medicine

There is evidence that agricultural productivity growth has a substantial impact on poverty reduction, although this is conditional on contextual and socioeconomic conditions. Economists have developed techniques to quantify the total economic value of the multitude of products and services (social/environmental and local/ global) from agricultural programs, such as agroforestry (Pearce and Mourato, 2004). Impact assessments of investment in agricultural research have shown that it has been highly cost effective. Goals L, E, D Certainty B Range of Impacts Scale +2 to +4 G, R, N Specificity Wide applicability Investment in research has resulted in substantial economic gains from increased productivity. Other estimates of forestalled conversion of habitat to agricultural use are as high as 970 million ha (Golkany, 1999). Increases in total factor productivity, which contribute to increased output, are always associated with investment in research (Pingali and Heisey, 1999; McNeely and Scherr, 2003). These studies pay less attention to the social and institutional distribution of impacts or to noneconomic benefits. A livelihood is said to be sustainable "when it can cope with and recover from shocks and maintain or enhance its capabilities and assets both now and in the future, while not undermining the natural resource base" (Carney, 1998). Livelihoods approaches have usefully contributed to conceptual and methodological innovations. Goals N, H, L, E, S, D Certainty B Range of Impacts 0 to +3 Scale R, N, L Specificity Wide applicability analysis for research and development planning and to assess specific institutional, policy and technology and rural development options prior to intervention (Ashley and Carney, 1999; Shackleton et al. More recently it has been used to assist evaluation of outcomes and impacts (Ashley and Hussein, 2000; Adato and Meinzen-Dick, 2003; Meinzen-Dick et al. Livelihoods analysis has been further assisted by the development and refinement of participatory tools for poverty and situational analysis, especially in the context of improving client orientation and gender relevance of agricultural research and development (World Bank, 1998). Recently, the framework has helped to identify principles and processes critical to achieving sustainable livelihoods, and to understand the complexities associated with partnerships to promote local empowerment, resiliency and diversification (Butler and Mazur, 2007). Its limitations include the absence of integration of dimensions of power, the unspecified nature of "institutions and processes" which require further elaboration of knowledge, culture and innovation and the need for further tools to understand the dynamics of livelihood changes. This depends on the factors influencing uptake, the distribution of benefits of specific technologies and their impacts. Particular attention is paid to impacts on overall levels of poverty and economic status, human health; natural and physical assets, social relationships, and vulnerability. The livelihoods framework considers livelihoods as comprising the capabilities, assets and activities required for a means of living. This is a broader and more holistic view than just equating "livelihood" with income or employment (Booth et al. It links the notion of sustaining the means of living with the principle of environmental sustainability (Carney, 1998). The elements of the livelihoods framework include the assets that people use and combine to make a living, the factors which cause vulnerability; the policies, institutions and processes which affect the environment for livelihoods; the livelihood strategies followed and the outcomes. In sub-Saharan Africa, although there was a small decline in the rate of poverty, the number of people living in extreme poverty increased by 140 million. While the Green Revolution yielded large production gains in some commodity crops, basic grains and livestock, it was often at the expense of environmental degradation (Pingali and Rosegrant, 1994). Elsewhere, for example, in Uttar Pradesh and Tamil Nadu in India, it benefited the poor, including some landless laborers, reducing inequality and improving economic opportunities (Hazell and Ramasamy, 1991; Sharma and Poleman, 1993). Intensive agricultural development, particularly in Europe, led to oversupply, sanitary problems affecting livestock production and ecological issues, while the concentration of production caused economic and social decline in marginal areas (Hervieu and Viard, 1996). Goals N, H, L, S Certainty B Range of Impacts 0 to +3 Scale G, R, N, L Specificity Widespread the initial success of the Green Revolution was a result of its focus on more favorable irrigated rice and wheat systems (Huang et al. Although the adoption of "modern" varieties has been widespread (up to 70% in some crops) (Evenson and Gollin, 2003ab), farmers in more marginal areas have not always benefited from the latest research on pest/disease resistance and yield (Witcombe, 1999; Witcombe et al. Varieties bred on research stations have not always been well adapted to local conditions and preferences; nor for acceptable quality, utility for multipurpose uses; or acceptable postharvest characteristics. Consequently, comparatively few of the hundreds of rice varieties released in India are grown by farmers (Witcombe et al. Some new and potentially better modern varieties have failed to reach farmers due to the inefficiency of the varietal release and seed multiplication system (Witcombe et al. Livestock are important for rural livelihoods, but livestock technologies have made only a limited contribution to improving rural livelihoods. The important developments in livestock technologies (feed technologies in intensive livestock production systems; artificial insemination; embryo transfer, etc. Thus, the rapid growth in consumption of livestock products in developing countries has been due to increased numbers, rather than increased productivity (Delgado et al.

Over the years the battery has expanded to include tests designed to assess visual and verbal memory, executive function, attention, decisionmaking and response control, and social cognition. In addition two short "induction" tests can be used to familiarize participants with the general testing milieu and response format. Another important parameter of test batteries purported to be well suited to repeat administration, and tracking of change over time or with intervention, is test-retest reliability. Lowe and Rabbitt (1998) administered all tests of the 11 the Cambridge Neuropsychological Test Automated Battery. The authors hypothesized that practice effects may be a more significant issue for tests that assess frontal or executive functions than tests of temporal function, as the former tend to rely on identification of strategies for successful performance. Further, as task novelty decreases with repetition, practice effects and individual variability in improvement with repeat testing may be amplified. Practice effects were found to vary with test, task difficulty, level of intellectual ability, and outcome parameters. In general, test-retest correlations were higher for tests of memory than for tests of planning or working memory. More specifically, measures such as number of moves to solution on the Tower of London had poor testretest correlations. On some tests higher intelligence was related to greater improvement with practice, while on others the opposite was true. Speed versus accuracy measures also differed in their sensitivity to repeat testing. For the purposes of this review, discussion will be limited to those publications addressing deficits in executive function. Further, we focus on a selection of diagnostic groups that represent some of the main targets of research with this instrument. While it is beyond the scope of this chapter to summarize all relevant research efforts even in these diagnostic categories, every effort has been made to include those articles describing the most rigorous scientific methodology. Responses are by touch screen or with a response button, depending on the task demands. The tests described below are those that assess executive function and related domains; additional tests of verbal and visual memory and social cognition that are part of the complete battery are beyond the scope of this chapter but are described on their website. The participant is initially instructed to press a left or right button in response to the direction in which an arrow in the center of the screen is pointing. The second phase requires the participant to attend to a cue at the top of the screen that will determine whether the response reflects the direction in which the arrow is pointing or the side of the screen on which the arrow is located. Outcome measures include speed, accuracy, and types of errors (commission and omission), as well as switch cost and congruency cost. This test, described as a computer-based analog of the Wisconsin Card Sorting Test, assesses set formation and maintenance, shifting, and attentional flexibility. The test initially presents two simple colored shapes and the participant must determine which one is correct in response to feedback. Among the multiple outcome measures are errors to criterion, number of trials and stages completed, and response latencies. The time taken to complete the pattern, number of moves taken, and trials performed in minimum number of moves are measured. The response is based on working out the solution without actually moving any balls. Outcome measures are based on speed and accuracy of response and include problems solved on first choice, mean choices to correct response, latency to first choice, and latency to correct choice. Described as a visual analog of the Digit Span Test, in this task white squares in an irregular array change color briefly in random sequences. The participant touches the boxes in the same order, or in reverse order, for varying sequence spans. Participants are asked to search through randomly arrayed boxes to locate colored tokens within the boxes, in order to fill a column on the side of the display.

They also have to be extended to the critical steps of preparation, handling, and use of the bottles with the reconstituted liquid formulas (38). The use of boiled water for reconstitution and of sterilized bottles and teats are part of the recommendations. Using hot (boiling) water for reconstitution assures the killing of low levels of Enterobacteriaceae, if present. Citrobacter freundii, Enterobacter cloacae, Enterobacter agglomerans, Klebsiella pneumoniae, and others have also been involved in outbreaks and have also been isolated from infant formulas (10,31,39). Formulas containing living microorganisms added on purpose, such as probiotic bacteria, should of course not be prepared with hot water. Low levels of Enterobacteriaceae would, however, most probably not cause problems in this type of product. In any case, bottles should be used directly when lukewarm and not kept for prolonged periods in bottle warmers (26). The World Health Organization does not recommend storage of foods for infants and young children (40). However, when it is practiced, cooling should be rapid and bottles should be kept refrigerated (also for limited periods of time) in order to prevent multiplication of microorganisms such as spore formers that are still present. Although the use of in-pack sterilized liquid formulas is considered expensive and impractical for hospitals by some authors (10), this would represent, just as the reconstitution in boiling water, a safe manner to provide feeding for the most vulnerable group of neonates, in particular premature infants. Enzymatic profiles of Enterobacter sakazakii and related species with special reference to the -glucosidase reaction and reproducibility of the test system. Enterobacter sakazakii: A Tween 80 esterase-positive representative of the genus Enterobacter isolated from powdered milk specimens. Thermal resistance of Enterobacter sakazakii in reconstituted driedinfant formula. Biochemical identification of new species and biogroups of Enterobacteriaceae isolated from clinical specimens. The occurrence of the Enterobacter geus rods in clinical materials and materials taken from the hospital environment (In Polish). Outbreak of necrotising enterocolitis associated with Enterobacter sakazakii in powdered milk formula. Bacteremia associated with Enterobacter sakazakii (yellow-pigmented Enterobacter cloacae). Meningoencephalitis and compartmentalization of the cerebral ventricles caused by Enterobacter sakazakii. A fatal case of sepsis in a premature newborn associated with Enterobacter sakazakii bacteremia. Epidemiologic typing of Enterobacter sakazakii in two neonatal nosocomial outbreaks. Nosocomial bacteremia caused by Enterobacter sakazakii and Leuconostoc mesenteroides resulting from extrinsic contamination of infant formula. Enterobacter sakazakii brain abscess in the neonate: the importance of neuroradiologic imaging. Analysis of eight cases of neonatal meningitis and sepsis due to Enterobacter sakazakii. Enterobacter sakazakii infections in neonates associated with intrinsic contamination of a powdered infant formula. Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. Quality of powdered substitutes for breast milk with regard to members of the family Enterobacteriaceae. Phenotypic and genotypic typing of food and clinical isolates of Enterobacter sakazakii. Identification of infant food as a vehicle in a nosocomial outbreak of Citrobacter freundii: epidemiological subtyping by allozyme, whole-cell protein and antibiotic resistance. Although mounting evidence suggests that this organism may be a human pathogen, medical science has not classified this bacterium as a zoonotic agent.

Serological typing is employed for research and epidemiological purposes on group A streptococci and on some group C and G isolates that have T or M antigens. The M proteins are the most important type determinants and are virulence factors that correlate with protection. T antigens are trypsin-sensitive surface proteins that have no relationship to virulence but are useful for classification. Certain T typing patterns are consistent markers for many of the important M types (121); many isolates can be assigned a T type even if the strain produces little M protein or if the strain cannot be typed with existing M antisera. Currently, there are 81 classically established M types (including 4 originally from group C and G strains) for which rabbit antisera have been made at reference laboratories. Several dozen strains isolated in recent years were unassigned because of lack of M antisera but are now being typed by molecular methods. A variety of molecular methods are now available for subspecies discrimination of streptococci (119). Similar methods have been used to study isolates from a milkborne outbreak of group C disease in Australia (54) and a foodborne outbreak at a college in the United States (85). The molecular equivalent of M typing of group A streptococci is based on sequencing the 5-variable region of the emm gene, which codes for the M protein (124). Several antibody tests are sometimes used to help document recent infection by group A streptococci. These are useful when it is necessary to confirm a clinical diagnosis but are not helpful in diagnosing acute suppurative streptococcal disease. In addition to culture, rapid antigen-detection tests for onsite diagnosis group A streptococcal pharyngitis have been available for some years (34,119). Most tests are based on detection of cell wall antigens extracted from material on a throat swab. This permits patients to return to work or school a day or two earlier and helps avoid prescribing antibiotics unnecessarily. Since a large portion of patients with false-negative tests are truly infected and not merely carriers, it is recommended that negative rapid tests be confirmed with conventional culture on blood agar. Cultures are still recommended in any investigation of a foodborne outbreak, because strains of group C, G, or other species are not detected by the rapid antigen test and because intact live isolates may be required for further specific identification. A list of the more important virulence factors, extracellular enzymes, and other products along with their functions is provided in Table 8. Group C and G streptococci also elaborate their own versions of these products, with the exception of the pyrogenic exotoxins. Also aiding the organisms is the C5a peptidase, which inhibits the chemotactic activity of complement. Several other components, including immunoglobulin-binding proteins, interfere with host defenses by interacting with antibodies or complement. M18 strains are almost entirely dependent on capsule expression for protection against phagocytosis. The hemolysins streptolysin O and streptolysin S are cytotoxic, capable of killing phagocytes, and they may also be responsible for some secondary inflammation. Fibronectin-binding protein is one of several factors that promote adherence, along with other proteins and lipoteichoic acids on the cell surface (1,30). The hyaluronidase is thought to facilitate the spread of infection within the tissues by breaking down basement membrane matrix. Streptokinases are plasminogen converting factors, some of which may play a role in the renal damage leading to acute glomerulonephritis. A streptokinase from group C is also used therapeutically to dissolve clots in certain cases of acute thrombosis or empyema. These "superantigens" induce lymphocyte blastogenesis, suppress antibody synthesis, potentiate endotoxic shock, and promote the febrile response (30,128). Although its genome has been sequenced and many of its pathogenic features have been studied at the genetic level, investigators are only beginning to understand the complex interactions of the bacterium and its host environment and the factors that influence development of disease. Other mobile elements include plasmids and transposons, mainly associated with resistance to erythromycin, aminoglycosides, tetracycline, and chloramphenicol. The major virulence gene are located in a cluster called the vir regulon, which contains the emm genes coding for M and M-like proteins.