Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh

Background: Until recently, the experience on implementing community based management of acute malnutrition (CMAM) among children has been largely based in African settings. While the government in Bangladesh is yet to scale up CMAM approach, there is still paucity of knowledge on the experience of CMAM within the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka, Bangladesh, this paper describes a CMAM programme performance and outcomes run by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme data of children admitted with severe acute malnutrition between May 2010 and November 2011. Kamrangirchar is an urban slum of a large migrant population in Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of whom 333 (52%) were males. The median age was 18 months (Inter-quartile range (IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of 69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5% reported to the programme that they will leave the slum and go back to their villages. These performance indicators did not meet the threshold level indicators set by MSF and Sphere standards. Conclusions: Our experience highlights the need for developing more adapted and contextualised indicators for assessing the performance of CMAM programmes in settings such as urban slums. Community engagement in the process of developing relevant standards is crucial. Nutrition humanitarian actors have a vital role to collaborate with local authorities to contextualize and refine these standards.

Registered Nurses’ Perceptions of Factors Contributing to Trust-Based Public Management

Aim: The aim of this study was to illuminate registered nurses’ (RNs) perceptions of Trust-Based Public Management (TBPM) in Swedish health care. Design: This study follows a phenomenografic approach guided by Ference Marton’s philosophy. Methods: Semi-structured interviews were used to identify variations in RNs’ perceptions of TBPM. Between February and April 2019, 24 RNs from five Swedish public healthcare departments participated in the study. Results: The results show that none of the participants had previously heard about the work of the Swedish Delegation for TBPM. The study revealed perceptions those politicians and managers were absent from the workplace, that power had been displaced to HR, and that perceptions of trust in the leadership and of working to guidelines varied. Perceptions varied between RNs employed by the municipalities and by the hospitals concerning administration, the time allotted for work, cooperation, and education.

Research and Design of Network Management Construction Based on Mobile AGENT

The technical characters of mobile agent （MA） originated in the distributional artificial intelligence domain is introduced. A network management construction based on agent （NMCA） is then proposed. The NMCA structure features are elaborated in detail. A prototype design of NMCA is given by using the jKQML programming. The establishment of NMCA platform will be helpful to reduce the correspondence load of network management and improves the efficiency and the expansion ability of network management systems.

A Model-Based, Aspiration-Led Decision Support System NY-IEDSS

An AI-aided simulation system embedded in a model-based, aspiration-led decision support system NY-IEDSS is reported. The NY-IEDSS is designed for mid-term development strategic study of the Nanyang Region in Henan, China, and is getting beyond its prototype stage under the decision maker's (the end user) orientation. The integration of simulation model system, decision analysis and expert system for decision support in the system implementation was reviewed. The intent of the paper is to provide insight as to how system capability and acceptability can be enhanced by this integration. Moreover, emphasis is placed on problem orientation in applying the method.

Design of intelligent detecting system based on wireless transmission

An intelligent detecting system based on wireless transmission is designed. Its hardware includes the card reading module, the wireless digital transmission module, the LCD module, the random password keyboard module and a 16×16 lattice word database based on e-Flash MM36SB020. Its software is a communication protocol between the central control computer and the entrance management base station. To resolve the conflicting problems occurred during the data transmission, a method of delaying time at random is proposed.

Perceptive insight into incentive design and sustainability of participatory mangrove management: a case study from the Indian Sundarbans

Incentive design is among the decisive factors behind active community participation and long-term sustainability of participatory forest management. Especially in case of mangroves, where multiple interests apply, it requires a careful integration of several ecological, economic and institutional factors. The primary objective of this paper is to understand the basis of incentive design and make a comprehensive inquiry into the existing incentive mechanism of participatory mangrove management in Indian Sundarbans. The qualitative and in-depth assessment was derived against a conceptual framework that contains three main determinants: (1) resources availability, (2) control mechanism, and (3) perception of end-users. The study deploys the results of various participatory exercises such as structured interviews with forest officials, focus group discussions with 10 Joint Forest Management Committees and semi-structured interviews with 119 mangrove users. In general, we observed an over-cautious, hierarchical and safety-margin-based incentive design with distinct bifurcation of communities over the adequacy and effectiveness of derived benefits. Although, the incentives are diverse and align well with the overall conservation of mangroves, they are considered to be insufficient by nearly half of the mangrove users. The main issues that were observed to hinder effective community participation can be summarized as (1) serious restrictions on access to economically exploitable mangrove products, (2) passive involvement of vulnerable occupational groups, and (3) lack of trust and conflicting interests between the officials and the communities. Although the existing preventive management of mangroves can be justified considering the magnanimity of the Indian Sundarbans, it can severely impair community participation and emerge as a clear threat to future sustainability. To secure greater participation of the communities, we propose small scale, innovative developmental incentives to supplement traditional forest-resource-based incentives.

Comparative assessment on rodent impacts and cultural perceptions of ecologically based rodent management in 3 Afro-Malagasy farming regions

Rodents generate negative consequences for smallholder farmers in Africa that directly impact household and livestock damage,food security,and public health.Ecologically Based Rodent Management(EBRM)seeks sustainable solutions for the mitigation of rodent damage through assessments of rodent population dynamics,agro-ecosystems,and socio-cultural contexts.We adopt a comparative approach across 3 rural Afro-Malagasy smallholder farming regions in South Africa,Tanzania,and Madagascar to assess the household impacts of rodent pests and current perceptions and preferences associated with several rodent control measures.We conducted focus group questionnaires and interviews in different study site locations.Rodents assert multiple impacts on Afro-Malagasy farmers demonstrating recurrent and emerging agricultural and household costs,and public health impacts.We identify a significant knowledge gap in educating communities about the application of different EBRM approaches in favor of acute poisons that are perceived to be more effective.Cultural issues and taboos also have a significant impact on the social acceptance of rodent hunting as well as biological control using indigenous predators.We advocate for an enhanced investigation of the socio-cultural beliefs associated with different rodent practices to understand the factors underlying social acceptance.A collaborative approach that integrates the perspectives of target communities to inform the design of EBRM initiatives according to the specific agro-ecosystem and socio-cultural context is necessary to ensure programmatic success.

STATUS AND CONTROL POLICY OF MAIN CHRONIC DISEASES IN COMMUNITY HEALTH MANAGEMENT BASES IN SHANGHAI AND GUANGDONG

Objective To investigate the current conditions of the main chronic diseases and to make the control policy in community health management base in China. MethodsThe questionnaire consisting of prevalence, awareness rate, management rate, behavior correct rate, control rate, and medicine obey was used to survey the chronic disease condition in 2009. A total of 809 736 residents were randomly selected from Shanghai and Guangdong, China. ResultsThe hypertension prevalence was 17.81%. From sex analysis, the female has higher rate than male in hypertension prevalence, understand rate, management rate, behavior correct rate, control rate, and medicine obey rate. From age analysis, the prevalence, understand rate, management rate, control rate, and medicine obey were increasing along with the age, but behavior correct rate was not in this condition. The diabetes prevalence was 6.92%. To compare with Shanghai and Guangzhou in 5 aspects, the prevalence of chronic diseases was alike. Except lower behavior correct rate in Shanghai, management rate, behavior correct rate, control rate, and medicine obey rate were higher in Shanghai. ConclusionThe government must take main principle in chronic disease control. Base construction of community health management and increase management level of chronic diseases should be enhanced and practitioner's knowledge of chronic disease management should also be enhanced.

Effects of newly devised plasma lice comb on human hair

A plasma device was developed showing high potential for a pesticide-free treatment of pediculosis. As a first safety assessment of the device was presented earlier, this present paper focuses on the damage introduced to human hair during a plasma treatment for pediculosis control. Therefore, human hairs were treated repeatedly to assess the possible occurring damage developing with increasing treatment durations. To analyse the inflicted changes on human hair examinations using x-ray photoelectron spectroscopy(XPS/ESCA), scanning nearfield optical microscopy(SNOM) and scanning electron microscopy were conducted, to compare the modifications of surface chemistry and mechanical alterations. The investigations revealed a mild impact on the surface chemistry(XPS/SNOM), while more distinct morphological changes on the hair surface could be observed. The authors conclude that an effect of the plasma comb device on the hair during a real-life treatment is negligible, due to the very short contact times during a standard combing procedure for pediculosis control.

Estimating Security Risk of Healthcare Web Applications: A Design Perspective

In the recent years,the booming web-based applications have attracted the hackers’community.The security risk of the web-based hospital management system(WBHMS)has been increasing rapidly.In the given context,the main goal of all security professionals and website developers is to maintain security divisions and improve on the user’s confidence and satisfaction.At this point,the different WBHMS tackle different types of security risks.In WBHMS,the security of the patients’medical information is of utmost importance.All in all,there is an inherent security risk of data and assets in the field of the medical industry as a whole.The objective of this study is to estimate the security risk assessment of WBHMS.The risks assessment pertains to securing the integrity of the information in alignment with the Health Insurance Portability and Accountability Act.This includes protecting the relevant financial records,as well as the identification,evaluation,and prevention of a data breach.In the past few years,according to the US-based cyber-security firm Fire-eye,6.8 million data thefts have been recorded in the healthcare sector in India.The breach barometer report mentions that in the year 2019,the data breaches found were up to 48.6%as compared to the year 2018.Therefore,it is very important to assess the security risk in WBHMS.In this research,we have followed the hybrid technique fuzzy analytic hierarchy process-technique for order of preference by similarity to ideal solution(F-AHPTOPSIS)approach to assess the security risk in WBHMS.The place of this empirical database is at the local hospital of Varanasi,U.P.,India.Given the affectability of WBHMS for its board framework,this work has used diverse types of web applications.The outcomes obtained and the procedure used in this assessment would support future researchers and specialists in organizing web applications through advanced support of safety and security.

Questioning Ecosystem Assessment and Restoration Practices in a Major Urban Estuary： Perpetuating Myths of Degradation in Spite of the Facts

The Jamaica Bay ecosystem is a dichotomy. It encompasses more than 12,000 acres of coastal estuarine marshes and an ecological diversity rivaling any coastal environment in the world. It is considerably altered, and is affected by a variety of ecological insults directly related to the fact that more than 14 million people live in its vicinity. Environmental protection institutions responded to the challenge of protecting the bay, surrounding wetlands and recreational benefits by addressing the increasing load of contaminants into the ecosystem. Billions of dollars have been spent during the past five decades on restoration attempts, including upgrading wastewater treatment plantsand the closure of three major sanitary landfills. Even with the curtailment of untreated wastewater release and ending periodic dredging and filling programs, all activities that are necessary processes in maintaining an urban harbor, the Jamaica Bay ecosystem has reached a point where many believe it to be unrecoverable, requiring massive infusions of restoration dollars. This categorization has been perpetuated based on questionable data （the ＂myths＂） that, when investigated in rigorous scientific detail, prove to be unsubstantiated. In this paper, the origin of these myths and the scientific investigation that dispel them are discussed.

Suggesting the use of integrated methods for vole population management in alfalfa fields

Human-made agro-ecosystems lack negative feedback controls, which may result in rodent population explosions,causing considerable economic loss and thus increasing human–wildlife conflicts. The traditional solution is theextensive use of rodenticides, which have a negative impact on the environment. In Beit-Sheaan Valley, Israel,which is located on a major route for migrating birds, poisoning of voles may result in the death of birds that preyon the dead voles (e.g. storks and herons). In the present essay we discuss some integrated methods, based on theimplementation of ecological principles in agro-ecosystems, that could be used to decrease the use of rodenticides.The first method is light interference during winter (long scotophase), which can result in the death of the socialvole Microtus socialis kept in enclosures under natural conditions. Under laboratory conditions such interferencecauses a decrease in thermoregulatory ability in the cold. As light interference is a source of pollution, only activevole burrows should be illuminated. The second method involves using the mobile irrigation pipelines to flood thevole burrows and force them to escape into the open, where diurnal birds such as storks and herons will prey onthem. The third method involves the use of nesting boxes for barn owls and stands for diurnal raptors, both ofwhich prey on voles. The great advantage of using an integrated approach is that voles cannot become adapted toany one of the methods. Such integrated methods, together with appropriate treatment of alfalfa fields by farmers,can provide an efficient and sustainable pest control approach.

The status of fertility control for rodents—recent achievements and future directions

Management of overabundant rodents at a landscape scale is complex but often required to sustainably reduce rodent abundance below damage thresholds.Current conventional techniques such as poisoning are not species specific,with some approaches becoming increasingly unacceptable to the general public.Fertility control,first proposed for vertebrate pest management over 5 decades ago,has gained public acceptance because it is perceived as a potentially more species-specific and humane approach compared with many lethal methods.An ideal fertility control agent needs to induce infertility across one or more breeding seasons,be easily delivered to an appro-priate proportion of the population,be species specific with minimal side-effects(behavioral or social structure changes),and be environmentally benign and cost effective.To date,effective fertility control of rodents has not been demonstrated at landscape scales and very few products have achieved registration.Reproductive targets for fertility control include disrupting the hormonal feedback associated with the hypothalamic-pituitary-gonadal axis,gonad function,fertilization,and/or early implantation.We review progress on the oral delivery of various agents for which laboratory studies have demonstrated efficacy in females and/or males and synthesize progress with the development and/or use of synthetic steroids,plant extracts,ovarian specific peptides,and immunocontracep-tive vaccines.There are promising results forfield application of synthetic steroids(levonorgestrel,quinestrol),chemosterilants(4-vinylcyclohexene diepoxide),and some plant extracts(triptolide).For most fertility control agents,more research is essential to enable their efficient and cost-effective delivery such that rodent impacts at a population level are mitigated and food security is improved.

Impact of contraceptive hormones on the reproductive potential of male and female commensal black rats (Rattus rattus)

The black rat is considered one of the world’s top pests.With increased restrictions on rodenticides,new alternatives to manage rats are urgently needed.Research on the use of contraceptive hormones,levonorgestrel(LE),and quinestrol(QU),have been evaluated against some rodent species,and this research is thefirst study to assess these on black rats.Hormones were incorporated into rodent bait at 10 and 50 ppm concentrations singly and in combination(EP-1).Groups of 10 animals of each sex were fed the baits over 7 days.Lower bait consumption was observed with slight body mass reductions.On dissection,it was observed that the uterus was in a state of edema and male reproductive organs weighed less with reduced sperm counts/motility.The 2 most promising baits,50 ppm QU and EP-1,were used to assess impact on pregnancy and litter size.Pregnancy was reduced from 70%success when both males and females consumed untreated bait,down to 30%when males had consumed contraceptive bait but females had not,and down to 0%when females had consumed contraceptive bait,regardless of whether they had paired with a treated or untreated male.Litter size in the untreated pairs was 8 pups,but only 4 pups in those cases where the male only had consumed the contraceptive.Further studies should investigate how long the effect lasts and its reversibility.Field studies at the population level may also shed light on the practicality of using contraceptive baits for black rats in different habitats.

Impact of fertility versus mortality control on the demographics of Mastomys natalensis in maize fields

The multimammate mouse,Mastomys natalensis,is the most common rodent pest species in sub-Saharan Africa.Currently,rodenticides are the preferred method used to reduce the population of rodent pests,but this method poses direct and indirect risks to humans and other non-target species.Fertility control is a promising alternative that has been argued to be a more sustainable and humane method for controlling rodent pests.In this study,we compared the effectiveness of fertility control bait EP-1(quinestrol(E)and levonorgestrel(P),10 ppm)and an anticoagulant rodenticide bait(bromadiolone,50 ppm)on the population dynamics of M.natalensis in maizefields in Zambia during 2 cropping seasons.M.natalensis was the most abundant species in maizefields(77%of total captures).Fertility control reduced the number of juveniles and suppressed population growth of M.natalensis at the end of the 2019–2020 cropping season.The population density initially decreased after rodenticide treatment,but the population rapidly recovered through immigration.None of the treatments influenced maize damage by rodents at germination(F2,67=1.626,P=0.204).Applying the treatments during the maize seeding time was effective at suppressing population growth at the end of the cropping season than application the month before maize seeding.This research indicates that a single-dose delivery of EP-1 and rodenticide have comparable effects on the population dynamics of M.natalensis.Thesefindings are important in developing fertility control protocols for rodent pest populations to reduce maize crop damage and improve yields.

Reproductive responses of rice field rats(Rattus argentiventer)following treatment with the contraceptive hormones,quinestrol and levonorgestrol

The ricefield rat,Rattus argentiventer,is a significant pest of rice in Southeast Asia.Fertility control methods have the potential to provide safe and effective alternatives to control methods that often include indiscriminate use of rodenticides or electric barriers.The aim of this laboratory study was to assess uptake of bait coated with different concentrations of the contraceptive hormones,quinestrol(E)and levonorgestrel(P),delivered alone and in combination(i.e.EP-1)and determine the short-term effects on reproductive parameters of adult male and female R.argentiventer.In Experiment 1,2 concentrations of E,P,and EP-1(10,20 ppm)were fed to groups of wild-caught rats for 7 days.In females,both E and EP-1 induced uterine edema.In males,EP-1 reduced epididymis and seminal vesicle weights and lowered sperm motility.However,these responses were inconsistent due to low bait acceptance,especially with increasing concentrations.In Experiment 2,EP-1(0,20,50,100 ppm)was administered by oral gavage daily for 7 days to male R.argentiventer.There were significant reductions in epididymal and seminal vesicle weights for all oral doses of EP-1,in sperm counts for the 50 ppm dose,and in sperm motility for the 20 and 50 ppm doses compared to the control group.To select the optimum dose of EP-1,we must address the poor acceptance of contraceptive-coated baits by ricefield rats.Further research is required to improve the palatability of EP-1 and to test its uptake underfield conditions.