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Households included in the evaluation were finalized after a review of the list of randomly selected households and on the basis of accessibility and advice received from village authorities blood pressure water pill discount 75mg triamterene with amex. Households whose inclusion in the survey was not feasible pulse pressure deficit order 75 mg triamterene otc, according to arrhythmia ultrasound triamterene 75mg amex village authorities arteria lienalis discount 75 mg triamterene otc, were considered part of the nonresponse group. Surveyors were trained to use a standard sampling procedure for the entomological surveys. The Cambodia National Center for Parasitology, Entomology and Malaria Control and the University of the Philippines Manila conducted a small research study to calibrate the sweep-net method used in the entomology surveys. The number of guppy fish in the water jars, tanks, and drums was based on direct observation by the surveyors. It was translated into local languages by the country project managers and tested on a small scale in each country before the baseline survey. Findings from the interviews and focus group discussions were used in planning the intervention and mobilization strategies of the research project. Cambodia, drawing on its previous experience with the use of guppy fish, duplicated the system found to be useful in the country. Consequently, the system of guppy fish breeding and distribution to the health centers was established within the time period originally planned. As a result, the fish stocks and distribution system were not established within the time period originally planned. This experience highlights the importance of testing before large-scale implementation to allow adjustments to fit the local reality. As Table 8 shows, the project achieved, and in most cases exceeded, its performance goals. It is as important to evaluate how the process went as to measure the impact of the intervention. This type of evaluation looks into whether and how the delivery of the intervention may have affected the project outcomes. For example, delays or unplanned changes in any component, such as changes in the behavioral messages or the delivery of the guppy fish to the households, could adversely affect the use of fish in water jars. This negative impact may be incorrectly attributed to rejection of the dengue control method when in reality the people were merely confused by the messages or never received their fish. Reported 100% target households, health centers, and schools 100% of planned radio broadcasting in the local districts completed School poster competition (reminder messages) N = no. A distinction must be made between active acceptance by the community of the fish in its water storage containers, and passive acceptance. With active acceptance householders are generally Project Evaluation 45 more motivated to replace the fish that die or disappear from the containers, while with passive acceptance householders may accept the fish but will not go out of their way to replace them if they die. In both countries households actively accepted the guppies: almost all accepted the fish in their water jars, tanks, and drums when first asked, and maintained the fish over time (Figures 16 and 17). Information about the percentage of homes with fish and the percentage of all large water containers with fish can be very helpful in program planning when combined with information from interviews with householders about why they have fish in their water containers or why they do not. The use of guppies to control dengue has featured in dengue education messages on radio and television in both countries for several years, although there were no formal program strategies for distributing guppy fish to households. In November 2009, while visiting a village as part of the project start-up, a team member holding guppy fish in a plastic bag was approached by a young girl who asked if she could have some of the fish. Figure 16 shows the coverage, by type of container, at the time of the various surveys. There was a drop in the percentage of drums with guppy fish during the second, third, and fourth surveys as these surveys were done during the dry season, when drums are not used. The presence of guppy fish in water jars and tanks, on the other hand, remained high throughout the year; over 79% of these containers had fish at any given time. Between June 2010 (baseline survey) and September 2011 (final, or fifth, survey), over 80% of the three targeted water containers had guppy fish in them, as shown in Table 9. As in the intervention villages, none of the targeted containers in the comparison villages had fish at baseline.

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A Moscow-based nongovernmental organization that monitors hate crimes recorded over 500 attacks against foreigners in 2008 jnc 07 hypertension generic triamterene 75mg with mastercard, a one-third increase over 2007 blood pressure terms purchase triamterene 75mg mastercard. Some components of this adaptive capacity are near term blood pressure medication and pregnancy triamterene 75mg online, such as the ability to heart attack one direction cheap triamterene 75mg deliver aid swiftly to those affected by. Other components include a high enough level of education so that people can change livelihoods, sufficient unmanaged land that can be brought into food production, and institutions that provide knowledge and assistance in times of change. For instance, Yohe and Tolcxiv identified eight qualitative "determinants of adaptive capacity," many of which are societal in character, although the scientists draw on an economic vocabulary and framing: 1. The structure of critical institutions, the derivative allocation of decision-making authority, and the decision criteria that would be employed. The ability of decision-makers to manage information, the processes by which these decision-makers determine which information is credible, and the credibility of the decision-makers themselves. Russian Adaptive Capacity in a Global Context Researchers have only recently taken on the challenge of assessing adaptive capacity in a comparative, quantitative framework. Literacy: proxy for human capital generally, especially the ability to adapt by changing employment. Income equity: proxy for the potential of all people in a country or state to participate in the economic benefits available. Percent of land that is unmanaged: proxy for potential for economic use or increased crop productivity and for ecosystem health. Sulfur dioxide per unit land area: proxy for air quality and, through sulfur deposition, other stresses on ecosystems. Economic Capacity · Environmental Capacity · Adaptive capacity for a sample of 10 countries from the 160-country study is shown in Figure 6 (base year of 2005). Russia ranks high, both in the sample and overall: · Russia ranks 32nd and Libya 34th (in the highest quartile). Any country-level analysis must take into account the comparative ranking of the country. The vulnerability index (level 1) is derived from two indicators (level 2): sensitivity (how systems could be negatively affected by climate change) and adaptive capacity (the capability of a society to maintain, minimize loss of, or maximize gains in welfare). For adaptive capacity these sectors are human resources, economic capacity, and environmental capacity. For sensitivity, the sectors are settlement/infrastructure, food security, ecosystems, human health, and water resources. Proxies in the sensitivity sectors are water availability, fertilizer use per agricultural land area, percent of managed land, life expectancy, birth rate, protein demand, cereal production per agricultural land area, sanitation access, access to safe drinking water, and population at risk due to sea level rise. Each of the hierarchical level values is composed of the geometric means of participating values. Proxy values are indexed by determining their location within the range of proxy values over all countries or states. The final calculation of resilience is the geometric mean of the adaptive capacity and sensitivity. Ranking of Adaptive Capacity in Base Year Russian Federation Libya Indonesia Belize Mexico China Philippines India Morocco Haiti 0 20 40 60 80 100 Figure 6. Figure 7 shows the contribution of each variable to the overall ranking (slight differences occurring because of the methodology [see box]). In current adaptive capacity, Russia ranks first among the 10 countries shown in Figure 6. Russia has some significant areas of vulnerability, but it also stands to see some beneficial impacts from climate change. It has a well-educated populace, an economy that has some diversification but not a great deal, and a socioeconomic picture in which there is a small middle class, a small cluster of people with great wealth, and many who have only limited means. Figure 8 shows projected adaptive capacity growth over time for the 10-country sample. These alternative development tracks are not intended to be predictive; they are scenarios. Both scenarios feature moderate population growth and a tendency toward convergence in affluence (with market-based solutions, rapid technological progress, and improving human welfare). The scenarios used in this study differ in the rate of economic growth, one modeling high-and-fast economic growth, the other delayed growth. Over time, a low-growth scenario widens the gap among the 10 countries-and the highgrowth scenario widens the gap even more (Figure 8).

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Magnetic resonance imaging and electrodiagnostic studies can also be helpful in demonstrating the areas involved blood pressure numbers generic triamterene 75mg fast delivery. The dilemma posed by this condition is the discrepancy between physical signs blood pressure medication makes me feel weird buy cheap triamterene 75mg online, which are usually not great arrhythmia from excitement triamterene 75 mg with amex, and the subjective complaints heart attack las vegas cheap triamterene 75mg without prescription. Pathology Encroachment upon and narrowing of the vertebral canal as a whole or of multiple lateral recesses thereof by osteophytes of the zygapophysial joints or syndesmophytes of the intervertebral disks. Congenital narrowing of the vertebral canal may predispose to this condition insofar as symptoms may arise in the face of osteophytes and syndesmophytes that in other individuals would not cause significant encroachment. The mechanism of the neurological features is unknown but may involve constriction of the dural sac with obstruction of flow of the cerebrospinal fluid, or obstruction of venous blood flow in the vertebral canal, or direct compression of spinal nerve roots. Radicular pain may arise as a result of compression or other compromise of one or more nerve roots but there is no evidence that the constrictive effects of spinal stenosis cause spinal pain and referred pain. These latter forms of pain ostensibly arise from the disorders of one or more of the disks or zygapophysial joints whose osteophytic overgrowth coincidentally causes the stenosis. Spinal stenosis is characterized by an essentially global distribution of neurological symptoms in the lower limbs, and in this respect should be distinguished from radicular pain due to foraminal stenosis, in which the pathology is restricted to a single intervertebral foramen and as such does not encroach upon the vertebral canal as a whole. Differential Diagnosis Peripheral vascular claudication, sciatic nerve compression, osteoarthritis of hip or knee, retroperitoneal tumors, other tumor or abscess, prolapsed lumbar disk. Diagnostic Features Imaging evidence of a congenital vertebral anomaly affecting the sacrum. Although they may be associated with pain, the specificity of this association is unknown. Clinical Features Sacral spinal pain with or without referred pain, together with features of the disease affecting the viscus or vessel concerned. Diagnostic Features Imaging or other evidence of the primary disease affecting an abdominal or pelvic viscus or vessel. In some instances, a more definitive diagnosis might be attainable using currently available techniques, but for logistic or ethical reasons these may not have been applied. Clinical Features Pain perceived in the region of the sacroiliac joint with or without referred pain into the lower limb girdle or lower limb itself. Selectively infiltrating the putatively symptomatic joint with local anesthetic completely relieves the patient of the pain. Presumably the pain is caused by excessive stresses being imposed on the ligaments of the sacroiliac joint as a result of some structural fault in the joint itself or as a result of the joint as a whole being subject to inordinate stresses. Remarks this category does not encompass sacroiliitis, ankylosing spondylitis, or seronegative spondylarthropathies that may be demonstrated by radionuclide imaging other forms of imaging or diagnosed by other means. While there are beliefs that such disorders can befall the sacroiliac joint, no clinical tests of laudable validity and reliability have been devised whereby this condition can be diagnosed. Diagnostic Features Sacral spinal pain for which no other cause has been found or can be attributed. Remarks this definition is intended to cover those complaints that for whatever reason currently defy conventional diagno- Page 191 of such a condition, however, in the absence of any overt inflammatory joint disease, is implied by a positive response to an intraarticular injection of local anesthetic. Until such time as appropriate clinical tests are demonstrated to be valid and reliable, any diagnosis of sacroiliac joint pain based exclusively on clinical examination must be held to be only presumptive. Diagnostic Features Coccygeal pain for which no other cause has been found or can be attributed. Remarks this definition is intended to cover those complaints that for whatever reason currently defy conventional diagnosis. Patients given this diagnosis could in due course be accorded a more definitive diagnosis once appropriate diagnostic techniques are devised or applied. Diagnostic Criteria Complete relief of pain upon infiltration of the putatively symptomatic joint or joints with local anesthetic, provided that the injection can be shown to have been selective in that it has not infiltrated other structures that might constitute the actual source of pain. Pathology Unknown, but presumably involves sprain of the capsule of the affected joint. Diagnostic Features Radiographic or other imaging evidence of multiple fractures throughout the vertebral column. X1*R Infiltrating Neoplastic Disease of the Vertebral Column or Its Adnexa, Other than Primary or Metastatic Tumors. Diagnostic Features Imaging or other evidence of metabolic bone disease affecting multiple regions of the vertebral column. Diagnostic Features Imaging or other evidence of neoplastic disease that directly or indirectly affects multiple regions of the vertebral column or its adnexa.

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