Pastoral camel management practices in Kenya, characterised by free herd mobility that enables efficient utilisation of rangeland resources, is progressively restricted to foraging within the vicinity of urban milk market outlets. The emerging peri-urban camel production system (PUCPS) has potential livelihood benefits to households, but adapting herd management practices responsive to market demands is a challenge with implications for its sustained development. This study assessed marketing practices in PUCPS, guided by two research questions. To what extent are (i) camel keepers involved in trading of camel stock and milk? (ii) milk hygiene practices responsive to market demands? Data was obtained from cross-sectional surveys complemented by focus group discussions. Compared to the pastoral production system, the peri-urban system exhibited greater market integration with more milk marketing opportunities, 2.4 times more (25.8% vs 62.8%) steer sales and 2.2 times more heifer purchases for breeding (12.3% vs 27.5%). Camels were sold to meet livelihood needs of the households as well as to raise cash for other direct investments. On the other hand, PUCPS growth is facing market barriers from poor milk hygiene practices. Compared to the pastoral system, the peri-urban system exhibits greater market-oriented production of camel stock and milk. Existing milk hygiene and quality practices are unlikely to meet the safety and quality requirements for urban consumers. Development of organised marketing channels and strengthening of processes that add value to milk would enable camel producers to earn more from their stock and guarantee safety and quality to urban consumers.
Background: Understanding the risk factors for loss to follow-up in prospective clinical studies may allow for a targeted approach to minimizing follow-up bias and improving the generalizability of conclusions in anterior cruciate ligament reconstruction (ACLR) and other sports-related interventions. Purpose: To identify independent risk factors associated with failure to complete (ie, loss to follow-up) patient-reported outcome measures (PROMs) at 2 years after ACLR within a well-funded prospective longitudinal cohort. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: All patients undergoing primary or revision ACLR enrolled in the prospectively collected database of the multicenter consortium between 2002 and 2008 were included. Multivariate regression analyses were conducted to determine which baseline risk factors were significantly associated with loss to follow-up at a minimum of 2 years after surgery. Predictors assessed for loss to follow-up were as follows: consortium site, sex, race, marital status, smoking status, phone number provided (home or cell), email address provided (primary or secondary), years of school completed, average hours worked per week, working status (full-time, part-time, homemaker, retired, student, or disabled), number of people living at home, and preoperative PROMs (Knee injury and Osteoarthritis Outcome Score, Marx Activity Rating Scale, and International Knee Documentation Committee). Results: A total of 3202 patients who underwent ACLR were enrolled. The 2-year PROM follow-up rate for this cohort was 88% (2821 of 3202). Multivariate analyses showed that patient sex (male: odds ratio [OR], 1.80) and race (black: OR, 3.64; other nonwhite: OR, 1.81) were independent predictors of 2-year loss to follow-up of PROMs. Education level was a nonconfounder. Conclusion: While education level did not predict loss to follow-up, patients who are male and nonwhite are at increased risk of loss to follow-up of PROM at 2 years. Capturing patient outcomes with minimal loss depends on equitable, not equal, opportunity to maximize generalizability and mitigate potential population-level health disparities. Registration: NCT00478894 (ClinicalTrials.gov identifier).
Althou gh lingual thyroid gland is the most comm on benign mass f ound at the jun ction ofthe ant erior two-thirds and the posterior one-third of the tongue, it is still a rare clinical entity. This developmental anomaly is the result of an arrested descent of the gland anlage early in the course of embryogenesis. Patients may have symptoms of dysphagia due to obstruction or even hemorrhage. These symptoms can occur at any time from inf ancy throu gh adulthood. The clini cal findin gs, laboratory tests, and radiograph ic imaging studies emplo yed in confi rming the diagn osis and in planning appropriate treatm ent hav e been evaluated. The primary therap eutic goal is to restore thyroid fun ction. We describ e a case of lingual thyroid gland and summarize the current man agement pr incipl es f or this condition.
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