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This article explores the history of colonial state nutrition interventions in Malawi from the 1920s to 1960. Paying particular attention to the underlying motivations, the processes by which the i...

Since the late 1850s, Malawi has seen various attempts by missionaries, settler farmers and administrators to transform peasant agriculture in the face of ecological, political and economic challen...

We quantified microhabitat use of Etheostoma inscriptum (Turquoise Darter) in 2 streams in the Oconee River watershed in the Georgia Piedmont using snorkeling observations during September 2020. This species has a restricted distribution, and little is known about its habitat associations. Principal component analysis indicated that Turquoise Darters were over-represented in patches characterized by higher column and bottom water velocities and higher percentages of erosional substrata (gravel or small cobble) at both sites. Turquoise Darters were under-represented in patches characterized by higher amounts of depositional substrata (sand and silt) in both sites. These results indicate that sedimentation and hydrological alterations could limit suitable habitat for Turquoise Darters.

Given its economic significance, agriculture has been at the centre of historical scholarship in Malawi. Yet despite the significant contribution this scholarship has made to the country’s development, there has been no effort to systematically reconstruct Malawi’s agricultural historiography. This article, therefore, takes stock of the progress that has been made by historians on research in the country’s agricultural history since the mid-1950s. The ultimate goal is to establish not only what might be regarded as the country’s agricultural historiography, but also the place of food production, which has become an important food security aspect of most Malawian peasants. After assessing the earlier works, the study observes that Malawi has an agricultural historiography which, prompted by the political and economic thoughts of the time, has conceptually evolved after the traditions of modernisation, underdevelopment and social history schools. It is argued here that, despite raising a strong case about the processes by which colonialism and capitalism disrupted peasant food economies, the historiography has made little effort to explore the patterns of peasant food production that emerged through this process, except for those studies that sought to understand the growth of famine and hunger. While resonating in many respects with the agricultural historiography of southern Africa, the Malawi case has gone beyond to include smallholder irrigation farming, which despite being globally recognised as a panacea for maintaining food production in the changing climate, has been under researched even in the dominating regional climate historiography.

Over the past two decades, Malawi has been adversely hit by climatic variability and changes, and irrigation schemes which rely mostly on water from rivers have been negatively affected. In the face of dwindling quantities of water, distribution and sharing of water for irrigation has been a source of contestations and conflicts. Women who constitute a significant section of irrigation farmers in schemes have been major culprits. The study seeks to analyze gender contestations and conflicts over the use of water in the schemes developed in the Lake Chilwa basin, in southern Malawi. Using oral and written sources as well as drawing evidence from participatory and field observations conducted at Likangala and Domasi irrigation schemes, the largest schemes in the basin, the study observes that women are not passive victims of male domination over the use of dwindling waters for irrigation farming. They have often used existing political and traditional structures developed in the management of water in the schemes to competitively gain monopoly over water. They have sometimes expressed their agency by engaging in irrigation activities that fall beyond the control of formal rules and regulations of irrigation agriculture. Other than being losers, women are winning the battle for water and land resources in the basin.

Refrigerant sprays have been used for pain relief at the time of minor office procedures. However, their sterility remains in question. This study investigates the microbiologic effect of this vapocoolant when sprayed after 70 % isopropyl alcohol skin preparation. In 50 healthy volunteers, three skin culture samples were collected: Group 1 prior to alcohol application; Group 2 after preparation with alcohol, and Group 3 after preparation with alcohol followed with vapocoolant spray. Samples were cultured in a blinded fashion and analyzed after 5 days of incubation. Gram staining was performed when cultures were positive. Bacterial growth was found in 98 % of samples prior to any skin preparation. This was reduced to 54 % after alcohol use (Group 2). Spraying with the skin refrigerant further reduced bacterial growth to 46 % (Group 3). The results showed a significant reduction in the number of positive bacterial cultures following skin preparation with alcohol and when alcohol prep was followed by vapocoolant spray (p

Background The plastic surgeon competes with both core and noncore physicians and surgeons for traditional cosmetic procedures. In 2007, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) joined efforts to form a Cosmetic Medicine Task Force to further analyze this trend. Objectives Our objective is to document and quantify the patient capture and total collections generated in a single surgeon's practice exclusive from Botulinum Toxin A and filler injections over a 10-year period. We subsequently identified the effect and importance that fillers and Botulinum Toxin A have on an active cosmetic practice. Methods A retrospective chart review of all male and female patients who received Botulinum Toxin A or soft tissue filler injections (noninvasive aesthetic treatment) in a single surgeons practice from January 2004 to December 2013 was undertaken. Only those patients new to the practice and who were exclusively seeking out Botulinum Toxin A or fillers were included in the study. Chart review then identified which of these selected patients ultimately underwent invasive aesthetic surgery during this 10-year period. Noninvasive and invasive aesthetic surgery total collections were calculated using billing records. Results From January 2004 to December 2013, 375 patients entered the senior surgeon's practice specifically requesting and receiving noninvasive aesthetic treatments. Of these 375 patients, 59 patients (15.7%) subsequently underwent an aesthetic surgery procedure at an average of 19 months following initial noninvasive aesthetic treatment. Of these 375 patients, 369 were female and 6 were male. The most common initial invasive aesthetic procedure performed after injectable treatment included 22 facelifts (18.5%), 21 upper eyelid blepharoplasties (17.6%), and 15 endoscopic brow lifts (12.6%). Total collections from noninvasive aesthetic sessions and invasive surgery combined represented US$762,470 over this 10-year span. This represented US$524,771 and US$396,166 in total collections for injectables and surgery respectively. Conclusions Noninvasive aesthetic surgery is a critical part of a plastic surgery practice. A measurable and significant number of patients who sought out a single plastic surgeon exclusively for noninvasive treatment ultimately underwent traditional invasive cosmetic surgical procedures.

BACKGROUND Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty. METHODS Our review investigates methods used for pain control in the surgical facial rejuvenation patient. We highlight those techniques that have been documented efficacy. We share specific methods of pain management for the more common surgical facial rejuvenation procedures that we perform. RESULTS In an effort to maximize patient comfort, we assess the effectiveness of various devices, technologies, and treatment modalities available for pain control after surgical facial rejuvenation. These include local anesthetics, topical creams, intravenous acetaminophen, perioperative ketorolac, local anesthetic wound catheter delivery systems, liposomal bupivacaine, tarsorrhaphy/frost sutures, postoperative pharmacologic therapeutics, prophylactic steroids, and tricks to eliminate pain with suture removal. Additionally, we summarize the primary investigator's preferred method of pain management for the common surgical facial rejuvenation procedures performed. CONCLUSIONS Recent advances in postoperative pain control can significantly improve the patient's surgical experience. This multimodal therapy includes new pharmaceuticals, longer-acting local anesthetics, and devices designed to minimize postoperative pain. Adoption of these techniques may also reduce the need for narcotics and prevent postoperative adverse sequelae.

While the literature is replete with articles about body contouring after bariatric surgery, little information exists regarding the outcomes of facelift following massive weight loss (MWL). A case report and a technique article are the only sources available addressing this issue. This pilot study objectively examines the effects of MWL in the cervicofacial region and results after facelift.A retrospective review of seven patients who underwent facelift after MWL (100 pounds) was performed. Patient's change in appearance was objectively evaluated using an apparent age model. Forty blinded reviewers assessed pre- and postoperative photographs of seven MWL and eleven non-MWL female patients. The reviewers estimated the apparent age for each subject. Reduction in apparent age was calculated by comparing patient's apparent age against actual age.The preoperative apparent age of MWL patients was 5.1 years older than their actual age (p0.02) compared to the increased preoperative apparent age of 1.2 years in non-MWL subjects (p0.05); suggesting MWL patients appear older than their actual age. Post-operatively, the apparent age reduction in MWL patients was 6.0 years; and their apparent age after surgery was 0.9 year less than their actual age (p0.05). In contrast, the control group exhibited an apparent age reduction of 5.4 years and a postoperative apparent age 4.2 years younger than their actual age (p0.01). Apparent age reduction was not significantly different for the two groups (p0.05). Age, BMI, and follow-up were similar between groups (p0.05).MWL may accelerate apparent cervicofacial aging. Facelift following MWL enhances cervicofacial appearance and significantly reduces apparent age. We hope this study stimulates further interest in the study of facial esthetics in this increasing population.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This study examines the process of irrigation management transfer (IMT) in Malawi using the case studies of Likangala and Domasi irrigation schemes in the lake Chilwa basin. It observes that the concept of irrigation management transfer has been adopted against the background of poor performance of irrigation schemes in Malawi and the desire of the state to conform to global trends and approaches in the management of irrigation schemes. In the context of Malawi, the process of IMT involves rehabilitation of schemes and training of farmers before handing them over. The paper notes that so far the handover process has been fraught with many challenges, not least of which includes lack of adequate funds, delays, lack of public awareness and farmers’ conflicting perceptions on the handover of irrigation schemes. These problems militate against the success of IMT in the Domasi and Likangala irrigation schemes in particular and other schemes in the country as a whole.

Background Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that provides postoperative pain control and reduces narcotic requirements. However, concerns regarding postoperative hematoma have limited its use in plastic surgery. Objectives Our goal is to critically review the risk of bleeding with ketorolac in plastic surgery patients, with a focus on aesthetic surgery. Methods A PubMed/Medline literature search of clinical trials using the keywords “surgery” and “NSAID” yielded 2574 results. Of these results, 1036 included ketorolac and twelve involved plastic surgery patients. Six studies reported postoperative hematoma rates: three prospective randomized trials, two retrospective reviews, and one case series. These were subjected to statistical analysis to determine if an association existed between ketorolac and postoperative hematomas. Results Six papers reported 981 cases. Ketorolac use resulted in similar hematoma rates when compared to control groups, 2.5% (12 of 483) versus 2.4% (12 of 498), respectively ( P = .79). There were no reported hematomas associated with ketorolac in over 115 patients undergoing aesthetic facial procedures. Hematoma rates of those undergoing aesthetic breast surgery, including reduction and augmentation mammoplasties, were 4.3% (11 of 257) in the ketorolac group versus 2.2% (6 of 277) in controls ( P = .59). Reduction in postoperative narcotic use and improved pain scores was also reported. Conclusions Our literature review did not find a significant association between hematoma formation and ketorolac use in a variety of plastic surgery procedures. These findings are similar to those in other surgical subspecialties. Level of Evidence 3![Graphic][1] Risk [1]: /embed/inline-graphic-1.gif

This paper examines the uses and management of water for agriculture in Lake Chilwa catchment area in Zomba district of Southern Malawi. It focuses on the Likangala Rice Irrigation Scheme Complex situated along the Likangala River. The scheme is one of the largest government-run schemes. Established in the late 1960s by the government to meet the growing demand for rice, the scheme contributes greatly to the agricultural industry of the country. Besides, the scheme was established to ensure maximum utilization of Malawi’s largest wetland, which, due to its hydromorphic soils and the littoral floodplains, does not favour the production of traditional upland seasonal crops such as maize. The scheme’s overdependence on water from the Likangala River has attracted a considerable degree of academic interest in the use and management of the river to ensure that there is equity and efficiency for both productive and domestic users. The paper focuses on four main issues: the historical development of the scheme, the distribution of water to farmers, social relations, and the overall contribution of the scheme towards the social and economic development of the area and the country in general. The paper contends that the growing population of the basin and the increase in the number of formal and informal smallholder farmers, contributes greatly to the growth of competition and conflicts over water, which tends to undermine the economic potential of the scheme. Furthermore, the paper provides clearest indication of the need for a realistic and informed water management policy and strategy to solve the growing problem of social inequity without necessarily compromising the production of rice in the scheme.

Leakage from a gastrointestinal anastomosis in bariatric surgery is a catastrophic complication and is the second-most preventable cause of death after Roux-en-Y gastric bypass. Several adjuncts for staple line reinforcement have been investigated to reduce the incidence of this complication. The purpose of our study was to determine whether a commercially available tissue sealant (BioGlue) could reinforce a stapled gastrojejunal anastomosis and whether it could seal an artificially created anastomotic leak.Circular-stapled gastrojejunostomies were performed on freshly explanted porcine stomach and intestine. Experiment 1 consisted of 10 control nonreinforced gastrojejunostomies and 10 gastrojejunostomies reinforced with BioGlue. The staple lines were submerged in saline and exposed to increased pressure using constant-rate infusion of air. The burst pressures were recorded at the point of visible leakage from the anastomosis. In experiment 2, a small defect was created in 10 gastrojejunostomies. The burst pressures were recorded before and after application of BioGlue to the anastomosis. The data were analyzed using the 2-tailed paired t test.In experiment 1, the burst pressure was significantly increased in the reinforced gastrojejunostomies, from 27.4 ± 8.4 mm Hg to 59.1 ± 19.2 mm Hg (P.001). In experiment 2, the defective gastrojejunostomies had an average burst pressure of 1.2 ± 0.8 mm Hg. After application of BioGlue, the burst pressure increased to 42.8 ± 15.9 mm Hg (P.001).These ex vivo findings suggest that the surgical adhesive BioGlue can reinforce both intact and defective stapled gastrojejunal anastomoses. Additional in vivo study is warranted to determine whether BioGlue can prevent or help seal gastrojejunal leaks.

Background In submuscular breast augmentation, the muscle is transected along its inferior and medial border to allow the implant to rest beneath the breast mound and supply adequate cleavage. This leads to significant pain in the postoperative period. Objective This study was undertaken to quantitatively document the effectiveness of tumescent infiltration and bupivicaine with epinephrine injection in controlling postoperative pain in primary submuscular breast augmentation and its effect on operating time, narcotic use, and complications. Methods A retrospective chart review of 150 primary submuscular augmentation mammaplasties performed by 2 surgeons was conducted. Seventy-five consecutive augmentations performed by each physician during the same time period were studied. One surgeon used tumescent infiltration, using a syringe and a blunt infiltration cannula, placing 50 mL of standard tumescent solution in the planned pocket area of each breast before dissection. In addition, all cut muscle ends were injected with 0.25% bupivicaine with epinephrine (1:100,000, 40 mL per patient) under direct vision. The other surgeon omitted these steps. Patients evaluated pain subjectively using a 0 to 10 numeric pain intensity scale reported to the recovery room staff at specific times in the postanesthesia care unit. Results Postoperatively, the initial and discharge average pain rating was significantly different between the groups. The group that received tumescence and bupivicaine with epinephrine entered the recovery room with a significantly lower average pain score: 0.5 as compared with the pain score of the control group, which was on average 3.3. In addition, the highest average pain rating was 2.6 in the infiltrated group compared with 5.4 in the noninfiltrated group. Pain at discharge between the groups was also seen to be markedly lower with a subjective average rating of 2.0 in the infiltrated group compared with 4.0 in the control group. No difference was seen in operative time or complications. Conclusions This is the first report to quantitatively show a pain reduction regimen that is effective in significantly decreasing postoperative pain and decreasing the use of narcotics in the recovery room. The authors conclude that its advantages are significant, and they advocate its use in all breast augmentations.