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While there may be no documented evidence that mortality decline is a causative factor in demographic transition, there is a close association between reductions in mortality and fertility. The Indian experience of more than 40 years shows that consistent efforts in the promotion of family planning will be rewarded with demographic transition. In the Indian state of Kerala, population 30 million, improving child survival, female literacy, strict child labor laws, and effective high coverage primary health care reduced mortality and fertility. Its infant mortality rate is 22/100 births, which is 25% of the national average. Its birth rate is 20/1000 and is continuing to fall. In the past decade population growth was only 14% compared to 25% nationally and 28% in the northern states. If Kerala's figures were applied to all of India, there would be 2 million less infant deaths and 8 million less births. The impact of reducing infant mortality on population growth in raw numbers in insignificant. With a mortality rate of 150/1000 there are 850 survivors. If the mortality rate is cut in half there will be only a .18% increase in population, but with a 50% reduction in infant suffering and death. Historically such mortality declines are associated with a 25% or more decline in fertility. This is the reason that UNICEF has been a long-time advocate of child survival programs as an integral part of population control measures. Euthanasia is surely not the solution to the population problem. The daily loss of 40,000 childhood lives is a tragic part of the human experience. However, helping these children to become and stay healthy is the best method of reducing population.

Sugar-based oral rehydration therapy (ORT) for diarrhoea is promoted in many countries of the world. One programme in Bangladesh has instructed more than 13 million mothers in the preparation of a sugar-salt solution in the home; despite very high rates of correct mixing and knowledge, subsequent application was found in only some 20% of all diarrhoea episodes. Since rice is far more available in rural homes (95%) than any type of sugar (30%) and rice gruel is a widely accepted food during illness, a field trial was conducted in three areas (total population, 68,345) to compare the acceptability and use of rice-based ORT with that of sugar-based ORT. Although the mothers unanimously agreed that the rice-based solutions "stopped" the diarrhoea more quickly, they used the sugar-based solutions twice as often (in 40% of severe watery episodes) as the rice-based solutions (in 18%), because the rice-ORT was much more time-consuming and difficult to prepare. The observed reduced utilization of home-made rice-ORT makes it a poor substitute for sugar-ORT at the community level in rural Bangladesh.Sugar-based oral rehydration therapy (ORT) for diarrhea is promoted in many countries in the world. 1 program in Bangladesh has instructed more than 13 million mothers in the preparation of a sugar-salt solution in the home; despite very high rates of correct mixing and knowledge, subsequent application was found in only some 20% of all diarrhea episodes. Since rice is far more available in rural homes (95%) than any type of sugar (30%) and rice gruel is a widely accepted food during illness, a field trial was conducted in 3 areas (total population=68,345) to compare the acceptability and use of rice-based ORT with that of sugar-based ORT. Although the mothers unanimously agreed that the rice-based solutions stopped the diarrhea more quickly, they used the sugar-based solutions twice as often (in 40% of severe watery episodes) as the rice-based solutions (in 18%), because the rice ORT was more time-consuming and difficult to prepare. The observed reduced utilization of homemade rice-ORT makes it a poor substitute for sugar-ORT at the community level in rural Bangladesh. (author's)

In consort with the focus on women's enrichment and status improvement in developing countries, the following principles and strategies are discussed: decentralized planning, maximizing schooling, experiential learning, avoidance of exploitation. Planning must involve adolescents and women and be consistent with cultural influences and patterns. Girls also need to be encouraged by parents to stay in schools as long as possible, with minimizing the attractions of staying out of school, and provision for dropouts to return. Experiential learning through interaction, observation, and enjoyment is the best method and will work best with the disadvantaged and neglected, and enable women to, for instance, understand the importance of breastfeeding, immunization, or hygiene. The program which may involved service is not to be exploitative, be a convenience, and benefit her. The content needs to be flexible and suitable to the age such that nutrition must be taught before menarche and at the first sign of breast development, and when bone growth is at its peak. School feeding programs are of proven benefit. Goals can be satisfied without being rigid and allowing for dream time also. The shape of a better tomorrow will depend upon these women. Adequate funding is always necessary, and something for nothing doesn't work without adequate food, useful learning materials, and attractive incentives such as a culturally appropriate items of clothing, confidence and prestige building are a must. The challenges are to provide formal schooling and the concomitant self-esteem building and public recognition of women's competence. Seclusion of pubescent girls in purdah needs to be eliminated and replaced with programs of responsible, mature and positive interaction with older women, who provide leadership skills and linkages to larger society. Interactions between girls is also important with village based continuing education, and practical self-guided curricula. Vocational training in marketable skills contributes to the economy and independence. Awareness of legal rights and utilization of resources available in primary health care needs to be encouraged. Changes need to be made in family perceptions that allow women educational growth without neglect of family chores and responsibilities. Health programs need to assess adequate intake of iron and folic acid, and nutrition starting at menarche, and proper hygiene. Reproductive information must be provided.

Infections pose a nutritional stress on the growing child. No therapeutic goal is as important as the rapid recovery of preillness weight after acute infections. Successful convalescence, with supernormal growth rates, can be achieved with relatively brief periods of intensive refeeding, offsetting any tendency toward reduced immune defenses or other nutritionally determined susceptibilities to further infection. Since the mother is the only person who can effectively manage convalescent care, she must be given specific tasks with measurable targets in order to reliably oversee the child's rehabilitation. Not generally considered in the realm of preventive medicine, effective home-based convalencent care is the first crucial step in preventing the next round of illness. An approach to the widespread mobilization of mothers to monitor and sustain their children's growth is proposed in this paper. Rather than a passive recipient of health services, the mother becomes the basic health worker, providing diagnostic and therapeutic primary care for her child. Only the mother can break the malnutrition-infection cycle.The interactions between infection, nutrition, and malnutrition are discussed in detail. Relevant data from various developing countries is tabulated. It is the job of the health care system to intervene in this cycle with specific programs. Only mothers can break the infection-malnutrition cycle, since they are the ones who provide postinfection convalescent care for their children. Indonesia with the help of the World Bank and UNICEF, has recently organized a program to educate mothers in basic health care, thus making them the main personnel in preventive, primary health care. Supervision should be provided along with the proper diagnostic tools for the mothers to evaluate their own success. Mass media campaigns can be used to publicize the program. Such an approach seems to be the only cost-effective means of intervening in the malnutrition-infection cycle in these countries.

1. Double-tracer studies have been carried out in order to investigate the validity of a whole-gut perfusion technique for the measurement of gut lumen-to-plasma and plasma-to-gut lumen sodium fluxes in man. 2. The use of two tracers permits differentiation between the unabsorbed orally administered sodium in the stools and the sodium which has been absorbed and resecreted. The latter is by no means negligible and may amount to some 30% of the recovered material. 3. The available data do not permit the calculation of the absolute values of the bidirectional fluxes without the introduction of some assumption concerning the reabsorption of the sodium which crosses from the plasma to the gut lumen. It is assumed here that this sodium is absorbed by the gut to the same extent as the orally administered material. Analysis of the kinetics of sodium transfer from mouth to stool direct and via the blood plasma in normal subjects and patients with diarrhoea provided experimental evidence confirming the correctness of this assumption. 4. In eleven normal volunteers the gut lumen-to-plasma flow of sodium averaged 13.0 mmol min−1, implying that the observed absorption averaging 1.65 mmol min−1 represents a relatively small imbalance between the bidirectional fluxes. Although one patient with post-gastrectomy dumping syndrome had high fluxes and another with malabsorption following gut resection gave low values, it is suggested that changes in the fluxes in the same patient are more significant than isolated observations on individuals. 5. Granted the validity of the primary assumption, a considerably simpler technique may be used for clinical and field studies which is sufficiently accurate for most purposes and employs a single tracer.

Whole-bowel perfusion with the addition of isotope labelling has been used to study sodium-ion transport across the intestinal mucosa in human cholera. The site of maximal disturbance of ion transfer was in the duodenum and upper jejunum. During the acute phase of the disease there was a striking reduction in bidirectional sodium movement across the mucosa. The movement from lumen to plasma was the more depressed, and this resulted in net accumulation of sodium in the intestinal lumen. These findings do not support previous concepts of predominant effects of cholera on a sodium pump or excess filtration and secretion, but raise wider issues relating to mucosal-cell function and the splanchnic circulation. These disturbances may not be unique to cholera, and their elucidation may explain the pathogenesis of other diarrhœal states.

With attack rates exceeding two episodes per year in the young diarrhoea with attendant dehydration is by far the major single killer in the developing world. An invariable accompaniment of the more insidious and chronic protein-energy malnutrition (PEM), diarrhoea is itself an acute form of malnutrition: fluid-electrolyte malnutrition (FEM). Scientific attention to FEM has focused heavily on mechanisms of pathogenesis and disordered physiology, often to the neglect of preventive and effective control measures. A notable exception was the huge step from the short-circuit chamber to the cholera ward which carried the science of coupled transport to the field. Glucose-electrolyte solutions provide effective prevention and treatment of dehydration and, where combined with early proper feeding, an interruption of the FEM-PEM cycle. Wider use of this simple technology awaits greater understanding and interact-on with the social systems that determine the ecology of diarrhoeal disease.

The design, fabrication, and initial testing of energy efficient engine combustors, developed for the next generation of turbofan engines for commercial aircraft, are described. The combustor designs utilize an annular configuration with two zone combustion for low emissions, advanced liners for improved durability, and short, curved-wall, dump prediffusers for compactness. Advanced cooling techniques and segmented construction characterize the advanced liners. Linear segments are made from castable, turbine-type materials.

In a combined anthropological and parasitological study in a rural Balinese village, two distinct sub-populations were identified on the basis of nutritional and health practices. A significant negative correlation between Ascaris burden and nutritional status (P less than 0.05) was apparent only in the subpopulation characterized by lower nutritional intakes and low utilization of health care facilities. The results of this study suggest that the relationship between Ascariasis and child malnutritional is a conditional one, dependent upon the interaction of multiple biomedical and behavioural factors.