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PubMed2006

Environmental acceptability of beneficial use of waste as construction material--state of knowledge, current practices and future developments in Europe and in France.

Since a decade, numerous industrial and public initiatives have been launched in order to make knowledge, practices and mentalities evolve in relation to the acceptability of using waste instead of raw material as construction product. The objectives of these initiatives have been to evaluate current practices and to make new solutions and beneficial use channels emerge. At the same time scientific and standardisation communities have developed methodologies and tools to fit with the assessment needs expressed by industrialists and public decision-makers. In spite of that, some factors, some of them being cross-linked, make the perpetuation of beneficial use channels or even the concretisation of research projects difficult. To cope with this situation, in the framework of sustainable development applied to natural and alternative material, the French Directorate of Road has launched a project aiming at providing public contracting authorities with a document gathering both technical and environmental requirements that they can prescribe in public market tender calls to promote the use of waste and out-of-technical-specifications-material. This paper deals with the presentation of this project focusing more specifically on the approach to assess both technical and environmental acceptability of waste and out-of-technical-specifications-material to be used as alternative material in road construction in France. The current European situation is first described and this paper finally discusses briefly the other key aspects--than environmental acceptability--that have to be taken into account to succeed waste beneficial use.

Construction Materials↗
PubMed1984

Luteinizing hormone increases the number of ova shed in the cyclic hamster and guinea-pig.

Osmotic minipumps containing 400 micrograms ovine LH installed subcutaneously on day 1 (oestrus) of the cycle in the hamster induced superovulation of 30.0 +/- 2.1 ova (n = 5) at the next expected oestrus. Controls ovulated 12.0 +/- 0.8 ova (n = 6). Bovine LH, human LH, porcine LH, human chorionic gonadotrophin and pregnant mare serum gonadotrophin were effective in approximately doubling the number of ova spontaneously shed in the hamster. Ovine FSH (200 micrograms/pump) was most effective in increasing the number of ova spontaneously shed (55 +/- 6, n = 5) in the hamster. Infusion of ovine LH on days 1-4 prevented the reduction of the number of antral follicles that occurs normally between days 3 and 4 of the 4-day cycle. Since this reduction in follicular numbers in control cyclic hamsters is due to atresia, the exogenous LH might prevent atresia of the developing follicles. In the hamster, exogenous ovine LH significantly increased the serum concentrations of androstenedione, oestradiol and LH but not of FSH. Hamsters were hypophysectomized on the day of oestrus, given immediate LH (400 micrograms) or FSH (200 micrograms) replacement therapy and autopsied on day 4. Ovarian histology revealed that immediate LH treatment after hypophysectomy sustained development of histologically normal preovulatory follicles but had no effect on the number of smaller sizes of follicles. Immediate FSH treatment after hypophysectomy increased only the number of smaller sized follicles. Since LH did not increase the smaller sized follicles, no 'FSH-like' effect on follicular development was observed. In the hamster, the ability of various preparations of LH to induce superovulation did not correlate with their ability to displace 125I-labelled ovine FSH from its ovarian binding sites. The superovulatory action of LH required the presence of the pituitary gland, indicating that LH might synergize with FSH and/or prolactin (or hamster LH) for spontaneous superovulation and it appears that exogenous LH might induce superovulation by prevention of atresia. Infusion of LH into the guinea-pig beginning on day 12 of the cycle (day 1 is the day of ovulation) doubled the ovulation rate whereas in the cyclic rat and mouse LH treatment throughout the cycle was ineffective in increasing the number of ova shed.

Androstenedione↗
PubMed2006

Managing extreme natural disasters in coastal areas.

Extreme natural hazards, particularly the hydro-meteorological disasters, are emerging as a cause of major concern in the coastal regions of India and a few other developing countries. These have become more frequent in the recent past, and are taking a heavy toll of life and livelihoods. Low level of technology development in the rural areas together with social, economic and gender inequities enhance the vulnerability of the largely illiterate, unskilled, and resource-poor fishing, farming and landless labour communities. Their resilience to bounce back to pre-disaster level of normality is highly limited. For the planet Earth at crossroads, the imminent threat, however, is from a vicious spiral among environmental degradation, poverty and climate change-related natural disasters interacting in a mutually reinforcing manner. These, in turn, retard sustainable development, and also wipe out any small gains made thereof. To counter this unacceptable trend, the M.S. Swaminathan Research Foundation has developed a biovillage paradigm and rural knowledge centres for ecotechnological and knowledge empowerment of the coastal communities at risk. Frontier science and technologies blended with traditional knowledge and ecological prudence result in ecotechnologies with pro-nature, pro-poor and pro-women orientation. The rural communities are given training and helped to develop capacity to adopt ecotechnologies for market-driven eco-enterprises. The modern information and communication-based rural knowledge centres largely operated by trained semi-literate young women provide time- and locale-specific information on weather, crop and animal husbandry, market trends and prices for local communities, healthcare, transport, education, etc. to the local communities. The ecotechnologies and time- and locale-specific information content development are need-based and chosen in a 'bottom-up' manner. The use of recombinant DNA technology for genetic shielding of agricultural crops for coastal regions against abiotic stress (induced by the water- and weather-related natural disasters), strengthens the foundations of sustainable agriculture undertaken by the resource-poor small farm families.

Disaster Planning↗
PubMed1996

The Role of Corporations in Ensuring Biodiversity

/ Corporations own approximately 25% of all private land in the United States and, therefore, play an essential role in protecting biodiversity and maintaining natural habitats. The Wildlife Habitat Council (WHC) is a unique joint venture between conservation organizations and corporations to utilize corporate lands for ensuring biodiversity. The following case studies demonstrate how corporations have helped ensure healthy ecosystems and provided critical leadership in regional efforts. Amoco Chemical Company's Cooper River Plant has been instrumental in developing a cooperative project that involves numerous corporations, plantation owners, private citizens, nonprofit organizations, government agencies, and community groups to develop a comprehensive, ecosystem-based management plan for part of the Cooper River in Charleston, South Carolina, USA. The second case focuses on the Morie Company, a national sand quarry operator headquartered in southern New Jersey, USA. Morie Company is working with WHC, community groups, the Pinelands Commission, and other state regulatory agencies to explore sustainable development opportunities for companies within the Pinelands regulations. The third case takes us to DuPont Company's Asturias, Spain, site. A win-win success story of improved habitat and cost savings is the result of DuPont's concern for the environment, ability to work with a variety of groups, and willingness to consider innovative restoration techniques. The fourth case discusses Consumers Power Company's Campbell Plant in West Olive, Michigan, USA. In addition to implementing projects that contribute to biodiversity, Consumers Power has developed an environmental education field station to teach others about the importance of natural habitats. The final case highlights Baltimore Gas & Electric Company's efforts to maintain habitat for endangered species at their Calvert Cliffs site in Maryland.KEY WORDS: Partnerships; Stewardship; International; Habitats; Biodiversity

Journal Article↗
PubMed2005

GIS applications in land management: the loss of high quality land to development in Central Mississippi from 1987-2002.

The socio-economic trends and history of Central Mississippi reveal a major rural influence based upon a dependence on agricultural activities as part of the economic engine driving the state's economy. Yet, in the last several years, the amount of agricultural land in the counties continues to decline. Similar changes in other variables associated with agricultural land use and the continuity of farming in the state have also been changing. Indeed, under the pressure of urban growth, some farmers are forced to use less productive soils or have abandoned the agricultural business. Considering the gravity of the problem and the implications for sustainable development, public concern has increased in the state of Mississippi that urbanization and other factors may be eroding potential farmland. Given the effects of the current trends on the future capacity to produce food items, there are concerns that the growing incidence of farmland loss may also erode the basis for sustainable use of agricultural land, biodiversity and protection of the state's ecological treasures. Notwithstanding the gravity of these trends, no major effort in the literature has aimed at documenting the incidence of agricultural land loss and the linkages to urbanization in the region of Central Mississippi. What changes have taken place in the size of agricultural land within the counties and what factors are responsible for it? This paper examines the issue of farmland loss in Central Mississippi with a focus at the county level between 1987 and 2002 from a temporal-spatial perspective. In terms of methodology, the paper uses a mixed scale approach based upon the existing literature. Data were drawn from the United States Census databases of Population and Agriculture. This information is analyzed with basic descriptive statistics and GIS with particular attention to the spatial trends at the county level. Results indicate that the counties under consideration have experienced considerable change in the amount of agricultural land and other variables associated with the use of farmland, due to urbanization. With the types of changes occurring, instituting effective policies anchored in sustainability, community participation, and growth management will go a long way in addressing the situation. Other strategies for farmland protection based upon land information inventory and mapping in the region, are also recommended. The paper stands as an update of the existing literature and offers a valuable tool for decision makers within the domain of natural resources management.

Agriculture↗
PubMed1986

[Late potentials, myocardial kinetics and ventricular vulnerability as markers of sudden death after myocardial infarct].

The 1st myocardial infarction requires the identification of patients who are at high risk of malignant ventricular arrhythmias. Our study group included 55 consecutive patients (age less than 70): all had non-invasive "signal averaging" recording and 24 hour dynamic electrocardiogram at the post-acute phase of their 1st myocardial infarction (MI) and 3 months later. Wall motion abnormalities were evaluated in each patient but two. 24 randomized patients (without documented sustained ventricular tachycardia) underwent right programmed ventricular stimulation at the 3rd month after MI and pathological repetitive responses were evaluated (Table III); they were hemodynamically stable and without persistent ischemia. Late potentials have been compared to spontaneous and induced ventricular arrhythmias, wall motion abnormalities (Table II) and two-year follow-up (Table VI), in order to identify predictive markers of sudden death or malignant arrhythmias. Ventricular late potentials were identified in 28 patients (51%) 4-8 days after MI: mean duration was equal to 75 +/- 33 msec; they did not show any relationship to the site (Table I) and to the extension of necrosis (Table II). Ventricular late potentials had no significant association with myocardial dyskinesia (Table II) while their association with complex ventricular arrhythmias, detected on Holter monitoring within 8 days after MI, and with the induction of repetitive ventricular responses (greater than or equal to 2 complexes) showed significant correlations (respectively p = 0.02; p = 0.01). In regard of the recognition of spontaneous ventricular tachycardia (greater than or equal to 3 complexes) in the follow-up, the detection of late potentials showed 75% sensibility with predictive value equal to 32% (Table V); the combination of late potentials and ventricular dyskinesia exhibited the highest specificity (88%) and predictive value (54%). By the end of follow-up there had been 6 cardiac deaths (2 sudden, 4 from left ventricular failure): late potentials longer than 75 msec were recorded in all patients who had cardiac death; in the post acute phase of MI repetitive ventricular arrhythmias were detected in only 1 of the 2 case of sudden cardiac death and in none of the patients who developed sustained ventricular tachycardia in the follow-up (Table VI). Myocardial dyskinesia was present in each patient who developed non sudden cardiac death (Table VI).(ABSTRACT TRUNCATED AT 400 WORDS)

Arrhythmias, Cardiac↗
PubMed2002

A corporate approach to social monitoring and assessment for development in a fragile environment.

The prevailing corporate trend regarding development of energy resources in the tropics emphasizes financial gain over long-term societal benefits. Some corporations are beginning to find a competitive advantage linked to proactive relations with host communities and adequate protection of fragile ecosystems. Herein, we describe a case study where an international energy production company worked with stakeholders to achieve social capital and sustainable development. The strategies aimed to strengthen local capacity to improve social welfare and to ensure conservation and wise use of biodiversity. We provide examples, discuss lessons learned and make recommendations for future development projects.

Community-Institutional Relations↗
PubMed1992

Late potentials in an ovine model of acute transmural myocardial infarction.

The development of slow conduction during the first hours of acute transmural myocardial infarction (ATMI) was studied by signal-averaged electrocardiograms (SAE) in 19 adult anesthetized sheep. SAEs were recorded before and after intravenous infusions of lidocaine and bretylium were begun and 10, 30, and 60 min after ATMI produced by ligation of the left anterior descending and second diagonal coronary arteries. Four sheep died promptly of ventricular tachyarrhythmias; two others developed sustained ventricular arrhythmias, which precluded additional data. Biphasic changes in QRS duration, root mean square voltage of the terminal 40 ms of the QRS complex, and duration of terminal low-amplitude (less than 30 microV) signal were observed. Peak changes in conduction occurred 30 min after infarction and regressed toward baseline thereafter. At 30 min, all animals developed late potentials, which were defined as signals that exceeded both after-drug QRS duration and duration of terminal low-amplitude signal less than 30 microV by more than two standard deviations. At 60 min, only 3 of 13 (23%) animals had late potentials. Conduction is slowest 30 min after ATMI in sheep but may not be related to development of ventricular arrhythmias. In five of six sheep (83%), ventricular arrhythmias occurred within 15 min of infarction before peak slowing was observed by SAE.

Animals↗
PubMed1993

Comparative action of three major ciguatoxins on guinea-pig atria and ilea.

The actions of pure ciguatoxin-1, ciguatoxin-2 and ciguatoxin-3 were assessed on the contractile activity of isolated guinea-pig left atria and ilea. Low concentrations of each ciguatoxin caused transient positive inotropy, whereas moderate concentrations induced transient and sustained positive inotropic phases. The transient positive inotropic phase was inhibited by tetrodotoxin or atenolol, indicating this phase stems from indirect effects of the ciguatoxins via the stimulation of intrinsic adrenergic nerves. On atria pretreated with atropine and alpha- and beta-adrenoceptor antagonists to block neural actions of the ciguatoxins, moderate concentrations of each ciguatoxin induced only slowly developing, sustained positive inotropy. ED50s for the indirect positive inotropic phase were 2.7 x 10(-11), 1.6 x 10(-10) and 1.4 x 10(-11) M and for the direct positive inotropic phase were 1.6 x 10(-10), 1.4 x 10(-9) and 1.5 x 10(-9) M for ciguatoxin-1, -2 and -3, respectively, indicating that their effects on neurons are 10-fold (ciguatoxin-1 and -2) to 100-fold (ciguatoxin-3) more potent than those directly on the myocardium. High concentrations of each ciguatoxin additionally induced sustained negative inotropy which could be reversed by lidocaine. On guinea-pig ilea, each ciguatoxin induced a transient contracture which could be abolished by atropine. Each ciguatoxin significantly reduced the contractile response of ilea to nicotine, without affecting the contractile response to acetylcholine. We conclude that ciguatoxin-1, -2 and -3 activate similarly the voltage-dependent Na+ channels in neuronal and myocardial tissues, but vary in their relative affinity for the Na+ channels in these tissues.

Acetylcholine↗
PubMed2025

In silico encounters: harnessing metabolic modelling to understand plant-microbe interactions.

Understanding plant-microbe interactions is vital for developing sustainable agricultural practices and mitigating the consequences of climate change on food security. Plant-microbe interactions can improve nutrient acquisition, reduce dependency on chemical fertilizers, affect plant health, growth, and yield, and impact plants' resistance to biotic and abiotic stresses. These interactions are largely driven by metabolic exchanges and can thus be understood through metabolic network modelling. Recent developments in genomics, metagenomics, phenotyping, and synthetic biology now enable researchers to harness the potential of metabolic modelling at the genome scale. Here, we review studies that utilize genome-scale metabolic modelling to study plant-microbe interactions in symbiotic, pathogenic, and microbial community systems. This review catalogues how metabolic modelling has advanced our understanding of the plant host and its associated microorganisms as a holobiont. We showcase how these models can contextualize heterogeneous datasets and serve as valuable tools to dissect and quantify underlying mechanisms. Finally, we consider studies that employ metabolic models as a testbed for in silico design of synthetic microbial communities with predefined traits. We conclude by discussing broader implications of the presented studies, future perspectives, and outstanding challenges.

Plants↗
PubMed1998

Health profile of the ageing population: the Swedish experience.

Sweden is demographically one of the oldest countries in the world. The average life expectancy is comparatively high. However, the total number of physical and mental disorders, which may affect the elderly, seems to be increasing and becoming more and more complicated to prevent and treat. The rapid changes in the human biotope, threatening the quality of life of Man, play an important role in this development. The elderly in the future will, thus, have a health profile which may differ significantly from that of today's elderly. As general health is largely dependent on the 'health' of the environment and oral health may be the mirror image of general health, dentistry has a key position and responsibility in the international action programme for a sustainable development (Agenda 21, UNCED, 1992). Therefore, traditional curricula in, for example, odontology should be supplemented with interdisciplinary courses with a focus on a holistic view of the human condition. In collaboration with UNESCO, such an educational programme has been developed at Göteborg University. It aims at assisting each person to take on an increased self-responsibility for his or her immediate environment and health ('individual Agenda 21'). At present, an educational network is being established in Eastern Europe, in collaboration with medical and odontological faculties at the national universities.

Aged↗
PubMed2000

Ammonium chloride potentiation of streptozotocin-induced diabetes in juvenile pigs.

In preparation for direct vital microscopic evaluation of microcirculatory dynamics in the diabetic pig myocardium, we were initially unsuccessful in inducing sustained hyperglycemia in juvenile pigs using streptozotocin according to previously reported methods. Therefore, we modified the technique in a way previously unreported in an effort to improve the success rate of diabetes induction. In the first set of 9 pigs, we followed described methods of intravenous injection with 150 mg/kg streptozotocin. In the second group of 9, the technique was modified. The change was based on human studies with ammonium chloride and animal experiments with alloxan, and consisted of the addition of a period of pretreatment with ammonium chloride. Of the nine pigs not treated with ammonium chloride, only two developed sustained hyperglycemia in excess of 17 mmol/L (300 mg/dl), and only after reinjection with a full dose of streptozotocin within 7 days of the first injection. Conversely, of the ammonium chloride pretreated pigs, eight of nine developed diabetes. We conclude that the addition of ammonium chloride to produce systemic acidosis prior to streptozotocin injection improves the efficacy of the drug.

Acidosis↗
PubMed2005

Genetic difference in susceptibility to the blood-retina barrier breakdown in diabetes and oxygen-induced retinopathy.

The breakdown of the blood-retina barrier (BRB) is a common feature of diabetic retinopathy. The purpose of the present study is to determine whether there are genetic differences in susceptibility to the breakdown of the BRB in diabetic retinopathy using two rat models. In streptozotocin (STZ)-induced diabetes, Brown Norway (BN) rats developed sustained vascular hyperpermeability in the retina during the entire experimental period (16 weeks of diabetes), while diabetic Sprague Dawley (SD) rats only showed retinal hyperpermeability from 3 to 10 days after the onset of diabetes. The strain difference in permeability was not correlated with the blood glucose levels in these two strains. In oxygen-induced retinopathy (OIR), BN rats developed retinal vascular hyperpermeability from postnatal day 12 (P12) to P22 with a peak at P16, which was 8.7-fold higher than that in the age-matched normal controls. In OIR-SD rats, however, hyperpermeability was observed from P14 to P18, with a peak only 2.2-fold higher than that in the controls. The strain difference in vascular hyperpermeability was correlated with the different overexpression of vascular endothelial growth factor (VEGF) in the retina of these two models. This finding suggests that genetic backgrounds contribute to the susceptibility to diabetic retinopathy.

Animals↗
PubMed2000

Assessing the potential hazard of chemical substances for the terrestrial environment. Development of hazard classification criteria and quantitative environmental indicators.

Hazard assessment constitutes an essential tool in order to evaluate the potential effects of chemical substances on organisms and ecosystems. It includes as a first step, hazard identification, which must detect the potential dangers of the substance (i.e. the kind of effects that the substance may produce), and a second step to quantify each danger and to set the expected dose/response relationships. Hazard assessment plays a key role in the regulation of chemical substances, including pollution control and sustainable development. However, the aquatic environment has largely received more attention than terrestrial ecosystems. This paper presents the extrapolation of several basic concepts from the aquatic to the terrestrial compartment, and suggests possibilities for their regulatory use. Two specific proposals are discussed. The first focuses on the scientific basis of the hazard identification-classification criteria included in the EU regulations and their extrapolation to the terrestrial environment. The second focuses on the OECD programme for environmental indicators and the development of a soil pollution pressure indicator to quantify the potential hazards for the soil compartment and its associated terrestrial ecosystem related to the toxic chemicals applied deliberately (i.e. pesticides) or not (i.e. heavy metals in sludge-based fertilisers; industrial spills) to the soil.

Ecosystem↗
PubMed1994

Smooth muscle protein kinase C.

Protein kinase C (PKC) was first implicated in the regulation of smooth muscle contraction with the observation that phorbol esters induce slowly developing, sustained contractions. In some vascular smooth muscles, e.g., ferret aorta, phorbol ester induced contractions occur without an increase in sarcoplasmic free-Ca2+ concentration ([Ca]i) or myosin light chain phosphorylation. This response appears to be mediated by a Ca(2+)-independent isoenzyme of PKC (probably PKC epsilon), since saponin-permeabilized single ferret aortic smooth muscle cells, which retain receptor coupling, developed force in response to phenylephrine at low free [Ca2+] (pCa 7.0-8.6) and the constitutively active proteolytic fragment of PKC (PKM) elicited a contraction at pCa 7 comparable with the phenylephrine-induced contraction. Both contractions were reversed by a pseudo-substrate peptide inhibitor of PKC. These observations suggest a mechanism whereby alpha-adrenergic agonists may elicit a contractile response without a Ca2+ signal: alpha-adrenergic stimulation of phosphatidylcholine-specific phospholipase C or D (the latter in conjunction with phosphatidate phosphohydrolase) generates diacylglycerol. In the absence of an increase in [Ca2+]i, diacylglycerol specifically activates so-called novel PKCs, of which epsilon is the only isoenzyme known to be expressed in vascular smooth muscle. Recent evidence suggests that PKC may trigger a cascade of phosphorylation reactions, resulting in activation of mitogen-activated protein kinase and phosphorylation of the thin filament associated protein caldesmon. Alternatively, or additionally, PKC may directly phosphorylate calponin, another thin filament associated protein. These phosphorylations are predicted to alleviate inhibition of the cross-bridge cycling rate by these thin-filament proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Genetic polymorphisms of interleukin-1-beta in association with sustained response to anti-viral treatment in chronic hepatitis B in Chinese.

BACKGROUND: Interleukin-1beta is a pro-inflammatory cytokine that may influence host defence against viral infection. AIM: To investigate the impact of interleukin-1beta gene polymorphism on the response to anti-viral treatment. METHOD: Hepatitis B e antigen-positive chronic hepatitis B patients who have completed a randomized study of peginterferon alpha-2b and lamivudine combination vs. lamivudine monotherapy were included. Sustained responders were patients who had persistent hepatitis B e antigen loss and less than two occasions with hepatitis B virus DNA >100 000 copies/mL at any time up to week 76 post-treatment. Polymorphisms at interleukin-1beta-511, -31 and -3954 and interleukin-1 receptor antagonist (RN) were studied. RESULTS: Eighty-eight patients were studied and 18 (20%) patients developed sustained response. Near complete linkage disequilibrium was observed between interleukin-1beta-511 and -31 loci. After adjustment for the potential confounding effects of treatment allocation, hepatitis B virus genotype, pre-treatment alanine aminotransferase and hepatitis B virus DNA levels, genotype C/T at interleukin-1beta-511 was found to be associated with higher sustained response than genotype C/C (adjusted odds ratio 10.4, 95% CI 1.1, 96.9, P = 0.040). The proportion of sustained responders tend to be higher among patients with allele T at interleukin-1beta-511 (83%) than those without (70%) (P = 0.058). CONCLUSION: High interleukin-1beta production genotype at position -511 has a favourable response to anti-viral treatments.

Adult↗
PubMed2000

Competency development in public health leadership.

The professional development of public health leaders requires competency-based instruction to increase their ability to address complex and changing demands for critical services. This article reviews the development of the Leadership Competency Framework by the National Public Health Leadership Development Network and discusses its significance. After reviewing pertinent literature and existing practice-based competency frameworks, network members developed the framework through sequential use of workgroup assignments and nominal group process. The framework is being used by network members to develop and refine program competency lists and content; to compare programs; to develop needs assessments, baseline measures, and performance standards; and to evaluate educational outcomes. It is a working document, to be continually refined and evaluated to ensure its continued relevance to performance in practice. Understanding both the applications and the limits of competency frameworks is important in individual, program, and organizational assessment. Benefits of using defined competencies in designing leadership programs include the integrated and sustained development of leadership capacity and the use of technology for increased access and quality control.

Curriculum↗
PubMed2002

Treatment of human African trypanosomiasis--present situation and needs for research and development.

Human African trypanosomiasis re-emerged in the 1980s. However, little progress has been made in the treatment of this disease over the past decades. The first-line treatment for second-stage cases is melarsoprol, a toxic drug in use since 1949. High therapeutic failure rates have been reported recently in several foci. The alternative, eflornithine, is better tolerated but difficult to administer. A third drug, nifurtimox, is a cheap, orally administered drug not yet fully validated for use in human African trypanosomiasis. No new drugs for second-stage cases are expected in the near future. Because of resistance to and limited number of current treatments, there may soon be no effective drugs available to treat trypanosomiasis patients, especially second-stage cases. Additional research and development efforts must be made for the development of new compounds, including: testing combinations of current trypanocidal drugs, completing the clinical development of nifurtimox and registering it for trypanosomiasis, completing the clinical development of an oral form of eflornithine, pursuing the development of DB 289 and its derivatives, and advancing the pre-clinical development of megazol, eventually engaging firmly in its clinical development. Partners from the public and private sector are already engaged in joint initiatives to maintain the production of current drugs. This network should go further and be responsible for assigning selected teams to urgently needed research projects with funds provided by industry and governments. At the same time, on a long term basis, ambitious research programmes for new compounds must be supported to ensure the sustainable development of new drugs.

Africa South of the Sahara↗