Advanced Value Chain Collaboration in Ghana's Cocoa Sector: An Entry Point for Integrated Landscape Approaches?

Value chain analyses have focused mainly on collaboration between chain actors, often neglecting collaboration "beyond the chain" with non-chain actors to tackle food security, poverty and sustainability issues in the landscapes in which these value chains are embedded. Comparing conventional and advanced value chain collaborations involving small-scale cocoa farmers in Ghana, this paper analyzes the merits of a more integrated approach toward value chain collaboration. It particularly asks whether advanced value chain collaboration targeting cocoa-producing areas potentially offers an entry point for implementing a landscape approach.

Magnetic resonance imaging in gynecological oncology.

Magnetic resonance imaging (MRI) has become an indispensable tool in the assessment of malignant disease. With increasingly sophisticated systems and technical advancements, MRI has continued to expand its role in providing crucial information regarding cancer diagnosis and management. In gynecological malignancies, this modality has assumed greater responsibility, particularly in the evaluation of cervical and endometrial cancers.

Variable size computer-aided detection prompts and mammography film reader decisions.

Introduction: The purpose of the present study was to investigate the effect of computer-aided detection (CAD) prompts on reader behaviour in a large sample of breast screening mammograms by analysing the relationship of the presence and size of prompts to the recall decision.

Methods: Local research ethics committee approval was obtained; informed consent was not required. Mammograms were obtained from women attending routine mammography at two breast screening centres in 1996.

Visually assessed breast density, breast cancer risk and the importance of the craniocaudal view.

Introduction: Mammographic density is known to be a strong risk factor for breast cancer. A particularly strong association with risk has been observed when density is measured using interactive threshold software. This, however, is a labour-intensive process for large-scale studies.

Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.

Background: The long-term effects of disease management programmes for coronary heart disease on health status are unknown. In a randomized trial of nurse-led secondary prevention clinics, we found significantly improved health status at 1 year. Participants were followed-up again at 4 years to determine if improvements had been sustained.

Cluster randomized trial of a guideline-based open access urological investigation service.

Background: Out-patient services are trying to achieve effective and efficient health care in overcrowded, busy clinic settings. "One stop" and "open access" clinics have been advocated as a way of improving out-patient services.

Objectives: Our aim was to evaluate the effectiveness and efficiency of a guideline-based open access urological investigation service.

Magnetic resonance imaging appearances of the uterus following microwave endometrial ablation.

Aim: Microwave endometrial ablation (MEA) is a treatment for dysfunctional uterine bleeding. It is a second generation ablative technique which is as effective as hysteroscopic methods but quicker and easier to perform. Our aim is to describe the Magnetic Resonance Imaging (MRI) appearances of the uterus following this procedure.

The accuracy of "one-stop" diagnosis for 1,110 patients presenting to a symptomatic breast clinic.

Unlabelled: To minimise delay in diagnosis and reduce patient anxiety, triple assessment with immediate reporting has been used in our symptomatic breast clinic since 1991. This article examines the accuracy of the diagnostic modalities used and the efficacy of the "one-stop" diagnostic policy. The data on 1,110 new patients presenting to the symptomatic breast clinic between January and July 1993, were analysed and subsequent three year follow-up and outcome established.

Routine receiver operating characteristic analysis in mammography as a measure of radiologists' performance.

A system for calculating receiver operating characteristic (ROC) curves from routine audit data is described. Both diagnostic opinion and pathology outcome data from the symptomatic mammography department were recorded in an audit database, from which ROC curves were calculated. A comparison of overall radiologists' performance was made and the appropriate performance indices discussed.

Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care.

Objective: To evaluate whether nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease.

Design: Randomised controlled trial.

Setting: A random sample of 19 general practices in northeast Scotland.

Secondary prevention clinics for coronary heart disease: randomised trial of effect on health.

Objective: To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease.

Design: Randomised controlled trial of clinics over one year with assessment by self completed postal questionnaires and audit of medical records at the start and end of the trial.

Setting: Random sample of 19 general practices in northeast Scotland.

Secondary prevention in coronary heart disease: baseline survey of provision in general practice.

Objective: To determine secondary preventive treatment and habits among patients with coronary heart disease in general practice.

Design: Process of care data on a random sample of patients were collected from medical records. Health and lifestyle data were collected by postal questionnaire (response rate 71%).

Incident round cancers: what lessons can we learn?

At the time of implementation of the National Health Service Breast Screening Programme a range of targets were set, and have since been updated. This study looks at a subset of cancers detected by screening - the incident round cancers - which are not currently identified and addressed by the targets. In our first incident round we screened 24838 women and detected 112 breast cancers in 111 women.

A novel diagnostic index for use in the breast clinic.

The diagnostic accuracy of clinical examination, mammography, ultrasonography and fine needle aspiration (FNA) cytology in discriminating between benign and malignant breast lesions has been retrospectively assessed in 603 patients who attended the Professorial Breast Clinic and then underwent surgical biopsy, in Aberdeen Royal Infirmary, between January 1989 and September 1992. In this series of patients, FNA cytology gave the highest overall prediction of malignancy (92.6%) with a sensitivity of 87% and a specificity of 98%, whilst ultrasonography gave the lowest correct overall prediction (75.

Identification of women at high genetic risk of breast cancer through the National Health Service Breast Screening Programme (NHSBSP).

Breast cancer is a multifactorial disease with an inherited predisposition being implicated in around 5% of all cases. Using previous epidemiological data assessing risks for the relatives of women with breast cancer, we have identified 154 women (from a screened population of 35,505) and 289 of their relatives between 50 and 64 years who have more than twice the age related risk of developing breast cancer. This constitutes 1.

Free intra-peritoneal gall-stones following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is now the operation of choice for symptomatic gall-bladder stones. Two cases of retained free intra-peritoneal gall-stones following this procedure are described; the first resulting in a peritoneal granuloma and causing initial confusion in diagnosis, and the second seen incidentally in a biloma. In the appropriate clinical setting free intra-peritoneal gall-stones must be added to the differential diagnosis of abdominal and pelvic calcification.

Doctors' views on anxiety management in general practice.

Various guidelines have been issued to doctors concerning the treatment of anxiety in primary care and particularly on the use of benzodiazepines. Little has been reported about how this advice has influenced doctors' opinions and practice. This paper describes results of interviews with 15 general practitioners and 15 general practitioner trainees on their management of anxiety problems.

Neuropsychological deficits and morphological MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis. A controlled study.

By means of psychometric testing, we have determined the frequency of latent hepatic encephalopathy in a group of 19 cirrhotics with no clinical evidence of encephalopathy. Magnetic resonance imaging (MRI) of the brain was performed in order to determine whether morphological cerebral abnormalities were associated with latent encephalopathy. Nineteen age and educationally matched patients with normal liver function acted as controls.

Fetal fat measurement by magnetic resonance imaging.

A method to assess the average percentage of fetal fat with respect to other fetal tissue is described. This method was then used to assess the percentage of fat in 13 normal fetuses who had a magnetic resonance imaging (MRI) examination late in pregnancy (38-41 weeks). The scans of a further 13 fetuses of diabetic mothers and one case of intrauterine growth retardation (IUGR), all of whom had MRI examinations in the last 3 years, were reviewed and similar calculations were carried out.

Magnetic resonance imaging of the orbits using a binocular surface coil.

Sixty subjects, including 12 normal volunteers, have been studied using the Aberdeen 0.08 T magnetic resonance imager. A wide range of pathological conditions, including both ocular and and orbital disease, have been examined using a specialized binocular surface coil.

Magnetic resonance imaging of the parotid glands using inversion-recovery sequences at 0.08 T.

One hundred and eight examinations on 103 patients with suspected disease of the salivary glands were studied using a 0.08 T resistive magnet and inversion-recovery pulse sequences. Sixty-eight patients who had a mass lesion within a salivary gland later had surgery, and specimens were obtained for histological diagnosis.

Technetium 99m HMPAO scanning in patients with subarachnoid haemorrhage: a preliminary study.

Technetium 99m hexamethylpropylene amine oxime (HMPAO) is an agent which, when injected intravenously, gives images which reflect cerebral blood flow. Seven patients who had suffered subarachnoid haemorrhage were examined by cerebral angiography and by 99Tcm HMPAO scanning. The two studies were compared and in six cases there was evidence of decreased cerebral perfusion in relation to the ruptured aneurysm causing the subarachnoid haemorrhage.