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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Daniel Joseph Brotman, M.D.
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Bolivia finds itself in a similar circumstance in regard to the Andean market gastritis symptoms upper right quadrant pain generic bentyl 20 mg mastercard, where its soybean exports have privileged access gastritis diet ketosis cheap bentyl 20mg with visa. In regard to labour markets gastritis uptodate discount bentyl 20mg line, the technology used to produce soybeans is highly capital-intensive and requires little labour gastritis or gallstones discount bentyl 20mg on line. This means that rapid growth is unlikely to provoke labour shortages that push up wages and curtail subsequent growth gastritis from not eating trusted 20mg bentyl. In situations gastritis in children buy bentyl 20 mg with visa, such as in southern Brazil, where soybeans replaced more labour-intensive crops, the advance of soybean production actually displaced labour. In other contexts, such as in the Brazilian Cerrado and the Santa Cruz expansion zone, where farmers have removed natural vegetation to plant soybeans, the demand for labour rises, but only slightly. The profits resulting from technological change can also provide the capital required to expand agricultural production. Many farmers in southern Brazil used the profits obtained from soybeans to move to frontier regions and clear additional forest. Three unique features of our theoretical framework compared with other chapters in this book are the roles we attribute to: economies of scale, the interaction between technology and other policies and the impact of technology on the political economy. To produce soybeans competitively, you need a large and modern processing, transportation, storage, financial, technological and marketing system. Technological progress can make it easier to profitably reach levels of production that justify installing ancillary services and infrastructure. Since one piece of agricultural machinery can cultivate a large area, mechanized soybean production also exhibits economies of scale at the farm level. For example, credit subsidies in the Brazilian Cerrado induced farmers to adopt agricultural machinery and soil amendment technologies that made growing soybeans more profitable than extensive cattle ranching. Once this process had begun, the economies of scale in soybean production accelerated it. As long as the capital/land price ratio remains high, farmers 198 David Kaimowitz and Joyotee Smith. Technology choice and land use under soybean and extensive cattle ranching (Brazilian Cerrado): impact of factor price ratios and economies of scale. Thus, policy can stimulate farmers to adopt a capital-intensive technology in a land-abundant area. Thus, even though subsidized credit makes capital cheap compared with land, rather than using more capital and less land, farmers are inclined to use more of both. Finally, technological change not only changes relative prices, it also modifies political relations. By favouring the development of a large, concentrated, agroindustrial sector, new soybean technologies facilitated the creation of powerful interest groups, which successfully lobbied the Brazilian and Bolivian governments to implement policies favourable to the soybean sector. Southern Brazil Southern Brazil includes Parana, Rio Grande do Sul and Santa Catarina. Small farmers with less than 50 ha of land, many of whom were sharecroppers, tenants or squatters, planted much of that (Stedman, 1996). Technologies and policies promoting soybean expansion Coffee boomed in Parana and the other southern states in the 1950s, expanding from 7% of harvested area to 19% (Stedman, 1996). Soon after, however, low coffee prices, soil erosion, plant diseases and frost caused a crisis in the regional coffee economy (Diegues, 1992). A handful of farmers in Rio Grande do Sul were already planting soybeans in the early 1960s. Yields averaged only 1060 kg ha-1 (Kaster and Bonato, 1980; Wilkinson and Sorj, 1992). Thanks to its similar climate, soils and day length, these varieties adapted easily to southern Brazil. The new varieties permitted average yields to increase 15% between 1960 and 1970 to 1141 kg ha-1 (Wilkinson and Sorj, 1992). The 1964 Land Statute gave tenant farmers and sharecroppers greater rights and many large landholders responded by expelling tenants and sharecroppers from their farms. Similarly, landholders reacted to new minimum wage laws by hiring fewer agricultural labourers. One way to achieve that was to plant soybeans and wheat, which required less labour, instead of coffee and traditional food crops. The government further accelerated the shift towards mechanized annual crop production by providing subsidized credit to purchase agricultural machinery (Sanders and Ruttan, 1978). Agricultural credit rose almost fivefold between 1970 and 1980 and soybeans received over 20% of that (Skole et al. The government gave incentives to domestic wheat producers to promote import substitution. This benefited soybean-growers, since farmers frequently rotated wheat with soybeans and the two crops shared the same machinery, equipment and labour (Wilkinson and Sorj, 1992). Rapid urbanization and rising per capita incomes increased domestic demand for soybean products. The government used subsidies and fiscal incentives to encourage domestic processing of soybean products, while restricting exports of unprocessed beans. This allowed producers to increase yields, reduce costs and degrade their soils less. Rhizobium-based nitrogen fixation alone saved farmers over 5 million t annually of nitrogen fertilizer and reduced fertilizer costs by 80% (Wilksinon and Sorj, 1992). Kaster and Bonato (1980) attribute two-thirds of that increase to new varieties and the remainder to improved agronomic practices. Simoes (1985) calculated that, for each percentage increase in expenditure on soybean research between 1973 and 1983, the soybean area grew by 0. Moreover, this calculation ignores how new technologies interacted with other contextual factors, since the sum was certainly greater than the parts. It was probably less than a third, since the total utilized farmland in the south increased only 1. It is worth noting, however, that virtually all of Parana was originally old-growth forest, with a high prevalence of Arucaria trees (M. Technological change contributed to this process by depressing soybean prices and thus dampening the initial incentive it had provided to increase the area. Stagnating yields, in part due to growing problems of soil erosion and compaction, the elimination of wheat subsidies and high port costs, also contributed to the decline in soybean area (Wilkinson and Sorj, 1992). General equilibrium effects: the labour market and farmer incomes the principal way the advance of soybeans in the south influenced deforestation was through the labour market. The shift to soybeans stimulated land concentration and agricultural mechanization. Many small farmers could not afford the machinery and chemical inputs required for growing soybeans. Rising yields, high soybean prices and subsidized credit pushed up land prices and poor farmers found it increasingly difficult to compete in the land markets (Brandao and Rezende, 1992). Subsidized credit went mostly to large farmers and this accelerated the concentration of landholdings (Goldin and de Rezende, 1993). The number of tractors in Brazil jumped from 134,500 to 545,200 between 1965 and 1980 and southern soybean producers accounted for a lot of this (Stedman, 1996). During the same period, Rio Grande do Sul lost some 300,000 farms (Genetic Resources Action International, 1997). Nevertheless, a significant number went to the Amazon and cleared forest to grow crops. Sawyer (1990) cites Parana as an important source of migrants to the Amazon in that period. While the expansion of mechanized agriculture destroyed the livelihoods of many migrants to the Amazon, in other cases soybean and wheat production provided the resources that allowed small farmers to purchase land on the agricultural frontier. Many better-off small farmers who moved to the Cerrado took advantage of land price increases in the south to sell their farms and buy larger areas in the Cerrado, where land was cheap (Coy and Lucker, 1993). The Brazilian Cerrado Just as soybean production stagnated in the south, it took off in the Cerrado. The term Cerrado refers to a characteristic set of vegetative types, which include natural savannahs and woodlands. In northern Mato Grosso, one finds a transition between Cerrado vegetation and rain forest. Technologies and policies promoting soybean expansion Historically, the Cerrado had a low population density and large unoccupied areas, dominated by extensive cattle ranches (Mueller et al. New soybean technologies, public road construction and subsidized credit, fuel and soybean prices changed that. Heavily capitalized farms with between 200 and 10,000 ha grew most of this (Mueller et al. In 1992, a farmer in Maranhao needed to invest almost $1 million to grow 1000 ha of soybeans (Carvalho and Paludzyszyn Filho, 1993). Farmers solved the first constraint by applying a lot of lime and phosphate and using machinery to plough heavy soils (Sanders and Ruttan, 1978; Goldin and de Rezende, 1993). Existing soybean varieties were sensitive to photoperiod and performed poorly in the lower latitudes, where day length is uniform and short. They were also susceptible to aluminium toxicity and required large amounts of calcium (Spehar, 1995). Beginning in the mid-1970s, the National Soybean Research Centre and other research centres worked to produce varieties adapted to the Cerrado, with the explicit goal of advancing the agricultural frontier (Kueneman and Camacho, 1987). Thanks to these efforts, mean yields rose 45% between 1975 and 1983, from 1300 kg ha-1 to 1900 kg ha-1 (Simoes, 1985). Spehar (1995) estimates that the new varieties increased the annual earnings of soybean producers in the Cerrado by $1 billion. Without new varieties, soil treatments and machinery, the rapid spread of soybeans into the Cerrado would have been impossible. In particular, as noted earlier, credit subsidies proved an essential precondition for the rapid adoption of agricultural machinery and soil amendments. Without government subsidies, soybean production would probably have been restricted to accessible areas with better soils. Subsidies allowed farmers to grow soybeans profitably in more remote areas, such as northern Mato Grosso. The Brazilian government also made land and credit available to large private companies, which built roads and other infrastructure and then resold part of the land in 50 to 400 ha parcels to enterprising small farmers from the south. Some large private investor groups used the proceeds from the land sales to grow soybean in the remaining areas and create local infrastructure for storing soybeans and carrying out the initial stages of processing to make vegetable oil. General equilibrium effects: the product market From the mid-1980s, several factors turned against soybean production. Higher soybean production in the Cerrado, generated by technological changes, may have contributed to this, but as far as we know no one has studied the issue. The Brazilian government also greatly reduced credit subsidies and real interest rates rose sharply (Goldin and de Rezende, 1993). The 1994 macroeconomic stabilization policy, known as the Real Plan, generated positive real growth rates and radically reduced inflation, both of which stimulated domestic demand for soybeans (Smith et al. Nevertheless, the exchange rate became progressively overvalued and real interest rates remained high and volatile, causing severe financial stress among indebted soybean farmers (Smith et al. General equilibrium effects: the labour market Thanks to in-migration from the south and the north-east and the limited labour requirements of soybean cultivation, the growth of the soybean area put little upward pressure on wages. Between 1970 and 1985, the area in crops rose by 172%, the cattle herd by 128% and the number of tractors by 660% (Mueller et al. However, the agricultural labour force in the savannah region grew by only 45%, from 1. Soybean Technology 205 the soybean lobby Despite low international prices, declining credit subsidies and an overvalued exchange rate, soybean production in the Cerrado has continued to expand, except for a few years in the early 1990s (Stedman, 1996). Powerful interest groups linked to the soybean sector lobbied successfully for compensating government concessions whenever conditions turned unfavourable. This group, which includes processors and exporters, machinery and input manufacturers, investor groups and farmer organizations, has become a potent force in Brazilian politics (Pompermayer, 1984; Coy, 1992). Its great influence appears to be linked to the important contribution made by agricultural exports to meeting balance-of-payments deficits, particularly during the debt crisis of the 1980s and again in the mid-1990s. To compensate for the decline in subsidized credit and to protect farmers from falling international soybean prices during the mid-1980s, the government purchased large quantities of soybeans from farmers at pre-established prices (Goldin and de Rezende, 1993). The government also established uniform fuel prices, without considering the high cost of transporting fuel to remote areas. This not only made it feasible for farmers to transport their crops long distances to markets, but also lowered fuel costs for the use of agricultural machinery (Mueller et al. In the 1990s, the private sector and government agencies initiated several projects designed to reduce the cost of transporting soybeans from the Cerrado to different ports. In 1990, private companies, banks and government agencies jointly established the northern export corridor initiative to increase soybean production in Tocantins, Maranhao and Piaui, with a goal of 500,000 ha by 1998. The initiative includes fiscal incentives, agricultural research, credit and infrastructure for transporting soybeans to the Amazon River (Carvalho and Paludzyszyn Filho, 1993). Soybean farmers benefited from the 1996 removal of a tax on primary and semi-manufactured exports. In response to the high interest rates of the 1990s, the government provided guarantees to commercial banks to allow exporters to obtain credit at rates similar to those available internationally. Soybean expansion and the loss of natural vegetation Over the last 20 years, soybean and pasture expansion dramatically affected the natural vegetation of the Cerrado.
Syndromes
As we saw previously gastritis diet цще purchase bentyl 20 mg with mastercard, since adopting irrigated systems (stage I) chronic gastritis medscape discount bentyl 20mg mastercard, the amount of labour each farmer demanded per hectare during each cropping season fell from 42 gastritis diet quality purchase 20 mg bentyl with mastercard. Further simulations with our model show that suboptimizing behaviour in the dry season could lead to an overall reduction in annual labour use of up to 2% ha-1 compared with the amount used by rain-fed farms gastritis diet 411 order bentyl 20 mg line. The story that emerges gastritis surgery generic bentyl 20 mg line, therefore gastritis vs gerd discount 20mg bentyl visa, is that, while the short-run impact of irrigation on forests may be beneficial, the long-run impact will depend on whether irrigated farms seek and achieve profit-maximizing factor intensities and, if so, whether irrigation in the delivery area is fully utilized during the dry season. Conclusions and Policy Implications In Palawan, natural population growth and migration rates influence the size of the agricultural labour force. The persistence of activities that degrade forests reflects lack of economic opportunity and low economic returns from current agricultural options. This study examined the pathway though which investments in lowland irrigation development increase agricultural productivity and wages, and how these, in turn, generate employment opportunities for households that rely on forests for agricultural land and timber. Where upland and lowland communities are close to one another, increased employment resulting from irrigation development can draw pressure away from the forest margin. Our results suggest that lowland irrigation projects can raise employment among upland residents and improve their welfare. This implies that lowland agricultural intensification can have beneficial impacts on adjacent upland forests. First, the area described here is unusual, in that the upland area is physically adjacent to the lowland area. For most upland households, working on lowland farms required only a 1 h trip on foot. If larger distances separated the lowland and upland areas, the opportunity cost of travel for upland households would be much higher and could discourage upland households from seeking employment on lowland farms. Secondly, the adoption of mechanization, direct seeding, chemical-based weed control and other labour-saving technologies could lead irrigated lowland farms to shed additional labour in the future and hence partially reverse the employment gains we observe. The relative costs Deforestation, Irrigation, Employment and Cautious Optimism 345 of labour and inputs that can substitute for labour partially determine how much labour farmers demand. Some sets of relative prices could undermine the labour absorption we observed in this case. Thus policy-makers should take into account the environmental gains associated with labour-intensive production in frontier areas, when considering economy-wide policies that discourage labour use, by reducing the relative prices of fertilizer, pesticides and machinery, such as tractors. Our analysis demonstrates that irrigation reduces labour demand per hectare per cropping but raises total labour use per hectare in a calendar year and that encouraging labour use in lowland agriculture can reduce upland deforestation. To the extent that off-farm labour displaces environment- and forest-degrading activities with lower rates of return, shifts in time allocation may increase incomes at the same time as they reduce environmental pressure. The more important policy lesson, however, is that the labour market plays a key role in facilitating environmental improvements. For this reason, policy-makers should embrace opportunities to expand employment and labour-market participation, especially in areas where upland deforestation is a continuing problem. Notes 1 We gratefully acknowledge comments from the editors, Ed Barbier, Ian Coxhead, John Lee, Will Masters and an anonymous reviewer. Nevertheless, this exercise allows us to roughly compare observed levels of labour use on rain-fed farms and those that might be expected on irrigated farms under a plausible set of conditions. Elsewhere (Martinez and Shively, 1998) we show that, on average, irrigated farms are operating below profit-maximizing levels. We also argue that the observed increase in labour use associated with irrigation may partially reflect other farmer concerns such as risk aversion. Papers Presented at a Conference Held in Chiang Mai, Thailand, 23 to 26 August 1983. National Centre for Development Studies, Australian National University, Canberra, pp. Agricultural Development Policies and Land Expansion Agricultural Development Policies and Land Expansion in a Southern Philippine Watershed 19 Ian Coxhead, Gerald Shively and Xiaobing Shuai 1. In addition to their usual effects on supply, price supports increase farm profitability, and this spurs both the demand for innovations and the investments in R&D intended to increase their supply. In this setting, policy-makers and farmers give only secondary attention to long-run environmental concerns and thus fail to anticipate many of the environmental effects of technical progress. Philippine government policies reinforce both expansion and intensification in marginal agricultural lands. Agricultural expansion, when it occurs, may have severe environmental consequences. Between 1960 and 1987, the upland area devoted to agriculture in the Philippines increased sixfold and much of this increase coincided with a decline in forest cover (Cruz et al. We use survey data gathered from low-income maize and vegetable farmers in a southern Philippine watershed at the forest margin to evaluate the roles expected prices and yields and their variances play in agricultural land allocation. We find that land allocation within farms responds to relative crop prices and yields. Some crop expansion takes place primarily through the substitution of one crop for another (and, to a lesser extent, through intensified input use). Changes in prices or yields of other crops provoke an expansion of total farm area. Land and family labour constraints bind at different points, depending on the crop involved. These results suggest that, just as multiple agricultural development policies interact, environmental policies must also have multiple strands if they are to eliminate the incentives for further land expansion. In our study area, as in many other upland areas of developing market economies, commercial agriculture is the norm but farmers are poor, and therefore concerned about risks. Thus, our study site shares many other characteristics with similar sites elsewhere. Next we briefly review recent land-use trends and the policies that have influenced resource allocation at the agricultural margin. Section 3 presents a model of land allocation among crops by risk-averse farmers and the equations we used for econometric estimation. We present our main results in section 5, and in section 6 we discuss how our findings might contribute to answering the question, `Do investments in agricultural productivity for upland farms promote deforestation Historical Background and Context Recent agricultural development trends in Lantapan, Bukidnon Our study site is Lantapan, a municipality in central Bukidnon province, northern Mindanao. From east to west, the landscape rises from irrigated lowland rice-fields at about 500 m a. By 1994, it had 39,500 inhabitants (Municipality of Lantapan, Municipal Agricultural and Demographic Database). Annual population growth since 1980 has thus averaged 4%, much higher than the Philippine average of 2. Neither of these figures includes large areas of coffee, rubber, abaca and other tree and shrub crops. Since the 1950s, agricultural land has expanded substantially in Lantapan, as just noted, and farmers have substituted certain crops for others in response to new commercial opportunities. At the end of the Second World War, forest covered most sloping and high-altitude land. Farmers in the midand high-altitude villages primarily produced maize, cassava and coffee, using various forms of long-fallow shifting cultivation. In the 1950s, migrants from northern Luzon introduced commercial cultivation of potatoes, cabbages and other temperate-climate vegetables. The success of these crops, as well as the introduction of new maize varieties and the replacement of coffee and shrub crops by annual crops, all indicate steady land-use intensification. Maize production has flourished, becoming a major commercial crop, where formerly it had been traded very little outside northern Mindanao. Vegetable cultivation has also continued to increase in area and economic importance. Over a 20-year period ending in 1994, the permanent forest area shrank from about half to a little over one-quarter of the total area. Part of that land went into shrubs or secondary forest, but farmers converted a much larger part to 350 Ian Coxhead et al. Relative crop prices have changed over time, but so too have input prices and, since the major crops differ widely in the factor intensity of production, this probably influenced the product mix. After five decades of economic growth with rapidly increasing population in the Philippines, agriculture remains the largest employment sector and, until recently at least, most industrial production was highly capital-intensive. The relative abundance of labour favoured agriculture and, within the sector, relatively labour-intensive crops, such as annual crops. For a long time, the frontier served as the employer of last resort for underemployed, unskilled labour. Over time, land scarcity promoted intensification, which further increased labour demand and raised the returns to land used for intensive production. Only within the last decade has non-agricultural growth shown signs of absorbing labour at rates significantly faster than labour-force growth, foreshadowing a slow-down in the net growth of upland populations. Lantapan, whose population grew rapidly in past decades, is just now beginning to display signs of labour shortage. Agricultural development policy in the Philippines Although soil quality, moisture, temperature and (for some vegetable crops) the presence of soil-borne pathogens all condition agricultural land use, farmers in Lantapan usually explain their land-use decisions in terms of the relative economic benefits of different crops. Over time, a number of Philippine government policies have directly and indirectly affected the profitability of cultivating maize and vegetables. These consist mainly of market interventions directed at stabilizing farm prices; trade interventions designed to Table 19. Quantitative restrictions on maize, cabbage and potato imports (recently converted to tariffs at the maximum allowable rate under the World Trade Organization) have raised their domestic prices relative to world prices. For these crops, nominal protection has been so high that it more than offset the prevailing bias against agriculture introduced through industrial promotion and exchange rate policies (Bautista et al. Even in the recent era of declining protectionism, protection of vegetable producers has been stable and that of maize producers has risen: the implicit tariff on maize rose from near zero in the early 1970s to close to 100% by the early 1990s (Intal and Power, 1990; Pagulayan, 1998). As a result, regional coffee production has deteriorated in both quantity and quality, and processing and marketing infrastructure, extension support and other assistance to the industry have all but disappeared. As a result, the area planted to maize has risen steadily in Bukidnon, even as it has declined nationally. Foreign agencies also support potato research, which is regionally concentrated in Department of Agriculture facilities in northern Luzon and in Bukidnon and strongly promoted by industrialists in the potato-processing industry. Bacterial wilt, cyst nematodes, late blight and various insect pests threaten potato production. A similar story applies in cabbage and other temperate vegetable crops, where pests and disease pose the greatest threats to yields and maintaining crop health is a large component of production costs. Philippine cabbage research appears largely to focus on reducing yield variability and input costs by addressing pest and disease problems. Although maize yields have risen over time with the development and spread of improved varieties, vegetables have not progressed to the same degree. However, technological breakthroughs, if they emerge, will be at least as important for dampening the volatility of vegetable yields as for increasing expected profits. If the main effect of vegetable research is to reduce variability of returns, then technical progress could have a substantial impact on the land-use decisions of risk-averse farmers. Other things being equal, existing vegetable farmers will opt to increase production, and other farmers not currently growing vegetables may switch existing land or expand planted area to begin. However, the magnitude of the land-area response will depend on product prices and their volatility and the availability of inputs. For vegetable farmers, credit for inputs and the managerial skills required by technologically advanced vegetable production are both likely to significantly constrain land-area expansion. With this in mind, we conducted an ex ante analysis of the probable land-use effects of technological improvements in Philippine vegetable production. We encourage interested readers to consult the appendix to this chapter and the more formal exposition in Coxhead et al. Our main goal in this study is to measure how land and labour allocations for various crops respond to changes in expected output prices, expected yields or price or yield volatility. The model we base our analysis on assumes that farmers are endowed with land and family labour, which they use to produce a combination of maize and vegetable crops. They purchase other inputs, whose farm-gate prices (as well as those of outputs) are determined by distance from a central market. Given family labour availability and the prices of inputs (including hired labour), each farmer decides at the beginning of a season: (i) how much land to plant; and (ii) what fraction of the land to allocate to each crop. Since prices and yields are stochastic, we assume that farmers make choices to maximize expected utility. Production or yield risk arises both from the characteristics of the land (its slope and quality, for example) and family labour endowments and 354 Ian Coxhead et al. Price risk arises because, at the time farmers decide how to allocate their land, they do not know with certainty what crop prices will be at harvest time.
During the year [2007] the government expanded its reach to new areas gastritis in children purchase bentyl 20mg with mastercard, including the eastern border region with Pakistan gastritis turmeric buy bentyl 20mg with visa, through the use of auxiliary police 7 day gastritis diet order 20 mg bentyl with mastercard. Kaftar probably never meant to strike a blow for gender equality gastritis diet symptoms discount 20 mg bentyl mastercard, but this Country of Origin Information Report contains the most up-to-date publicly available information as at 29 August 2008 gastritis diet еду cheap bentyl 20mg with amex. Last month hemorrhagic gastritis definition discount bentyl 20 mg fast delivery, she surrendered to the government together with five armed men, most of them her relatives. It was the second time she had laid down her weapons since the fall of the Taleban regime in 2001. After the United States-led invasion sent the Taleban running, Kafter surrendered her weapons under a governmentrun demobilisation programme. The cabinet in 2005 approved an Action Plan on Peace, Justice, and Reconciliation, including commemoration for victims, truth-seeking and justice mechanisms, and the vetting of potential state employees, but the plan was not formally launched until December 2006. Many perpetrators were elected to the National Assembly despite calls for them to be disqualified, and some, such as warlord Abdul Rasul Sayyaf, have established dominant positions in the new parliament, making any attempt at prosecution difficult. In March 2007, President Karzai signed a law initiated by parliament that provides a sweeping amnesty for war crimes committed prior to 2002, drawing criticism from human rights groups and some lawmakers. Similarly, between 1992 and 1996 armed conflict between various factions was also accompanied by serious violations of international human rights law and humanitarian law. In December [2007], President Karzai stated that his administration did not yet have the capacity to arrest and prosecute many of those responsible for past and continuing human rights abuses. Those accused of such abuses included members of parliament as well as provincial government officials. The report gives the names of commanders during this period who were involved in the abuses and states: "To say that all of the armed forces that fought in Afghanistan committed war crimes is not to say that every single fighter has been guilty of such actions. What the Afghanistan Justice Project has documented are incidents in which senior officers and commanders ordered actions amounting to war crimes by their forces, or allowed such actions to take place and did nothing to prevent or stop them. This process included the safe removal and cantonment of over 10,880 heavy weapons. Cities such as Gardez, Mazar-e Sharif and Bamyan are now largely free of operational heavy weapons. The cantonment of these weapons, coupled with the demobilization of Afghan militia forces, has reduced opportunities for factions to engage in clashes of the scope and intensity that affected the Northern provinces in the period 2002-2004, and the Western provinces in 2006. Fifty-five thousand eight hundred and four (55,804) ex-combatants chose one of the reintegration options, which further benefited 53,415 of them, leaving aside 2,759 drop-outs. While imperfect, this progress has undoubtedly enhanced political space, since thousands of armed men no longer have to be factored into the security equation. It was estimated that there could be up to 120,000 persons operating in over 1,800 illegal armed groups. Piloted during the run-up to the parliamentary and provincial council elections in 2005, its main phase was launched between 1 May and 7 June 2006. From September 2006 to 25 February 2007, only 4,496 light and heavy weapons had been submitted. The pace of weapons submission and overall disbandment compliance, particularly in the north, was thought to have suffered from the overall deterioration of the security situation. In response to stalled implementation, a joint review of the disarmament programme was undertaken by key stakeholders. The recommendations of the review were reflected into an action plan, which President Karzai endorsed on 7 February 2007. The plan attempts to put new impetus in the disarmament process in part by giving the national security adviser a ministerial coordination and 60 this Country of Origin Information Report contains the most up-to-date publicly available information as at 29 August 2008. Out of 51 targeted districts, 21 have complied with the programme, and 161 illegal armed groups were disbanded. There were 160 actual suicide attacks in 2007, with a further 68 thwarted attempts, compared to 123 actual and 17 thwarted in 2006. Civilians were increasingly caught in fighting between anti-government forces and government forces and their international supporters. Anti-government forces also routinely violate the laws of war by launching attacks from civilian areas, or retreating to such areas, knowingly drawing return fire. The incident levels during the winter months nevertheless stood well in excess of those recorded for previous years. The figures for January 2007, for example, were more than double those in January 2006. The insurgency-related violence resulted in 2,732 fatalities between 1 September 2006 and 25 February 2007. They continue to mount widespread roadblocks on the ring road connecting Kabul to Kandahar and Herat and to target senior public officials and community leaders. In the central and south-east regions, military operations conducted by Government and international military forces managed to clear areas only temporarily. Such agreements were concluded in the Zadran-populated districts in Paktya and Khost provinces, and in the Narhai district in Kunar province, where tribal elders from both sides of the border with Pakistan negotiated a non-aggression pact. An agreement of September 2006 with local elders from Musa Qala district, Helmand province, stipulating that the district would not be used as a staging ground for insurgent attacks in exchange for the withdrawal of international military forces from a radius of five kilometres from the district centre, led to five months of relative stability. Attacks on international organizations, international aid workers and their local counterparts, and foreign interests and nationals increased significantly during the year and prompted some organizations to leave. The Taliban can be described as a semi-spontaneous movement lacking deep ideological roots, whose political purposes derived from a fundamentalist interpretation of the Koran. Although small in number at first, the Taliban succeeded in building alliances with local warlords and progressively acquired power. However, although the number of alleged Taliban increased, not all shared the original hyper-conservative beliefs. Their objective once in power, would be to restore peace and security and enforce the Sharia or Islamic law. They emerged with high popularity by stamping out corruption, curbing lawlessness and making roads and areas under their control safe for commerce and by 1998 they were in control of almost 90 percent of the country. However, after losing power in 2001 the Taliban is now re-emerging as a hardline Islamic Movement mounting an insurgence against the government. Some Taliban and Al-Qaeda elements escaped, largely into border-areas with Pakistan, where they set-up [sic] bases and re-grouped. Since late 2001, the remnants of the Taliban have been based mainly in Pakistan, and have been supported by a loose coalition comprising Afghans loyal to the former Taliban regime, disenchanted and nationalist Pashtuns, religious conservatives, criminal gangs, opium traffickers, and a new generation of Pakistani and Afghan scholars educated in the madrassas along the Pakistan-Afghan border. However, the tactics employed by the neo-Taliban differ from those of the original Taliban. Indeed, field research indicates that the composition of the neo-Taliban exposes a proxy war dynamic, especially given the well-funded, highly organised and technologically sophisticated nature of parts of the insurgency. One aspect is highly funded, and technologically sophisticated, while the other conforms to low-level, classic guerrilla-warfare techniques. Pakistan has been implicated in the coordination, financing and organisation of the insurgency. So far, the strategy for reconciliation has produced no substantial results in softening the insurgency. They carried out at least 28 beheadings, several of them filmed and broadcast on the internet. For instance, in April the Taliban distributed video footage of a clearly prepubescent boy beheading Ghulam Nabi, a Pakistani militant accused of betraying a top Taliban official killed in a December airstrike. The Taliban targeted humanitarian aid workers, journalists, doctors, religious leaders, and civilian government employees, condemning them as spies or collaborators. If these reports are credible, this would indicate that the Taliban are returning to a practice which was common during the latter period of their rule. They may also be attracted by the nationalist rhetoric against the foreign troops. Similarly, the Taliban have generated support by giving poppy farmers protection and financial compensation when their crops are eradicated. The Taliban are also recruiting trained Afghan policemen and guards, who are offered a choice between fighting for the Taliban, and facing death. Mansoor Dadullah who was seriously injured in the incident, was reportedly sacked in December after disobeying orders. However: "The source mentioned that low profiled, or ordinary Taliban members generally do not face problems when integrating in the local community. The source was of the opinion that many ordinary people choose [sic] to join the Taliban just in order to get a job and are therefore not necessarily guilty of human rights abuses. The source found that at the present time there is very little persecution going on of the Taliban supporters. They have adapted to the society and have no problems solely because they are former members of the Taliban. The source explained that a number of the acts of revenge related to the conflicts that aroused [sic] during the Taliban period is [sic] being carried out. The source [k]new of episodes where the local population had imposed certain conditions towards a refugee wishing to return, whom they believed had committed human rights violations. The questions as to whether a former member will have problems in Afghanistan today depends on whether the person concerned has a solid network, and is in a position to persuade that he has changed side [sic] to the people in power. The report noted: "The detainees were Taliban combatants who were captured in 2001 by Northern Alliance forces under the command of General Dostum. Others died under conditions that have been described as murder and torture, such as those who reportedly died of suffocation in metal cargo containers. There are also attempts to include a number of moderate Taliban in the political process to further national unity. To this end, a Commission, headed by Sigbatullah Mojadeddi, has been established, which follows issues of reconciliation, including questions related to amnesties for specific Afghans wishing to return to and participate in the political process in Afghanistan. However, the country has seen surges in the level of violent incidents in some parts directed against the transition process, against the Government and its institutions, which is largely attributed to remnants of the Taliban as well as segments of the Hezb-e-Islami (Hekmatyar). Active association with Taliban or other anti-Government elements may therefore entail serious consequences for the individual concerned, including arbitrary and prolonged detention, ill-treatment and torture, intimidation and extortion by military forces. There are reports from the Eastern and Southeastern regions that Afghans are falsely accused of supporting active Taliban networks. The accusers may be local commanders or members of security forces intent on extorting money from influential and rich Afghans. The co-operation, in many instances, of these local commanders, with Coalition forces to counter remnants of the Taliban and Al-Qaida, has increased the real and perceived authority of these. They were named as Mullah Mohammed Naseem, the former governor of Zabul province and former police chief of Farah province Akhtar Mohammed. It was also reported that another Taliban commander, Mullah Abdul Wahid, had surrendered last month in Helmand. The Afghan Interior Ministry spokesman was quoted as saying that many Taliban had come forward under the amnesty offer. Karzai spoke of an amnesty for all except the Taliban senior leadership, many of them now voice support for the policy. In the absence of the federal program, some provincial and even national law enforcement officials around the country have been welcoming the former Taliban officials and fighters home if they promise to eschew violence and support the government. Two of those freed have been appointed district police chiefs in the border provinces most prone to Taliban-led incursions. A third man had been accused of involvement in an explosion in Paktika Province last October that killed five people, including a local doctor who was a senior election official. While Mutawakkil was an important figure within the Taliban regime, he was not part of the neoTaliban; in fact, he was arrested in Pakistan soon after the collapse of the Taliban government and handed over to U. Moreover, the 700 figure presented by Mojaddedi does not include any key figures from among those who have kept parts of southern and eastern Afghanistan in a constant state of insecurity. He was reported as saying that he did not want to join the Taliban in waging war against coalition and Afghan forces but would always remain a talib, "a student of truth and knowledge. Other successful candidates included former Bamyan governor Maulavi Mohammad Islam Mohammadi (Samangan), Deputy Planning Minister Haji Moosa Hotak (Maidan Wardak), army division commander Maulavi Hanif Shah (Khost), military commander Mullah Tarakhail Kuchi, provincial revenues department chief Khiyal Mohammad Husseini (Ghazni), Ustad Akbari (Bamyan) and Sangar Dost (Maidan Wardak). The report should be referred to directly if further information on the activities of Hizb-i-Islami during those years is required. The present situation taken into consideration, the source found that it depends on the history of a former member of the Hezb-e-Islami whether or not he/she risks being persecuted in Afghanistan. There is also a risk that people will accuse others of having connections to Hekmatyar for personal motives. The source was of the opinion that a former member of the Hezb-e-Islami who has changed side, and who is clearly expressing his support for the government can remain in Afghanistan without being involved in problems. People who are currently active for the Hezb-e-Islami are considered to be at war with the current government like the Taliban supporters. Analysts were reported as attributing their failure in the capital to the fighting in Kabul during 1992 which claimed more than 60,000 lives; tough opponents, a dispute with the Government and officials of the Electoral Commission and quarantined ballot boxes. But few of them will have a soft corner for Hekmatyar as most of them are believed to be staunch supporters of the government-backed national reconciliation programme. In the eastern region, elected Hezb leaders are Ataullah Ludin and Haji Azizur 11. Haji Amir Lali from Kandahar, Haji Mir Wali Khan from Helmand, Abdul Qader Imami from Ghor and former Zabul governor Hamidullah Tokhi from Zabul.
On the day prior to presentation gastritis questionnaire order 20mg bentyl visa, the patient began having memory difficulties and was noted by her husband to have completely forgotten many events and details of the previous days gastritis diet еврофутбол cheap 20 mg bentyl visa. She presented to an outside hospital where a comprehensive neurologic examination disclosed a nonfluent expressive aphasia but was otherwise unremarkable gastritis diet фотострана buy 20mg bentyl with mastercard. Basic laboratory tests including electrolytes gastritis diet танки generic bentyl 20 mg line, complete blood count gastritis diet киви buy bentyl 20 mg free shipping, and liver function tests had normal results gastritis diet циан bentyl 20mg overnight delivery. What is the differential diagnosis for subacute memory disturbances and confusion in this patient Seizures with postictal confusion or exposure to psychoactive medications or drugs of abuse could produce the changes described. Stroke or cerebral hemorrhage must be considered, but the purely cognitive abnormalities without associated motor or sensory changes on examination would by atypical. Finally, transient global amnesia is a consideration, but is a diagnosis of exclusion. The initial workup would include intracranial imaging to assess for mass lesion, stroke, or hemorrhage. Lumbar puncture and systemic infectious workup should be considered given the recent fevers, upper respiratory symptoms, and changes in cognition. Infectious workup was notable for a rapid influenza swab that was positive for influenza A. What is the differential diagnosis of subacute altered mental status and seizures in association with mesial temporal lobe changes Seizure activity itself can lead to transient T2 hyperintensities in the medial temporal lobes. Other considerations in this patient would be a paraneoplastic or autoimmune encephalitis, but the acute onset and rapid decompensation is atypical. Lumbar puncture showed total protein of 443 mg/dL, glucose of 98 mg/dL, with 4 leukocytes and 11 erythrocytes per mm3. The patient became progressively more somnolent, requiring transfer to an intensive care unit, and she was transferred to our hospital for further evaluation and management. Her cranial nerves were normal, and she was able to localize to noxious stimuli in all extremities. Reflexes were brisk, measuring 3/4 in all 4 extremities, and the patient had positive Hoffman signs, flexor plantar response on the right, and equivocal response with fanning of the toes on the left. Acyclovir was continued, and the patient was empirically treated for bacterial meningitis with vancomycin and ceftriaxone. Repeat lumbar puncture showed total protein of 794 mg/dL, glucose of 84 mg/dL, with 4 leukocytes and 19 erythrocytes per mm3. Chest X-ray demonstrated a left lower lobe opacity, and the patient was treated with a 7-day course of ceftriaxone and azithromycin for pneumonia. She was enrolled in a clinical trial comparing oseltamivir to zanamivir for treatment of influenza. However, her condition continued to deteriorate despite antiviral therapy, and she required intubation for airway protection. Over the next several days, her examination results worsened such that she no longer spontaneously moved her extremities and only demonstrated stereotyped movements in response to noxious stimuli. She demonstrated some purposeful movements on hospital day 9 and was extubated on hospital day 11. Her condition slowly improved over the next week, and she was discharged to a rehabilitation facility on hospital day 21. On discharge, she was alert, was able to speak in 2-word sentences, could follow simple commands, and was able to walk with assistance. On follow-up 8 months later, the patient was fully ambulatory without residual aphasia, but had significant persistent deficits in anterograde and retrograde memory. McCray cared for the patient presented, wrote the text, and helped to assemble the figures. Deborah Forst cared for the patient presented, helped edit the text, and helped to assemble the figures. Neurological complications of pandemic influenza A H1N1 2009 infection: European case series and review. H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Grinspan, Division of Pediatric Neurology, Harkness Pavilion, 5th Floor, 180 Fort Washington Ave. She presented to the obstetrical service fully dilated after 2 days of leaking vaginal fluid, and delivered a healthy baby girl. She had had a febrile seizure at age 4, and several brief convulsions as a teenager. She recalled 2 of 3 words at 5 minutes, but had no memory for recent events, including her delivery. She could not describe cocktail ingredients, despite working as a bartender, but correctly recited old addresses. Encephalopathy suggests a process affecting large areas of the brain bilaterally due to metabolic derangements or diffuse structural injury to gray and/or white matter. Focal insults to structures responsible for memory or attention, such as the thalamus, hippocampus, and medial temporal lobe, may present similarly. Linking encephalopathy with the focal upper motor neuron sign of right leg hyperreflexia suggests a multifocal process. The differential diagnosis includes emergent peripartum conditions, such as dural sinus thrombosis, metastatic choriocarcinoma, and postpartum angiopathy, a form of reversible cerebral vasoconstriction syndrome. Subacute processes, such as demyelinating diseases and paraneoplastic processes, should also be considered. A complete blood count showed an elevated white blood cell count (14,000 per mm3). Lumbar puncture revealed a protein of 121 mg/dL, normal glucose, 3 white blood cells/mm3, and 23 red blood cells/mm3. Neurology 73 October 13, 2009 13 e75 agulation, endocrine, cardiac, lipid, and immunologic studies were unrevealing. Many lesions were hypointense on T1-weighted imaging and some demonstrated restricted diffusion. There were multiple lesions in the corpus callosum, many with a rim of T2 hyperintensity around a center of T1 hypointensity (figure 1). Magnetic resonance angiography showed caliber changes in the distal branches of both middle cerebral arteries. Optic neuritis worsens over hours to days, and lasts days to weeks, rather than 30 minutes. Susac syndrome is a microvasculopathy due to endothelial damage, which links encephalopathy, hearing loss, and visual changes. Digital subtraction angiography found generalized small caliber arteries intracranially, but no morphologic changes consistent with a large vessel vasculopathy as would be expected in postpartum angiopathy. To evaluate for Susac syndrome, ophthalmologic and audiologic evaluations were performed. Bedside dilated funduscopic examination revealed bilateral branch retinal artery occlusions with retinal infarcts. Fluorescein angiography found bilateral retinal infarcts, retinal artery branch occlusions, and arteriolar hyperfluorescence, suggesting a retinal vasculopathic process (figure 2). Muscle biopsy and additional serum tests to look for evidence of endothelial damage were obtained. We diagnosed Susac syndrome, or retinocochleocerebral vasculopathy, based on the pathognomonic triad of encephalopathy, branch retinal artery occlusions, and hearing loss. Only after an unrevealing evaluation for stroke did we learn of the visual and hearing loss. Also of note, initial bedside funduscopic examination found 16 e78 Neurology 73 October 13, 2009 sharp disc margins, but missed the retinal infarcts. Once we considered the rare diagnosis of Susac syndrome, ophthalmologic examination confirmed the branch retinal artery occlusions. This case underscores the importance of the history in an encephalopathic patient and the utility of a broad differential diagnosis. Months to years may separate the initial symptom from the development of the others. The characteristic callosal lesions in Susac syndrome are frequently misdiagnosed as demyelinating disease. Branch retinal artery occlusions present as flashes of light, black spots, scintillating scotoma, or occasionally monocular amaurosis fugax. Low frequencies are typically lost first, as the apex of the cochlea, which transduces lower frequencies, is more susceptible to infarction. Two developed symptoms during pregnancy, in 1 symptoms abated with pregnancy, and 3 had recurrent encephalopathy postpartum. Mycophenolate mofetil was added after a week, as she had not significantly improved, and the disease severity warranted additional immunosuppression. On discharge, 3 weeks postpartum, she demonstrated right visual field deficits, brisk reflexes, and clonus at both ankles, right more than left. Seven months postpartum, she continues to take mycophenolate mofetil, and is slowly tapering prednisone. She still complains of short-term memory problems, right eye visual problems, and poor hearing in her left ear. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Two weeks later, he experienced a severe headache of sudden onset without associated nausea, vomiting, or focal neurologic symptoms. This lasted for a few hours, abating after several doses of ibuprofen and acetaminophen. He continued to drive normally, but had a befuddled facial expression and did not respond to questions from his wife. He also developed recurrent, sudden, severe headaches that occurred several times per day. These episodes occurred more frequently when lying in bed than when he was standing or sitting, and were associated with nausea. He was admitted to another hospital for evaluation of these symptoms and transferred to our facility after a 1-hour spell of "unresponsiveness," which resolved spontaneously, while there. His wife described him as "vacant" and "not as active and happy-go-lucky" as usual. He developed a slowly progressive, mild dysarthria; difficulty walking due to frequent "buckling" of the right knee; and numbness in the right medial forearm and little finger. He also described difficulty in using his hands to perform tasks such as putting toothpaste on a toothbrush, which he described as being like "putting two magnets together. In addition to the childhood seizures, his past medical history was notable for a fungal infection of the lung in 1997 for which he had been admitted to an intensive care unit. The details of this illness were not known beyond the fact that he was treated for several months with an antibiotic. What features of the history are most useful in narrowing the differential diagnosis In this case, the history has two main components: spells of altered consciousness and episodes of severe headache. The spells of altered consciousness are most consistent with complex partial seizures. Migraine is unlikely in light of the sudden onset, postural variations, and associated intermittent confusion. Episodic intracranial hypertension from a mass lesion, hydrocephalus, meningitis, or some combination of these diagnoses is an important consideration given the positional nature of the headaches. Equally crucial to formulating a neurologic differential diagnosis is to begin to localize the disease process within the nervous system from the history. While the long duration of the event and the postictal period suggests a temporal lobe focus, it is impossible to precisely localize the seizure focus in this case solely from the history. The personality change suggests dysfunction of anterior portions of the frontal lobe, caudate nucleus, or the anterior thalamus, while the difficulty with hand coordination suggests a cerebellar or parietal lobe lesion. Numbness in the medial right arm and little finger suggests a lesion of the ulnar nerve or C8 root, while the knee buckling may localize to the femoral nerve, lumbar roots, thoracic spinal cord, or medial left frontal lobe. Without further semiologic characterization, the dysarthria could localize to a number of structures and therefore is of little localizing value. On neurologic examination, he was listless, somewhat inattentive, and seemed unconcerned with his illness. Motor examination revealed a right pronator drift and a low-amplitude, highfrequency action tremor in the arms. Pinprick sensation was reduced on the medial aspect of the right hand, including the little finger. Sensation of light touch and vibration as well as cortical sensory function were normal. This suggests the presence of a mass lesion, disease of the leptomeninges, or both. While other localizations are possible, this combination of findings best localizes simultaneously to the frontal lobe cortex and the meninges. When considered along with the history of weight loss and remote history of a fungal lung infection, likely etiologies include subacutely progressive meningoencephalitides such as those caused by fungi and mycobacteria, autoimmune inflammatory conditions, and neoplastic processes such as lymphoma and metastatic carcinoma. Results of complete blood count, electrolytes, renal function, and coagulation studies were normal. C-reactive protein and erythrocyte sedimentation rate were not elevated and testing for antinuclear and antineutrophil cytoplasmic antibodies as well as rheumatoid factor was negative.
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