Peering into the Cuba phytosanitary black box: An institutional and policy analysis.

To mitigate the movement of non-native organisms with trade, phytosanitary systems have been implemented within and between countries. In some countries such as Cuba, little is known about the within-state plant health system. To facilitate the development of future trade partnership between Cuba and the United States, agencies need to understand the organizational structure and diagnostic capacity of the Cuban Plant Protection System, identify potential synergies between the United States and Cuban systems, and identify steps towards cooperation. This paper fills this critical void by presenting a descriptive analysis of the plant health system in Cuba. Information was integrated from available literature, informal interviews with Cuban experts, and workshops focused on Cuban policies, risk, and potential collaboration attended by Cuban and American experts. We identify the next practical steps in improving cooperation, including building trust and capacity. Mutual understanding of phytosanitary systems will be crucial for the regional economic and environmental stability of a post-embargo United States-Cuban relationship.

Health-related quality of life in cystic fibrosis.

PURPOSE OF REVIEW: To review the contribution of various therapeutic interventions on both longevity and quality of life in cystic fibrosis patients. RECENT FINDINGS: Long-term survival in cystic fibrosis has increased markedly in the past 25 years, largely due to a robust clinical trials program carried out at Cystic Fibrosis Foundation accredited clinical centers in the United States and similar organizations worldwide. Cystic fibrosis patients are recommended complex, time-intensive daily therapies that are often difficult for families and patients to sustain long-term. Recently, attention to the perceived value of a particular therapy on a patient's well being is recognized as important for individualizing therapeutic regimens that provide maximal clinical benefit and are more likely to be adhered to long-term by the patient. Cystic fibrosis care is in a new era in which patient-related outcomes (PROs) for the assessment of health-related quality of life (HRQOL) are regarded with equal importance to medically beneficial therapies. SUMMARY: Numerous advances in the clinical care of cystic fibrosis have led to improved survival, although definitive correction of the abnormal cystic fibrosis transmembrane regulator protein function remains elusive. Patients struggle to maintain rigorous, time-intensive therapeutic regimens, whereas clinicians strive to identify which interventions preserve quality of life. Cystic fibrosis patients depend on their caregiver's ability to assess both the medical benefit and the contribution to quality of life that therapeutic regimes bring to their disease. Caregivers, in turn, need measures of HRQOL in order to prioritize the various therapeutic interventions that are at their disposal in order to provide not just longevity, but meaningful quality of life.

Growth hormone treatment improves growth and clinical status in prepubertal children with cystic fibrosis: results of a multicenter randomized controlled trial.

CONTEXT: This multicenter, randomized, controlled, crossover trial of prepubertal children with cystic fibrosis (CF) tests the hypotheses that recombinant human GH (rhGH) treatment 1) improves height, weight, lean mass, and bone content irrespective of baseline measures; 2) improves clinical status and quality of life; and 3) has continued effect after cessation after 1 yr of treatment. METHODS: Sixty-one prepubertal subjects (