Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Periodontal and dental health and oral self-care among adults with diabetes mellitus.

ABSTRACT Bakhshandeh, Soheila. Periodontal and dental health and oral self-care among adults with diabetes mellitus. Department of Oral Public Health, Institute of Dentistry, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 2011. 49 pp. ISBN 978-952-10-7193-5(paperback). The aim of the present study was to assess oral health and treatment needs among Iranian adults with diabetes according to socio-demographic status, oral hygiene, diabetes related factors, and to investigate the relation between these determinants and oral health. Moreover, the effect of an educational oral health promotion intervention on their oral health and periodontal treatment needs was studied. The target population comprised adults with diabetes in Tehran, Iran. 299 dentate patients with diabetes, who were regular attendants to a diabetic clinic, were selected as the study subjects. Data collection was performed through a clinical dental examination and self-administered structured questionnaire. The questionnaire covered information of the subject s social background, medical history, oral health behaviour and smoking. The clinical dental examinations covered the registration of caries experience (DMFT), community periodontal index (CPI) and plaque index (PI). The intervention provided the adults with diabetes dental health education through a booklet. Reduction in periodontal treatment needs one year after the baseline examination was used as the main outcome. A high prevalence of periodontal pockets among the study population was found; 52% of the participants had periodontal pockets with a pocket depth of 4 to 5 mm and 35% had periodontal pockets with pocket depth of 6 mm or more. The mean of the DMFT index was 12.9 (SD=6.1), being dominated by filled teeth (mean 6.5) and missing teeth (mean 5.0). Oral self-care among adults with diabetes was inadequate and poor oral hygiene was observed in more than 80% of the subjects. The educational oral health promotion decreased periodontal treatment needs more in the study groups than in the control group. The poor periodontal health, poor oral hygiene and insufficient oral self-care observed in this study call for oral health promotion among adult with diabetes. An educational intervention showed that it is possible to promote oral health behaviour and to reduce periodontal treatment needs among adults with diabetes. The simplicity of the model used in this study allows it to be integrated to diabetes programmes in particular in countries with a developing health care system.

Dental identification and aspects of medico-legal investigations of the Finnish victims of the Sumatra-Andaman earthquake on 26 December 2004

Tsunami waves of the Sumatra-Andaman earthquake on 26 December 2004 claimed approximately 230 000 lives and started the biggest identification operation in Interpol's history. The aim of this study was to resolve methods of the identification and results received. The viewpoint is mainly that of forensic odontology, but also includes other means of identification and results of the medico-legal examination performed in Finland. Of the 5395 victims in Thailand, approximately 2 400 were foreigners from 36 nations including 177 Finnish nationals. Additionally, a Finnish woman perished in Sri Lanka and a severely injured man after the evacuation in a hospital. The final numbers of missing persons and dead bodies registered in the Information Management Centre in Phuket,Thailand, were 3 574 ante-mortem (AM) and 3 681 post-mortem (PM) files. The number of identifications by December 2006 was 3 271 or 89% of the victims registered. Of Finnish victims, 172 have been identified in Thailand and 163 repatriated to Finland. One adult and four children are still missing. For AM data, a list of Finnish missing persons including 178 names was published on 30 December 2004. By February 2005 all useful dental AM data were available. Five persons on the list living in Finland lacked records. Based on the AM database, for the children under age 18 years (n=60) dental identification could be established for 12 (20%). The estimated number for adults (n=112) was 96 (86%). The final identification rate, based on PM examinations in Finland, was 14 (25%) for children (n= 56) and 98 (90%) for adults (n= 109). The number of Finnish victims identified by dental methods, 112 (68%), was high compared to all examined in Thailand (43%). DNA was applied for 26 Finnish children and for 6 adults, fingerprints for 24 and 7, respectively. In 12 cases two methods were applied. Every victim (n=165) underwent in Finland a medico-legal investigation including an autopsy with sampling specimens for DNA, the toxicological and histological investigation. Digital radiographs and computed tomography were taken of the whole body to verify autopsy findings and bring out changes caused by trauma, autolysis, and sampling for DNA in Thailand. Data for identification purposes were also noted. Submersion was the cause of death for 101 of 109 adults (92.7%), and trauma for 8 (7.3%). Injuries were 33 times contributing factors for submersion and 3 times for trauma-based death. Submersion was the cause of death for 51 (92.7%) children and trauma for 4 (7.3%). Injuries were in 3 cases contributing factors in submersion and once in trauma-based death. The success of the dental identification of Finnish victims is mainly based on careful registration of dental records, and on an education program from 1999 in forensic odontology.

An Effective Seamless Connectivity Scheme for Ubiquitous Applications

The idea of ubiquity and seamless connectivity in networks is gaining more importance in recent times because of the emergence of mobile devices with added capabilities like multiple interfaces and more processing abilities. The success of ubiquitous applications depends on how effectively the user is provided with seamless connectivity. In a ubiquitous application, seamless connectivity encompasses the smooth migration of a user between networks and providing him/her with context based information automatically at all times. In this work, we propose a seamless connectivity scheme in the true sense of ubiquitous networks by providing smooth migration to a user along with providing information based on his/her contexts automatically without re-registration with the foreign network. The scheme uses Ubi-SubSystems(USS) and Soft-Switches(SS) for maintaining the ubiquitous application resources and the users. The scheme has been tested by considering the ubiquitous touring system with several sets of tourist spots and users.

Strain field measurement using digital image correlation

Digital Image Correlation and Tracking (DIC/DDIT) is an optical method that employs tracking & image registration techniques for accurate 2D and 3D measurements of changes in images. This is often used to measure deformation (engineering), displacement, and strain, but it is widely applied in many areas of science and engineering. One very common application is for measuring the motion of an optical mouse.

AIWIN - A fast and jigless inspection technique for machined parts

Precision inspection of manufactured components having multiple complex surfaces and variable tolerance definition is an involved, complex and time-consuming function. In routine practice, a jig is used to present the part in a known reference frame to carry out the inspection process. Jigs involve both time and cost in their development, manufacture and use. This paper describes 'as is where is inspection' (AIWIN), a new automated inspection technique that accelerates the inspection process by carrying out a fast registration procedure and establishing a quick correspondence between the part to inspect and its CAD geometry. The main challenge in doing away with a jig is that the inspection reference frame could be far removed from the CAD frame. Traditional techniques based on iterative closest point (ICP) or Newton methods require either a large number of iterations for convergence or fail in such a situation. A two-step coarse registration process is proposed to provide a good initial guess for a modified ICP algorithm developed earlier (Ravishankar et al., Int J Adv Manuf Technol 46(1-4):227-236, 2010). The first step uses a calibrated sphere for local hard registration and fixing the translation error. This transformation locates the centre for the sphere in the CAD frame. In the second step, the inverse transformation (involving pure rotation about multiple axes) required to align the inspection points measured on the manufactured part with the CAD point dataset of the model is determined and enforced. This completes the coarse registration enabling fast convergence of the modified ICP algorithm. The new technique has been implemented on complex freeform machined components and the inspection results clearly show that the process is precise and reliable with rapid convergence. © 2011 Springer-Verlag London Limited.

MULTI-OBJECTIVE GENETIC ALGORITHM FOR EFFICIENT POINT MATCHING IN MULTI-SENSOR SATELLITE IMAGE

This paper investigates a new approach for point matching in multi-sensor satellite images. The feature points are matched using multi-objective optimization (angle criterion and distance condition) based on Genetic Algorithm (GA). This optimization process is more efficient as it considers both the angle criterion and distance condition to incorporate multi-objective switching in the fitness function. This optimization process helps in matching three corresponding corner points detected in the reference and sensed image and thereby using the affine transformation, the sensed image is aligned with the reference image. From the results obtained, the performance of the image registration is evaluated and it is concluded that the proposed approach is efficient.

Multiobjective discrete particle swarm optimization for multisensor image alignment

A new technique is proposed for multisensor image registration by matching the features using discrete particle swarm optimization (DPSO). The feature points are first extracted from the reference and sensed image using improved Harris corner detector available in the literature. From the extracted corner points, DPSO finds the three corresponding points in the sensed and reference images using multiobjective optimization of distance and angle conditions through objective switching technique. By this, the global best matched points are obtained which are used to evaluate the affine transformation for the sensed image. The performance of the image registration is evaluated and concluded that the proposed approach is efficient.

Accurate point matching based on multi-objective Genetic Algorithm for multi-sensor satellite imagery

This paper investigates a novel approach for point matching of multi-sensor satellite imagery. The feature (corner) points extracted using an improved version of the Harris Corner Detector (HCD) is matched using multi-objective optimization based on a Genetic Algorithm (GA). An objective switching approach to optimization that incorporates an angle criterion, distance condition and point matching condition in the multi-objective fitness function is applied to match corresponding corner-points between the reference image and the sensed image. The matched points obtained in this way are used to align the sensed image with a reference image by applying an affine transformation. From the results obtained, the performance of the image registration is evaluated and compared with existing methods, namely Nearest Neighbor-Random SAmple Consensus (NN-Ran-SAC) and multi-objective Discrete Particle Swarm Optimization (DPSO). From the performed experiments it can be concluded that the proposed approach is an accurate method for registration of multi-sensor satellite imagery. (C) 2014 Elsevier Inc. All rights reserved.

A mean-reverting stochastic model for the political business cycle

In this article, we look at the political business cycle problem through the lens of uncertainty. The feedback control used by us is the famous NKPC with stochasticity and wage rigidities. We extend the New Keynesian Phillips Curve model to the continuous time stochastic set up with an Ornstein-Uhlenbeck process. We minimize relevant expected quadratic cost by solving the corresponding Hamilton-Jacobi-Bellman equation. The basic intuition of the classical model is qualitatively carried forward in our set up but uncertainty also plays an important role in determining the optimal trajectory of the voter support function. The internal variability of the system acts as a base shifter for the support function in the risk neutral case. The role of uncertainty is even more prominent in the risk averse case where all the shape parameters are directly dependent on variability. Thus, in this case variability controls both the rates of change as well as the base shift parameters. To gain more insight we have also studied the model when the coefficients are time invariant and studied numerical solutions. The close relationship between the unemployment rate and the support function for the incumbent party is highlighted. The role of uncertainty in creating sampling fluctuation in this set up, possibly towards apparently anomalous results, is also explored.

Randomized, double-blind, placebo-controled clinical trial of sublingual immunotherapy in natural rubber latex allergic patients

Trial registration number: CTRN12611000543987

Sistema seguro de votação eletrônica multi-células

Em uso desde a Grécia antiga e atualmente massificado na maioria dos países do mundo, o sistema de votação tradicional baseado em cédulas de papel possui diversos problemas associados à segurança, tais como dificuldades para evitar coerção do eleitor, venda do voto e substituição fraudulenta do eleitor. Além de problemas de usabilidade que acarretam erros de preenchimento da cédula e um processo de apuração lento, que pode durar dias. Ao lado disso, o sistema tradicional não fornece a contraprova do voto, que permite ao eleitor conferir se o seu voto foi corretamente contabilizado na apuração. Inicialmente acreditou-se que a informatização do sistema de votação resolveria todos os problemas do sistema tradicional. Porém, com a sua implantação em alguns países o sistema de votação eletrônica não mostrou-se capaz de fornecer garantias irrefutáveis que não tivesse sido alvo de alterações fraudulentas durante o seu desenvolvimento ou operação. A má reputação do sistema eletrônico está principalmente associada à falta de transparência dos processos que, em sua maioria, não proporcionam a materialização do voto, conferido pelo eleitor para fins de contagem manual, e nem geram evidências (contraprova) da correta contabilização do voto do eleitor. O objetivo deste trabalho é propor uma arquitetura de votação eletrônica que integra, de forma segura, o anonimato e autenticidade do votante, a confidencialidade e integridade do voto/sistema. O sistema aumenta a usabilidade do esquema de votação baseado em "Três Cédulas" de papel, implementando-o computacionalmente. O esquema oferece maior credibilidade ao sistema de votação através da materialização e contraprova do voto, resistência à coerção e ao comércio do voto. Utilizando esquemas de criptografia assimétrica e segurança computacional clássica, associado a um sistema de auditoria eficiente, a proposta garante segurança e transparência nos processos envolvidos. A arquitetura de construção modular distribui a responsabilidade entre suas entidades, agregando-lhe robustez e viabilizando eleições em grande escala. O protótipo do sistema desenvolvido usando serviços web e Election Markup Language mostra a viabilidade da proposta.

Control of Variable Watermilfoil in Bashan Lake, CT with 2,4-D: Monitoring of Lake and Well Water.

Variable watermilfoil (Myriophyllum heterophyllum Michx.) has recently become a problem in Bashan Lake, East Haddam, CT, USA. By 1998, approximately 4 ha of the 110 ha lake was covered with variable watermilfoil. In 1999, the milfoil was spot treated with Aquacide®, an 18% active ingredient of the sodium salt of 2,4-D [(2,4-dichlorophenoxy) acetic acid], applied at a rate of 114 kg/ha. Aquacide® was used because labeling regarding domestic water intakes and irrigation limitations prevented the use of Navigate® or AquaKleen®, a 19% active ingredient of the butoxyethyl ester of 2,4-D. Variable watermilfoil was partially controlled in shallow protected coves but little control occurred in deeper more exposed locations. 2,4-D levels in the treatment sites were lower than desired and offsite dilution was rapid. In 2000, the United States Environmental Protection Agency (USEPA) issued a special local need (SLN) registration to allow the use of Navigate ® or AquaKleen® in lakes with potable and irrigation water intakes. Navigate® was applied at a rate of 227 kg/ha to the same areas as treated in 1999. An additional 2 ha of variable watermilfoil was treated with Navigate® in 2001, and 0.4 ha was treated in mid-September. Dilution of the 2,4-D ester formulation to untreated areas was slower than with the salt formulation. Concentrations of 2,4-D exceeded 1000 μg/ L in several lake water samples in 2000 but not 2001. Nearly all of the treated variable watermilfoil was controlled in both years. The mid-September treatment appeared as effective as the spring and early summer treatments. Testing of homeowner wells in all 3 years found no detectable levels of 2,4-D.(PDF contains 8 pages.)

A Review of the Aquatic Environmental Fate of Triclopyr and its Major Metabolites

The purpose of this paper is to provide an overview of the aquatic environmental fate of triclopyr and its major metabolites, TCP and TMP. This review is primarily based on results of laboratory and field studies conducted by various Federal Agencies and the registrant to support the US aquatic registration for triclopyr TEA.

Proceedings of the Eighteenth International Sea Turtle Symposium, 3-7 March 1998, Mazatlán, Sinaloa, Mexico

For the first time in its history, the International Symposium on Sea Turtle Biology and Conservation migrated to a site outside of the United States. Thus the Eighteenth edition was hosted by the Mazatlán Research Unit of the Instituto de Ciencias del Mar y Limnología of the Mexican National Autonomous University (UNAM) in Mazatlán, Sinaloa (Mexico) where it was held from 3-7, March, 1998. Above all, our symposium is prominent for its dynamism and enthusiasm in bringing together specialists from the world´s sea turtle populations. In an effort to extend this philosophy, and fully aware of how fast the interest in sea turtles has grown, the organizers paid special attention to bring together as many people as possible. With the tremendous efforts of the Travel Committee and coupled with a special interest by the Latin American region´s devotees, we managed to get 653 participants from 43 countries. The number of presentations increased significantly too, reaching a total of 265 papers, ranging from cutting-edge scientific reports based on highly sophisticated methods, to the experiences and successes of community-based and environmental education programs. A priority given by this symposium was the support and encouragement for the construction of "bridges" across cultural and discipline barriers. We found success in achieving a multinational dialogue among interest groups- scientists, resource managers, decision makers, ngo's, private industry. There was a broad representation of the broad interests that stretch across these sectors, yet everyone was able to listen and offer their own best contribution towards the central theme of the Symposium: the conservation of sea turtles and the diversity of marine and coastal environments in which they develop through their complicated and protracted life cycle. Our multidisciplinary approach is highly important at the present, finding ourselves at a cross roads of significant initiatives in the international arena of environmental law, where the conservation of sea turtles has a key role to play. Many, many people worked hard over the previous 12 months, to make the symposium a success. Our sincerest thanks to all of them: Program committee: Laura Sarti (chair), Ana Barragán, Rod Mast, Heather Kalb, Jim Spotilla, Richard Reina, Sheryan Epperly, Anna Bass, Steve Morreale, Milani Chaloupka, Robert Van Dam, Lew Ehrhart, J. Nichols, David Godfrey, Larry Herbst, René Márquez, Jack Musick, Peter Dutton, Patricia Huerta, Arturo Juárez, Debora Garcia, Carlos Suárez, German Ramírez, Raquel Briseño, Alberto Abreu; Registration and Secretary: Jane Provancha (chair), Lupita Polanco; Informatics: Germán Ramírez, Carlos Suárez; Cover art: Blas Nayar; Designs: Germán Ramírez, Raquel Briseño, Alberto Abreu. Auction: Rod Mast; Workshops and special meetings: Selina Heppell; Student prizes: Anders Rhodin; Resolutions committee: Juan Carlos Cantú; Local organizing committee: Raquel Briseño, Jane Abreu; Posters: Daniel Ríos and Jeffrey Semminoff; Travel committee: Karen Eckert (chair), Marydele Donnelly, Brendan Godley, Annette Broderick, Jack Frazier; Student travel: Francisco Silva and J. Nichols; Vendors: Tom McFarland and J. Nichols; Volunteer coordination: Richard Byles; Latin American Reunión: Angeles Cruz Morelos; Nominations committee: Randall Arauz, Colleen Coogan, Laura Sarti, Donna Shaver, Frank Paladino. Once again, Ed Drane worked his usual magic with the Treasury of the Symposium Significant financial contributions were generously provided by government agencies. SEMARNAP (Mexico´s Ministry of Environment, Natural Resources and Fisheries) through its central office, the Mazatlán Regional Fisheries Research Center (CRIP-Mazatlán) and the National Center for Education and Capacity Building for Sustainable Development (CECADESU) contributed to the logistics and covered the costs of auditoria and audiovisual equipment for the Symposium, teachers and their hotels for the Community Development and Environmental Education workshop in the 5th Latin American Sea Turtle Specialists; DIF (Dept of Family Affairs) provided free accomodation and food for the more than 100 participants in the Latin American Reunion. In this Reunion, the British Council-Mexico sponsored the workshop on the Project Cycle. The National Chamber of the Fisheries Industry (CANAINPES) kindly sponsored the Symposium´s coffee breaks. Personnel from the local Navy (Octave Zona Naval) provided invaluable aid in transport and logistics. The Scientific Coordination Office from UNAM (CICUNAM) and the Latin American Biology Network (RELAB) also provided funding. Our most sincere recognition to all of them. In the name of this Symposium´s compilers, I would like to also express our gratitude to Wayne Witzell, Technical Editor for his guidance and insights and to Jack Frazier for his help in translating and correcting the English of contributions from some non-native English speakers. Many thanks to Angel Fiscal and Tere Martin who helped with the typing in the last, last corrections and editions for these Proceedings. To all, from around the world, who generously helped make the 18th Symposium a huge success, shared their experiences and listened to ours, our deepest gratitude! (PDF contains 316 pages)