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The CA provided some valuable insights into how to improve the financial services of FFIs to the population by adapting the existing services. The results of this research show that the VBP particularly can improve its credit services by offering individual loans, as this kind of lending scheme was strongly preferred by the sample population. This approach would also reduce the administration time of the credit procedure, i.e. TCs.115 It could also go hand in hand with the increasing introduction of physical collateral instead of group liability, as farmers showed that they are able and willing to use their land use certificates Red Books ; as collateral. However, without an effective land market for trading Red Books, it will probably be risky for the credit institutes to rely more on land use certificates as collateral. Nevertheless, VBP and VBARD together already have enormous outreach. At this stage, implementing a consolidation policy and establishing financially sustainable structures would deserve priority over boosting credit outreach further by implementing new structures. An important element for inducing innovation in the microfinance industry is to nurture conditions for greater competition between different suppliers. As long as no effective competition exists in the rural financial market in Northern Vietnam, there is little incentive for the institutes to improve their products. The only competition exists between the VBP and the VBARD. This research has shown that poor households are able and willing to save. Over 80% of the households demand a formal savings scheme. The supply of savings services offers firstly the possibility to create financially sustainable structures within the existing institutes, and secondly to boost the outreach of the formal financial sector. When offering savings services to the rural population, especially to the poor, close physical proximity to customers is seen as a key factor. This proximity could be achieved by creating decentralized profit centers. Credit officers would collect and pay out savings as well as performing all credit activities. Thus, the deposit collection could be done within the village. The local savings collection by the credit officer would also influence very positively the credit business. The credit officer has access to a much broader range of information to. Small ventricular septal defect arterial O2 saturation 90%, hemoglobin 123 g L ; . PPH was a diagnosis of exclusion and required the demonstrated absence of a variety of cardiopulmonary and systemic diseases, as previously described.4 None of the patients had familial PAH. Patients had a right heart catheterization and a 6-minute walk at baseline and after 3 months of treatment. Two 6-minute walks were performed before entering the study to avoid confounding training effects. The 6-minute walks were performed randomly during working hours, but the catheterizations always were performed early in the morning, before the morning dose of sildenafil. Patients 3, 4, and 5 had cardiac MRI at baseline and after 3 months of treatment. Patients 1 and 2 could not be studied because of claustrophobia and a pacemaker, respectively. MRI studies were performed on a 1.5 T Siemens Sonata unit using a body phase-array coil. The right ventricle was imaged using 8- to 9-mm contiguous, single-slice, breath-hold cine, true-FISP sequences in the short-axis plane.

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There is no accepted normal range for cortisol concentrations in the preterm infant. Clinically well preterm infants may have quite low cortisol concentrations without evidence of harm.36 However, lower cortisol concentrations and or decreased response to adrenal stimulation have been documented in sicker infants, in those receiving vasopressor support or mechanical ventilation, and in those developing BPD or dying.69, 12, 13 These lower values are contrary to the expectation that the seriously ill should have higher cortisol concentrations than well individuals and may be similar to the relative adrenal insufficiency documented in other critically ill patients, which manifests as cardiovascular instability and increased mortality.13 The decreased mortality rate in hydrocortisone-treated infants born after chorioamnionitis may be analogous to the decreased mortality reported in adults with septic shock and adrenal insufficiency treated with hydrocortisone.4 Hydrocortisone-treated infants in this study also showed higher blood pressure without an increase in hypertension. We found that infants developing BPD had decreased cortisol response to ACTH stimulation after the treatment period, which is consistent with several previous studies showing decreased basal and or stimulated cortisol values early in life in such infants6, 12, 14, 20, and with the hypothesis that decreased adrenal function promotes the development of BPD in intubated extremely low birth weight infants. In 1 previous study, Ng et al38 reported that although lower cortisol values in the first week of life correlated with a longer duration of oxygen therapy, by the second week the reverse was true: higher cortisol values correlated with longer duration of oxygen therapy, perhaps indicating a stress response to continuing illness. The infants in our study were smaller and sicker, and all were intubated at study entry. These more immature infants might be at risk for a longer period of developmental adrenal immaturity. In our study, we also included the presence or absence of histologic chorioamnionitis in the analyses. Because chorioamnionitis increases both inflammation and cortisol concentrations in the fetus and newborn, 15, 18, 20, not including this factor in the analysis may mask differences between groups. Hydrocortisone treatment resulted in serum concentrations similar to values previously documented in other patient populations under stress.14 However, a few infants had substantially elevated cortisol concentrations, and those who experienced spontaneous gastrointestinal perforation had significantly higher values than those who did not, both before and during therapy, suggesting that cortisol concentrations should be monitored in infants being treated with hydrocortisone. Patient enrollment in this study was stopped because of a significant increase in apparently spontaneous perforation of the gastrointestinal tract in hydrocortisone-treated infants. Differentiating this entity from NEC can be difficult; however, there was no difference in NEC-associated perforation between groups. Spontaneous gastrointestinal perforation occurred less often in this placebo group 2% ; than has and ifex.

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