Agriculture is crucial for the Democratic People's Republic of Korea (DPRK), involving approximately 50% of the economically active population and contributing an estimated 25% to the gross national product. However, agricultural production has remained low due to soil degradation and pest damage in cabbage and maize (particularly due to lepidopteron pests), amongst other reasons. To help improve productivity and address food security issues, CABI has been working in DPRK since 2002 to introduce integrated pest management (IPM). This is a sustainable approach combining cultural, biological and chemical control methods to provide stable yields and long-term reduction in pesticide use. By integrating IPM into agricultural production, as well as into extension and education in DPRK, higher yields for staple crops, such as maize and cabbage, have been achieved and communities protected from the short-and long-term effects of harmful chemical pesticides. Sustained support and facilitation from CABI to national research institutions has also helped to strengthen capacity, so that further IPM can be developed across the country. Whilst the initiative initially focused on technical interventions, including the introduction of biocontrol-using Bacillus thuringiensis (Bt) biopesticides and Trichogramma wasps-CABI's approach changed over time. In order to scale up successful interventions in the field, CABI recognised that it needed to develop a broader approach. This involved training with: • technicians-to produce the biocontrol agent; • extension workers-to introduce participatory approaches for the training of farmers in IPM practices; • farmers-to apply the biocontrol method and other IPM tools.

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of the Journal. The article was difficult to follow and confusing to me in the documentation of gastroesophageal reflux disease (GERD) and in the selection and follow-up of patients. The article begs the question of whether the patients were studied consecutively and whether there were any patients with preoperative esophageal pH studies who died before their follow-up esophageal pH study could be performed after percutaneous endoscopic gastrostomy (PEG). The reader also needs to know how many of the authors' patients studied died in the first year after PEG.The study performed has serious problems in terms of methodology and use of esophageal pH monitoring. The placement of the esophageal pH probe 5 cm proximal to the lower esophageal sphincter (LES) and also being at the T7 to T8 level is impossible, unless all of their patients were of the same size and were the size of normal adults If the pH probe was truly positioned 5 cm proximal to the LES, then the probe was in different segments of the esophagus for small and large children. The reflux index and the DeMeester score for analyzing the esophageal pH recording are inaccurate in children for evaluating the presence of GERD because they both have a high false-negative rate (40% to 50%). 2 This means that the authors missed one half of the patients with actual GERD pre-and post-PEG. Furthermore, I have never seen, in my 25 years of doing esophageal pH monitoring, a patient whose GERD improved after PEG or Stamm gastrostomy, unless a lesser-curve gastrostomy was performed to simulate the effect of a Boerema gastropexy.The authors use the upper limit of normal of 5% for the reflux index. This upper limit of normal for the reflux index is for the entire 24-hour esophageal pH study. However, the authors seem to apply inappropriately this upper limit of normal of 5% to individual segments of the esophageal pH recording (ie, postprandial, daytime, nighttime). The authors should state the published studies that establish the normal range in children for the other parameters used to define GERD, such as "(1) greater than 50 episodes in which the pH is less than 4.0, (2) greater than 3 episodes in which pH was less than 4.0 for greater than 5 minutes during the 24 hour study, and (3) symptom index of 50% or more." I feel that this article's conclusions are misleading in the setting of an unclear definition and documentation of GERD provided by the authors. The study by Grunow et al 3 is a more reliable study of the risk for developing GERD in children post-PEG. The method of esophageal pH monitoring and analysis used by Grunow et al does not have the pitfalls associated with the analysis of GERD used by Samuel and Holmes.