Pediatric carcinoma of rectum - Varanasi experience

Background : Primary gastrointestinal system malignancies constitute approximately 2% of pediatric neoplasm and of these; colorectal carcinoma is the second most common malignancy. This is one of the rarer diseases in children. Aim : We reviewed our records to study the clinical features, outcome and the follow-up of this condition with evaluation of the prognostic factors. Settings and Design: Tertiary care Pediatric Surgery centre. Retrospective study. Materials and Methods : The data of all patients with diagnosis of colorectal carcinoma from January 1986 to January 2006 were reviewed. The confirmation of the diagnosis was by biopsy from the lesion. The age, sex, family history, clinical features, response to the treatment and follow-up were studied. Results : There were four male patients. All had bleeding per rectum as the presenting complaint. Three patients had advanced disease at presentation. All the patients had signet cell adenocarcinoma. The two patients expired and one was lost to follow-up. One patient is alive after one year of follow up and is receiving treatment. Conclusion : Colorectal cancer in children though rare can be a reality, hence any children presenting with pain in abdomen along with doubtful history of constipation and rectal bleeding should be examined carefully with special emphasis on digital rectal examination

The use of segmented regression in analysing interrupted time series studies : an example in pre-hospital ambulance care

Peer reviewedPublisher PD

Decadal variations in NDVI and food production in India

In this study we use long-term satellite, climate, and crop observations to document the spatial distribution of the recent stagnation in food grain production affecting the water-limited tropics (WLT), a region where 1.5 billion people live and depend on local agriculture that is constrained by chronic water shortages. Overall, our analysis shows that the recent stagnation in food production is corroborated by satellite data. The growth rate in annually integrated vegetation greenness, a measure of crop growth, has declined significantly (p < 0.10) in 23 of the WLT cropland area during the last decade, while statistically significant increases in the growth rates account for less than 2. Inmost countries, the decade-long declines appear to be primarily due to unsustainable crop management practices rather than climate alone. One quarter of the statistically significant declines are observed in India, which with the world's largest population of food-insecure people and largest WLT croplands, is a leading example of the observed declines. Here we show geographically matching patterns of enhanced crop production and irrigation expansion with groundwater that have leveled off in the past decade. We estimate that, in the absence of irrigation, the enhancement in dry-season food grain production in India, during 1982-2002, would have required an increase in annual rainfall of at least 30 over almost half of the cropland area. This suggests that the past expansion of use of irrigation has not been sustainable. We expect that improved surface and groundwater management practices will be required to reverse the recent food grain production declines. © 2010 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland

Confronting Standard Models of Proto–Planetary Disks With New Mid–Infrared Sizes from the Keck Interferometer

This is the final version of the article. Available from American Astronomical Society via the DOI in this record.The accepted author manuscript is in ORE at http://hdl.handle.net/10871/21611We present near- and mid-infrared (MIR) interferometric observations made with the Keck Interferometer Nuller and near-contemporaneous spectro-photometry from the infrared telescope facilities (IRTFs) of 11 well-known young stellar objects, several of which were observed for the first time in these spectral and spatial resolution regimes. With au-level spatial resolution, we first establish characteristic sizes of the infrared emission using a simple geometrical model consisting of a hot inner rim and MIR disk emission. We find a high degree of correlation between the stellar luminosity and the MIR disk sizes after using near-infrared data to remove the contribution from the inner rim. We then use a semi-analytical physical model to also find that the very widely used "star + inner dust rim + flared disk" class of models strongly fails to reproduce the spectral energy distribution (SED) and spatially resolved MIR data simultaneously; specifically a more compact source of MIR emission is required than results from the standard flared disk model. We explore the viability of a modification to the model whereby a second dust rim containing smaller dust grains is added, and find that the 2-rim model leads to significantly improved fits in most cases. This complexity is largely missed when carrying out SED modeling alone, although detailed silicate feature fitting by McClure et al. recently came to a similar conclusion. As has been suggested recently by Menu et al., the difficulty in predicting MIR sizes from the SED alone might hint at "transition disk"-like gaps in the inner au; however, the relatively high correlation found in our MIR disk size versus stellar luminosity relation favors layered disk morphologies and points to missing disk model ingredients instead.M.S. was supported by NASA ADAP grant NNX09AC73G. R.W.R. was supported by the IR&D program of The Aerospace Corporation

Comparison of the CDC Backpack aspirator and the Prokopack aspirator for sampling indoor- and outdoor-resting mosquitoes in southern Tanzania.

BACKGROUND\ud \ud Resting mosquitoes can easily be collected using an aspirating device. The most commonly used mechanical aspirator is the CDC Backpack aspirator. Recently, a simple, and low-cost aspirator called the Prokopack has been devised and proved to have comparable performance. The following study evaluates the Prokopack aspirator compared to the CDC backpack aspirator when sampling resting mosquitoes in rural Tanzania.\ud \ud METHODS\ud \ud Mosquitoes were sampled in- and outdoors of 48 typical rural African households using both aspirators. The aspirators were rotated between collectors and households in a randomized, Latin Square design. Outdoor collections were performed using artificial resting places (large barrel and car tyre), underneath the outdoor kitchen (kibanda) roof and from a drop-net. Data were analysed with generalized linear models.\ud \ud RESULTS\ud \ud The number of mosquitoes collected using the CDC Backpack and the Prokopack aspirator were not significantly different both in- and outdoors (indoors p = 0.735; large barrel p = 0.867; car tyre p = 0.418; kibanda p = 0.519). The Prokopack was superior for sampling of drop-nets due to its smaller size. The number mosquitoes collected per technician was more consistent when using the Prokopack aspirator. The Prokopack was more user-friendly: technicians preferred using the it over the CDC backpack aspirator as it weighs considerably less, retains its charge for longer and is easier to manoeuvre.\ud \ud CONCLUSIONS\ud \ud The Prokopack proved in the field to be more advantageous than the CDC Backpack aspirator. It can be self assembled using simple, low-cost and easily attainable materials. This device is a useful tool for researchers or vector-control surveillance programs operating in rural Africa, as it is far simpler and quicker than traditional means of sampling resting mosquitoes. Further longitudinal evaluations of the Prokopack aspirator versus the gold standard pyrethrum spray catch for indoor resting catches are recommended

Making use of fuzzy cognitive maps in agent-based modeling

One of the main challenges in Agent-Based Modeling (ABM) is to model agents’ preferences and behavioral rules such that the knowledge and decision-making processes of real-life stakeholders will be reflected. To tackle this challenge, we demonstrate the potential use of a participatory method, Fuzzy Cognitive Mapping (FCM), that aggregates agents’ qualitative knowledge (i.e., knowledge co-production). In our proposed approach, the outcome of FCM would be a basis for designing agents’ preferences and behavioral rules in ABM. We apply this method to a social-ecological system of a farming community facing water scarcity

Summary review and synthesis: Effects on habitats and wildlife of the release and management of pheasants and red-legged partridges on UK lowland shoots

This is the final version. Available on open access from the Nordic Council for Wildlife Research via the DOI in this recordThis review examines 128 items of primary and other literature to provide an insight into current knowledge of the effects of pheasant and red-legged partridge releasing and associated management for shooting on habitats and wildlife in the UK. It summarizes key findings and uses them to define sub-topic sections for which the effects are classified as positive, neutral or negative. This forms the basis of a numerical synthesis of effects and some overall conclusions. Fifty-four directly related studies were identified, which defined 25 sub-topics or effects. A mix of positive, neutral and negative ecological consequences of releasing are described, for which the corresponding number of sub-topics approximately balance each other. Positive effects are usually a consequence of gamebird management activities, most negative effects are caused by the released birds themselves. The different spatial scales at which effects are likely to operate are identified, for example effects on generalist predators or of gamecrops occur at the landscape scale, while many habitat effects have a local impact. Some local negative effects have relatively straightforward management solutions for example, by identifying and avoiding especially sensitive sites when locating release pens. The synthesis identifies seven negative effects associated with the increasing scale of releasing. Several positive effects are linked to economic considerations and are more likely to have greater impact at larger shoots. Pheasants released into woodland have more direct local effects than partridge releases on farmland. The framework of sub-sections could be used as the basis for a more complex synthesis or weighted analysis for a particular set of ecological priorities. The review findings should be interpreted as representing a median type of shoot in terms of size and adherence to good practice over recent decades. They increase the awareness of potential conflicts, highlighting the need for best practice and what factors to consider for mitigation

Antimigraine medication use and associated health care costs in employed patients

Migraine is under diagnosed and suboptimally treated in the majority of patients, and also associated with decreased productivity in employees. The objective of this retrospective study is to assess the antimigraine medication use and associated resource utilization in employed patients. Patients with primary diagnosis of migraine or receiving antimigraine prescription drugs were identified from an employer-sponsored health insurance plan in 2010. Medical utilization and health care costs were determined for the year of 2010. Generalized linear regression was applied to evaluate the association between health care costs and the use of antimigraine medications by controlling covariates. Of 465 patients meeting the study criteria, nearly 30% that had migraine diagnosis were prescribed antimigraine medications, and 20% that had migraine diagnosis were not prescribed antimigraine medications. The remaining 50% were prescribed antimigraine medications but did not have migraine diagnosis. Patients with antimigraine medication prescriptions showed lower frequency of emergency department visits than those without antimigraine medication prescriptions. Regression models indicated an increase in migraine-related health care costs by 86% but decreases in all-cause medical costs and total health care costs by 42 and 26%, respectively, in the antimigraine medication use group after adjusting for covariates. Employed patients experienced inadequate pharmacotherapy for migraine treatment. After controlling for covariates, antimigraine prescription drug use was associated with lower total medical utilization and health care costs. Further studies should investigate patient self-reported care and needs to manage headache and develop effective intervention to improve patient quality of life and productivity