Management of Renal Failure and Ascites in Patients with Cirrhosis

Ascites and renal dysfunction in cirrhosis occur when the liver disease is decompensated and signify the presence of advanced liver failure. However, the precipitating causes should be looked for and treated. Although liver transplantation is the treatment of choice in patients with advanced liver failure, mild to moderate ascites can be treated effectively with medical management. Similarly, renal failure in cirrhotics is reversible if the precipitating causes can be treated effectively and by use of combination of vasoconstrictors and albumin. Transjugular intrahepatic portosystemic shunts also offer an effective therapy for refractory ascites and HRS. Such treatments may offer effective bridge to liver transplantation, by improving short and medium term survivals. Here, we shall discuss all the options available for the management of these complications of cirrhosis

Genetic diversity in tomato (Solanum lycopersicum L.) genotypes revealed by simple sequence repeats (SSR) markers

Twenty five tomato (Solanum lycopersicum L.) genotypes were subjected to genetic diversity analysis using twenty SSR markers. Out of 20 markers used, 14 SSRs were polymorphic and a total numbers of 22 SSR alleles were generated by 14 SSR markers, out of which 19 were polymorphic and 3 were monomorphic, with an average of 1.57 alleles per locus. The range of amplified products was 100-400bp approximately. Jaccard’s similarity coefficient varied from 0.65 between germplasm EC519821 and CO-3 to a maximum of 1.0 between genotypes EC519769 and DARL-66, with an average value of 0.83. Cluster analysis based on Jaccard’s similarity coefficient using the unweighted pair-group method with arithmetic mean (UPGMA) revealed 2 distinct clusters, A and B, comprising 1 and 24 genotypes respectively and at 75 and 78 per cent similarity, respectively. The genotypes which showed similar morphological and genetic trends were grouped more or less together in both these cases were a few. Cluster A comprised most diverse germplasm (EC519821)belongs to pimpinellifolium wild species with similarity coefficient 0.65% and differentiated with other cultivated species.Cherry Tomato and Cherry-2 were trends in similar cluster similar with approximately 96% similarity.SSR markers were able in in differentiating the genotypes based on morphologically and genotypically.However, the grouping of 25 genotypes were independently of geographic distribution.The genetic distance information found in this study might be helpful to breeder for planning among these genotypes

An edge-cloud infrastructure for weed detection in precision agriculture

Accurate identification of weeds plays a crucial role in helping farmers achieve efficient agricultural practices. An edge-cloud infrastructure can provide efficient resources for weed detection in resource-constrained rural areas. However, deployed applications in these areas often face challenges such as connectivity failures and network issues that affect their quality of service (QoS). We introduce a signal quality-aware framework for precision agriculture that allocates weed inference tasks to resource nodes based on the current network connectivity and quality. Two Machine Learning (ML) models based on ResNet-50 and MobileNetV2 are trained using the publicly available DeepWeeds image classification dataset. A rule-based approximation algorithm is formulated to execute tasks on resource-constrained computational nodes. We also designed a testbed setup consisting of Raspberry Pi (RPi), personal laptop, cloud server and Parsl environment for evaluating the framework. Reliability of the framework is tested in a controlled setting, under various dynamically injected faults. Experimental results demonstrate that the proposed setup can accurately identify weeds while ensuring high fault tolerance and low completion time, making it a promising solution for weed management in rural agriculture

Performance analysis of Apache openwhisk across the edge-cloud continuum

Serverless computing offers opportunities for auto-scaling, a pay-for-use cost model, quicker deployment and faster updates to support computing services. Apache OpenWhisk is one such open-source, distributed serverless platform that can be used to execute user functions in a stateless manner. We conduct a performance analysis of OpenWhisk on an edge-cloud continuum, using a function chain of video analysis applications. We consider a combination of Raspberry Pi and cloud nodes to deploy OpenWhisk, modifying a number of parameters, such as maximum memory limit and runtime, to investigate application behaviours. The five main factors considered are: cold and warm activation, memory and input size, CPU architecture, runtime packages used, and concurrent invocations. The results have been evaluated using initialization, and execution time, minimum memory requirement, inference time and accuracy

Private Sector and Waste Management in Delhi: A Political Economy Perspective

Due to their size and rapid growth, large cities in developing countries are increasingly challenged by burgeoning waste generation. Waste management, however, has traditionally provided employment opportunities to the many urban poor in the informal sector. These traditional models, working largely in parallel with state?led interventions, are under pressure because they fail to address the waste management crisis. This failure, coupled with the lack of capacities of local governments, has paved the way for formal private sector participation. We examine the case of Delhi where a complex interplay of competing approaches have accompanied efforts of urban local bodies, civil society and the private sector (informal and formal) at finding a sustainable working solution. Our analysis of the complex relationship within the private sector players, and between private and public actors, provides novel insights into potential contribution of public–private partnerships for effective waste management in developing countries

Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss

Difference in clinical profile between juvenile onset and adult-onset systemic lupus erythematosus: a meta-analysis

The aim was to systematically review the studies that compared clinical and serological variation between adult-onset systematic lupus erythematosus (aSLE) andjuvenile-onset systematic lupus erythematosus (jSLE). A comprehensive literature search was done, in various available electronic databases for relevant publication that compared juvenile onset SLE and adult onset SLE. The data of adverse clinical features, serological profile and mortality were extracted. Juvenile onset was defined as 18 years. The methodological quality of study was assessed by Newcastle Ottawa scale (NOS) criteria and R version 3.3.1 was used for analysis and ORs and 95% CIs, were used as statistical parameter. A total of 14,920 patients; (12,230: aSLE, and 2,690: jSLE) were included. Renal involvement especially nephritis was significantly more in j-SLE OR: 2.18, 95% CI: [1.81;2.62]; I2=10.8% whereas musculoskeletal was significant in aSLE O.R: 0.64; C.I: [0.44; 0.93]; I2=83.4%. Seizure and malar rash were significantly higher in J-SLE OR:1.69, CI: [1.31; 2.18]; I2=31.1%,1.43; C.I [1.04; 1.97]; I2=82%, respectively. Raynaud’s phenomenon and pleuritis were significantly higher in adult onset SLE. Anemia and thrombocytopenia were significantly higher in juvenile onset SLE. Anti-ds DNA, anti-histone, and anti-ribosomal-P were more frequent in juvenile-onset SLE while, anti-Ro was more common in adult-onset disease. The cause of mortality was not significantly different in both groups. Renal biopsy of class III and IV combined and class V were significantly more in adult-onset SLE. SLEDAI was higher in j-SLE. Meta-analysis indicated that, regardless of many similar clinical and serological manifestations, there is still some variation between adult-onset SLE and juvenile-onset SLE. Although, SLE disease is continuum from juvenile to adult but disease aggressive in juvenile onset SLE

Breeding tomato (Solanum lycopersicum L.) for resistance to biotic and abiotic stresses

Tomato (Solanum lycopersicum L.) is an important vegetable crop cultivated in the tropical and sub-tropical regions of the world. Low productivity in India is due to occurrence of both biotic and abiotic stresses. Among the biotic stresses, tomato leaf curl disease, bacterial wilt, early blight and Groundnut Bud Necrosis Virus disease have become serious production constraints causing considerable yield loss in the major tomato growing areas of the country. Adoption of multiple disease resistant varieties or F1 hybrids would be the most appropriate way to address these diseases. At ICAR-IIHR, Bengaluru systematic breeding strategies were employed to pyramid genes for resistance to early blight, bacterial wilt and tomato leaf curl diseases and to develop advanced breeding lines& F1 hybrids with triple disease resistance. Stable source of resistance to early blight and bi-partite begomo-virus (Tomato Leaf Curl New Delhi Virus) has been identified in Solanum habrochaites LA-1777. Validation with molecular markers linked to tomato leaf curl virus resistance revealed that LA-1777 carryTy2 and other putative resistant genes. Several high yielding dual purpose hybrids were also developed for fresh market and processing with high level of resistance to multiple diseases. Cherry tomato lines have also been bred for high TSS, total carotenoids, total phenols, flavonoids, vitamin C, acidity and lycopene content. IIHR-249-1, IIHR-2101 (Solanum habrochaites LA-1777), IIHR- 2866 and IIHR-2864 recorded high values for quality parameters like total carotenoids, lycopene, vitamin C, total phenols, flavonoids and TSS. Drought tolerant root stock has been developed by an interspecific cross between S. habrochaites LA-1777 and S. lycopersicum (15 SB SB). Resistant sources have also been identified against Tuta absoluta, a serious insect pest reported from major tomato growing areas in the country in recent time. High temperature tolerant breeding lines are in pipe line

Assessing the level of healthcare information technology adoption in the United States: a snapshot

BACKGROUND: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. METHODS: We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. RESULTS: Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. CONCLUSION: Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss