Analyzing color infrared aerial photographs for the delineation of management units in site-specific agricultural management

Non-Peer ReviewedThis poster addresses the potential of a color infrared aerial photograph to provide spatially distributed information for site specific management. In this process digitized color infrared aerial photographs were used to extract vegetation index information. Crop and soil information were obtained through field sampling. Most important factors for affecting crop productivity were determined using principal component analysis. Point information were interpolated using kriging to create grid surface of the study area. Centroid of each grid cell was used to collect crop and soil information, and vegetation index at a regular interval throughout the study area. Fuzzy k-means with extra-grades algorithms were used to delineate potential within-field management units based on soil and crop information and vegetation index separately. Within-zone grain yield variation were calculated and used to evaluate management zones. The methodology is fast, can be easily automated in commercially available GIS software and has considerable advantages when comparing to other methods for delineating within-field management zones

Study of Serum Lactate Dehydrogenase and Gamma-Glutamyl Transpeptidase in Breast Cancer Patients Receiving Chemotherapy.

Breast cancer (BC) is the most common type of cancer worldwide, being a major cause of morbidity in female. In Nepal it is the second most common type of cancer among females of perimenopausal age group. More than one quarter of the BC diagnosed in young Nepalese female, with familial history of breast cancer, early pregnancy, longer lactation and estrogen exposure and often with tumors showing aggressive biological behaviors. Anthracyclines (Doxorubicin) based treatment regime were reported to cause cardiotoxicity by increasing intramyocardial free radical production, lipid alterations and decreasing antioxidant level. Oxidative stress involving cellular reactive oxygen species (ROS) production is widely accepted mechanism but the molecular basis of chemotherapy induced organ toxicity remains highly controversial. An increased rate of metabolism and oxidative stress results rapid turnover of cancer cells that modulates the enzyme level in blood circulation. Serum LDH and GGT level correlates with tumor burden, metastatic character of BC and intensity of organtoxicity. The aim of our study is to evaluate the serum level of LDH and GGT in BC patients receiving chemotherapy and correlate these enzyme levels with different stages of BC. A total number of 150 subjects were included in the study, comprising 90 histopathologically confirmed 24 to 76 years aged patients of different breast cancer stages, receiving at least 3 cycles of 5-Fluorouracil, Adriamycin and Cyclophosphamide (FAC) chemotherapy. Sixty age- matched healthy women were enrolled as controls. Blood samples from each individual was collected after informed consent and analysed for serum LDH and GGT levels using standard biochemical methods. Data were analyzed using student's paired 't' test, Pearson correlation test and ANOVA. Serum LDH and GGT levels were significantly (p<0.001) increased in BC patients as compared to control group. When all 4 stages of BC were compared to control group, LDH and GGT showed steady and progressive increase in the activities of these enzymes from stage I-IV. The study concludes that serum LDH and GGT may be sensitive, specific and cost effective biomarkers in early diagnosis of breast cancer, assessing cancer prognosis and response to treatment

Strengthening Altitude Knowledge: A Delphi Study to Define Minimum Knowledge of Altitude Illness for Laypersons Traveling to High Altitude.

Berendsen, Remco R., Peter Bärtsch, Buddha Basnyat, Marc Moritz Berger, Peter Hackett, Andrew M. Luks, Jean-Paul Richalet, Ken Zafren, Bengt Kayser, and the STAK Plenary Group. Strengthening altitude knowledge: a Delphi study to define minimum knowledge of altitude illness for laypersons traveling to high altitude. High Alt Med Biol. 00:000-000, 2022. Introduction: A lack of knowledge among laypersons about the hazards of high-altitude exposure contributes to morbidity and mortality from acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) among high-altitude travelers. There are guidelines regarding the recognition, prevention, and treatment of acute-altitude illness for experts, but essential knowledge for laypersons traveling to high altitudes has not been defined. We sought expert consensus on the essential knowledge required for people planning to travel to high altitudes. Methods: The Delphi method was used. The panel consisted of two moderators, a core expert group and a plenary expert group. The moderators made a preliminary list of statements defining the desired minimum knowledge for laypersons traveling to high altitudes, based on the relevant literature. These preliminary statements were then reviewed, supplemented, and modified by a core expert group. A list of 33 statements was then presented to a plenary group of experts in successive rounds. Results: It took three rounds to reach a consensus. Of the 10 core experts invited, 7 completed all the rounds. Of the 76 plenary experts, 41 (54%) participated in Round 1, and of these 41 a total of 32 (78%) experts completed all three rounds. The final list contained 28 statements in 5 categories (altitude physiology, sleeping at altitude, AMS, HACE, and HAPE). This list represents an expert consensus on the desired minimum knowledge for laypersons planning high-altitude travel. Conclusion: Using the Delphi method, the STrengthening Altitude Knowledge initiative yielded a set of 28 statements representing essential learning objectives for laypersons who plan to travel to high altitudes. This list could be used to develop educational interventions

A Case of Preperitoneal Herniation of the Small Bowel Causing Intestinal Obstruction Following a Totally Extra Peritoneal Hernia Repair

Preperitoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. A 57-year-old male underwent a right inguinal hernia totally extra peritoneal repair on 20/10/2021. Initial recovery was uncomplicated but on post operative day 10, he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction with a possible transition point. An internal hernia was suspected and he was offered urgent diagnostic laparoscopy following counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. A small bowel run-through did not reveal any pathological abnormalities. A presumptive diagnosis of a preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful postoperative recovery. An inadvertent breach in the peritoneum during a totally extra peritoneal repair can lead to preperitoneal herniation of the small bowel and intestinal obstruction postoperatively

A Longitudinal Cline Characterizes the Genetic Structure of Human Populations in the Tibetan Plateau

Indigenous populations of the Tibetan plateau have attracted much attention for their good performance at extreme high altitude. Most genetic studies of Tibetan adaptations have used genetic variation data at the genome scale, while genetic inferences about their de- mography and population structure are largely based on uniparental markers. To provide genome-wide information on population structure, we analyzed new and published data of 338 individuals from indigenous populations across the plateau in conjunction with world- wide genetic variation data. We found a clear signal of genetic stratification across the east- west axis within Tibetan samples. Samples from more eastern locations tend to have higher genetic affinity with lowland East Asians, which can be explained by more gene flow from lowland East Asia onto the plateau. Our findings corroborate a previous report of admixture signals in Tibetans, which were based on a subset of the samples analyzed here, but add evidence for isolation by distance in a broader geospatial context

Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins

Background Typhoid and paratyphoid (enteric fever) are febrile bacterial illnesses common in many low‐ and middle‐income countries. The World Health Organization (WHO) currently recommends treatment with azithromycin, ciprofloxacin, or ceftriaxone due to widespread resistance to older, first‐line antimicrobials. Resistance patterns vary in different locations and are changing over time. Fluoroquinolone resistance in South Asia often precludes the use of ciprofloxacin. Extensively drug‐resistant strains of enteric fever have emerged in Pakistan. In some areas of the world, susceptibility to old first‐line antimicrobials, such as chloramphenicol, has re‐appeared. A Cochrane Review of the use of fluoroquinolones and azithromycin in the treatment of enteric fever has previously been undertaken, but the use of cephalosporins has not been systematically investigated and the optimal choice of drug and duration of treatment are uncertain. Objectives To evaluate the effectiveness of cephalosporins for treating enteric fever in children and adults compared to other antimicrobials. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the WHO ICTRP and ClinicalTrials.gov up to 24 November 2021. We also searched reference lists of included trials, contacted researchers working in the field, and contacted relevant organizations. Selection criteria We included randomized controlled trials (RCTs) in adults and children with enteric fever that compared a cephalosporin to another antimicrobial, a different cephalosporin, or a different treatment duration of the intervention cephalosporin. Enteric fever was diagnosed on the basis of blood culture, bone marrow culture, or molecular tests. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were clinical failure, microbiological failure and relapse. Our secondary outcomes were time to defervescence, duration of hospital admission, convalescent faecal carriage, and adverse effects. We used the GRADE approach to assess certainty of evidence for each outcome. Main results We included 27 RCTs with 2231 total participants published between 1986 and 2016 across Africa, Asia, Europe, the Middle East and the Caribbean, with comparisons between cephalosporins and other antimicrobials used for the treatment of enteric fever in children and adults. The main comparisons are between antimicrobials in most common clinical use, namely cephalosporins compared to a fluoroquinolone and cephalosporins compared to azithromycin. Cephalosporin (cefixime) versus fluoroquinolones Clinical failure, microbiological failure and relapse may be increased in patients treated with cefixime compared to fluoroquinolones in three small trials published over 14 years ago: clinical failure (risk ratio (RR) 13.39, 95% confidence interval (CI) 3.24 to 55.39; 2 trials, 240 participants; low‐certainty evidence); microbiological failure (RR 4.07, 95% CI 0.46 to 36.41; 2 trials, 240 participants; low‐certainty evidence); relapse (RR 4.45, 95% CI 1.11 to 17.84; 2 trials, 220 participants; low‐certainty evidence). Time to defervescence in participants treated with cefixime may be longer compared to participants treated with fluoroquinolones (mean difference (MD) 1.74 days, 95% CI 0.50 to 2.98, 3 trials, 425 participants; low‐certainty evidence). Cephalosporin (ceftriaxone) versus azithromycin Ceftriaxone may result in a decrease in clinical failure compared to azithromycin, and it is unclear whether ceftriaxone has an effect on microbiological failure compared to azithromycin in two small trials published over 18 years ago and in one more recent trial, all conducted in participants under 18 years of age: clinical failure (RR 0.42, 95% CI 0.11 to 1.57; 3 trials, 196 participants; low‐certainty evidence); microbiological failure (RR 1.95, 95% CI 0.36 to 10.64, 3 trials, 196 participants; very low‐certainty evidence). It is unclear whether ceftriaxone increases or decreases relapse compared to azithromycin (RR 10.05, 95% CI 1.93 to 52.38; 3 trials, 185 participants; very low‐certainty evidence). Time to defervescence in participants treated with ceftriaxone may be shorter compared to participants treated with azithromycin (mean difference of −0.52 days, 95% CI −0.91 to −0.12; 3 trials, 196 participants; low‐certainty evidence). Cephalosporin (ceftriaxone) versus fluoroquinolones It is unclear whether ceftriaxone has an effect on clinical failure, microbiological failure, relapse, and time to defervescence compared to fluoroquinolones in three trials published over 28 years ago and two more recent trials: clinical failure (RR 3.77, 95% CI 0.72 to 19.81; 4 trials, 359 participants; very low‐certainty evidence); microbiological failure (RR 1.65, 95% CI 0.40 to 6.83; 3 trials, 316 participants; very low‐certainty evidence); relapse (RR 0.95, 95% CI 0.31 to 2.92; 3 trials, 297 participants; very low‐certainty evidence) and time to defervescence (MD 2.73 days, 95% CI −0.37 to 5.84; 3 trials, 285 participants; very low‐certainty evidence). It is unclear whether ceftriaxone decreases convalescent faecal carriage compared to the fluoroquinolone gatifloxacin (RR 0.18, 95% CI 0.01 to 3.72; 1 trial, 73 participants; very low‐certainty evidence) and length of hospital stay may be longer in participants treated with ceftriaxone compared to participants treated with the fluoroquinolone ofloxacin (mean of 12 days (range 7 to 23 days) in the ceftriaxone group compared to a mean of 9 days (range 6 to 13 days) in the ofloxacin group; 1 trial, 47 participants; low‐certainty evidence). Authors' conclusions Based on very low‐ to low‐certainty evidence, ceftriaxone is an effective treatment for adults and children with enteric fever, with few adverse effects. Trials suggest that there may be no difference in the performance of ceftriaxone compared with azithromycin, fluoroquinolones, or chloramphenicol. Cefixime can also be used for treatment of enteric fever but may not perform as well as fluoroquinolones. We are unable to draw firm general conclusions on comparative contemporary effectiveness given that most trials were small and conducted over 20 years previously. Clinicians need to take into account current, local resistance patterns in addition to route of administration when choosing an antimicrobial

Adaptation with the to high altitude in sherpas: Association insertion/deletion polymorphism in the angiotensin-converting enzyme gene

ArticleWILDERNESS & ENVIRONMENTAL MEDICINE. 19(1): 22-29 (2008)journal articl

Medical Workforce Issues in Australia: Tomorrow's Doctors - Too Few, Too Far

The Australian medical workforce, like those of most developed countries, is increasingly feminised and exposed to the global market for doctors. Demand for healthcare services is increasing in the Australian community. Concern in relation to doctor shortages is increasing, particularly in rural areas. There should be greater flexibility for entry of highly-trained overseas doctors. There is an urgent need to increase medical school student intake. Issues of workforce practice, including task substitution, should be explored