Mini gastric bypass with 4k technology as treatment of morbid obesity in patient with ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunt placement is used to treat idiopathic intracranial pressure. Obesity is a risk factor related to shunt migration, dislodgement, and subsequent failure due to increased intraabdominal pressure. Minigastric bypass consists in both restrictive and malabsorbative mechanisms, and indications to this procedure as an efficient primary and redo procedure are increasing lately. Technology can always improve the surgical act, and 4K vision is spreading in many operating rooms. Laparoscopic approach is subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarised glasses. We present the laparoscopic one anastomosis gastric bypass, done with the new 4K technology, as primary bariatric procedure for morbid obese patient with VP shunt

A case of pancreatic cancer with concomitant median arcuate ligament syndrome treated successfully using an allograft arterial transposition

An association of pancreatic cancer and median arcuate ligament syndrome (MALS) is a rare and challenging situation in terms of treatment. A 60-year-old man diagnosed with pancreatic cancer underwent laparotomy. A pancreaticoduodenectomy was planned, but during the resection part of the operation, a celiac artery stenosis was noticed. The patient was diagnosed with MALS causing almost total celiac artery occlusion, with no radiological solution. The patient was re-operated the next day, and an iliac artery allograft was used for aorta-proper hepatic artery reconstruction, concomitant with the total pancreaticoduodenectomy. Preoperative meticulous evaluation of vascular structures of the celiac trunk and its branches is important, especially in pancreatic surgery. A vascular allograft may be a lifesaving alternative when vascular reconstruction is necessary

Most significant change stories from the Challenge Program on Water and Food (CPWF)

The following stories were collected from CPWF project and theme leaders in two rounds. The first round of stories were collected in January 2007 based on the following two questions: What has been the most significant technical development or advance made by your 1) CPWF project / theme / basin since the start? What has been the most significant partnership change (significant in terms of making 2) scientific progress and/or developmental impact more likely) that has taken place since the start of your CPWF project (or theme or basin)? In June 2009 we repeated the process asking the same basic question, without specifying between technical and partnership changes. We asked for photographs and references to documents that substantiate the stories. We collected 54 stories in Round 1, and 15 in Round 2. A selection of 44 stories are presented here. Those we left out we did so if the stories they told were not clear, if they did not follow the format, or if we did not receive answers to clarifying questions. T he stories are organized by the CPWF’s five themes and according to First Call projects, Basin Focal Projects and Small Grants projects. They show the broad range of outcomes and impacts that the CPWF is beginning to have. The stories are not a comprehensive audit of CPWF impact, but rather what people felt motivated to write about. The stories provide gateways to evidence of change, and are not to be interpreted as definitive but as iterative. Indeed, some projects presented change stories in both rounds. CPWF Theme Leaders selected the first round story or stories they thought most significant and gave their reasons. The selection decisions and criteria are given as feedback to the projects as a way for the CPWF to focus innovation towards explicitly valued directions and away from less valued ones. One story was selected as the most significant from the second round stories. T he Most Significant Change (MSC) method was used to collect and analyze the stories1. MSC is part of a repertoire of iterative learning-based approaches that are employed by the CPWF and its projects in response to emergent change. The authors of the stories are principally the program’s Theme Leaders, Project Leaders and Principle Investigators. In writing the stories they were able to give their interpretation of the emerging issues and changes that most mattered to the leadership in these projects

Stories from the field: Most Significant Change (MSC) synthesis

In January of 2007, a number of people working with the CGIAR Challenge Program on Water and Food (CPWF) were invited to tell stories about the “most significant change” (MSC) they had observed as a result of CPWF activity. They were guided by two questions, posed to establish the stories’ domain and time frame of interest. These were: “What has been the most significant technical development/advance made by your CPWF project / theme / basin since the start?” “What has been the most significant partnership change (significant in terms of making scientific progress and/or developmental impact more likely) that has taken place since the start of your CPWF project (or theme or basin)?” This paper aims to pull together some of the threads emerging from these stories, weaving them into a fabric that gives insight into CPWF approaches and achievements

Characterization and antimicrobial susceptibility pattern to commonly prescribed antimicrobials of diarrheagenic Escherichia coli in patients attending Thika district Hospital - Kenya, 2014.

Background: Diarrheagenic E. coli (DEC) are associated with outbreaks of severe diarrhea and multiple drug resistance. We characterize DEC among diarrhoeal patients attending Thika Hospital and determine their antimicrobial susceptibility patterns.Methods: A cross-sectional study was conducted among patients of all ages seeking diarrhea treatment. Stool samples were collected, inoculated on bacterial differential media for growth of enteric pathogens, characterized and antimicrobial susceptibility of DEC isolates determined.Results: A total of 402 stool samples were cultured. E. coli was isolated from 269, of which 72 (27%) were DEC; 60 (83.3%) enteroaggregative E. coli (EAEC), 6 (8.3%) enteropathogenic E. coli (EPEC) and 6 (8.3%) enterotoxigenic E. coli (ETEC). Of the 72, 58% were female, median age was 8 (IQR: 2-28) years, 75% did not boil water and 100% did not treat water. Twenty five (35%) patients with DEC were under-five years. Drinking un-boiled water (OR: 2.51, 95% CI: 1.36-4.61) was associated with having DEC. All DEC isolates were sensitive to cefoxitin, meropenem, amikacin, gentamicin and ciprofloxacin. They were resistance to ampicillin (92%), trimethoprim-sulfamethoxazole (92%) and amoxicillin-clavulanic acid (85%).Conclusion: The predominant DEC strain was EAEC. High resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxicillin-clavulanic acid were observed. All isolates were sensitive to ciprofloxacin and gentamicin.Keywords: Diarrhea, E. coli, Diarrheagenic E. coli, Characterization, KenyaAfr J Health Sci. 2016; 29(1):25-3

Research in development: learning from the CGIAR Research Program on Aquatic Agricultural Systems

This working paper aims to synthesize and share learning from the experience of adapting and operationalizing the Research in Development (RinD) approach to agricultural research in the five hubs under the The CGIAR Research Program on Aquatic Agricultural Systems. It seeks to share learning about how the approach is working in context and to explore the outcomes it is achieving through initial implementation over 3 ½ years. This learning can inform continuation of agricultural research in the second phase of the CGIAR research programs and will be useful to others aiming to implement research programs that seek to equitably build capacity to innovate in complex social-ecological systems. Each of the chapters in this working paper have shown that RinD has produced a range of outcomes that were often unexpected and broader in scope than might result from other approaches to agricultural research. RinD also produces innovations, and there is evidence that it builds capacity to innovate. - See more at: http://www.aas.cgiar.org/publications/research-development-learning-cgiar-research-program-aquatic-agricultural-systems#sthash.xfjhbHpl.dpu

Guidelines to engage with marginalized ethnic minorities in agricultural research for development in the Greater Mekong

This document is an output of Humidtropics, a CGIAR Research Program on Integrated Systems for the Humid Tropics. This document is designed to help researchers who want to engage with ethnic groups to ensure agricultural research for development (R4D) stops contributing to their further marginalization. It can be used by those wanting to design new projects that engage with ethnic minorities from the start or those already implementing projects and wanting to improve their current practice. Based on an analysis of internal and external factors that lead to marginalization of ethnic minority groups through agricultural R4D, the Guidelines are organized around three sets of challenges: (a) the agricultural R4D system as a whole; (b) for research teams; and (c) for agricultural R4D projects. The document identifies for each challenge strategies that can help prevent further marginalization according to different stages in the project cycle. The overall approach that these Guidelines recommend is transdisciplinary action research. The strategies are thus those that can help agricultural R4D researchers to carry out transdisciplinary action research that engages more effectively with marginalized ethnic minority groups in order to achieve more inclusive and equitable rural development from agriculture

Blending hard and soft science: the Follow the Technology approach to analyzing and evaluating technology change

Published online: 20 Dec 2001The types of technology change catalyzed by research interventions in integrated natural resource management (INRM) are likely to require much more social negotiation and adaptation than are changes related to plant breeding, the dominant discipline within the system of the Consultative Group on International Agricultural Research (CGIAR). Conceptual models for developing and delivering high-yielding varieties have proven inadequate for delivering natural resource management (NRM) technologies that are adopted in farmers' fields. Successful INRM requires tools and approaches that can blend the technical with the social, so that people from different disciplines and social backgrounds can effectively work and communicate with each other. This paper develops the "follow-the-technology" (FTT) approach to catalyzing, managing, and evaluating rural technology change as a framework that both "hard" and "soft" scientists can work with. To deal with complexity, INRM needs ways of working that are adaptive and flexible. The FTT approach uses technology as the entry point into a complex situation to determine what is important. In this way, it narrows the research arena to achievable boundaries. The methodology can also be used to catalyze technology change, both within and outside agriculture. The FTT approach can make it possible to channel the innovative potential of local people that is necessary in INRM to "scale up" from the pilot site to the landscape. The FTT approach is built on an analogy between technology change and Darwinian evolution, specifically between "learning selection" and natural selection. In learning selection, stakeholders experiment with a new technology and carry out the evolutionary roles of novelty generation, selection, and promulgation. The motivation to participate is a "plausible promise" made by the R&D team to solve a real farming problem. Case studies are presented from a spectrum of technologies to show that repeated learning selection cycles can result in an improvement in the performance of the plausible promise through adaptation and a sense of ownership by the stakeholders

Spatial Congruence or Mismatch Between Phylogenetic and Functional Structure of Seed Plants Along a Tropical Elevational Gradient: Different Traits Have Different Patterns

Compared to species richness, few studies have investigated the patterns and relationship of phylogenetic and functional structures along elevational gradients. Here, we used the general additive models to determine the trends of taxonomic diversity (species richness, SR), phylogenetic and functional diversity (PD and FD), phylogenetic structure net relatedness index (NRI), and functional structure net functional relatedness index (NFRI) of seed plants along the elevational gradient in Mount Kenya, a tropical mountain in Africa. We measured growth form, fruit type, maximum height, and maximum leaf size of each species, calculated the phylogenetic signal of each trait, and tested the Pearson correlation coefficients between NRI and NFRI of each trait. Our results showed that SR, PD, and FD decreased gradually along the elevational gradient. NRI exhibited a fluctuating pattern along the elevational gradient, while NFRI of the four functional traits showed noticeably different patterns. We concluded that the relationship between the phylogenetic and functional structures in different functional traits could be congruent or mismatched along the elevational gradient. Compared with relatively conservative categorical traits (e.g., growth form and fruit type), continuous traits (e.g., height and leaf size) have a random or convergent evolutionary pattern. Therefore, they could be more easily affected by the environment and possibly have higher phenotypic plasticity

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background: The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures—Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods: Two online questionnaires—first having 11 questions on SG/GBP frequency with a follow-up of 5–10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR—a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results: Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 ± 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 ± 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). Conclusion: Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development