Proposing a Popular Method for Meteorological Drought Monitoring in the Kabul River Basin, Afghanistan

This paper investigates meteorological drought in one of Afghanistan's most important socio-economic river basins called Kabul River Basin (KRB) using a 38 years monthly precipitation data. Several drought indices such as Standardized Precipitation Index (SPI), Percent of Normal Precipitation Index (PNPI), Deciles Index (DI), and China-Z Index (CZI) were applied for the first time on the basin in order to observe the correlation among the indices in the basin for drought, and to see which method is suitable for drought monitoring in KRB. Due to the concerns that climate is changing and especially the rapid snowmelt that accounts for 80% of the precipitation in Afghanistan, it was essential to carry such a study in order to warn the responsible bodies in the country for a better drought management. Moreover, the rapid population increase and USAge of more water for both drinking and agricultural purposes in the basin with a possible decrease in the annual precipitation make it necessary to undertake such a study. The results of the investigation show that KRB area experienced drought conditions continuously from 2000 to 2004 with a peak extreme drought in 2001 which confirm to the reported worst drought in the region. It is noted that log-SPI, gamma-SPI, and Deciles captured the historical extreme and severe drought periods successfully, therefore, these methods are recommended to be applied to this region as drought assessment tools

Training evaluation: a case study of training Iranian health managers

<p>Abstract</p> <p>Background</p> <p>The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers and trainers. This process was also intended to develop the capacity of the National Public Health Management Centre in Tabriz, Iran, to enable it to organize relevant short courses in health management on a continuing basis. A total of seven short training courses were implemented, three in the United Kingdom and four in Tabriz, with 35 participants. A detailed evaluation of the courses was undertaken to guide future development of the training programmes.</p> <p>Methods</p> <p>The Kirkpatrick framework for evaluation of training was used to measure participants' reactions, learning, application to the job, and to a lesser extent, organizational impact. Particular emphasis was put on application of learning to the participants' job. A structured questionnaire was administered to 23 participants, out of 35, between one and 13 months after they had attended the courses. Respondents, like the training course participants, were predominantly from provincial universities, with both health system and academic responsibilities. Interviews with key informants and ex-trainees provided supplemental information, especially on organizational impact.</p> <p>Results</p> <p>Participants' preferred interactive methods for learning about health planning and management. They found the course content to be relevant, but with an overemphasis on theory compared to practical, locally-specific information. In terms of application of learning to their jobs, participants found specific information and skills to be most useful, such as health systems research and group work/problem solving. The least useful areas were those that dealt with training and leadership. Participants reported little difficulty in applying learning deemed "useful", and had applied it often. In general, a learning area was used less when it was found difficult to apply, with a few exceptions, such as problem-solving. Four fifths of respondents claimed they could perform their jobs better because of new skills and more in-depth understanding of health systems, and one third had been asked to train their colleagues, indicating a potential for impact on their organization. Interviews with key informants indicated that job performance of trainees had improved.</p> <p>Conclusion</p> <p>The health management training programmes in Iran, and the external university involved in capacity building, benefited from following basic principles of good training practice, which incorporated needs assessment, selection of participants and definition of appropriate learning outcomes, course content and methods, along with focused evaluation. Contracts for external assistance should include specific mention of capacity building, and allow for the collaborative development of courses and of evaluation plans, in order to build capacity of local partners throughout the training cycle. This would also help to develop training content that uses material from local health management situations to demonstrate key theories and develop locally required skills. Training evaluations should as a minimum assess participants' reactions and learning for every course. Communication of evaluation results should be designed to ensure that data informs training activities, as well as the health and human resources managers who are investing in the development of their staff.</p

Morpho-physiological diversity and its implications for improving drought tolerance in grain sorghum at different growth stages

Abstract Sorghum grown under rain-fed conditions is usually affected by drought stress at different stages resulting in negative effect on yield. The assessment and quantification of morpho-physiological diversity for the traits contributing towards drought tolerance at these stages is of vital importance. For this purpose, drought stress was imposed on 44 sorghum accessions at seedling stage and natural incidence of water stress at post anthesis stage. The data of 21 different morpho-physiological traits were subjected to different multivariate techniques, including correlation, principal component (PC) and cluster analysis to assess the diversity for drought tolerance in sorghum. The correlation analysis revealed that selection for long roots; higher root/shoot ratio, leaf area and leaf dry matter could be performed simultaneously. There was positive association between relative water contents and cell membrane stability but both of these traits were negatively correlated with residual transpiration and excised leaf weight loss. Principal component (PC) analysis showed first 7 PCs having Eigen value &gt;1 explaining 77.653% of the total variation with head width, head weight, grain yield per plant, fresh and dry shoot weight being the most important characters in PC1. Cluster analysis classified 44 accessions into four divergent groups. The members of first two clusters exhibited adequate degree of drought tolerance on the basis of majority of morpho-physiological traits, whereas, cluster 3 and 4 included genotypes with lower level of drought tolerance. The D 2 statistics revealed the highest distances between 2 nd and 3 rd clusters, while 3 rd and 4 th clusters displayed maximum similarity. Scatter plot and tree diagrams demonstrated sufficient diversity among the sorghum accession for various traits and some extent of association between different clusters. The results concluded that morpho-physiological diversity in the studied material is structured by genotypes and this diversity could be utilized for cultivar breeding and germplasm conservation programs aimed at improving drought tolerance in sorghum

Omeprazole ameliorates aspirin-induced gastroduodenal injury

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) damage the gastroduodenal epithelium by two mechanisms: direct toxic effects and effects related to the depletion of endogenous prostaglandins. The prostaglandin-depleted mucosa has increased suceptibility to luminal aggressive factors, yet the role of acid in the pathogenesis of the NSAID ulcer is controversial. In humans, standard doses of H 2 -receptor antagonists prevent only duodenal injury and provide no protection for the gastric mucosa. It is not known whether more potent suppression of acid can prevent NSAID damage. Twenty healthy volunteers were randomized to a double-blind, placebo-controlled, crossover study to determine if omeprazole, 40 mg/day prevents gastroduodenal injury due to two weeks of aspirin administration (650 mg four times a day). The severity of mucosal injury was quantitated by endoscopy and stratified by a scale from 0 (normal) to 4 (ulcer). Fourteen of the 20 subjects had less gastric injury during cotherapy with omeprazole. All six with no difference received aspirin plus omeprazole in the first treatment period. Omeprazole significantly decreased aspirin-induced gastric mucosal injury ( P <0.001, Wilcoxon signed-rank test). Omeprazole protected 85% of subjects from extensive gastric erosions (often associated with evidence of intraluminal bleeding) or ulceration, whereas 70% of the subjects developed aspirin-induced grades 3 and 4 gastric injury on placebo ( P <0.01 by X 2 ). No subject taking omeprazole developed duodenal injury of any grade, while 50% taking placebo developed erosions and 15% had ulcer ( P <0.001). Medication side effects were mild in the majority of subjects. Heartburn occurred in seven subjects on aspirin and placebo vs one on aspirin and omeprazole ( P <0.01). Salicylate levels were 7.39±4.72 mg/dl (535±340 µmol/liter) in the placebo group and 6.95±4.3 mg/dl (503±311 µmol/liter) in the omeprazole group. We conclude that omeprazole, 40 mg/day eliminates duodenal injury and markedly ameliorates gastric injury due to administration of aspirin 2600 mg/day. Omeprazole prophylaxis of NSAID injury deserves further study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44420/1/10620_2005_Article_BF02090067.pd

A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) represent a diverse class of drugs and are among the most commonly used analgesics for arthritic pain worldwide, though long-term use is associated with a spectrum of adverse effects. The introduction of cyclooxygenase-2-selective NSAIDs early in the last decade offered an alternative to traditional NSAIDs with similar efficacy and improved gastrointestinal tolerability; however, emerging concerns about cardiovascular safety resulted in the withdrawal of two agents (rofecoxib and valdecoxib) in the mid-2000s and, subsequently, in an overall reduction in NSAID use. It is now understood that all NSAIDs are associated with some varying degree of gastrointestinal and cardiovascular risk. Guidelines still recommend their use, but little is known of how patients use these agents. While strategies and guidelines aimed at reducing NSAID-associated complications exist, there is a need for evidence-based algorithms combining cardiovascular and gastrointestinal factors that can be used to aid treatment decisions at an individual patient level

Immunotherapy-induced auto-splenectomy in a patient of malignant melanoma

Immune checkpoint inhibitors like programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) are biological agents that help in boosting the immune system of the body to fight against cancer cells. These checkpoint inhibitors are now being approved by the Food and Drug Administration (FDA) to treat various malignancies due to remarkable response. Here, we present a rare immune-related adverse event in a 77-year-old female with metastatic melanoma treated with ipilimumab and nivolumab, later presented with auto-splenectomy