Improving Decision Support Systems with Machine Learning: Identifying Barriers to Adoption

Precision agriculture (PA) has been defined as a “management strategy that gathers, processes and analyzes temporal, spatial and individual data and combines it with other information to support management decisions according to estimated variability for improved resource use efficiency, productivity, quality, profitability and sustainability of agricultural production.” This definition suggests that because PA should simultaneously increase food production and reduce the environmental footprint, the barriers to adoption of PA should be explored. These barriers include: 1) the financial constraints associated with adopting DSS, 2) the hesitancy of farmers to change from their trusted advisor to a computer program often behaves as a black box, 3) questions about data ownership and privacy, and 4) the lack of a trained workforce to provide the necessary training to implement DSSs on individual farms. This paper also discusses the lessons learned from successful and unsuccessful efforts to implement DSSs, the importance of communication with end-users during DSS development, and potential career opportunities that DSSs are creating in PA

Comparative ambient and indoor particulate matter analysis of operation theatres of government and private (trust) Hospitals of Lahore, Pakistan

The link between infection and indoor air quality (IAQ) in operating theatres is well established. The level of airborne particulate matter (PM) in operating theatres in Pakistan has not yet been studied comprehensively. Monitoring of both indoor (operating theatre) and outdoor concentrations of PM in both activity and non-activity time periods was done using a DUSTTRAK Aerosol Monitor (TSI Model 8520) and DRX Aerosol Monitor (TSI Model 8533) for 24 hours. Two hospitals in Lahore were selected: Services Hospital (government – site 1) and Shalamar Hospital (private – site 2). The highest concentration of PM was observed in the orthopaedic operating theatre at site 1 during working hours with an average concentration of 757(±540), 809(±58), 824(±585), 875(±586) and 970(±581) μg/m3 of PM1,PM2.5, PM4, PM10 and PMTotal respectively while the average PM2.5 outdoor concentration was 294 μg/m3. The minimum average PM concentration was found in the orthopaedic operating theatre at site 2 during working hours: 18(±8), 19(±8), 20(±9), 26(±9) and 39(±9) μg/m3 for PM1, PM2.5, PM4, PM10 and PMTotal respectively. The use of vertical laminar air flow ventilation strategy was found to be an effective measure in reducing PM levels and it might be possible to predict the air quality of operating theatres by determining PM dust load. Factors such as ventilation system, door opening /closing rates, building age, possible sources of infiltration, number of people present in the operating area all play a role in influencing PM concentrations in operating theatres

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

Correlated response of various morpho-physiological characters with grain yield in sorghum landraces at different growth phases

Seventeen sorghum landraces were exploited to establish morpho-physiological criteria for drought tolerance and higher grain yield in sorghum at seedling and post flowering stages under rainfed conditions at Barani Agricultural Research Station, Fatehjang, Pakistan during the years 2007 and 2008. Meteorological data of both the years revealed considerable water stress at post-flowering stage. The data were recorded for fresh root and shoot weights (g), dry root and shoot weights (g), root length (cm), shoot length (cm), coleoptile length (cm) and root shoot ratio at seedling stage. At postflowering stage data on flag leaf area (cm), specific flag leaf area, specific flag leaf weight, leaf dry matter (g), excised leaf weight loss (%), relative dry weight, relative water contents (%), residual transpiration (g H 2O/min/cm 2/10 5), cell membrane stability (%) and grain yield per plant (g) were recorded. Analysis of variance revealed significant genetic differences among the landraces for all the traits. Correlation and path coefficient analysis demonstrated that fresh root shoot weights, dry shoot weight and root: shoot ratio were important selection criteria for drought tolerance as well as higher grain yield at seedling stage. Similarly, higher flag leaf area, leaf dry matter, relative water contents and cell membrane stability along with lower values of specific flag leaf weigh, excise leaf weight loss and residual transpiration could be exploited as morpho-physiological markers for drought tolerance and higher grain yield at late growth stage. The studies revealed many important correlations among the characters which can be exploited to execute a breeding programme aimed at the development of drought tolerant sorghum cultivars

Rhetorics and realities of management practices in Pakistan: Colonial, post-colonial and post-9/11 influences

This study explores how colonial laws and administrative practices shaped the evolution of employment management in Pakistan. It identifies important mechanisms used by the British Raj (the period of British rule of the subcontinent) to institutionalise legal and administrative frameworks: the legacies of these structures continue to influence contemporary management practices in government sector organisations. This article investigates the legacy of the Raj's ¿quota system¿ in the civil services and the doctrine of the ¿martial race¿ in military services, both of which offered enduring structural advantages in the labour market to designated groups. It further considers the implications of the study's findings for international HRM in particular, but also management theory, comparative HRM and comparative management in post-colonial societies

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P &lt; 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P &lt; 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients