The Importance of Goats in the World

It is a challenge to transform the mindset of subsistence farmers to consider goats as a productive asset. Goat health, breeding, housing and nutrition are the main challenges in a smallholder production system. The development of the goat market sector is informal and underdeveloped. As a result, goats have not been identified as a significant contributor to the national gross domestic product. Many development organizations consider goats a preferred livestock commodity for poverty alleviation. Therefore, it is desirable to have a systematic approach to optimize goat production for smallholders. A smallholder goat value chain works well with a focus on improved goat production, increasing business and entrepreneur skills and organizing communities for strong social capital. Heifer International has large-scale goat value chain programs for smallholders in many countries. Partnership and collaborative efforts among academic/scientific, public/private sectors, producers and civil societies are critical for sustainable smallholder goat development

Identification and prioritisation of barriers to quality performance in medical education and patient care in Medical University in India

King George's Medical University (KGMU) is 100 years old and is one of the six medical universities in India. Like most other medical institutions here, there is no formal process of internal evaluation for improvement. This work was done to identify potential barriers to quality performance in medical education and patient care domains and to develop a methodology to prioritize them using qualitative and semi-quantitative techniques. About 30-faculty members identified around 42 barriers in the domains of education and patient care. Majority of the barriers were internal and required changes in systems and behavior. A stakeholder focused KGMU priority-setting matrix was developed to give each barrier a priority score ranging from 8-24. One-thirds (n=14) identified barriers obtained a priority score of ≥ 17 and were subject to external validation, using the same priority setting matrix, on 82 (81.7% males) stakeholders. Limited teacher postgraduate student interaction and less patient-physician interactions were identified as most important barriers in education and patient care domains, respectively, followed by barriers common to both domains (unaesthetic campus, irregular electricity and water supply and poor maintenance of equipment). Thus expedited action in domain specific as well as common priorities would potentially positively impact medical education as well as patient care. KGMU priority setting matrix was found to be a simple instrument, which could capture differences in perspectives of various stakeholders. It can be validated in similar settings elsewhere. There is a need to develop and validate methods of internal assessment and quality assurance within medical institutions in India

Comparison of outcomes after open versus robotic kidney transplantation: A systematic review and meta-analysis

INTRODUCTION: This meta-analysis compares the clinical outcomes of robot-assisted kidney transplant (RAKT) to open kidney transplant (OKT). METHODS: A systematic search of Scopus and MEDLINE databases was carried out using a combination of keywords to identify studies comparing RAKT to OKT. Baseline characteristics and preoperative and postoperative data were collected along with data on the short- and long-term outcomes. The study was registered in PROSPERO and Assessing the Methodological Quality of Systematic Reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 16 studies were included with a total of 2555 patients, of which 677 underwent RAKT and 1878 underwent OKT. This meta-analysis shows a significant benefit of RAKT over OKT in terms of less intra-operative blood loss, smaller incision length, less postoperative pain scores at 24 and 48 hours, and a lower incidence of surgical site infections (SSIs), especially in obese patients. In addition, the incidence of postoperative lymphoceles was lower in the RAKT group compared to the OKT group, although not statistically significant. There was no difference between the two groups in terms of short-term graft functional outcomes and overall survival. The number of deceased donor recipients undergoing RAKT was very small. At the time of reporting this meta-analysis, no randomized controlled trials (RCTs) had been published. CONCLUSION: This meta-analysis showed that RAKT is a safe and feasible alternative to OKT, especially in obese individuals. Further trials are needed to confirm the safety, efficacy, and cost-effectiveness of RAKT

Design of Automated Rainout Shelter to Conduct Experiment on Drought Tolerant Maize Genotype

Uneven and low precipitation areas of Nepal are continuously suffering from drought and received low productivity because of unavailability of suitable drought tolerant maize genotype. An attempt has been made first time in Nepal by constructing an automated rainout shelter with soil moisture based automated drip irrigation system at National Maize Research Program in 2018-2019 to conduct an experiment on drought tolerant maize genotype. The rainout shelters automatically covers the cropping area as soon as the rain sensor received a single drop of precipitation and also if the light intensity decreased to value set in the control panel. Likewise, the soil water level in different treatments were maintained on the basis of the treatment controlled with automatic drip irrigation system set to irrigate at threshold value set in the microcontroller. The complete system had found very useful in determining accurate amount of water required to cultivate drought tolerant maize genotype. We have tested drought tolerant variety RampurSo3Fo8 under 10 level of irrigation and it was determined that 495.2 mm of water is maximum level of water to produce highest yield of 3.32 t/ha whereas 445.6 mm to 247.6 mm of water could can be manage to produce competitive yield without any reduction. An experiment under such kind of infrastructure provide useful information on irrigation management practices required for drought variety in the natural environment. The research output also guides farmers and agriculturist in making Nepalese agricultural more sustainable, mechanized and productive

Productivity of maize (Zea mays L.) as affected by varieties and sowing dates

Genotypic yield potential of maize varieties is greatly affected by sowing dates. In order to investigate the effects of sowing dates and varieties on the grain yield of maize, the field experiment was carried out at research field of National Maize Research Program (NMRP), Rampur, Chitwan, Nepal from April 2009 to March 2010.  Three varieties namely Rampur Composite, Arun-2 and Gaurav were sown at every week. The results of experiment showed that interaction effect of variety and sowing date on grain yield of maize was significant. Rampur Composite produced highest grain yield (6.1 t/ha) in August and lowest yield (2.6 t/ha) in May. Similarly Arun-2 produced highest yield (4.6 t/ha) in August and lowest yield (2.1 t/ha) in May. Gaurav produced highest grain yield (5.1 t/ha) in September followed by 4.9, 4.8 and 4.6 t/ha in February, July and August respectively and lowest yield (1.5 t/ha) in November. The sowing date was highly significant on grain production. The highest grain production was 5.1 t/ha in August followed by in February (4.9 t/ha), September (4.6 t/ha) and March (4.4 t/ha) respectively. The lowest grain yield was produced in May (2.4 t/ha). Therefore it was concluded that August planting was best for higher grain production of maize varieties (Rampur Composite, Arun-2 and Gaurav) in terai region of Nepal

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients

INTRODUCTION: The literature on studies reporting trifecta or pentafecta outcomes following robot-assisted partial nephrectomy (RAPN) in Indian patients is limited. The primary aim of this study was to report and evaluate the factors predicting trifecta and pentafecta outcomes following RAPN in Indian patients using the multicentric Vattikuti collective quality initiative (VCQI) database. METHODS: From the VCQI database for patients who underwent RAPN, data for Indian patients were extracted and analyzed for factors predicting the achievement of trifecta and pentafecta following RAPN. Trifecta was defined as the absence of complications, negative surgical margins, and warm ischemia period shorter than 25 min or zero ischemia. Pentafecta covers all the trifecta criteria as well as \u3e90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease at 12 months. RESULTS: In this study, among 614 patients, the trifecta was achieved in 374 patients (60.9%) and pentafecta was achieved in 24.2% of the patients. Patients who achieved trifecta had significantly higher mean age (54.1 vs. 51.0 years, P = 0.005), body mass index (BMI) (26.7 vs. 26.03 kg/m 2, P = 0.022), and smaller tumor size (38.6 vs. 41.4 mm, P = 0.028). The preoperative eGFR (84.2 vs. 91.9 ml/min, P = 0.012) and renal nephrometry score (RNS) (6.96 vs. 7.87, P ≤ 0.0001) were significantly lower in the trifecta group. Comparing patients who achieved pentafecta to those who did not, we noted a statistically significant difference between the two groups for tumor size (36.1 vs. 41.5 mm, P = 0.017) and RNS (6.6 vs. 7.7, P = 0.0001). On multivariate analysis, BMI and RNS were associated with trifecta outcomes. Similarly, only RNS was identified as an independent predictor of pentafecta. CONCLUSIONS: RNS and BMI were independent predictors of the trifecta. At the same time, RNS was identified as an independent predictor of pentafecta following RAPN

Feasibility of Omitting Outer Renorrhaphy During Robotic Partial Nephrectomy

Introduction: Reconstruction technique after robotic partial nephrectomy (RPN) is a modifiable factor with possible impact on ischemia time, bleeding, renal function, and incidence of pseudoaneurysms. We sought to evaluate the feasibility of omitting cortical (outer) renorrhaphy (CR) in a multi-institutional setting.Methods: We analyzed 1453 patients undergoing RPN, from 2006-2018, within the Vattikuti Collective Quality Initiative database, which captures that data from 14 centers in 9 countries. Patients having surgery for bilateral tumors(n=73) were excluded. The CR and no-CR groups were compared in terms of operative and ischemia time, blood loss, major (Clavien≥3) complications, surgical margins, hospital stay, change in estimated glomerular filtration rate (eGFR), and need of angioembolization. Inverse probability of treatment weighting (IPTW) with a Firth correction for center code was done to account for selection bias.Results: CR was omitted in 120 patients; 1260 patients underwent both inner (base) layer renorrhaphy and CR. There was no difference in intraoperative complications (7.4% in CR; 8.9% in no-CR group;p=0.6) or postoperative major complications (1% and 2.8% in the CR and no-CR groups, respectively;p=0.2). Estimated blood loss was 100 mL (IQR 50-200) in both treatment groups(p=0.6). Angioembolization was needed in 0.7% patients in CR group vs 1.4% in no-CR group(p=0.4). Additionally, there was no difference in median operative time (168 minutes and 162 minutes, respectively;p=0.2), or ischemia time (18 minutes and 17 minutes, respectively;p=0.7). Conclusions: Omission of CR did not significantly improve operative or ischemia time; however, it also had no adverse effect on perioperative outcomes after RPN in a multi-institutional setting.https://scholarlycommons.henryford.com/merf2019clinres/1003/thumbnail.jp

Evidence-based decision making and covid-19: what a posteriori probability distributions speak

Background: In the absence of any pharmaceutical interventions, the management of the COVID-19 pandemic is based on public health measures. The present study fosters evidence-based decision making by estimating various “a posteriori probability distributions" from COVID-19 patients.  Methods: In this retrospective observational study, 987 RT-PCR positive COVID-19 patients from SMS Medical College, Jaipur, India, were enrolled after approval of the institutional ethics committee. The data regarding age, gender, and outcome were collected. The univariate and bivariate distributions of COVID-19 cases with respect to age, gender, and outcome were estimated. The age distribution of COVID-19 cases was compared with the general population's age distribution using the goodness of fit c2 test. The independence of attributes in bivariate distributions was evaluated using the chi-square test for independence. Results: The age group ‘25-29’ has shown highest probability of COVID-19 cases (P [25-29] = 0.14, 95% CI: 0.12- 0.16). The men (P [Male] = 0.62, 95%CI: 0.59-0.65) were dominant sufferers. The most common outcome was recovery (P [Recovered] = 0.79, 95%CI: 0.76-0.81) followed by admitted cases (P [Active]= 0.13, 95%CI: 0.11-0.15) and death (P [Death] = 0.08, 95%CI: 0.06-0.10). The age distribution of COVID-19 cases differs significantly from the age distribution of the general population (c2  =399.04, P < 0.001). The bivariate distribution of COVID-19 across age and outcome was not independent (c2 =106.21, df = 32, P < 0.001). Conclusion: The knowledge of disease frequency patterns helps in the optimum allocation of limited resources and manpower. The study provides information to various epidemiological models for further analysis

Evidence-based decision making and covid-19: what a posteriori probability distributions speak

Background: In the absence of any pharmaceutical interventions, the management of the COVID-19 pandemic is based on public health measures. The present study fosters evidence-based decision making by estimating various “a posteriori probability distributions" from COVID-19 patients.  Methods: In this retrospective observational study, 987 RT-PCR positive COVID-19 patients from SMS Medical College, Jaipur, India, were enrolled after approval of the institutional ethics committee. The data regarding age, gender, and outcome were collected. The univariate and bivariate distributions of COVID-19 cases with respect to age, gender, and outcome were estimated. The age distribution of COVID-19 cases was compared with the general population's age distribution using the goodness of fit c2 test. The independence of attributes in bivariate distributions was evaluated using the chi-square test for independence. Results: The age group ‘25-29’ has shown highest probability of COVID-19 cases (P [25-29] = 0.14, 95% CI: 0.12- 0.16). The men (P [Male] = 0.62, 95%CI: 0.59-0.65) were dominant sufferers. The most common outcome was recovery (P [Recovered] = 0.79, 95%CI: 0.76-0.81) followed by admitted cases (P [Active]= 0.13, 95%CI: 0.11-0.15) and death (P [Death] = 0.08, 95%CI: 0.06-0.10). The age distribution of COVID-19 cases differs significantly from the age distribution of the general population (c2  =399.04, P < 0.001). The bivariate distribution of COVID-19 across age and outcome was not independent (c2 =106.21, df = 32, P < 0.001). Conclusion: The knowledge of disease frequency patterns helps in the optimum allocation of limited resources and manpower. The study provides information to various epidemiological models for further analysis