Case Study: The Surgical Management of Angiokeratoma Resulting from Radiotherapy for Penile Cancer

Angiokeratoma is a rare, benign skin lesion and a recognised complication of radiation therapy. Here we describe a case of extensive angiokeratoma of the groin and external genitalia resulting from external beam radiation to that area in a patient with penile carcinoma. Furthermore, we outline the management of this problem by surgical reconstruction

The Challenges of Wastewater Irrigation in Developing Countries

The volume of wastewater generated by domestic, industrial, and commercial sources has increased with population, urbanization, improved living conditions, and economic development. The productive use of wastewater has also increased, as millions of small-scale farmers in urban and peri-urban areas of developing countries depend on wastewater or wastewater-polluted water sources to irrigate high-value edible crops for urban markets, often as they have no alternative sources of irrigation water. Undesirable constituents in wastewater can harm human health and the environment. Hence, wastewater irrigation is an issue of concern to public agencies responsible for maintaining public health and environmental quality. For diverse reasons, many developing countries are still unable to implement comprehensive wastewater treatment programs. Therefore in the near term, risk management and interim solutions are needed to prevent adverse impacts from wastewater irrigation. A combination of source control and farm-level and post-harvest measures can be used to protect farm workers and consumers. The WHO guidelines revised in 2006 for wastewater use suggest measures beyond the traditional recommendations of producing only industrial or nonedible crops, as in many situations it is impossible to enforce a change in the current cash crop pattern, or provide alternative vegetable supply to urban markets. There are several opportunities for improving wastewater management via improved policies, institutional dialogues, and financial mechanisms, which would reduce the risks in agriculture. Effluent standards combined with incentives or enforcement can motivate improvements in water management by household and industrial sectors discharging wastewater from point sources. Segregation of chemical pollutants from urban waste-water facilitates treatment and reduces risk. Strengthening institutional capacity and establishing links between water delivery and sanitation sectors through interinstitutional coordination leads to more efficient management of wastewater and risk reduction

The Challenges of Wastewater Irrigation in Developing Countries

The volume of wastewater generated by domestic, industrial, and commercial sources has increased with population, urbanization, improved living conditions, and economic development. The productive use of wastewater has also increased, as millions of small-scale farmers in urban and peri-urban areas of developing countries depend on wastewater or wastewater-polluted water sources to irrigate high-value edible crops for urban markets, often as they have no alternative sources of irrigation water. Undesirable constituents in wastewater can harm human health and the environment. Hence, wastewater irrigation is an issue of concern to public agencies responsible for maintaining public health and environmental quality. For diverse reasons, many developing countries are still unable to implement comprehensive wastewater treatment programs. Therefore in the near term, risk management and interim solutions are needed to prevent adverse impacts from wastewater irrigation. A combination of source control and farm-level and post-harvest measures can be used to protect farm workers and consumers. The WHO guidelines revised in 2006 for wastewater use suggest measures beyond the traditional recommendations of producing only industrial or nonedible crops, as in many situations it is impossible to enforce a change in the current cash crop pattern, or provide alternative vegetable supply to urban markets. There are several opportunities for improving wastewater management via improved policies, institutional dialogues, and financial mechanisms, which would reduce the risks in agriculture. Effluent standards combined with incentives or enforcement can motivate improvements in water management by household and industrial sectors discharging wastewater from point sources. Segregation of chemical pollutants from urban waste-water facilitates treatment and reduces risk. Strengthening institutional capacity and establishing links between water delivery and sanitation sectors through interinstitutional coordination leads to more efficient management of wastewater and risk reduction

The Challenges of Wastewater Irrigation in Developing Countries

The volume of wastewater generated by domestic, industrial, and commercial sources has increased with population, urbanization, improved living conditions, and economic development. The productive use of wastewater has also increased, as millions of small-scale farmers in urban and peri-urban areas of developing countries depend on wastewater or wastewater-polluted water sources to irrigate high-value edible crops for urban markets, often as they have no alternative sources of irrigation water. Undesirable constituents in wastewater can harm human health and the environment. Hence, wastewater irrigation is an issue of concern to public agencies responsible for maintaining public health and environmental quality. For diverse reasons, many developing countries are still unable to implement comprehensive wastewater treatment programs. Therefore in the near term, risk management and interim solutions are needed to prevent adverse impacts from wastewater irrigation. A combination of source control and farm-level and post-harvest measures can be used to protect farm workers and consumers. The WHO guidelines revised in 2006 for wastewater use suggest measures beyond the traditional recommendations of producing only industrial or nonedible crops, as in many situations it is impossible to enforce a change in the current cash crop pattern, or provide alternative vegetable supply to urban markets. There are several opportunities for improving wastewater management via improved policies, institutional dialogues, and financial mechanisms, which would reduce the risks in agriculture. Effluent standards combined with incentives or enforcement can motivate improvements in water management by household and industrial sectors discharging wastewater from point sources. Segregation of chemical pollutants from urban waste-water facilitates treatment and reduces risk. Strengthening institutional capacity and establishing links between water delivery and sanitation sectors through interinstitutional coordination leads to more efficient management of wastewater and risk reduction

WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial

Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan. The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by 'family volunteers' to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule - child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894). This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings. Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental Disorders and Delays. Identifier: NCT02792894 Registered on 6 July 2016

Moisture Stress Assessment through NDVI and Climate Tools for Crop Management at Anantpur District, AP

Anantapur is the driest district of Andhra Pradesh and hence, agriculture conditions are very often precarious. Groundnut grows where other crops fail and thus it is the predominant crop of Anantapur district. Groundnut is grown in about 7.5 lakh ha in Anantapur district; however the average yields are low af 500 kg ha-1. Among various available vegetation indices, normalised difference vegetation index (ND VI) is widely used for all reasons, which is a single numerical indicator of presence and condition of green vegetation. ND VI mapping at a regional scale helps to assess the spatial changes in the vigour of green vegetation and thus occurrence of any moisture stress. Climate tOQls have a great role in understanding the crop performance and estimating the yields. This study was taken up by using freely available MODIS data to understand ND VI in terms of abiotic stresses over Anantapur district and linking with the actual rainfall conditions, groundnut crop acreage and production. Results indicate that low groundnut yields in general,could be related to ND VI-based stress measurements and rainfall quantum and distribution in the area however, with a few exceptions. It is hoped that by combining improved practices through IWM with climate-adapted crop varieties, rainfed farmers of Anantapur district can sustain their crop production under present climate variability and become resilient to future climate chang