Can guidelines improve referral to elective surgical specialties for adults? A systematic review

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects

Alterations in reducing sugar in Triticum aestivum under irrigated and non-irrigated condition

This research was conducted with the objective of observing alterations in reducing sugars, which may play a part in distinguishing tolerant and susceptible genotypes. The experimental material consisted of thirteen wheat genotypes including eleven bread wheat advanced lines, one synthetic hexaploid and its durum parent. Seeds were sown in plastic pots and allowed to grow under normal irrigation for 32 days. Stress was imposed by withholding water for a period of 12 days. Subsequently, shoots were collected from stressed and non stressed young plants and the total reducing sugars were estimated. The agronomic performance of those advanced lines that were stable, such as CIM-47, CIM-51, NR-234, NR-241 and NR-264, had more elevation in reducing sugars as compared to others. This study therefore showed that stress tolerant varieties accumulated more glucose than sensitive ones. On the contrary, CIM-48 and NR-175 showed inhibition of sugars; and from their agronomic performance, they were also unstable with respect to yield and yield components. It was concluded that tolerant genotypes depict an elevated reducing sugar, and hence they could be useful in selecting tolerant varieties against water stress.Key words: Reducing sugars, water stress, tolerant and susceptible genotypes, Triticum aestivum

Effect of gibberrelic acid on á-amylase activity in heat stressed mung bean (Vigna radiata L.) seedlings

High temperature is a serious threat that can alter the number of biochemical processes in plants, which may lead to reduce crop yield. Gibberellic acid (GA3) is a plant growth hormone, responsible for growth, stress tolerance and regulation of many enzymes like amylase. Amylase is responsible for growth by hydrolyzing starch into maltose. This experiment was carried out to study the effect of GA3 on á-amylase activity under heat stress conditions of four genotypes of mung bean (NM 19-19, NM 20-21, NM 121-123 and NCM 89). Seeds were sown in Petri dishes and incubated at different temperatures with and without 100 µM GA3. It was found that the lethal temperature was 50°C when exposed for 2 h and reduced β-amylase activity in all genotypes which increased when a mild temperature (40°C,1 h) prior to lethal temperature was given. The application of GA3 can further alleviate the effect of heat stress by increasing β-amylase activity. Genotypic variations was also observed and activity of amylase and heat stress tolerance index was highest in NM 19-19 and lowest in NM 20-21 for all treatments.Key words: Mung bean, á-amylase, gibberellic acid, heat stress

Kicking away the financial ladder? German development banking under economic globalisation

© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. While extensive literature exists on how economic globalisation has limited developing countries' policy space for industrial policy, the literature on how it has affected advanced economies remains scant. We utilise original archival material to analyse the activities of the German public development bank, the Kreditantstalt für Wiederaufbau (KfW), in order to shed light on an important, but neglected aspect of German industrial policy. We analyse how the KfW responded to multiple challenges after the rise of economic globalisation, including a funding crisis, international agreements to limit export subsidies and Europeanisation. We argue that KfW successfully managed to navigate these challenges in order to retain, and even increase, its ability to conduct selective industrial policy in the post-1980s era. This was possible because of Germany's hard currency and low sovereign credit risk, large market size, which was augmented by membership in the European Union, and Germany's position as regional hegemon within Europe. More broadly, this shows how, conditional on domestic politics, advanced economies are able to shape and exploit the rules of the international economic system to implement industrial policies to their advantage, even as developing countries are given the opposite policy recommendations

Carcinoma of sigmoid colon following urinary diversion: a case report and review of literature

BACKGROUND: The association of ureterosigmoidostomy with colonic cancer is well established. A 100-fold increased risk of malignancy has been proposed in association with ureterosigmoidostomy. Characteristically there is a latent period of around 20–30 years before the occurrence of cancer. CASE PRESENTATION: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented. The patient underwent three operations in his infancy for exstrophy but after failure to close bladder, ureterosigmoidostomy was attempted at the age of 5 years and was converted to an ileal conduit after 8 months. At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon. CONCLUSION: Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case

Validated High Performance Liquid Chromatography Method for Analysis of Cefadroxil Monohydrate in Human Plasma

Purpose: To develop a simple, rapid and sensitive high performance liquid chromatography (HPLC) method for the determination of cefadroxil monohydrate in human plasma.Methods: Schimadzu HPLC with LC solution software was used with Waters Spherisorb, C18 (5 μm, 150mm × 4.5mm) column. The mobile phase was sodium dihydrogen phosphate buffer pH 4.0 and methanol in a ratio of 96:4. Flow rate was 1.5 ml/min and injection volume was 100 μl. Peak response was detected at 260 nm.Results: System suitability results revealed that the coefficient of variation (CV) for retention time, peak response, tailing factor and resolution of six replicate injections was < 3 %. The method was selective to determine cefadroxil in plasma because there was no peak interference of plasma with cefadroxil at its retention time (7.792 min). Linearity was in the range of 0.5 - 30 μg/ml with slope and intercept of 41694.53 and 22614.87, respectively (R2 = 0.9953). Limit of detection (LOD) and lower limit of quantification (LLOQ) of the method were 0.03 and 0.06 μg/ml, respectively. Absolute recovery of cefadroxil from plasma was in the range 71 - 90.4 %, while inter-day and intra-day analysis showed satisfactory precision and accuracy; thus, the method was reproducible with the range of CV, i.e., 0.35 - 4.01 and 1.88 - 7.9 % for interday and intraday precision, respectively.Conclusion: The developed method being simple, rapid, reproducible can be suitably employed in pharmacokinetic and bioequivalence studies of cefadroxil monohydrate.Keywords: Validation, Cefadroxil monohydrate, Human plasma, Pharmacokinetics Bioequivalenc

A Homogenization Approach for Turbulent Channel Flows over Porous Substrates: Formulation and Implementation of Effective Boundary Conditions

The turbulent flow through a plane channel bounded by a single permeable wall is considered; this is a problem of interest since a carefully chosen distribution of grains and voids in the porous medium can result in skin friction reduction for the flow in the channel. In the homogenization approach followed here, the flow is not resolved in the porous layer, but an effective velocity boundary condition is developed (and later enforced) at a virtual interface between the porous bed and the channel flow. The condition is valid up to order two in terms of a small gauge factor, the ratio of microscopic to macroscopic length scales; it contains slip coefficients, plus surface and bulk permeability coefficients, which arise from the solution of microscale problems solved in a representative elementary volume. Using the effective boundary conditions, free of empirical parameters, direct numerical simulations are then performed in the channel, considering a few different porous substrates. The results, examined in terms of mean values and turbulence statistics, demonstrate the drag-reducing effects of porous substrates with streamwise-preferential alignment of the solid grains

Comparative analysis of regulatory elements in different germin-like protein gene promoters

Germin and germin-like proteins (GLPs) the members of cupin superfamily of proteins, which are functionally most diverse proteins. Germin and GLPs have some unique features as they are highly resistant to proteases and to degradation by heat, high pH and detergents like Sodium dodecylSulphate (SDS). They are water soluble extracellular enzymatic protein that may also have Oxalate Oxidase (OxO), Superoxide dismutase (SOD) or ADP-glucose pyrophosphate or phosphodiestrase (AGPPase) activities. At the moment seven GLP gene promoter from different organisms have been studied and published. These all promoter sequences have been analyzed in this study. It was observed that these promoters have important regulatory elements, which are involved in various important functions. These elements have been compared on the basis of location, copy number, and distributed on positive and negative strands. It was also observed that some of these elements are common and remained conserved among all GLP promoters during evolution. Such regulatory elements are commonly observed in seed storage proteins, dehydration in response to light, senescence observed on exposure to dark and in elements specific for expression in pollen. Moreover, these commonelements are reported to be expressed under environmental stresses (salt and pathogen attack) and to growth regulators