Market surveys and social media provide confirmation of the endangered giant freshwater whipray Urogymnus polylepis in Myanmar

The giant freshwater whipray Urogymnus polylepis is a threatened species that is vulnerable to riverine and coastal marine pressures. Despite its threatened status, the range of U. polylepis is still being determined. In this study, photographic evidence of U. polylepis in Myanmar was provided through market surveys (2017-2018) and social media (Sharks and Rays of Rakhine Facebook page, 2021). Urogymnus polylepis is exposed to fisheries and habitat degradation pressures in Myanmar; therefore, conservation management is likely needed to ensure populations persist into the future

Evaluation of Tropical Herbaceous Legumes for Drought Resistance in Myanmar

Animal nutrition systems in the tropical and subtropical countries utilize a wide range of feedstuffs, mainly the crops and agricultural by-products, grasses, legumes, trees and shrubs. During the dry season, the crude protein concentration in the native grasses can drop below 3% crude protein (Atta-Krah and Reynolds, 1989). Fodder tree is not sufficient and is of low quality in Myanmar (Myo and Aye, 2007). Shrubs represent an enormous potential source of protein for ruminants in the tropics (Devendra, 1992). Browses are rich in nitrogen and minerals which are low in other conventional feeds of tropical regions. Herbaceous legume species play an important role in feeding ruminants worldwide. Herbaceous forage legume have been identified as potential protein supplements for ruminants since they contain high crude protein, minerals and vitamins needed for the growth of ruminal microbes (Norton and Poppi,1995). Herbaceous legumes can be grown as a relay within cereal crops or as a rotation with cereals. Herbaceous legumes can access ‎atmospheric ‎N‎ (‘fixation’)‎ through‎ bacterial‎ activity‎ in‎ root ‎nodules.‎ The‎ ‘fixed’ ‎N‎ becomes‎ available ‎to‎ the‎ legume and subsequent cereal crops. Herbaceous legumes are best planted from seed (Nulik et al., 2013). The aim of using herbaceous legumes in cropping systems is to increase animal productivity, particularly live weight gain in animals being prepared for market. Herbaceous legumes may be fed directly to animals as fresh material in the late wet and early dry seasons, with browse or tree legumes retained for later dry season feeding, or stored as hay and fed in the late dry or early wet seasons when the availability and quality of local feed is lower (Nulik et al., 2013). Legume based pastures give high individual animal performance for growth, fattening, reproduction and wool growth. Cattle live weight gain has been related positively to the proportion of legume in the sward (Mureithi et al., 1995). As pastures become mature, they are characterized by high content of fibre with a higher grade of lignifications and low protein content (Enoh et al., 2005). In Myanmar there is only 0.35% cultivated pasture area to that of cultivated acreages. The improvement and development of pasture is a necessity for Myanmar (Myo and Aye, 2007). For that reason it is needed to evaluate the yield herbaceous legumes for the potential use for ruminants in Myanmar

Selection of Suitable Varieties of Grasses for Myanmar

The basal feed resources for ruminants available in most developing countries in the tropics are crop residues, pasture from infertile land, for example communal land, or agro-industrial by-products. These are low in protein and of low digestibility. A major problem facing livestock producers in tropical areas is proper nutrition for their animals during the dry season when pastures, cereal residues and maize stover are limiting in nutritional quality. The researchers in Myanmar have tried to improve the nutritive value of fibrous agricultural residues. Aung Aung et al. (2006) supplemented the sesame and chickpea husk to bulls fed on urea-treated rice straw. One way of improving the utilisation of such crop residues is by proper supplementation with leguminous forages (Poppi and McLennan 1995). In most regions of Myanmar, the green forage is available during the rainfall and become shortage during dry season. Therefore, feedstuff for ruminant animals mainly has to depend upon the availability of agricultural by-products. Almost more than half of the livestock population of Myanmar is inhabited in dry zone and thus, to overcome the scarcity of the feedstuff during summer, the irrigation system was introduced in these areas for the development of agriculture. A simple and effective way to increase livestock production is to grow improved pastures. Throughout Myanmar, extensive areas of idle land could grow excellent pasture. At present, most of the “pastures” consist of low rank, poor quality grasses and a limited range of edible shrubs. During prolonged dry periods, grazing animals subsist on dry mature roughage of poor quality (Myo Kywe and Tin Mg Aye, 2007). Grass species, which can rapidly grow after the rain also having drought tolerance, would be very useful in the production system. There is still little information on the use of forage in Myanmar. It is needed to select the grass species which have drought resistance in Myanmar and thus this experiment was conducted to evaluate a range of introduced tropical grasses in the central dry zone of Myanmar

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Diversity in the workplace: an overview of disability employment disclosures among UK firms

People with disabilities (PWD) have been defined as the world’s largest minority group. This societal group continues to face significant barriers to labor market entry and social inclusion. The associated costs to supporting non-working PWDs can be high and long term. Yet, their potential as motivation, contribution and impact to human capital, adaptability, firm productivity and the innovative capacity of business entities is valuable and underutilised. PWD employment is a pressing ‘advanced market’ issue with strong implications on the nature of equitable opportunities, social mobility and diversity in the workplace. A better level of responsiveness by firms is needed to endorse enabling conditions towards broader social sustainability and as impact on PWDs quality of life. This study attempts to assess the quality of corporate reporting disclosure on disability issues by U.K. firms, as a stepping stone for mainstreaming integration of PWDs into labor markets under the scope of corporate social accountability. The information published in 274 sustainability reports highlights trends pertaining to disability employment. We benchmark U.K. sustainability reports against PWD-adapted indicators of the Global Reporting Initiative guidelines. Findings suggest that U.K. corporate disclosures on PWD employment are lacking in key respects, leaving much to be desired, and with plenty of room for improvement in order to clearly set out their commitment in favor of PWD employment. Drawing on these findings, implications for PWD employee policy and practice are outlined

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat