A cluster-randomised trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country

OBJECTIVE: To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS: Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomised trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS: Enrollment began on 25.09.2017 and was complete by 24.07.2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomised to either home- or clinic-care. Home-care recepients were more likely to have used up their monthly-dispensed epilepsy medicine stock (Regression Coefficient: 0.585; 95% Confidence Intervals, 0.289 to 0.881; P=0.001) and had fewer seizures (Regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P=0.002). More people from clinic-care (n=44; 37%) than home-care (n=23; 19%) exited the trial (P=0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE: Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap

Conservation Agriculture and Scale of Appropriate Agricultural Mechanization in Smallholder Systems

This manual has focused on the need to amplify and accelerate adoption of conservation agriculture (CA) practices that enable productivity increases on a sustainable basis. The development of the training manual on ‘Conservation Agriculture and Scale Appropriate Agricultural Mechanization in Smallholder Systems’ is an outcome of the series of advanced training programs on Conservation Agriculture over past one decade. The objectives of this training manual are; (1) To foster capacity building of researchers, extension workers, farmers and machinery manufacturers to promote CA in Asia and Africa; and (2) To raise the awareness of policy planners and decision makers to develop a strategic plan for the development of CA and agricultural mechanization in the developing world. There are several initiatives in South Asia and Africa to promote CA practices as environment-friendly and alternative to conventional agriculture. However, little has been done to document the CA practices or even lessons learnt from these initiatives. Farmers today still lack access to information on CA practices. This is a comprehensive manual that explains in a step by step easy to follow manner on how to implement CA by smallholders in Asia and Africa. It explains what CA is, and why it is important, how to use CA principles in the field and highlights the issues and challenges that researchers, farmers, machinery manufacturers and service providers may encounter when they adopt and adapt CA practices. This manual aims to be a valuable reference and is intended for use by researchers, agricultural extension officers/workers, farmers, machinery manufacturers and service providers to promote CA in Asia and Africa for increasing productivity and reducing poverty. It is written in clear, easy-to-understand language, and is illustrated with numerous figures and tables. It is not intended to cover the subject of conservation agriculture comprehensively but to provide an overview of the principles and practices. Indeed, as the training draws from many distinct disciplines, it is unlikely that any one person will have the necessary technical skills to cover the complete course content. Manual also focuses on two crucial aspects: the provision of farm mechanization services as a viable business opportunity for entrepreneurs, and the essential criteria of raising productivity in an environmentally sensitive and responsible way. This manual is also designed to serve as source of information for custom hire service providers – whether already in the business or intending to start their own hire service business – with skills and competencies in both the technical and the management aspects of the small-scale mechanization business. CA to reach smallholder farmers needed the publication of simplified technical manual. This manual contains useful technical information on CA practices that offer practical answers to questions normally asked by farmers of what, why, how

Modelling organic carbon turnover in salt-affected soils.

Salinity and sodicity are major constraints for crop production in arid and semi-arid regions of the world. Salt-affected soils cover 6.5% of the total land area of the world. Since the global soil carbon (C) pool is greater than the atmospheric and biotic pool combined, changes in soil organic matter content will affect atmospheric carbon dioxide (CO₂) concentration. Therefore it is important to understand soil organic carbon (SOC) dynamics. Soil organic carbon models, which have been successfully validated for non-saline soils, are important for estimation of past and future SOC contents and for evaluating management effects on SOC. However, it was unclear if they accurately predict CO₂ emission/SOC stocks in salt-affected soils. In this work, an integrated approach using remote sensing, incubation experiments, modelling and geographical information system was used to simulate SOC dynamics in salt-affected soils at field and regional scale in the past, present and the future. Satellite imagery was used to map soil salinity and select soil sampling sites in two climatically distinct regions which also differ in cause of salinity: Kadina, South Australia and Muktsar district (Punjab), India. High resolution multispectral satellite imagery (Quick bird, spatial resolution 0.6 m) was used to map salinity (~1:10000 scale) in an agricultural area around Kadina, South Australia where salinity associated with ground water or an impermeable subsoil is wide-spread. Resourcesat-I (spatial resolution 23.5 m) was used for mapping salinity on a 1:50000 scale in Muktsar (Punjab), India where salinity is induced by irrigation. Unsupervised classification of the Quick bird imagery (September, 2008) covering the study area in South Australia (hereafter called Australia) allowed differentiation of severity levels of salt-affected soils, but these levels did not match those based on electrical conductivity (EC) and sodium adsorption ratio (SAR) measurements of the soil samples, primarily because the expression of salinity was strongly influenced by paddock-level variations in crop type, growth and prior land management. Segmentation of the whole image into 450 paddocks and unsupervised classification using a paddock-by-paddock-approach resulted in a more accurate discrimination of salinity with image derived salinity classes correlated with EC but not with SAR. For the Indian site (hereafter called India), Resourcesat-I LISS-III data of April 2005, October 2005 and February 2006 was visually interpreted for variation in spectral properties. The map of salt-affected soils was generated after integration of ground and laboratory data with delineated land use units from the satellite data. On the basis of land use and soil types, 120 (59 saltaffected and 61 non-salt-affected) and 160 (70-salt-affected and 90-non-salt-affected) soils were collected from 0-0.30 m depth from the Indian and Australian sites, respectively. Salt-affected soils occur in dry climates and often contain calcium carbonate (CaCO₃) particularly at pH > 7.5. Therefore, using CO₂ emission as a measure of microbial activity and SOC decomposition in these soils is problematic, but an experiment involving addition of 2% wheat residues and varying the rate of calcium carbonate added to a non-calcareous soil showed that CO₂ emission from salt-affected soils was not affected by CaCO₃ addition in the presence of residues. It has been suggested that the salt concentration in the soil solution (osmotic potential) is a better parameter than the EC of a soil suspension to estimate the salinity effect on plant growth. Therefore, an incubation experiment with four soils differing in texture and amended with sodium chloride (NaCl) was conducted to assess the effect of soil texture and osmotic potential (O[subscript]s, calculated from EC and water content) on CO₂ release. The results of this study showed that, compared to saline soils from the field, the decrease in CO₂ release was greater in these soils suggesting that the sudden increase in salinity leads to overestimation of the salinity effect compared to saline soils in the field where salinity increases gradually. The relative decrease in respiration was less when plotted against O[subscript]s than if plotted against EC. To investigate the importance of salinity compared to other soil properties in soils from a salt-affected landscape, CO₂ emission from the soils of India and Australia with a wide range of EC and SAR with 2% (w/w) mature wheat residue was measured over 120 days at constant temperature and soil water content. Cumulative CO₂ emission from unamended and amended soils was related to soil properties by stepwise regression models. Carbon dioxide release in salt-affected landscapes is affected by EC, C availability (size of C pools) and clay content. Electrical conductivity had a negative impact on CO₂ release in soils of India and Australia, which shows the universal effect of salinity on CO₂ release, irrespective of climate and origin of salinity. Therefore, there is a need to add a decomposition rate modifier for salinity in the SOC models for accurate prediction of SOC dynamics and CO₂ release from salt-affected soils. The Rothamsted Carbon Model (RothC) was modified to take into account the reduced plant inputs into salt-affected soils. Plant inputs were calculated based on a generalised equation from the literature. The decomposition rate modifier for saltaffected soils was based on the comparison of measured and modelled CO₂ emissions from wheat residue amended soils of India and Australia. The modelled CO₂ emissions were higher than measured CO₂ emissions. In order to match the measured and modelled CO₂ emissions, rate modifiers ranging from 0.2-1 were introduced in the model. After accounting for the laboratory effect due to soil disturbance, the impact of salinity (calculated using O[subscript]s) or sodicity (measured as SAR) on the rate of decomposition was calculated. A significant positive relationship was found between decomposition rate modifier and O[subdcript]s whereas SAR had no effect. Therefore, a decomposition rate modifier due to salinity (as a function of O[subscript]s) was introduced into RothC. The RothC with the plant input modifier and decomposition rate modifier was used to estimate past SOC content when saline soils were non-saline and future SOC content. These simulations were performed for the Indian and Australian sites. The results showed that the modelled past SOC when the soils were non-saline was higher than measured SOC of saline soils; thus these soils have lost SOC (31 t ha⁻¹ for India and 55 t ha⁻¹ for Australia). On the other hand, simulations with the decomposition rate modifier only, without taking into account the reduced plant input, suggest that SOC of saline soils has increased since they became saline. Since SOC in saline soils is lower than in non-saline soils, this shows that in order to accurately model SOC stocks in saline soils, both reduced plant inputs and reduced decomposition rate have to be taken into account. Overall SOC content was more strongly affected by reduced plant inputs than by reduced decomposition rates. In addition, future SOC stocks of India and Australia were simulated with and without modifiers from 2009-2100. In saline soils of both regions, the simulation of SOC without modifiers showed that, compared to the present SOC content, SOC would decrease by ≤15% by the year 2100, whereas simulations with decomposition rate modifier and plant input modifier indicate that SOC would decrease by 39% for the Indian site and by 29% for the Australian site. The key findings from the research are: I. High resolution multispectral imagery with paddock-by-paddock approach allowed accurate mapping of different levels of salinity severity. II. In saline soils, osmotic potential is a better measure to assess the impact of salt on microbial activity than EC, particularly when comparing soils of different texture. III. In soils from salt-affected landscapes, salinity and reduced carbon availability determine CO₂ emission. IV. Two novel approaches were developed: (a) calculation of a decomposition rate modifier from incubation experiments after taking into account the laboratory effect and (b) calculation of past SOC content when saline soils were nonsaline. V. The predictions of SOC stocks from saline soils have been overestimated by not taking into account the negative effect of salt on decomposition rate and plant inputs. VI. For realistic modelling of SOC stocks and turnover in saline soils, both reduced decomposition rate and reduced plant inputs need to be considered.Thesis (Ph.D.) -- University of Adelaide, School of Agriculture, Food and Wine, 201

Influence of land use/land cover changes on surface temperature and its effect on crop yield in different agro-climatic regions of Indian Punjab

Land surface temperature (LST) is an important indicator of the earth’s environmental analysis which is significantly affected by changes in land use/land cover (LULC). The Landsat 5, 7 and 8 satellite data of January and September of the years 1991, 2001, 2011 and 2016 was used to study the impact of LULC changes on LST and its effect on crop yield (rice and wheat) in SBS Nagar, Ludhiana and Bathinda districts representing three different agro-climatic zones of Punjab (India). The Landsat satellite imageries were classified for the major LULC classes (water, vegetation [including agriculture and forest], built-up and bare soil) in each district using different spectral indices. The results showed that vegetation is the key land provider for built-up development in SBS Nagar and Ludhiana districts, whereas bare soil and water bodies were the main contributor of land for expansion of built-up and vegetation over the years in Bathinda district. Compared with 1991, the surface temperature of all the land cover features has increased over the years and the increase in temperature was higher for built-up features. Among different districts, the rate of increase was highest in Ludhiana district due to higher urban sprawl. The increase in temperature was higher in the direction where land use has been changed from agriculture, bare soil and forest to urban. The air temperature in agro-climatic regions of Punjab can be estimated from LST by multiplying it with a factor of 0.86. Normalized difference vegetation index (NDVI) was significantly positively correlated with rice and wheat yield, but significantly negatively correlated with LST. It is concluded that there is potential link between LULC and crop yield via impacts on horizontal surface temperature gradients which can be differentiated from Landsat data

Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury

【Abstract】Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow. Key words: Isolated trochlea fracture; Clavicle; Radius fracture

A Comparison Of Secondary Polycythemia In Hypogonadal Men Treated With Clomiphene Citrate Versus Testosterone Replacement: A Multi-Institutional Study

Purpose We evaluated the relative prevalence of secondary polycythemia in hypogonadal men treated with clomiphene citrate or testosterone replacement therapy. Materials and Methods In this retrospective, multi-institutional study, we included 188 men who received clomiphene citrate and 175 who received testosterone replacement therapy with symptomatic hypogonadism. The overall prevalence and ORs of secondary polycythemia for clomiphene citrate treatment vs testosterone replacement were primarily measured, as were baseline characteristics. Subset analysis included polycythemia rates for different types of testosterone replacement therapy. Results Overall, men on testosterone replacement therapy were older than clomiphene citrate treated men (age 51.5 vs 38 years). Men on testosterone replacement had longer treatment duration than clomiphene citrate treated men (19.6 vs 9.2 months). For testosterone replacement therapy and clomiphene citrate the mean change in hematocrit was 3.0% and 0.6%, and the mean change in serum testosterone was 333.1 and 367.6 ng/dl, respectively. The prevalence of polycythemia in men on testosterone replacement was 11.2% vs 1.7% in men on clomiphene citrate (p = 0.0003). This significance remained on logistic regression after correcting for age, site, smoking history and pretreatment hematocrit. Conclusions The prevalence of polycythemia in men treated with clomiphene citrate was markedly lower than that in men on testosterone replacement therapy. The improvement in absolute serum testosterone levels was similar to that in men on testosterone replacement. There is no significant risk of polycythemia in men treated with clomiphene citrate for hypogonadism

Simulation of Salinity Effects on Past, Present, and Future Soil Organic Carbon Stocks

Soil organic carbon (SOC) models are used to predict changes in SOC stocks and carbon dioxide (CO₂) emissions from soils, and have been successfully validated for non-saline soils. However, SOC models have not been developed to simulate SOC turnover in saline soils. Due to the large extent of salt-affected areas in the world, it is important to correctly predict SOC dynamics in salt-affected soils. To close this knowledge gap, we modified the Rothamsted Carbon Model (RothC) to simulate SOC turnover in salt-affected soils, using data from non-salt-affected and salt-affected soils in two agricultural regions in India (120 soils) and in Australia (160 soils). Recently we developed a decomposition rate modifier based on an incubation study of a subset of these soils. In the present study, we introduce a new method to estimate the past losses of SOC due to salinity and show how salinity affects future SOC stocks on a regional scale. Because salinity decreases decomposition rates, simulations using the decomposition rate modifier for salinity suggest an accumulation of SOC. However, if the plant inputs are also adjusted to reflect reduced plant growth under saline conditions, the simulations show a significant loss of soil carbon in the past due to salinization, with a higher average loss of SOC in Australian soils (55 t C ha^–1) than in Indian soils (31 t C ha^–1). There was a significant negative correlation (<i>p</i> < 0.05) between SOC loss and osmotic potential. Simulations of future SOC stocks with the decomposition rate modifier and the plant input modifier indicate a greater decrease in SOC in saline than in non-saline soils under future climate. The simulations of past losses of SOC due to salinity were repeated using either measured charcoal-C or the inert organic matter predicted by the Falloon et al. equation to determine how much deviation from the Falloon et al. equation affects the amount of plant inputs generated by the model for the soils used in this study. Both sets of results suggest that saline soils have lost carbon and will continue to lose carbon under future climate. This demonstrates the importance of both reduced decomposition and reduced plant input in simulations of future changes in SOC stocks in saline soils

Short-term carbon mineralization in saline–sodic soils

Previous studies have shown that carbon (C) mineralization in saline or sodic soils is affected by various factors including organic C content, salt concentration and water content in saline soils and soil structure in sodic soils, but there is little information about which soil properties control carbon dioxide (CO2) emission from saline-sodic soils. In this study, eight field-collected saline–sodic soils, varying in electrical conductivity (ECe, a measure of salinity, ranging from 3 to 262 dS m−1) and sodium adsorption ratio (SARe, a measure of sodicity, ranging from 11 to 62), were left unamended or amended with mature wheat or vetch residues (2% w/w). Carbon dioxide release was measured over 42 days at constant temperature and soil water content. Cumulative respiration expressed per gram SOC increased in the following order: unamended soil<soil amended with wheat residues (C/N ratio 122)<soil with vetch residue (C/N ratio 18). Cumulative respiration was significantly (p < 0.05) negatively correlated with ECe but not with SARe. Our results show that the response to ECe and SARe of the microbial community activated by addition of organic C does not differ from that of the less active microbial community in unamended soils and that salinity is the main influential factor for C mineralization in saline–sodic soils.Raj Setia, Deepika Setia, Petra Marschne