38 research outputs found
Impact of adoption of heat-stress tolerant maize hybrid on yield and profitability: Evidence from Terai region of Nepal
Abiotic stresses (drought, heat) are one of the major impediments to enhancing the maize productivity of marginal farmers in the facet of climate change. The present study attempts to investigate the impact of heat-tolerant maize hybrid on yield and income in the Terai region of Nepal. This study uses cross-sectional farm household-level data collected in August 2021 from a randomly selected sample of 404 rural households. We used a doubly robust inverse probability weighted regression adjustment method to obtain reliable impact estimates. Adoption of heat-tolerant hybrid increases yields by 16% and income by 44% in the spring season (a stress condition). Overall, yield increases by 12%, net income by 31%, saving of 40% in seed costs, and per capita food expenditure increases by 8.50%. Hence a conducive environment must be created for scaling up heat-tolerant maize varieties to increase productivity, minimize risk, and transform of the maize sector
Critical care bed capacity in Asian countries and regions
Objective: To assess the number of adult critical care beds in Asian countries and regions in relation to population size. Design: Cross-sectional observational study. Setting: Twenty-three Asian countries and regions, covering 92.1% of the continentâs population. Participants: Ten low-income and lower-middleâincome economies, five upper-middleâincome economies, and eight high-income economies according to the World Bank classification. Interventions: Data closest to 2017 on critical care beds, including ICU and intermediate care unit beds, were obtained through multiple means, including government sources, national critical care societies, colleges, or registries, personal contacts, and extrapolation of data. Measurements and Main Results: Cumulatively, there were 3.6 critical care beds per 100,000 population. The median number of critical care beds per 100,000 population per country and region was significantly lower in low- and lower-middleâincome economies (2.3; interquartile range, 1.4â2.7) than in upper-middleâincome economies (4.6; interquartile range, 3.5â15.9) and high-income economies (12.3; interquartile range, 8.1â20.8) (p = 0.001), with a large variation even across countries and regions of the same World Bank income classification. This number was independently predicted by the World Bank income classification on multivariable analysis, and significantly correlated with the number of acute hospital beds per 100,000 population (r2 = 0.19; p = 0.047), the universal health coverage service coverage index (r2 = 0.35; p = 0.003), and the Human Development Index (r2 = 0.40; p = 0.001) on univariable analysis. Conclusions: Critical care bed capacity varies widely across Asia and is significantly lower in low- and lower-middleâincome than in upper-middleâincome and high-income countries and regions
Defining the characteristics and expectations of fluid bolus therapy : A worldwide perspective
Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention. Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L. Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe
Defining the characteristics and expectations of fluid bolus therapy: a worldwide perspective
Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention.
Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT.
Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L.
Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes.Facultad de Ciencias MĂ©dica
Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.
BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions
Observation of gravitational waves from the coalescence of a 2.5â4.5 Mâ compact object and a neutron star
An overview of critical care in cancer patients
Intensivists often refuse admission to cancer patients needing critical
care, which may result in denial of effective care for some deserving
patients. A cancer patient may need admission to intensive care units
for a variety of reasons. The outcomes of patients with hematological
malignancies, previously dismal, have improved over last 10 years. The
previously known indicators of poor outcome are no longer valid in view
of recent advances in intensive care. A select group of patients with
hematological malignancies may be offered aggressive therapy for a
limited duration and then prognosis can be reassessed. Cancer
chemotherapy can produce toxicities affecting all major organ systems.
Such patients may be admitted with acute organ dysfunction or years
afterwards for incidental illnesses. Knowledge of these toxicities is
essential for early diagnosis, management and prognostication in such
patients. The post-surgical cancer patient has unique problems, the
problems of these groups are discussed. The post-surgical cancer
patient may need care ranging from only monitoring; in view of
supra-major surgery in some patients; to fully aggressive intensive
care for post-surgical anastomotic dehiscence, mediastinitis, septic
shock and multiorgan dysfunction in others. The metabolic and
mechanical complications commonly seen in non-surgical cancer patients
are also discussed. Intensive care should be offered to all cancer
patients who have a reasonable chance of cure or palliation of their
disease
Comparative electrocardiographic effects of intravenous ondansetron and granisetron in patients undergoing surgery for carcinoma breast: A prospective single-blind randomised trial
Background: Postoperative nausea and vomiting (PONV) are common and distressing symptoms after surgery performed under general anaesthesia. 5-hydroxytryptamine 3 antagonists are routinely used for prevention and treatment of PONV. The aim of our study was to compare the incidence of QTc prolongation and quantify the amount of QTc prolongation with ondansetron and granisetron. Methods: This prospective, randomised, single-blind study was carried out in the OT and Recovery Room (RR) of a tertiary referral cancer centre. After obtaining Institutional Review Board approval and written informed consent from the patients, 70 patients undergoing elective surgery for carcinoma breast were included. In the RR, patients randomly received 8 mg of ondansetron or 1 mg of granisetron intravenously. Serial ECGs were recorded at various intervals, Non-invasive blood pressure and SpO 2 were also recorded. Chi-square test and Mann-Whiteny test were used for statistical analysis. Results: The demographics were similar in both groups. The incidence of significant QTc prolongation was significantly higher in the ondansetron group (22 of 37 (59.4%) vs. 11 of 33 patients (33.33%) ( P<0.05)). There was an increase in the QTc interval in both the groups as compared to the baseline. The median prolongation in QTc interval from baseline was much more in the ondansetron group; this was statistically significant only at 5 and 15 min. Conclusion: Granisetron may be a safer option than ondanasetron for prevention and treatment of PONV due to lesser prolongation QTc interval. (ClinicalTrials.gov ID: NCT01352130