Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal

Background: Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Methods: Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain. Conclusions: Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines

Estimating Demand for Infrastructure in Energy, Transport, Telecommunications, Water, and Sanitation in Asia and the Pacific: 2010-2020

Infrastructure plays a key role in promoting and sustaining rapid economic growth. Properly designed infrastructure can also make growth more inclusive by sharing its benefits with poorer groups and communities, especially by connecting remote areas and small and landlocked countries to major business centers. Even if the Asia-Pacific region has witnessed progress in infrastructure development, the growth of infrastructure lags behind its economic growth, and also behind international standards of infrastructure quantity and quality. Inadequate infrastructure can hamper the potential economic growth of Asian countries, weaken their international competitiveness, and adversely affect their poverty reduction efforts. The circumstances and effects of the recent economic and financial crisis provide a number of reasons to further develop national and regional infrastructure in Asia. Among these reasons is that regional infrastructure enhances competitiveness and productivity, which could help in economic recovery and in sustaining growth in the medium to long-term. Regional infrastructure also helps increase standard of living and reduce poverty by connecting isolated places and people with major economic centers and markets, narrowing the development gap among Asian economies. This paper estimates the need for infrastructure investment, including energy, transport, telecommunications, water, and sanitation during 2010-2020, in order to meet growing demands for services and facilitate further rapid growth in the region. By using top-down and bottom-up approaches, this paper provides a comprehensive estimate of Asia's need for infrastructure services. The estimates show that developing countries in Asia require financing of US$776 billion per year for national (US$747 billion) and regional (US$29 billion) infrastructure during 2010-2020 to meet growing demand

Privaros: A Framework for Privacy-Compliant Delivery Drones

We present Privaros, a framework to enforce privacy policies on drones. Privaros is designed for commercial delivery drones, such as the ones that will likely be used by Amazon Prime Air. Such drones visit a number of host airspaces, each of which may have different privacy requirements. Privaros provides an information flow control framework to enforce the policies of these hosts on the guest delivery drones. The mechanisms in Privaros are built on top of ROS, a middleware popular in many drone platforms. This paper presents the design and implementation of these mechanisms, describes how policies are specified, and shows that Privaros's policy specification can be integrated with India's Digital Sky portal. Our evaluation shows that a drone running Privaros can robustly enforce various privacy policies specified by hosts, and that its core mechanisms only marginally increase communication latency and power consumption

Minsky, Monetary Policy and Mint Street: Challenges for the Art of Monetary Policymaking in Emerging Economies

This paper examines the emerging challenges to the art of monetary policymaking using the case study of the Reserve Bank of India (RBI) in light of developments in the Indian economy during the last decade (2003-04 to 2013-14). The paper uses Hyman P. Minsky's financial instability hypothesis as the conceptual framework for evaluating the endogenous nature of financial instability and its potential impact on monetary policymaking, and addresses the need to pursue regulatory policy as a tool that is complementary to monetary policy in light of the agenda of reforms put forward by Minsky. It further reviews the extensions to the Minskyan hypothesis in the areas of setting fiscal policy, managing cross-border capital flows, and developing financial institutional infrastructure. The lessons learned from the interplay of policy choices in these areas and their impact on monetary policymaking at the RBI are presented

Effect of Improved access to Antiretroviral Therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic, at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania

\ud Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART). In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania. A cross-sectional study looking at baseline characteristics of patients enrolled at the HIV clinic at MNH between June 2004-Dec 2005 compared to those enrolled between 2006 and September 2008. Of all enrolled patients, 2408 (58.5%) were used for analysis. More females than males were attending the clinic. Their baseline median CD4 cell count was low (136 cells/microl) with 65.7% having below 200 cells/microl. Females had higher CD4 cell counts (150 cells/microl) than males (109 cells/microl) p < 0.001). The most common presenting features were skin rash and/or itching (51.6%); progressive weight loss (32.7%) and fever (23.4). Patients enrolled earlier at the clinic (2004-5) were significantly more symptomatic and had significantly lower CD4 cell count (127 cells/microl) compared to CD4 of 167 cells/microl in those seen later (2006-8) (p < 0.001). Patients enrolled to the MNH HIV clinic were predominantly females, and presented with advanced immune-deficiency. Improved access to HIV care and treatment services seems to be associated with patients' early presentation to the clinics in the course of HIV disease.\u

Oxidative DNA damage preventive activity and antioxidant potential of plants used in Unani system of medicine

<p>Abstract</p> <p>Background</p> <p>There is increasing recognition that many of today's diseases are due to the "oxidative stress" that results from an imbalance between the formation and neutralization of reactive molecules such as reactive oxygen species (ROS) and reactive nitrogen species (RNS), which can be removed with antioxidants. The main objective of the present study was to evaluate the antioxidant activity of plants routinely used in the Unani system of medicine. Several plants were screened for radical scavenging activity, and the ten that showed promising results were selected for further evaluation.</p> <p>Methods</p> <p>Methanol (50%) extracts were prepared from ten Unani plants, namely <it>Cleome icosandra, Rosa damascena, Cyperus scariosus, Gardenia gummifera, Abies pindrow, Valeriana wallichii, Holarrhena antidysenterica, Anacyclus pyrethrum, Asphodelus tenuifolius </it>and <it>Cyperus scariosus</it>, and were used to determine their total phenolic, flavonoid and ascorbic acid contents, in vitro scavenging of DPPH^·, ABTS^·+, NO, ^·OH, O₂^.-and ONOO^-, and capacity to prevent oxidative DNA damage. Cytotoxic activity was also determined against the U937 cell line.</p> <p>Results</p> <p>IC₅₀values for scavenging DPPH^·, ABTS^·+, NO, ^·OH, O₂^.-and ONOO^-were in the ranges 0.007 ± 0.0001 - 2.006 ± 0.002 mg/ml, 2.54 ± 0.04 - 156.94 ± 5.28 μg/ml, 152.23 ± 3.51 - 286.59 ± 3.89 μg/ml, 18.23 ± 0.03 - 50.13 ± 0.04 μg/ml, 28.85 ± 0.23 - 537.87 ± 93 μg/ml and 0.532 ± 0.015 - 3.39 ± 0.032 mg/ml, respectively. The total phenolic, flavonoid and ascorbic acid contents were in the ranges 62.89 ± 0.43 - 166.13 ± 0.56 mg gallic acid equivalent (GAE)/g extract, 38.89 ± 0.52 - 172.23 ± 0.08 mg quercetin equivalent (QEE)/g extract and 0.14 ± 0.09 - 0.98 ± 0.21 mg AA/g extract. The activities of the different plant extracts against oxidative DNA damage were in the range 0.13-1.60 μg/ml. Of the ten selected plant extracts studied here, seven - <it>C. icosandra, R. damascena, C. scariosus, G. gummifera, A. pindrow, V. wallichii </it>and <it>H. antidysenterica - </it>showed moderate antioxidant activity. Finally, potentially significant oxidative DNA damage preventive activity and antioxidant activity were noted in three plant extracts: <it>C. icosandra, R. damascena </it>and <it>C. scariosus</it>. These three plant extracts showed no cytotoxic activity against U937 cells.</p> <p>Conclusions</p> <p>The 50% methanolic extracts obtained from different plant parts contained significant amounts of polyphenols with superior antioxidant activity as evidenced by the scavenging of DPPH^·, ABTS^·+, NO, ^·OH, O₂^.-and ONOO^-. <it>C. icosandra, R. damascena </it>and <it>C. scariosus </it>showed significant potential for preventing oxidative DNA damage and radical scavenging activity, and the <it>G. gummifera, A. pindrow, V. wallichii, H. antidysenterica, A. pyrethrum, A. tenuifolius </it>and <it>O. mascula </it>extracts showed moderate activity. The extracts of <it>C. icosandra, R. damascena </it>and <it>C. scariosus </it>showed no cytotoxicity against U937 cells. In conclusion, these routinely used Unani plants, especially <it>C. icosandra, R. damascena </it>and <it>C. scariosus</it>, which are reported to have significant activity against several human ailments, could be exploited as potential sources of natural antioxidants for plant-based pharmaceutical industries.</p

Making subaltern shikaris: histories of the hunted in colonial central India

Academic histories of hunting or shikar in India have almost entirely focused on the sports hunting of British colonists and Indian royalty. This article attempts to balance this elite bias by focusing on the meaning of shikar in the construction of the Gond ‘tribal’ identity in late nineteenth and early twentieth-century colonial central India. Coining the term ‘subaltern shikaris’ to refer to the class of poor, rural hunters, typically ignored in this historiography, the article explores how the British managed to use hunting as a means of state penetration into central India’s forest interior, where they came to regard their Gond forest-dwelling subjects as essentially and eternally primitive hunting tribes. Subaltern shikaris were employed by elite sportsmen and were also paid to hunt in the colonial regime’s vermin eradication programme, which targeted tigers, wolves, bears and other species identified by the state as ‘dangerous beasts’. When offered economic incentives, forest dwellers usually willingly participated in new modes of hunting, even as impact on wildlife rapidly accelerated and became unsustainable. Yet as non-indigenous approaches to nature became normative, there was sometimes also resistance from Gond communities. As overkill accelerated, this led to exclusion of local peoples from natural resources, to their increasing incorporation into dominant political and economic systems, and to the eventual collapse of hunting as a livelihood. All of this raises the question: To what extent were subaltern subjects, like wildlife, ‘the hunted’ in colonial India

Efficient land water management practice and cropping system for increasing water and crop productivity in semi‐arid tropics

In Indian semi-arid tropics (SATs), low water and crop productivity in Vertisols and associated soils are mainly due to poor land management and erratic and low rainfall occurrence. This study was conducted from 2014 to 2016 at the ICRISAT in India to test the effect of broad bed furrows (BBF) as land water management against conventional flatbed planting for improving soil water content (SWC) and water and crop productivity of three cropping systems: sorghum [Sorghum bicolor (L.) Moench]–chickpea (Cicer arientinum L.) and maize (Zea mays)–groundnut (Arachis hypogaea L.) as sequential and pearl millet [Pennisetum glaucum (L.)] + pigeonpea [Cajanus cajan (L.) Millsp.] as intercropping, grown under different nutrients management involving macronutrients (N, P, and K) only and combined application of macro- and micronutrients. The results stated that the SWC in BBF was higher over flatbed by 9.35–10.44% in 0- to 0.3-m, 4.56–9.30% in 0.3- to 0.6-m and 3.85–5.26% in 0.6- to 1.05-m soil depths during the cropping season. Moreover, depletion of the soil water through plant uptake was higher in BBF than in flatbed. Among the cropping systems, sorghum–chickpea was the best in bringing highest system equivalent yield and water productivity with the combined application of macro- and micronutrients. The BBF minimized water stress at critical crop growth stages leading to increase crop yield and water productivity in SATs. Thus, BBF along with the application of macro- and micronutrients could be an adaptation strategy to mitigate erratic rainfall due to climate change in SATs