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Although duodenal injuries are a rare entity of all trauma, they carry high risk of morbidity and mortality. The management of duodenal injuries should encompass a multidisciplinary approach. Optimal operative management of duodenal injuries has evolved in the last few decades. Isolated duodenal injuries are rare due to its proximity to major vascular and organ structures. Immediate mortality from duodenal injuries is due to hemorrhage from major vascular injuries. Non-operative management of isolated low-grade classification of duodenal injuries is accepted with close clinical and laboratory monitoring of patients. When operative management is necessary, recent evidence suggests simple repair over complex reconstructions that carry less morbidity and improved outcomes. When dealing with injuries to the duodenopancreas complex, reconstruction of the pancreaticobiliary system should involve expertise of hepatobiliary surgeons. Management of duodenal injuries and its complications should engage a multidisciplinary approach. Damage control techniques should be utilized in patients in extremis with associated major vascular injuries. Low-grade duodenal injuries may be monitored closely with clinical examinations and laboratory values. When duodenal repair is needed, conservative repair techniques over complex reconstructions should be utilized.

Nitrogen (N) is an essential element of the building blocks of almost all plant structures and a vital component of chlorophyll, enzymes, and proteins. It is used in relatively large amounts than other plant nutrients. Therefore, N has been recognized as the most limiting nutrient in crop production systems. Several transformation processes are involved in the nitrogen cycle. Among them, biological nitrogen fixation is an environmentally friendly natural resource for sustainable agricultural systems. Recently, the reports directed to a decrease in agricultural dependence on symbiotic nitrogen fixation due to abiotic stresses. Therefore, abiotic stresses are a topic that increasingly occupies the attention of the world is still a matter of debate. Although physiological mechanisms are affected in more intense abiotic stresses, most research efforts have focused on the study of these processes. In legume plants being grown under symbiotic conditions, one of the primary effects of abiotic stresses is a decline in the rates of symbiotic nitrogen fixation (SNF). In the present chapter, we summarize our current understanding of the factors that are affected by SNF in legumes. Finally, an overview of the available resources and applications of the physiological system for understanding the complex responses of legumes to abiotic stresses is provided. The overall conclusion was that all physiological mechanisms are important in understanding the regulation of N2 fixation and its response to abiotic stresses.

Drought and heat are the most important abiotic stresses that adversely affect phenology, growth, fiber yield, as well as the quality of cotton across the world. The problem will become more severe in future climate change scenarios because of the frequent occurrence of high temperatures and water shortage. Development of high yielding cotton genotypes, resistant to drought and heat stress, is one of the most important priorities of cotton breeders. Therefore, it is important to evaluate the genotypic performance for heat and drought stress and also important to understand the physiological, biochemical responses to stresses as well as the agronomic performance of the genotypes under stress conditions. The correlation between yield and physiological as well as biochemical (nonenzymatic antioxidants and enzymatic antioxidants) responses of cotton under heat and drought stress conditions is also the most important factor to develop the efficient genotypes that are possible to grow. Whereas, screening of cotton genotypes under heat and drought stress is one of the essential protocols that can be used to select a large number of population within the shortest period. This approach can be used to differentiate the agronomical, physiological, and biochemical attributes of cotton genotypes contrasting for drought and heat stress tolerance. The present review tried to highlight the management strategies that could be useful to mitigate the drought and heat stress by using antioxidant, phytohormone, nutrient management, and other appropriate management strategies for maximizing cotton yield. While, among the compatible antioxidants, exogenous application of proline or glycine betaine is a good option to improve drought and heat tolerance in cotton. Therefore, foliar application of antioxidants in combination with soil-applied organic fertilizers is very effective for reducing the negative effect of drought and heat stress and to increase productivity.

Background Trauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries. Methods A retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013-2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. Statistical comparisons were accomplished using Fisher's exact tests, and parametric two-sample t-tests or non-parametric Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Results: Of the 865 patients with penetrating extremity vascular injuries, 207 had femoral or popliteal artery injuries. Patients with isolated arterial injuries (n=131) had a significantly lower deep venous thrombosis (DVT) rate compared with those with concurrent venous injuries (n=76) (3.1% vs. 13.2%, p=0.008). There were 14 patients in the study who developed DVTs. Among the four patients with isolated femoral or popliteal arterial injuries who had developed DVTs, three had an open repair. Among patients with isolated arterial injuries, those with DVT spend significantly more time on the ventilator (median=2 vs. 0, p=0.0020) compared with patients without DVT. Patients with DVT also had longer stay in the hospital (median=17.5 vs. 8, p=0.0664) and in the ICU (median=3 vs. 1, p=0.0585). Conclusions: Risk of DVT exists in patients with penetrating isolated femoral and popliteal artery trauma. Open repair was associated with significantly higher DVT rates in isolated arterial injuries. Level of evidence: Level IV therapeutic care/management. Published version

Incidence and severity of pests and diseases in cinnamon vary with growth stage. Young leaves at the nursery stage are susceptible to pests and diseases, leading to higher motility rates. Over 70 species of insect pests were reported from cinnamon, but the majority does not cause significant damage in Sri Lanka. Plants from the nursery to the harvesting stage are susceptible to root grubs, thrips, and leaf galls makers (Eriophyes boisi and Trioza cinnamomi). Wood boring moth (Ichneumenoptera cinnamomumi) is most devastating to mature plantation. Rough bark disease (Phomopsis sp.) is the commonest and most destructive disease, while leaf blight (Colletotrichum gloeosporioides) is common at every development stage under wet and humid conditions. White root disease (Rigidoporus microporus) and brown root rot (Phellinus noxius) are very common under dry weather. Vertebrate pests also pose problems, especially in cultivations in close proximity to forests. Integrated pest and disease management strategies, combined with sound agronomical practices and resistant and clean planting material, are required for sustainable cinnamon cultivation. Synthetic pesticide application is not generally recommended in mature plants at or close to the harvesting stage. Endogenous essential oils do not seem to have a role in pest and disease incidence in cinnamon in spite of their antimicrobial and insecticidal properties. Understanding of pests and pathogens is crucial for keeping their populations below economic threshold.

Genetic diversity and population genetic structure of the wild rice species Oryza rufipogon and O. nivara in Sri Lanka were studied using 33 microsatellite markers. A total of 315 individuals of 11 natural populations collected from the wet, intermediate, and dry zones of the country were used in the study. We found a moderate to high level of genetic diversity at the population level, with the polymorphic loci (P) ranging from 60.6% to 100% (average 81.8%) and the expected heterozygosity (H E) varying from 0.294 to 0.481 (average 0.369). A significant genetic differentiation between species and strong genetic structure within species were also observed. Based on species distribution modeling, we detected the dynamics of the preferred habitats for the two species in Sri Lanka and demonstrated that both O. rufipogon and O. nivara populations have expanded substantially since the last internal glacial. In addition, we showed that the geographical distribution of the two species corresponded to the climate zones and identified a few of key environmental variables that contribute to the distribution of the two species, implying the potential mechanism for ecological adaptation of these two species in Sri Lanka. These studies provided important insights into the population genetics and evolution of these wild species in Sri Lanka and are of great significance to the in situ conservation and utilization of these wild resources in genetic improvement of rice.

Wild species of rice (Oryza) have superior agronomic characteristics to be incorporated in rice breeding programs worldwide. Population studies of wild relatives of rice in Sri Lanka has not being well documented despite a few of attempts. In the present study, phenotypic diversity of Oryza rufipogon populations exist in Sri Lanka were characterized based on nine quantitative morphological traits. Populations (P1, P2, P3, P4 and P5) were established in a common-garden and were characterized. The results revealed moderate phenotypic diversity among O. rufipogon populations studied. However, flag leaf length and awn length were the most variable traits while plant height, flag leaf angle, flag leaf panicle neck length and spikelet angle were the least variable traits. O. rufipogon can be simply distinguished using flag leaf length and width, panicle branching type and distance from panicle base to lowest spikelet insertion. The dendrogram results indicated that four main clusters are at a similarity level of 98.73, showing the diversely related populations with a high identity based on higher similarity values. P1 and P2 populations grouped together by forming the first cluster. The second, third and fourth clusters consisted of P3, P5 and P4 populations, respectively. One population from first cluster and P3, P5 and P4 populations can be used for conservation. This study highlights the phenotypic diversity of O. rufipogon populations existing in Sri Lanka across the geographic locations and Knowledge on such morphological diversity provides opportunities to design conservation strategies and the potentials of using particular population based on breeding objectives.

Urinothorax, defined as urine within the pleural space, is an uncommon finding in published trauma literature. To date, there are less than ten recorded cases of non-iatrogenic trauma-induced urinothorax, most resulting from blunt traumatic injuries from motor vehicle collisions. Given the rarity of the condition, the diagnosis is often missed or delayed. Once the diagnosis is suspected, the most reliable finding is a pleural fluid to serum creatinine ratio of >1. A confirmed diagnosis of urinothorax then requires drainage of pleural fluid and management of distal ureteral obstruction. Unfortunately, the added complexity of the poly-trauma patient obscures this difficult diagnosis often leading to a delay in treatment and prolonged hospital stay. No current published literature exists on penetrating trauma as a cause of urinothorax. Here, we describe a unique case of urinothorax in a 32-year-old male as a result of penetrating trauma.

Iodide ion conducting electrolytes are intensively studied as effectual electrolytes for dye-sensitized solar cells (DSSCs). However, the nature and concentration of the counter-ion (cation) in the electrolyte exert a profound influence on the performance of the thin film meso-porous TiO 2 based DSSCs. A series of gel electrolytes containing the alkaline iodides LiI, NaI, KI, RbI and CsI and polyacrylonitrile (PAN) were fabricated together with the non-volatile plasticizers ethylene carbonate (EC) and propylene carbonate (PC). A similar series was fabricated with the inclusions of performance enhancers (additives) tetrapropylammonium iodide (Pr 4 NI), the ionic liquid 1-methyl-3-propyl imidazolium iodide (MPII) and 4-tert-butylpyridine (4TBP). The ionic conductivity of the electrolytes was studied in order to investigate its dependence on the nature of the alkaline cation in presence or absence of additives. The conductivities were higher for the electrolytes with the larger cations, namely K + , Rb + and Cs + . A significant conductivity enhancement was observed in presence of the additives, and this effect was especially noticeable for samples with the smaller cations. The highest conductivity for electrolytes with additives, 3.96 mS cm −1 at 25 °C, is exhibited by KI containing samples.

WOS: 000402838800001 Present investigation was carried out at Natore Sugar Mills area, Natore, Bangladesh during 2014-15 to evaluate the growth and yield responses of hybrid maize varieties under different levels of nitrogen fertilization. Two hybrid maize varieties viz. BARI hybrid maize-7 and BARI hybrid maize-9 were tested under four nitrogen levels (N-0= without external nitrogen supply, N-1= 115 kg N ha(-1) , N-2= 230 kg N ha(-1) , and N-3= 345 kg N ha(-1)). All recommendations agronomic practices were used for both the variety. Yield and yield traits (plant height, plant girth, total leaves plant(-1) , effective leaves plant(-1) , non-effective leaves plant(-1) , total root plant(-1) ,straw weight plant(-1) ,cob length, grain free cob, cob girth, grain line cob(-1) , total grain cob(-1) , grain number line(-1) ,1000-grains weight, grain weight cob(-1) ,grain yield, straw yield and biological yield) were measured during and on the completion of the study. BARI hybrid maize-9 achieved maximum yield (10.99 t ha(-1)) and it was followed by the BARI hybrid maize-7 (10.37 t ha(-1)). Results of study revealed that yield traits and final yield significantly increased with increasing nitrogen fertilizer from 0 to 345 kg ha(-1). Among various tested N-fertilizer doses, highest grain yield was obtained from the plot treated with N-3 treatment (345 kg ha(-1)) but it was not statistically differing from the N-2 treatment (230 kg ha(-1)). Therefore, N-2 treatment (230 kg ha(-1)) could be recommended for variety BARI hybrid maize-9 as the best economical nitrogen level for maximum economical yield of maize.

WOS: 000402838800002 A field experiment was conducted to determine the best irrigation practice for maize crop under subtropical condition of Nature, Bangladesh. For this study, four irrigation conditions (I-0 under rain fed condition i.e. control, I-1-one time irrigation, I-2-two times irrigation and I-3-three times irrigation) and two hybrid verities of maize (BARI hybrid maize-7 and BARI hybrid maize-9) was used to access the effect of irrigation practices on yield and yield parameters of maize crop. Study was conducted at Natore Sugar Mill area, Natore, Bangladesh during Rabi season in 2013-14. All recommended crop production practices were used during the study. Results of the study revealed that irrigation pattern significantly influenced the plant height, plant girth, total leaves plant(-1), effective leaves plant(-1), number of non-effective leaves plant(-1), total roots plant-1, cob length, cob grain free, cob girth, grain line cob(-1), grain no. line(-1), total grains cob(-1), grain weight cob(-1), 1000 grain weight, grain yield (tha(-1)), straw weight plant(1), straw yield (tha(-1)) and biological yield. Further, results of grain yield suggested that application of three times irrigation (13) produced highest grain yield (10.09and 10.21t ha(-1)) in BARI hybrid maize-7 and BARI hybrid maize-9, respectively. Some varietal effect was also reported on almost all the traits and yield related parameters. The BARI hybrid maize-9 achieved better grain production as compared to the BARI hybrid maize-7. Based on the results, full irrigation is the best treatment to achieve the optimum growth and yield of maize.

Genitourinary injuries are infrequent consequences of trauma, but may carry significant morbidity and mortality if not treated and recognized promptly. Genitourinary injuries are seen about 1–5% of all traumas, with 80% of injuries related to the kidney. The majority of genitourinary injuries are related to blunt trauma. While controversies exist on the management of various genitourinary trauma using nonoperative management, we hope to guide the surgeon on the operative management of genitourinary trauma when encountered.

High soil salinity is one of the most important environmental stressors, and is an increasing concern under the alarmingly global climate uncertainties. Salinity affects the growth and productivity of food crops, including rice, and ultimately threatens global food security and sustainability. Conventional breeding efforts to develop salt tolerant rice varieties utilizing its primary gene pool have resulted in limited success due to the mutligenic inheritance of salt tolerance traits. On the other hand, Porteresia coarctata, the only halophyte wild rice, offers tremendous opportunities to improve salt tolerance in rice. However, reports on the characterization of its rich genetic resources are scanty. The present study was undertaken to functionally identify salt responsive genes of P. coarctata in Arabidopsis model using a cDNA overexpression (COX) strategy. COX-mediated hunting of transgenic Arabidopsis expressing a cDNA library of P. coarctata under control of a maize ubiquitin promoter identified 12 candidates that were involved in salt tolerance for seed germination, and seedling and reproductive growth. Of these, four genes coding for a metallothionein, a ribosomal protein, a photosystem II 10 kDa protein, and a ferredoxin:thioredoxin reductase conferred enhanced salt tolerance phenotypes, such as better root and shoot growth, and tissue tolerance by maintaining higher relative water content, membrane stability and protecting cells from reactive oxygen species. These genes could be ideal candidates for improving salt tolerance in rice; however, further studies are needed to ascertain their direct functional relevance in salt tolerance mechanisms. Keywords: cDNA overexpression, Functional screening, halophyte, Porteresia coarctata salinity

Recent trends show reductions in crop productivity worldwide due to severe climatic change. Different abiotic stresses significantly affect the growth and development of plants, leading to decreased crop yields. Salinity and drought stresses are the most common abiotic stresses, especially in arid and semi-arid regions, and are major constraints for barley production. The present review attempts to provide comprehensive information related to barley plant responses and adaptations to drought and salinity stresses, including physiological and agronomic, in order to alleviate the adverse effect of stresses in barley. These stresses reduce assimilation rates, as they decrease stomatal conductance, disrupt photosynthetic pigments, reduce gas exchange, enhance production of reactive oxygen species, and lead to decreased plant growth and productivity. This review focuses on the strategies plants use to respond and adapt to drought and salinity stress. Plants utilize a range of physiological and biochemical mechanisms such as adaptation strategies, through which the adverse effects can be mitigated. These include soil management practices, crop establishment, as well as foliar application of anti-oxidants and growth regulators that maintain an appropriate level of water in the leaves to facilitate adjustment of osmotic and stomatal performance. The present review highlighted the adverse effect of drought and salinity stresses barley and their mitigation strategies for sustainable barley production under changing climate. They review also underscored that exogenous application of different antioxidants could play a significant role in the alleviation of salinity and drought stress in plant systems. © 2007-2019 Southern Cross Publishing-Australia.

The oil of canola (Brassica napus L.), a globally important major oilseed crop, is used for salads, frying, the development of margarines, shortenings, and other food products. However, the growth and yield of canola are mainly restricted by drought and salinity, which can become acute in climate change. The exogenous application of some antioxidants has been shown to enhance tolerance to drought and salinity in select plants. Therefore, a thorough understanding of the effect of drought and salinity stress is crucial for understanding their adverse effect on canola cultivation and to establish useful strategies to maximize oil productivity. Given the economic importance of this crop, we reviewed studies within the extensive canola literature to assess the adverse effects of abiotic stresses, with a special emphasis on drought, water deficit and salinity, and how these stresses impact its growth and productivity in a bid to determine the role that antioxidants might play in alleviating the adverse effects of environmental stresses. This review notes how the productivity of canola tends to decrease under different abiotic stresses due to their adverse effect on morphological, physiological and biochemical processes, including lowered or reduced leaf area, leaf relative water content, stability of cell membranes, photosynthetic capacity, stomatal conductance, damage to chlorophyll and the production of reactive oxygen species. In addition, this review also discusses management strategies that would allow researchers or farmers to mitigate salinity and drought stress by using compatible solutes, nutrient management or other means to maximize canola yield. The application of antioxidants to soil, in combination with essential nutrients, alongside other management strategies, may assist in alleviating the harmful effects of environmental stresses in canola production. © 2007-2019 Southern Cross Publishing-Australia.

Background: Cancer care involves many different healthcare providers. Delayed or inaccurate communication between specialists and general practitioners (GP) may negatively affect care. Aim: To describe the pattern and variation of communication between primary healthcare (PHC) services and hospitals and specialists in relation to the patient's cancer care. Methods: A retrospective audit of clinical records of Indigenous Australians diagnosed with cancer during 2010–2016 identified through 10 PHC services in Queensland is described. Poisson regression was used to model the dichotomous outcome availability of hospital discharge summary versus not. Results: A total of 138 patient records was audited; 115 of those patients visited the PHC service for cancer-related care after cancer diagnosis; 40.0% visited the service before a discharge summary was available, and 36.5% of the patients had no discharge summary in their medical notes. While most discharge summaries noted important information about the patient's cancer, 42.4% lacked details regarding the discharge medications regimen. Conclusions: Deficits in communication and information transfer between specialists and GP may adversely affect patient care. Indigenous Australians are a relatively disadvantaged group that experience poor health outcomes and relatively poor access to care. The low proportion of discharge summaries noting discharge medication regimen is of concern among Indigenous Australians with cancer who have high comorbidity burden and low health literacy. Our findings provide an insight into some of the factors associated with quality of cancer care, and may provide guidance for focus areas for further research and improvement efforts.

To impart sustainability to modern intensive farming systems, environmental pollution caused by nitrogenous fertilizers needs to be reduced by optimizing their doses. To estimate the grain yield and nutrtional quallity of wheat, the normalized difference vegetation index (NDVI) and chlorophyll content (SPAD) are potential screening tools to identify the N deficiency and screen out the promising cultivars. The two-year field study was comprised of five levels of nitrogen (N) (control, 50, 100, 150 and 200 kg N ha-1) and two durum wheat genotypes (Sena and Svevo). The experimental design was split-plot, in which N levels were placed in the main plots, while wheat genotypes were arranged in sub-plots. To predict the yield and quality traits, NDVI and SPAD values recorded at heading, anthesis and milky growth stages were taken as response variables. The results revealed that N fertilization significantly influenced SPAD and NDVI attributed traits of durum wheat, except NDVI at milky stage (NDVI-M) during the first year. The maximum value of NDVI was recorded by 150 kg N ha-1, while control treatment gave the minimum value. The grain yield was increased with the increasing dose of N up to 100 kg N ha-1 (4121 kg ha-1), and thereafter, it was declined with further increased N levels. However, the variation between genotypes was not significant, except NDVI and SPAD values at the milky stage. The genotype Svevo had the highest NDVI values at all growth stages, while the genotype Sena recorded the maximum SPAD values during both years. Similarly, N levels significantly influenced the quality traits (protein, wet gluten, starch test weight and Zeleny sedimentation) of both genotypes. The highly significant relationship of SPAD and NDVI with the grain yield and yield attributes showed their reliability as indicators for determining N deficiency and selection of superior wheat genotypes for ensuring food security under climate change scenario., This research was financially supported by the Sirnak University Research Project Council (Grant Number: 2017.04.09.01).

Background The treatment of non-healing sacral, perineal, or ischial wounds often requires fecal diversion to promote wound healing. The purpose of this study was to identify risk factors for morbidity, rates of colostomy reversal and complications related to type of colostomy. A retrospective chart review was conducted on all patients with non-healing wounds who underwent diverting colostomies. Results Sixty six patients met criteria for inclusion in the study. Complication rates and revision rates were studied. 27% of all stomas required revision. Stoma revision was required in a higher proportion (33%) of all loop colostomies as compared to all end colostomies (10%). During the study period, 26% of diverted patients went on to have a myocutaneous flap. The stoma reversal rate was 5% (3/66). Complications occurred in 32% of patients. The most common complication was parastomal hernia (20%). Other complications included: small bowel obstruction, 8%; stoma prolapse, 6%; stoma bleeding 5%; and stoma retraction, 5%. Patients with loop colostomies had a higher rate of overall complications as compared to end colostomies (37% vs.10%) Conclusions Based on the findings of this study, consideration should be given to fashioning end sigmoid colostomies for fecal diversion in patients with non-healing wounds.

BackgroundTrauma patients with penetrating vascular injuries have a higher rate of venous thromboembolism (VTE). The objective of this study was to determine the risk of VTE formation in penetrating femoral and popliteal vascular injuries and the effects of endovascular management of these injuries.MethodsA retrospective study of Pennsylvania Trauma Outcome Study registry was conducted during a 5-year period (2013–2017). All adult patients with a penetrating mechanism with femoral/popliteal vascular injuries were studied. Primary outcome was incidence of VTE in patients with isolated arterial injuries versus combined arterial/venous injuries. Secondary endpoints were intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. Statistical comparisons were accomplished using Fisher’s exact tests, and parametric two-sample t-tests or non-parametric Wilcoxon rank-sum tests for categorical and continuous variables, respectively.ResultsOf the 865 patients with penetrating extremity vascular injuries, 207 had femoral or popliteal artery injuries. Patients with isolated arterial injuries (n=131) had a significantly lower deep venous thrombosis (DVT) rate compared with those with concurrent venous injuries (n=76) (3.1% vs. 13.2%, p=0.008). There were 14 patients in the study who developed DVTs. Among the four patients with isolated femoral or popliteal arterial injuries who had developed DVTs, three had an open repair. Among patients with isolated arterial injuries, those with DVT spend significantly more time on the ventilator (median=2 vs. 0, p=0.0020) compared with patients without DVT. Patients with DVT also had longer stay in the hospital (median=17.5 vs. 8, p=0.0664) and in the ICU (median=3 vs. 1, p=0.0585).ConclusionsRisk of DVT exists in patients with penetrating isolated femoral and popliteal artery trauma. Open repair was associated with significantly higher DVT rates in isolated arterial injuries.Level of evidenceLevel IV therapeutic care/management.

The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians.A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator.A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts.The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.

Background: The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. Materials and Methods: All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. Results: Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. Conclusion: Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as “high-risk” patients and treated accordingly.

Genetic diversity and population genetic structure of the wild rice species Oryza rufipogon and O. nivara in Sri Lanka were studied using 33 microsatellite markers. A total of 315 individuals of 11 natural populations collected from the wet, intermediate, and dry zones of the country were used in the study. We found a moderate to high level of genetic diversity at the population level, with the polymorphic loci (P) ranging from 60.6% to 100% (average 81.8%) and the expected heterozygosity (H E) varying from 0.294 to 0.481 (average 0.369). A significant genetic differentiation between species and strong genetic structure within species were also observed. Based on species distribution modeling, we detected the dynamics of the preferred habitats for the two species in Sri Lanka and demonstrated that both O. rufipogon and O. nivara populations have expanded substantially since the last internal glacial. In addition, we showed that the geographical distribution of the two species corresponded to the climate zones and identified a few of key environmental variables that contribute to the distribution of the two species, implying the potential mechanism for ecological adaptation of these two species in Sri Lanka. These studies provided important insights into the population genetics and evolution of these wild species in Sri Lanka and are of great significance to the in situ conservation and utilization of these wild resources in genetic improvement of rice.

Significance Current research linking biodiversity and human diets has used metrics without justification from a nutritional point of view. Diet species richness, or a count of the number of different species consumed per day, assesses both nutritional adequacy and food biodiversity of diets for women and children in rural areas. The positive association of food species richness with dietary quality was observed in both the wet and the dry season. Food biodiversity contributes to diet quality in vulnerable populations in areas with high biodiversity. Reporting the number of species consumed during dietary assessment provides a unique opportunity to cut across two critical dimensions of sustainable development—human and environmental health—and complements existing indicators for healthy and sustainable diets., Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which

The field of trauma and critical care has been gaining momentum in the last few decades in terms of dynamic changes in practice, scope of practice, and its popularity among young surgeons to enter the field. It is important to gain insight on its history and its evolving scope of practice before making a decision to enter the field. Application and interview process has become easier in the last few years with easy access to fellowship program information. It is important to choose a fellowship based on the needs of the surgeon entering the field.

The interview process is an important aspect of the job search. The interview provides you the opportunity to familiarize yourself with the prospective employer, hospital, practice, and partners. It also allows you to showcase your credentials and professionalism. The interview is an opportunity to attempt to grasp the feel of the prospective job and see if it fits your needs and expectations.

WOS: 000427886100002 Water stress has a significant effect on yield and quality of soybean through negatively influencing seedling establishment, growth, phenology and finally yield of soybean. The enhancement of soybean productivity and quality against water stress, application of proline, glycine betaine and soil application of compost play a vital role for improving the physiological processes. The current review highlights the physiological responses of soybean during various growth stages under water stress. Additionally, the review evaluates the mitigation mechanism of the adverse of water deficit stress on soybean through exogenous application of osmoprotectants as well as soil application of organic amendments. The study also tried to summarize the current understandings of exogenous application of osmoprotectants such asproline and glycine betaine, and soil amendments that could be used to minimize the harmful effect of water stress on seed yield and quality of soybean.

An intercropping experiment was conducted with varying combinations of turmeric and mung bean to find out the efficacy of productivity and economic return through competition functions. Treatments were evaluated on the basis of several competition functions, such as land equivalent ratio (LER), aggressiveness, competitive ratio (CR), monetary advantage index (MAI) and system productivity index (SPI). Results showed that rhizome yields of turmeric were higher in intercropping system than in mono crop. It indicated that intercropping of mung bean did not affect the rhizome yield of turmeric. However, turmeric (100 %) + 3 row mung bean (100 %) in between turmeric lines intercropping system exhibited maximum yield of both the crops as well as turmeric equivalent yield, LER, competitive indices values, SPI and MAI (Tk. 2,44,734.46 ha-1) compared to the other intercropping combinations and the mono crops. Aggressiveness of intercrop indicated dominance of turmeric over mung bean in all the combinations except turmeric (100 %) + 1 row mung bean (33 %). Competition functions of intercroping suggested beneficial association of turmeric and mung bean crops. The study revealed that mung bean could be introduced as intercrop with turmeric without hampering rhizome yield with higher benefit additionally increasing mung bean production area.

After your formal training, the next step in your successful career is to become a fellow of the American College of Surgeons (FACS) or a fellow of the American College of Osteopathic Surgeons (FACOS). There are many criteria that must be met.