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Cucumber fruit (Cucumis sativus L.) is believed to have originated from Southern Asia and fourth most important vegetable after tomato, cabbage and onion. The objective is to isolate and identify fungi responsible for rot of cucumber (Cucumis sativus L.) in the study area. Potato dextrose agar was used as growth medium. Three fungal pathogens (Aspergillus flavus, Rhizopus stolonifer and Aspergillus brasiliensis) were identified through pathogenicity test to be causing rot of Cucumber fruit in Jimeta markets (Gwari Market, Jimeta Modern Market and Jimeta Shopping Complex Market), Yola North of Adamawa state. Isolation and identification of pathogens responsible for cucumber fruit rot in Jimeta Markets were carried out, where Rhizopus stolonifera had the highest (25-48%) frequency of occurrence while Aspergillus flavus was the least (22-38%). From the study, it is concluded that Aspergillus brasiliensis, Rhizopus stolonifer and Aspergillus flavus were found out to be the fungal pathogen that caused rot of Cucumber (Cucumis sativus L.) fruit in the study area. The vulnerability of Cucumber fruit to fungal rot is not far from the poor way and manner at which the fruits are conveyed, stored and traded in the study area. It is recommended to farmers and fruit vendors to be conveying perishable fruits in soft bags and stored in cool dry places.

Background This study assessed the impact of the first COVID-19 wave in England on outcomes for acute appendicitis, gallstone disease, intestinal obstruction, diverticular disease, and abdominal wall hernia. Methods Emergency surgical admissions for patients aged 18 years and older to 124 NHS Trust hospitals between January and June in 2019 and 2020 were extracted from Hospital Episode Statistics. The risk of 90-day mortality after admission during weeks 11–19 in 2020 (national lockdown) and 2019 (pre-COVID-19) was estimated using multilevel logistic regression with case-mix adjustment. The primary outcome was all-cause mortality at 90 days. Results There were 12 231 emergency admissions and 564 deaths within 90 days during weeks 11–19 in 2020, compared with 18 428 admissions and 542 deaths in the same interval in 2019. Overall, 90-day mortality was higher in 2020 versus 2019, with an adjusted OR of 1.95 (95 per cent c.i. 0.78 to 4.89) for appendicitis, 2.66 (1.81 to 3.92) for gallstone disease, 1.99 (1.44 to 2.74) for diverticular disease, 1.70 (1.13 to 2.55) for hernia, and 1.22 (1.01 to 1.47) for intestinal obstruction. After emergency surgery, 90-day mortality was higher in 2020 versus 2019 for gallstone disease (OR 3.37, 1.26 to 9.02), diverticular disease (OR 2.35, 1.16 to 4.73), and hernia (OR 2.34, 1.23 to 4.45). For intestinal obstruction, the corresponding OR was 0.91 (0.59 to 1.41). For admissions not leading to emergency surgery, mortality was higher in 2020 versus 2019 for gallstone disease (OR 2.55, 1.67 to 3.88), diverticular disease (1.90, 1.32 to 2.73), and intestinal obstruction (OR 1.30, 1.06 to 1.60). Conclusion Emergency admission was reduced during the first lockdown in England and this was associated with higher 90-day mortality.

AIMS: Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). MATERIALS AND METHODS: Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. RESULTS: Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from

Background Electronic health records (EHRs) offer opportunities for comparative effectiveness research to inform decision making. However, to provide useful evidence, these studies must address confounding and treatment effect heterogeneity according to unmeasured prognostic factors. Local instrumental variable (LIV) methods can help studies address these challenges, but have yet to be applied to EHR data. This article critically examines a LIV approach to evaluate the cost-effectiveness of emergency surgery (ES) for common acute conditions from EHRs. Methods This article uses hospital episodes statistics (HES) data for emergency hospital admissions with acute appendicitis, diverticular disease, and abdominal wall hernia to 175 acute hospitals in England from 2010 to 2019. For each emergency admission, the instrumental variable for ES receipt was each hospital’s ES rate in the year preceding the emergency admission. The LIV approach provided individual-level estimates of the incremental quality-adjusted life-years, costs and net monetary benefit of ES, which were aggregated to the overall population and subpopulations of interest, and contrasted with those from traditional IV and risk-adjustment approaches. Results The study included 268,144 (appendicitis), 138,869 (diverticular disease), and 106,432 (hernia) patients. The instrument was found to be strong and to minimize covariate imbalance. For diverticular disease, the results differed by method; although the traditional approaches reported that, overall, ES was not cost-effective, the LIV approach reported that ES was cost-effective but with wide statistical uncertainty. For all 3 conditions, the LIV approach found heterogeneity in the cost-effectiveness estimates across population subgroups: in particular, ES was not cost-effective for patients with severe levels of frailty. Conclusions EHRs can be combined with LIV methods to provide evidence on the cost-effectiveness of routinely provided interventions, while fully recognizing heterogeneity. Highlights This article addresses the confounding and heterogeneity that arise when assessing the comparative effectiveness from electronic health records (EHR) data, by applying a local instrumental variable (LIV) approach to evaluate the cost-effectiveness of emergency surgery (ES) versus alternative strategies, for patients with common acute conditions (appendicitis, diverticular disease, and abdominal wall hernia). The instrumental variable, the hospital’s tendency to operate, was found to be strongly associated with ES receipt and to minimize imbalances in baseline characteristics between the comparison groups. The LIV approach found that, for each condition, there was heterogeneity in the estimates of cost-effectiveness according to baseline characteristics. The study illustrates how an LIV approach can be applied to EHR data to provide cost-effectiveness estimates that recognize heterogeneity and can be used to inform decision making as well as to generate hypotheses for further research.

Floriculture as a field of science deals with production, use, marketing and management of ornamental plants. This article examines floricultural propagation methods used by florists in the two towns (Jimeta and Yola) that formed Adamawa State capital. A total of 25 florists were purposively selected for the research and face to face interviewed using well-structured questionnaires. A total of 31 ornamentals plants species in the gardens of the florists were considered for the research. Both descriptive and inferential statistics were adopted for analysis of the data collected. The results revealed that florists preferred the use of seeds, stem cutting, rhizoids, tufts, and roots for the propagation of ornamentals. Results of challenges facing florists indicated that water, land to operate, credit facility, high cost of nursery implements, pest and disease control recorded lower confidence of variation in the response spread of the florists which are indications of acute problems. More sensitization on floriculture need be done to attract more women into the business and florists should go for training to improve their skills and organize cooperative groups to seek support from any institution that may be ready to help.

Background Perioperative chemotherapy is widely used in the treatment of oesophageal cancer with substantial survival benefit over surgery alone. However, the postoperative part of these regimens is given in less than half of cases, reflecting uncertainty about its benefit. This study estimates the effect of postoperative chemotherapy after surgery for oesophageal cancer using a large population-based dataset and modern statistical methods. Methods Patients with oesophageal adenocarcinoma diagnosed between 2012 and 2018 and underwent preoperative chemotherapy followed by surgery, were identified from a national level audit in England and Wales (National Oesophagogastric Cancer Audit). Postoperative therapy was defined as the receipt of at least one cycle of systemic chemotherapy within 90 days of surgery. The comparative effectiveness of postoperative chemotherapy compared to observation was estimated using inverse propensity treatment weighting (IPTW). Results The study included 2,814 patients, in whom postoperative therapy was given to 1,054 (37.5%). Patients who received postoperative therapy were younger, with a lower ASA grade and were less likely to have surgical complications of any type, including anastomotic leak (all p Conclusions Among patients with oesophageal adenocarcinoma treated with preoperative chemotherapy and surgery, improved overall survival was observed in those patients who received postoperative chemotherapy. Minimising surgical complications and improving patient fitness could increase the use of postoperative chemotherapy, leading to better outcomes for patients with oesophageal adenocarcinoma.

Background Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. Methods In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. Findings Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. Interpretation Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. Funding British Heart Foundation Data Science Centre, led by Health Data Research UK.

Summary Background Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding National Institute for Health Research Health Services and Delivery Research Programme.

This paper starts with a brief review of scattering statistics theory for diffusely scattered radar signals. Following, global navigation satellite systems reflected (GNSS-R) signals are used to demonstrate the results of non-coherent signal averaging on the mean and standard deviation of the signal power fluctuations. The retrieved signal fading statistics of GNSS-R signals detected in low Earth orbit have been analyzed as a function of consecutive uncorrelated measurements (or looks) and instrument antenna gain and compared to the theoretical description presented by Ulaby, Moore and Fung for a radar remote sensing configuration. The results of this analysis include empirically determined error distributions that provide a reference to asses the potential accuracy of GNSS-R model based retrieval methods, and to what extent increasing the instrument antenna gain will improve the retrieval accuracy. Additionally, in assessing the potential of using GNSS-R signals for ocean remote sensing, it is useful to compare the signal characteristics with those of existing radar altimeter instruments. With this in mind, a fitting accuracy and parameter retrieval analysis has been undertaken using observed fading noise from successful space based altimeters. The noise observed on real waveforms has been added to a simulated ideal waveform with the intent to study the accuracy of ocean observables using a Monte Carlo simulation. By adding observed noise to ideal model waveforms in this way, it is possible to quantitatively asses the fitting errors with respect to noise variance contained in the least-squares model fitting sensing technique. Finally, the key differences between the traditional approach and the GNSS-R approach are then analyzed with regard to identifying the critical adjustments required in using GNSS-R signals for ocean remote sensing.

Rossby waves are difficult to detect with in situ methods. However, as we show in this paper, they can be clearly identified in multi-parameters in multi-mission satellite observations of sea surface height (SSH), sea surface temperature (SST) and ocean color observations of chlorophyll-a (chl-a), as well as 1/12° global HYbrid Coordinate Ocean Model (HYCOM) simulations of SSH, SST and sea surface salinity (SSS) in the Indian Ocean. While the surface structure of Rossby waves can be elucidated from comparisons of the signal in different sea surface parameters, models are needed to gain direct information about how these waves affect the ocean at depth. The first three baroclinic modes of the Rossby waves are inferred from the Fast Fourier Transform (FFT), and two-dimensional Radon Transform (2D RT). At many latitudes the first and second baroclinic mode Rossby wave phase speeds from satellite observations and model parameters are identified. Wavelet transforms of these multi-parameters from satellite observations and model simulations help to discriminate between the annual and semi-annual signal of these Rossby waves. This comprehensive study reveals that the surface signature of Rossby waves in SSS anomalies is likely to be between 0.05 and 0.3 psu in the South Indian Ocean.

Numerical models are used to test whether the sea surface height (SSH) can be used as an indicator for the variability of Atlantic meridional oceanic mass transports. The results suggest that if the transports over the western boundary current region and those in the eastern part of the basin are considered separately, significant correlations (0.3–0.9) are found between zonal SSH differences and the meridional transports in the top 1100 m. Much weaker correlations are found for the basinwide transport, which corresponds to the surface branch of the meridional overturning circulation (MOC). For the eastern and western branches of the meridional transport, combining the SSH signal with the baroclinic structure obtained from Rossby wave theory enables calculation of a quantitative estimate of the transport variability in the top 1100 m. The results of the method are less convincing for the variability of the MOC. The reason for this is that even small relative errors in the variability of the eastern and western branches can be large compared with the MOC variability. These errors project onto the sum of the eastern and western transports and therefore onto the surface branch of the MOC. Nevertheless, being able to infer transport anomalies from SSH signals in the eastern and western parts of the Atlantic might prove useful in interpreting MOC observations from the U.K. Natural Environment Research Council Rapid Climate Change (RAPID) mooring array at 26°N, which show a large subannual variability that is mainly due to changes at the western boundary. Transports inferred from the SSH could help to identify the origin of this variability and whether transport anomalies propagate into the western boundary region from the basin interior or from other latitudes.

To examine patterns of care among women with urogenital fistula treated in the English National Health Service (NHS) between 2000 and 2009. To assess whether failure of repair was associated with hospital or surgeon workload.We conducted a retrospective cohort study using data from Hospital Episode Statistics on women undergoing vesicovaginal or urethrovaginal fistula repair between January 2000 and December 2009 in English NHS hospitals. The main outcome measure was the number of fistula repairs and the incidence of re-repair; re-repair rates were stratified by age, NHS trust and consultant team volume.Between 2000 and 2009, 1194 women underwent surgical repair (n = 905) or ileal conduit (n = 289) for urogenital fistula under the care of 490 consultant teams. A total of 281 teams performed only a single index procedure, and only three consultant teams performed a mean of3 per year. The rate of unsuccessful repair was 11.9% (108/905). The rate of re-operation at NHS trusts who performed over 30 procedures over the 10-year study period was 7.4% compared with 13.2% at those undertaking fewer (P = 0.02). A similar difference in re-operations between consultant teams performingor30 procedures did not reach significance (8.4% v 12.7%, P = 0.13).One in nine women required re-operation after surgical repair of a urogenital fistula. Our results lend weight to the argument for a 'minimum workload' for fistula management; given the number of fistulae occurring in England currently, this would best be provided by a network of supra-regional centres.

In the recent Everyone Counts document, NHS England describes its role in helping commissioners to deliver innovation and increase productivity, as well as facilitating patient choice and empowering local clinicians to improve the outcomes of care. To achieve this, their board will oversee the expansion of publicly available information on the outcomes of healthcare. The NHS Outcomes Framework will be an important element of this, and commissioners and providers will be expected to make improvements across its various indicators.