Search

Background The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. Methods A modified Delphi process was overseen by the OGAA committee, national leads, and engaged clinicians from high-income countries (HICs) and low/middle-income countries (LMICs). A three-stage iterative process was used to prioritize research topics, including a scoping systematic review (stage 1), and two rounds of anonymous electronic voting (stages 2 and 3) addressing research priority and ability to recruit. Stratified analyses were performed by country income. Results In stage 1, the steering committee proposed research topics across six domains: preoperative optimization, surgical oncology, technical approach, anastomotic technique, enhanced recovery and nutrition, and management of leaks. In stages 2 and stage 3, 192 and 171 respondents respectively participated in online voting. Prioritized research topics include prehabilitation, anastomotic technique, and timing of surgery after neoadjuvant chemo(radio)therapy. Stratified analyses by country income demonstrated no significant differences in research priorities between HICs and LMICs. However, for ability to recruit, there were significant differences between LMICs and HICs for themes related to the technical approach (minimally invasive, width of gastric tube, ischaemic preconditioning) and location of the anastomosis. Conclusion Several areas of research priority are consistent across LMICs and HICs, but discrepancies in ability to recruit by country income will inform future study design.

Background Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim of this study was to develop a core outcome set (COS)—a standardized group of outcomes important to key international stakeholders—that should be reported by future trials in this field. Methods Stage 1 of the study involved identifying potentially important outcomes from previous trials and a series of patient interviews. Stage 2 involved patients and healthcare professionals prioritizing outcomes using a multilanguage international Delphi survey that informed an international consensus meeting at which the COS was finalized. Results Some 498 outcomes were identified from previously reported trials and patient interviews, and rationalized into 56 items presented in the Delphi survey. A total of 952 patients, surgeons, and nurses enrolled in round 1 of the survey, and 662 (70 per cent) completed round 2. Following the consensus meeting, eight outcomes were included in the COS: disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and ‘serious’ adverse events. Conclusion A COS for surgical trials in gastric cancer has been developed with international patients and healthcare professionals. This is a minimum set of outcomes that is recommended to be used in all future trials in this field to improve trial design and synthesis of evidence.

Technological advancements and internationalisation has changed the dynamics of economic growth. As countries move towards entrepreneurial growth, the traditional large-scale organizations have become obsolete. Instead small and medium enterprises have contributed to the economy through job creation and increasing of exports. Technological start-ups with their lean structure and high growth have contributed to the economy manifold. In this regard Finland is known to have one of the leading start-up eco-systems globally. Health tech start-ups in Finland have contributed to economic growth through their exports and provided the country with an innovative technological base. They have further provided growth through job creation and foreign market penetration. This research is conducted to study the factors that enable a health tech start-up to internationalise and contribute to economic growth in Finland. Entrepreneurial orientation, market driven management, networking and culture are the internal and external factors associated with international entrepreneurship and studied in this research. Data was collected through semi structured interviews from three health tech start-ups in Finland, that have created an international customer base within the first six years of their operations. Results of the study show that entrepreneurial orientation when treated as a collective of its three constructs, innovativeness, risk taking and pro-activeness is an internal factor that enables a start-up to develop competitive advantage and seek international opportunities. Whereas market driven management was found essential for the start-ups to maintain that competitive advantage in international markets. Networking was found to have a significant impact on retention of international opportunities while culture did not seem to drive the international efforts of health tech start-ups.

Resistance evolution in weeds against all major herbicide groups demand investigations to identify various factors responsible for resistance development. Herbicide hormesis has not yet been included in the list of factors promoting the evolution of resistance. Studies were conducted to evaluate the degree of hormesis in fenoxaprop-p-ethyl susceptible and resistant Phalaris minor to provide a first indication of whether hormesis is a potential factor in the development of resistance. In the first experiment, a wide range of doses up to 160% of the recommended field rate was used to identify potential hormetic doses for resistant and susceptible P. minor populations. Doses below 40% have been designated as potential hormetic doses. In the second experiment, ten different doses of fenoxaprop below 40% (0, 2, 4, 8, 12, 16, 20, 24, 28 and 32% of the recommended rate) were sprayed at the 4-5 leaf stage of both resistant and susceptible P. minor populations. At fifteen days after spraying, dose range of 2-12% and 2-20% caused a significant increase (up to 22% and 24%) in growth traits of susceptible and resistant populations, respectively. At maturity, dose range of 2-12% for susceptible and 2-24% for resistant populations caused a significant increase (up to 20% and 57%) in growth and seed production potential (13% and 17%), respectively. The upper limit of the hormetic dose range (16 to 24%) for the resistant population was inhibitory for the susceptible populations. These results indicate that fenoxaprop hormesis could play a vital role in the evolution of fenoxaprop resistance in P. minor. RESUMO: A evolução da resistência de plantas daninhas contra todos os principais grupos de herbicidas requer estudos para que sejam identificados os vários fatores responsáveis pelo desenvolvimento dessa resistência. A hormese de herbicidas ainda não foi incluída na lista de fatores que promovem a evolução da resistência. Foram conduzidos estudos para avaliar o grau de hormese em Phalaris minor suscetível e resistente ao fenoxaprop-p-ethyl, com o propósito de fornecer uma primeira indicação sobre se a hormese é um fator potencial no desenvolvimento da resistência. No primeiro experimento, uma ampla gama de doses de até 160% da dosagem recomendada foi usada para identificar potenciais doses horméticas para populações de P. minor resistentes e suscetíveis. Doses abaixo de 40% foram designadas como potenciais doses horméticas. No segundo experimento, dez doses diferentes de fenoxaprop abaixo de 40% (0, 2, 4, 8, 12, 16, 20, 24, 28 e 32% da dose recomendada) foram pulverizadas no estádio de 4-5 folhas de ambas as populações resistentes e suscetíveis de P. minor. Aos 15 dias após a pulverização, as variações de dose de 2-12% e 2-20% provocaram aumento significativo (até 22% e 24%) nas características de crescimento das populações suscetíveis e resistentes, respectivamente. Na maturidade, as variações na dose de 2-12% para as populações suscetíveis e 2-24% para as resistentes causou aumento significativo (até 20% e 57%) no crescimento e potencial de produção de sementes (13% e 17%), respectivamente. O limite superior de variação na dose hormética (16% a 24%) para a população resistente causou inibição das populações suscetíveis. Esses resultados indicam que a hormese do fenoxaprop poderia desempenhar papel vital na evolução da resistência de P. minor ao fenoxaprop.

Low fertilizer use efficiency due to inappropriate weed control practices is one of the main causes of poor wheat yield worldwide. A 2 year field experiment was conducted to study the effects of three fertilizer levels and four weed control practices on fertilizer use efficiency and nutrient uptake by wheat and its associated weeds. Fertilizer levels were F0 (zero fertilizer), F1 (75 kg ha-1 N + 50 kg ha-1 P2O5), and F2 (150 kg ha-1 N + 100 kg ha-1 P2O5) and weed control included W1 (weedy check), W2 (pendimethalin applied at 1,031 g a.i. ha-1), W3 (isoproturon + carfentrazone ethyl applied at 750 g a.i. ha-1) and W4 (manual weed control). Different weed control practices significantly reduced the NPK uptake by weeds and increased NPK uptake by wheat. Maximum uptake of NPK by wheat and minimum uptake by weeds were recorded in W4. Increasing dose of fertilizer increased NPK uptake by both weeds and wheat. However maximum fertilizer use efficiency and grain yield of wheat were achieved when highest dose of fertilizers (F2) was used along with manual weed control method (W4), which was followed by F2 and W3 during both years. We have come to the conclusion that to achieve higher wheat yield by increasing fertilizer doses, farmers should take appropriate weed control measures. RESUMO: A utilização pouco eficaz de fertilizantes devido a práticas inadequadas de controle de plantas daninhas é uma das principais causas do baixo rendimento do trigo em todo o mundo. Foi realizado um experimento de campo de dois anos para estudar os efeitos de três níveis de fertilizantes e quatro práticas de controle de plantas daninhas, bem como para verificar a eficiência do uso de fertilizantes e a absorção de nutrientes pelo trigo e plantas daninhas associadas. Os níveis de fertilizantes foram: F0 (0), F1 (75 kg ha-1 N + 50 kg ha-1 P2O5) e F2 (150 kg ha-1 N + 100 kg ha-1 P2O5); e as práticas de controle de plantas daninhas foram: W1 (verificação de plantas daninhas), W2 (pendimethalin aplicado a 1.031 g i.a. ha-1), W3 (isoproturon + carfentrazone-ethyl aplicado a 750 g i.a. ha-1) e W4 (controle manual de plantas daninhas). As diferentes práticas de controle de plantas daninhas reduziram significativamente a absorção de NPK por elas e aumentaram a absorção de NPK pelo trigo. A absorção máxima de NPK pelo trigo e a absorção mínima pelas plantas daninhas foram registradas em W4. O aumento da dose do fertilizante intensificou a absorção de NPK tanto pelas plantas daninhas quanto pelo trigo. No entanto, a melhor eficiência de uso de fertilizantes e o maior rendimento de grãos de trigo ocorreram quando foi aplicada a maior dose de fertilizantes (F2) juntamente com a prática de controle manual de plantas daninhas (W4), seguida por F2 e W3, durante os dois anos. Conclui-se que, para aumentar o rendimento do trigo com maiores doses de fertilizantes, os agricultores devem empregar práticas adequadas de controle de plantas daninhas.

Aquatic weeds are higher plants found in the aquatic ecosystem and in anaerobic rice fields, where they have no economic benefits. The continuance of aquatic weeds is more widespread than terrestrial weeds because in aquatic ecosystems there is very little fluctuation in the environmental conditions compared with terrestrial ecosystems. Scientists have been working to address the harmful allelopathic effects of aquatic weeds on the aquatic ecosystem, but limited information is available on the allelopathic influence of aquatic weeds on agro-ecosystems through the release of phytotoxic compounds. Phytotoxic chemicals released by different aquatic weeds into irrigation water and/or directly into rice ecosystems might have a significant inhibitory influence on germination, growth and yield field crops, soil properties and nutrients availability, population and community structure, and weed invasion. However, aquatic weeds might also be used as a potential organic alternative to chemical weed-control, due to the higher susceptibility of terrestrial weeds to the phototoxic chemicals released by aquatic weeds. Natural alternatives to chemical weed control are need of time and are crucial for a sustainable weed control. Chemical weed control is challenged, due to recent increases in herbicides resistance from weeds and to the harmful side-effects of herbicides on the environment. This review is focused on the influence of aquatic weeds on agro-ecosystems, with examples of common weeds in aquatic ecosystems and invasive aquatic weeds found in anaerobic rice. RESUMO As plantas daninhas aquáticas são plantas superiores encontradas no ecossistema aquático e em plantações de arroz anaeróbio, onde não têm vantagens econômicas. A continuidade das plantas daninhas aquáticas é mais difundida do que a das plantas daninhas terrestres, pois nos ecossistemas aquáticos há flutuação muito baixa nas condições ambientais, em comparação com ecossistemas terrestres. Os cientistas têm trabalhado para abordar os efeitos nocivos alelopáticos dessas plantas nos ecossistemas aquáticos, mas há informações limitadas à disposição sobre a influência alelopática das plantas daninhas no ecossistema agrícola através da liberação de compostos fitotóxicos. Os compostos químicos fitotóxicos liberados por diferentes plantas daninhas aquáticas na água de irrigação e/ou diretamente no ecossistema do arroz podem ter significativa influência inibitória na germinação, no crescimento e rendimento das culturas, nas propriedades do solo e na disponibilidade de nutrientes, na estrutura da população e da comunidade e na invasão de plantas daninhas. No entanto, as plantas daninhas aquáticas podem ser usadas como uma potencial alternativa orgânica ao controle químico das plantas infestantes, devido à maior suscetibilidade das plantas daninhas terrestres aos compostos químicos fitotóxicos liberados pelas plantas daninhas aquáticas. Alternativas naturais ao controle químico das infestantes precisam de tempo e são cruciais para um controle sustentável. O controle químico das infestantes é desafiado pelo recente aumento da resistência aos herbicidas nas plantas daninhas e pelos efeitos colaterais nocivos dos herbicidas no ambiente. Esta revisão está focada na influência de plantas daninhas aquáticas em ecossistemas agrícolas, com exemplos de plantas daninhas comuns em ecossistemas aquáticos e plantas daninhas aquáticas invasivas encontradas em arroz anaeróbio.

Thalassaemia is the most frequent hereditary disorder in Pakistan, with an estimated 8-10 million carriers. This single-centre study reported the frequency of haemoglobinopathies among 504 consecutive cases visiting Islamabad Diagnostic Centre for haemoglobin electrophoresis from July 2010 to February 2011. Haemoglobin electrophoresis was performed on cellulose acetate membrane, followed by staining and densitometric scanning of bands. A total of 143 (28.4%) subjects had haemoglobinopathies. The most predominant was thalassaemia trait (25.6%), followed by thalassaemia major (1.4%) and HbS or HbD (1.4%). The gene frequencies for thalassaemia trait and major were 0.256 and 0.0139 respectively. The study provides support for continuing efforts towards early detection and characterization of haemoglobinopathies to control the affected births in Pakistan.

Background: There is a niche for developing an ideal pre-operative scoring system for predicting mortality in patients undergoing colorectal surgery. Biochemistry and Haematology Outcome Models (BHOM) adopt the approach of using a minimum dataset to model outcome following colorectal cancer surgery, a concept previously shown to be feasible after index arterial operations. Methods: Predictive binary logistic regression models (a mortality and morbidity model) were developed on 704 patients who underwent colorectal cancer surgery over a six-year period in a UK district general hospital. The outcome variables measured were 30 day post-operative mortality, and morbidity (defined as major/minor leak, abscess, bleeding or obstruction). Hosmer-Lemeshow goodness of fit statistics and frequency tables compared the predicted versus the reported number of deaths. Discrimination was quantified using the c-index. Results: The dataset consisted of 573 elective cases and 131 non-elective interventional cases. The overall mean predicted risk of death was 7.79% (50 cases). The actual number of reported deaths was also 50 (χ2 = 1.331, d.f.=4, p-value = 0.856; no evidence of lack of fit). For the mortality model, the predictive c-index was = 0.810. The morbidity model had less discriminative power, however, there was no evidence of lack of fit (χ2 = 4.198, d.f.=4, p-value = 0.380, c-index = 0.697). Conclusions: The CR BHOM mortality model suggests good discrimination (c-index >0.8) and uses only a minimal number of variables. However, the model needs to be tested on independent datasets from different geographical locations.