The rise in Climate-Smart Agriculture strategies, policies, partnerships and investments across the globe

Since the term ‘climate-smart agriculture’ (CSA) was coined in 2010, a growth in strategies, policies, partnerships and investments in the area has been observed. Here we have summarised key CSA efforts globally and in South Asia, Southeast Asia, East Africa, West Africa, and Latin America. We have interpreted CSA in the broad sense, including efforts which may not mention CSA but implicitly contribute to CSA pillars. We note that many international and regional organisations, and countries, are implementing policies and programmes promoting and upscaling CSA. While the growth in strategies, policies, partnerships and investments is positive and creates a favourable enabling environment for CSA, these need to be complemented with targeted implementation on the ground, sustainable financing, institutional coordination and metrics to measure the efficacy of interventions

Amaranth: An Ancient and High-Quality Wholesome Crop

Amaranth was a staple of the Aztec diet and is described as a “superfood” in part because of its high protein content and well-balanced amino acid profile. In terms of nutrient content, amaranth surpasses many staple crops such as rice, corn, and wheat. Additionally, lysine content is twice as much than in rice and thrice as much than in corn. Along with desirable agronomic traits, this crop has been hugely applauded for its gluten-free nature. Not only can it benefit vegan and gluten allergy personals, but it also has the potential to supply high-quality proteins and at the same time provides antimicrobial activities in the packaged food items. Despite all of these properties, this crop is still not in the mainstream cultivation practices in North America and in many parts of the world. As the planet is expecting massive increase in human population and global climate change, we firmly believe that this widely distributed, ancient, protein-rich pseudo-cereal has a potential to augment our food system. In this book chapter, we aim to report the nutritional properties of grain amaranth

Analysis of vibratory mode changes in symmetric and asymmetric activation of the canine larynx

Investigations of neuromuscular control of voice production have primarily focused on the roles of muscle activation levels, posture, and stiffness at phonation onset. However, little work has been done investigating the stability of the phonation process in regards to spontaneous changes in vibratory mode of vocal fold oscillation as a function of neuromuscular activation. We evaluated 320 phonatory conditions representing combinations of superior and recurrent laryngeal nerve (SLN and RLN) activations in an in vivo canine model of phonation. At each combination of neuromuscular input, airflow was increased linearly to reach phonation onset and beyond from 300 to 1400 mL/s. High-speed video and acoustic data were recorded during phonation, and spectrograms and glottal-area-based parameters were calculated. Vibratory mode changes were detected based on sudden increases or drops of local fundamental frequency. Mode changes occurred only when SLNs were concurrently stimulated and were more frequent for higher, less asymmetric RLN stimulation. A slight increase in amplitude and cycle length perturbation usually preceded the changes in the vibratory mode. However, no inherent differences between signals with mode changes and signals without were found

Measurement of Cough Aerodynamics in Healthy Adults.

ImportanceCough is a critical human reflex and also among the most frequent symptoms in medicine. Despite the prevalence of disordered cough in laryngeal pathologies, comprehensive and quantitative evaluation of cough in these patients is lacking.ObjectiveHerein we seek to establish normative values for cough aerodynamics to provide a population standard for reference in future studies.Design, setting, and participantsHealthy subjects were recruited from an outpatient clinic to perform voluntary cough. Subjects were instructed on the technique for maximal voluntary cough production with measurements recorded on pneumotachograph. Fifty-two subjects were studied, including 29 women and 23 men with a mean age of 51.6 and 52.3 years, respectively. Main Outcomes and Measures: Cough peak airflow, peak pressure, and expiratory rise time. Results were stratified by age, gender, and height.ResultsPeak airflow demonstrated significant differences across age, gender, and height, with flow increasing according to increasing height. Peak cough pressure also increased with height and was significantly greater in males versus females. Expiratory rise time, the time from glottal opening to peak airflow, did not vary with age or height but was statistically significantly longer in women.ConclusionsCough aerodynamics can be readily measured objectively in the outpatient setting. Expiratory rise time, peak flow, and peak pressure are important aspects of each cough epoch. Normative data provided herein can be used for future studies of patients with laryngotracheal disorders, and these cough parameters may prove to be simple, accessible, and repeatable outcome measures

A Comprehensive and Detailed Within-Host Modeling Study involving crucial Bio markers and Optimal Drug regimen for Lepra Type-I Reaction : A Deterministic Approach

Leprosy (Hansen's disease) is an infectious, neglected tropical disease caused by the Mycobacterium Leprae (M. Leprae). Each year there are approximately 2,02,189 new cases are detected globally. In the year 2017 more than half million people were disabled due to leprosy and almost 50000 new cases are added every year world wide. In leprosy, lepra reactions are the major cause for nerve damage leading to disability. Early detection of lepra reactions through study of biomarkers have important role in prevention of subsequent disabilities. To our knowledge there seems to be very limited literature available on within-host modeling at cellular level involving the crucial biomarkers and the possible optimal drug regimen for leprosy disease and lepra reactions. Motivated by these observations, in this study, we have proposed and analyzed a three dimensional mathematical model to capture the dynamics of susceptible schwann cells, infected schwann cells and the bacterial load based on the pathogenesis of leprosy. We estimated the parameters from various clinical papers to make the model more practical. The sensitivity of couple of parameters was evaluated through PRCC method to find out the single most influential parameter and also combination of two most influential parameters was studied using SRCC method. The sensitivity of other remaining parameters was evaluated using Sobol's index. We then have framed and studied an optimal control problem considering the different medication involved in the Multi Drug Therapy (MDT) as control variables. We further studied this optimal control problem along with both MDT and steroid interventions. The finding from this novel and comprehensive study will help the clinicians and public health researchers involved in the process of elimination and eradication of leprosy

Knowledge of Cardiopulmonary Resuscitation Among Interns Working at Kathmandu Medical College

Background: Cardiac arrest is a substantial public health problem estimated to account for 15-20% of all death. Cardiac arrest is one of the most common emergencies within the emergency department leading to serious and life threatening results which can be managed if medical and paramedical personnel working in the emergency department have adequate knowledge about cardiopulmonary resuscitation (CPR) and if they are well trained to administer it effectively.  Objective: To assess the knowledge, attitude and practice regarding CPR amongst interns in tertiary medical center of Nepal and comprehend the depth of knowledge about CPR and practice regarding defibrillation used during CPR. Methodology: This is a cross-sectional study carried out in Kathmandu Medical College Teaching Hospital  using a semi structured pretested questionnaire. We requested interns to answer the questionnaire, which included 25 questions to assess the knowledge of  BLS. Similarly, subjects were inquired about  the  attitude level questionnaire by the researcher and scoring was done accordingly.  We analyzed the statistics through frequency, percentage, mean and mean percentw. Results:  Out of 150 interns , regarding knowledge, on an average 11.71 questions were correctly answered. Highest score of 22 was scored by five participants and lowest of 5 scored by seven participants. Eleven questions were rightly answered by more than 50%. All the participants  agreed that resuscitation training need to  be added in the curriculum . . Conclusion: The present study identified the  attitude score was good however, knowledge score of BLS  was poor among medical interns.  BLS training should be the part of the MBBS curriculum to solve this very critical issue. The unconsolidated knowledge about resuscitation among the  interns is not adequate. This study  emphasizes the necessity for standardized systemic resuscitation program in the undergraduate curriculum and effort should be made to introduce an appropriate, efficient and effective course design

Postpartum Care Services during the Fourth Stage of Labour in Bharatpur Hospital of Nepal

Background: Postnatal care is an important part of maternal care, as serious and life-threatening complications can occur in the postpartum period. So, this study was conducted to assess the level of postpartum care services during the fourth stage of labour in the maternity ward of Bharatpur hospital in the Chitwan district of Nepal. Methods: Cross-sectional hospital-based study was done among women admitted in the maternity ward for vaginal delivery in Bhartapur hospital in Chitwan. Total 218 sample size derived by using the formula; n= N/1+N (e²). A set of data collection tool was developed, pretested and finalized. Part-1 of the tool was related to socio-demographic features of respondents, Part-2 and 3 of the tool was used as a checklist to assess institutional characteristics and level of postpartum care services respectively. The structured checklist had twenty-two items including twelve critical steps. The purpose of the study explained to the respondents; verbal informed consent obtained from respondents and ethical approval from the Institutional review committee of Chitwan Medical College. Results: The significant association observed between postpartum care during the fourth stage of labour and residence of mothers (p=0.021). Conclusions: Postpartum care in Bharatpur hospital is poor and there is an urgent need to develop plans and programs to enhance the capacity of staffs and health institutions to provide postpartum care according to the WHO recommendation guideline.  

Risk Analysis Index Frailty Score as a Predictor of Otolaryngology Surgical Outcomes.

OBJECTIVE: The Risk Analysis Index (RAI) score is a screening tool to assess patient frailty. It has been shown to be predictive of postoperative outcomes and mortality in orthopedic, urologic, and neurosurgical patient populations. We sought to evaluate the predictive ability of RAI score for surgical outcomes in an otolaryngology patient population. STUDY DESIGN: Retrospective study. SETTING: Academic tertiary medical center. METHODS: A retrospective study was conducted of adult patients undergoing otolaryngology surgery at a tertiary medical care center over 21 months. Patients were sent electronic RAI survey questionnaires via direct messaging, which was completed prior to surgery. Endpoint data were analyzed, including demographics, RAI score, and patient outcome data. Univariate analysis, ROC curves, and predictive modeling were utilized. RESULTS: A total of 517 patients responded to the RAI questionnaire, resulting in a 59.6% response rate. Mean RAI score was 21.38 ± 11.83. Higher RAI scores were associated with increased 30-day readmissions (P < .0015), postoperative complications (P < .001), hospital length of stay (P < .001), and discharge with home health (P < .001). Predictive models for RAI score and postoperative outcomes were created, and a cutoff score of RAI = 30 was established to identify frail patients. CONCLUSION: We evaluated if RAI scoring predicted postoperative complications in an otolaryngology patient population. Increased RAI score is significantly associated with poorer surgical outcomes, including increased hospital length of stay, 30-day readmissions, and postoperative complications. We propose a predictive model with suggested RAI cutoff scoring for use in the otolaryngology surgical population

Immediate Effects of Yoga Based Relaxation Technique on Heart Rate Variability in Young and Healthy Volunteers

Introduction: Cardiovascular autonomic functions are affected by the negative influences of stress which bring about alterations in heart rate variability (HRV). Yoga based relaxation techniques like Yoga Nidra have been found to relieve stress as shown by improved HRV. This study was conducted to assess the immediate effects of a yoga based guided relaxation technique, Yoga Nidra on HRV parameters in young and healthy volunteers. Methods: This was an interventional study conducted in the Department of Clinical Physiology, Institute of Medicine, Maharajgunj. Fifty two male medical students were divided into supine rest group (n=26) and Yoga Nidra group (n=26). HRV indices were recorded before and after supine rest and Yoga Nidra. Intra-group and inter-group comparisons of the HRV parameters were done before and after the interventions. Results: In comparison to the supine rest, Yoga Nidra produced significant increase in values of HF (1460.72 Vs 3272.99; p=0.03) and HFnu (50.32 Vs 62.68; p=0.004); and significant reduction in the values of LFnu (49.68 Vs 37.32; p=0.004) and LF:HF ratio (0.99 Vs 0.59; p=0.004), which suggested that the parasympathetic modulating response of Yoga Nidra was better than that of supine rest. Conclusion: Yoga Nidra, a yoga based relaxation technique brings better relaxation response than supine rest as indicated by the significantly improved HRV indices

Photodocumentation of the Development of Type I Posterior Glottic Stenosis after Intubation Injury

Bilateral vocal fold immobility may result from bilateral recurrent laryngeal nerve paralysis or physiologic insults to the airway such as glottic scars. The progression of mucosal injury to granulation tissue, and then posterior glottis stenosis, is an accepted theory but has not been photodocumented. This paper presents serial images from common postintubation injury to less common posterior glottic stenosis with interarytenoid synechia