Assessment of climate change vulnerability of farm households in Pyapon District, a delta region in Myanmar

Sea level rise causes saltwater intrusion and flooding of agricultural land and ultimately threatens the livelihoods of farm households in the delta region of Myanmar. Empirical research on the effects of climate change on the delta's agriculture and an assessment of the vulnerability are becoming necessary. This study explores the vulnerability of farm households to sea level rise using two methods: the Livelihood Vulnerability Index (LVI), which is comprised of 37 indicators, and the Socioeconomic Vulnerability Index (SeVI), which contains 35 indicators. Interviews with 178 farmers were conducted in Bogale, Pyapon and Dedaye Townships in Pyapon District. In addition, 7 focus group discussions were performed, with at least 2 discussions in each Township. Both methods identify Bogale to be the most vulnerable Township, followed by Dedaye and Pyapon Townships. Following the LVI approach, Bogale Township has the highest sensitivity to climate effects and the highest exposure to natural hazards, but also a higher adaptive capacity than the other townships. In contrast using the SeVI approach, Bogale was found to have the highest sensitivity and exposure to natural hazards but the lowest adaptive capacity score. The study found that the climate change adaptation measures taken by the farmers are important to limit vulnerable to the adverse effects of climate change and thus promotion of the adaptive capacity of farmers is important for the delta region of Myanmar

Cohexisting Medullary and Papillary Thyroid Cancer

Purpose: Papillary thyroid carcinomas (PTCs) and medullary thyroid carcinomas (MTCs) have always been considered different in terms of their incidence rates, cell origins, and histopathological features. Simultaneous occurrence of both disease entities is very rare. Methods: We describe a series of cases with simultaneous MTC and PTC occurrences in the thyroid gland. Results: From 2,897 patients (mean age, 49.2±12.5; 81% women) who underwent thyroidectomy for cancer between 2000 and 2015, we reviewed 11 cases of simultaneous occurrence of MTCs and PTCs. Multifocal PTC with simultaneous MTC was detected in 5 of the 11 cases (45%). Of these PTC patients, 2 had 2 foci, 2 had 3 foci, and 1 had 4 foci. There was 1 case of multifocal MTC with solitary PTC. One patient presented with “composite thyroid carcinoma” with mixed features of MTCs and PTCs. Eight patients (72%) presented an association with diffuse lymphocytic thyroiditis. The sizes of the tumors were 1.95±0.23 cm vs. 1.20±0.20 cm for PTCs and MTCs, respectively (P=0.531). The prevalence of extrathyroidal extension was 33.1% vs. 30.2% for PTCs and MTCs, respectively (P=0.282). All patients underwent total thyroidectomy and central neck node dissection. Radio iodine was delivered to 44% of patients. Follow-up review revealed 9 disease-free patients and 1 with local neck recurrence, while 1 patient died due to non-thyroid reasons. Conclusion: There are only 30 reports describing a total of 50 cases in the English literature regarding concurrent PTC and MTC in the same gland. This study represents one of the largest case series. Whether the incidence of another cancer in these patients is coincidental, or due to the possible activation of a common tumorigenic pathway for both follicular and parafollicular thyroid cells, remains to be elucidated

The GOODSTEP project: General Object-Oriented Database for Software Engineering Processes

The goal of the GOODSTEP project is to enhance and improve the functionality of a fully object-oriented database management system to yield a platform suited for applications such as software development environments (SDEs). The baseline of the project is the O2 database management system (DBMS). The O2 DBMS already includes many of the features regulated by SDEs. The project has identified enhancements to O2 in order to make it a real software engineering DBMS. These enhancements are essentially upgrades of the existing O2 functionality, and hence require relatively easy extensions to the O2 system. They have been developed in the early stages of the project and are now exploited and validated by a number of software engineering tools built on top of the enhanced O2 DBMS. To ease tool construction, the GOODSTEP platform encompasses tool generation capabilities which allow for generation of integrated graphical and textual tools from high-level specifications. In addition, the GOODSTEP platform provides a software process toolset which enables modeling, analysis and enaction of software processes and is also built on top of the extended O2 database. The GOODSTEP platform is to be validated using two CASE studies carried out to develop an airline application and a business application

COVID-19 and Biomedical Experts: When Epistemic Authority is (Probably) Not Enough

This critical essay evaluates the potential integration of distinct kinds of expertise in policymaking, especially during situations of critical emergencies, such as the COVID-19 pandemic. This article relies on two case studies: (i) herd immunity (UK) and (ii) restricted access to ventilators for disabled people (USA). These case studies are discussed as examples of experts’ recommendations that have not been widely accepted, though they were made within the boundaries of expert epistemic authority. While the fundamental contribution of biomedical experts in devising public health policies during the COVID-19 pandemic is fully recognized, this paper intends to discuss potential issues and limitations that may arise when adopting a strict expert-based approach. By drawing attention to the interests of minorities (disenfranchized and underrepresented groups), the paper also claims a broader notion of “relevant expertise.” This critical essay thus calls for the necessity of wider inclusiveness and representativeness in the process underlying public health policymaking

Strain rate, temperature and deformation state effect on Ecoflex 00-50 silicone mechanical behaviour

Silicone elastomers are extremely attractive materials due to their wide range of possible applications, from biomedical engineering to soft robotics. In this work, an extensive thermo-mechanical characterization of Ecoflex Shore hardness 00–50, a commercially available silicone elastomer, has been carried out to compensate for the lack of relevant literature. The mechanical behaviour of the material has been characterized by performing monotonic and cyclic loading tests. These tests were performed in different deformation states, i.e. uniaxial tension, pure shear and biaxial tension, at different strain rates and temperatures. Experimental findings allowed to highlight the material time-dependent response and quantify the contribution of dissipative deformation phenomena to the overall strain energy. Uniaxial tensile tests performed at different temperatures (between −40 °C and 140 °C) showed that the material mechanical behaviour is sensitive to temperature in this range: a decrease of the ultimate stress and strain has been observed with increasing temperature. Finally, the data obtained from the latter tests have been used to define a failure envelope, applied for the first time to Ecoflex silicones, and valuable to describe the material ultimate stress and strain at any temperature and strain rate

West Nile virus transmission. results from the integrated surveillance system in Italy, 2008 to 2015

IIn Italy a national Plan for the surveillance of imported and autochthonous human vector-borne diseases (chikungunya, dengue, Zika virus disease and West Nile virus (WNV) disease) that integrates human and veterinary (animals and vectors) surveillance, is issued and revised annually according with the observed epidemiological changes. Here we describe results of the WNV integrated veterinary and human surveillance systems in Italy from 2008 to 2015. A real time data exchange protocol is in place between the surveillance systems to rapidly identify occurrence of human and animal cases and to define and update the map of affected areas i.e. provinces during the vector activity period from June to October. WNV continues to cause severe illnesses in Italy during every transmission season, albeit cases are sporadic and the epidemiology varies by virus lineage and geographic area. The integration of surveillance activities and a multidisciplinary approach made it possible and have been fundamental in supporting implementation of and/or strengthening preventive measures aimed at reducing the risk of transmission of WNV trough blood, tissues and organ donation and to implementing further measures for vector control

Quantitative risk assessment of hepatitis E virus: modelling the occurrence of viraemic pigs and the presence of the virus in organs of food safety interest

Hepatitis E virus (HEV) is a zoonotic pathogen with consumption of pork and derived products identified in different countries as a risk factor for human exposure to HEV. Great efforts have been made to understand the dynamics of virus transmission within domestic swine populations through modelling. However, from a food safety prospective, it is critical to integrate the parameters involved in the transmission dynamics with those governing the actual presence of HEV in the bloodstream, the liver, gallbladder or faeces. To date, several aspects related to the pathogenesis of the disease are still unknown or characterized by significant levels of uncertainty, making this conjunction challenging. We used published serological data obtained from pigs in a farrow-to-finish farm to implement an Immune-Susceptible-Infected-Recovered (MSIR) model reproducing the on-farm dynamics that lead to the occurrence of viraemic pigs at slaughter. Expert opinion on the length of time infectious HEV can be detected in liver, gallbladder/bile and faeces after recovery from viraemic status were used to inform a stochastic model aimed at estimating the expected proportion of viraemic pigs, pigs with infectious HEV in liver, gallbladder/bile and faeces entering the slaughterhouse. To simulate the potential effect of on-farm mitigation strategies, we estimated the changes in outcomes of interest as a function of variations in the baseline transmission parameters. The model predicted a proportion of viraemic pigs entering the slaughterhouse of 13.8% while the proportions of, and ranged from 13.8% to 94.4%, 13.8% to 94.7% and from 25.3% to 30.8% respectively, due to the uncertainty surrounding the experts’ opinions. Variations in MSIR model’s parameters alert of the need to carefully consider the application of mitigation strategies aimed at delaying the decay of maternal immunity or the peak of the within herd transmission. When the rate of decay of maternal immunity and the transmission rate were decreased between 80% and 5% and 40% and 5% from the baseline values respectively, adverse effects on were observed. The model highlights the relevance of specific aspects in the pathogenesis of the disease from a food safety prospective and it was developed to be easily reproducible and updatable as soon as accurate data becomes available. As presented, the model can be directly connected to existing or future pig-related models to estimate the significance of the identified parameters on the risk of human exposure to HEV through consumption of pork products

Gastric Leak by Staple-Line Rupture after Sleeve Gastrectomy for Morbid Obesity

A 42-year-old, BMI 42kg/m2 female, suffering from arterious hypertension underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine-green enhanced fluorescence imaging showed proper vascularization of the gastric tube (Figure 1). A barium swallow on second postoperative day showed no leak or stenosis (Figure 2). A gastric fistula at the EGJ appeared 5 days after surgery. The patient presented fever, abdominal pain, dispnea, leukocytosis and high values of CRP. A thoraco-abdominal computed tomography (CT) scan with oral contrast detected a gastric leak just below the EGJ supplying a left sub diaphragmatic collection extended all over the splee