Influence of integrated crop management practices on yield, PAR interception, resource-use-efficiency and energetics in pigeonpea in North Indian Plains

Aim: The aim of the present study was to assess the influence of different integrated crop management (ICM) practices on productivity, resource-use efficiency and energetics of pigeonpea crop so as to overcome various production- and climatic-vulnerabilities in Indo-Gangetic Plains Region (IGPR). Methodology: A study was conducted during Kharif 2017 in pigeonpea under pigeonpea–wheat cropping system at IARI, New Delhi, India to assess the influence of nine different ICM modules [Conventional tillage (CT) based: 04 (ICM1–ICM4); Conservation agriculture (CA) based: 04 (ICM5–ICM8); Organic agriculture based: 01 (ICM9)] on productivity, PAR interception, resource-use-efficiency and energetics in pigeonpea in randomized block design replicated thrice. Results: Pigeonpea seed yield was significantly higher in ICM7 (1.92 t ha-1) – a CA-based ICM module which was followed by ICM5, ICM8 and ICM6. In general, the CA based ICM modules showed an edge over CT based ICM modules with reference to growth, yield and PAR interception. The resource-use-efficiency indices like total water-use-efficiency (TWUE), irrigation water-use-efficiency (IWUE), economic water-productivity (WPE), partial factor productivity of applied nutrients (NPK) also exhibited same trend as that of seed yield with highest TWUE (2.96 kg ha-mm–1) and WPE (104.5 INR ha-mm–1) in ICM7 module. The energy output was highest in ICM7 (2, 23, 664 MJ ha-1) followed by ICM5, ICM8 and ICM6. The trend of energy-use-efficiency was ICM4>ICM2>ICM1>ICM3>ICM5>ICM7>ICM6>ICM8>ICM9, respectively. Interpretation: Conservation agriculture (CA) based modules like ICM7 can be recommended to the farmers for enhancing the plant growth, PAR interception, crop productivity, resource-use efficiency and energetics in pigeonpea alone or on pigeonpea-wheat cropping system basis in semi-arid Indo-Gangetic plains region (IGPR).

Milk Production Function and Resource use Efficiency in Rajasthan

The study was undertaken in Rajasthan with the objective to examine the input-output relationships and assess the resource use efficiency in milk production. The study covered 60 dairy households. The results of Cobb-Douglas production function revealed that concentrate had positive and significant influence on returns from buffalo, crossbred cow and local cow milk. Green fodder and labour were also significantly influenced the returns from buffalo, crossbred and local cow. The results of resource use efficiency and marginal value productivity of inputs indicated that inputs were not optimally utilized by dairy households. The green fodder, dry fodder, concentrate and labour in buffalo, concentrate and labour crossbred cow milk production and green fodder in local cow milk production were found to be over utilized in study area resulting higher per litre cost of milk production on these species.

Custos do tratamento do hiperparatireoidismo secundário à doença renal crônica, com cinacalcete ou paratireoidectomia, para pacientes não controlados com a terapia clínica convencional sob a perspectiva do Sistema Único de Saúde / Secondary hyperparathyroidism treatment costs with cinacalcet or PTX, for uncontrolled patients with conventional clinical therapy under Brazilian Public Health System perspective

Objetivos: Estimar a população elegível para o tratamento de pacientes com hiperparatireoidismo secundário (HPTS), não controlados com terapia convencional, bem como avaliar a utilização de recursos para o tratamento dessa população com cinacalcete ou paratireoidectomia (PTX). Métodos: Utilização da técnica Delphi por painel de especialistas. A pesquisa foi realizada utilizando questionário estruturado, enviado por meio eletrônico aos especialistas, e seguida de encontro presencial. Os custos foram obtidos de bases de dados governamentais. Apenas custos médicos diretos foram incluídos, sob a perspectiva do Sistema Único de Saúde (SUS) (em reais no ano de 2014). Os dados foram avaliados pelo Microsoft Excel versão 2013. Resultados: A população no cenário de mundo real indicada para o tratamento com cinacalcete foi de 7.705 pacientes. Já a população real encaminhada para a PTX foi de 7.691 pacientes, sendo esse número 76,3% maior que a população ideal com indicação de PTX, que foi de 1.822 pacientes. O custo estimado do tratamento com cinacalcete foi de R$ 27.712,95 (considerando a dose recomendada em bula para cinacalcete, de 30 a 180 mg/ dia) e de R$ 16.841,85 para PTX (incluindo os períodos pré e pós-cirúrgico). A análise de sensibilidade foi baseada na dose média de cinacalcete, conforme o estudo EVOLVE (66,8 mg/dia). Nesse cenário, o custo do tratamento com cinacalcete foi de R$ 11.924,13 (57% menor que o cenário com a dose de bula). Conclusão: No cenário SUS, o número de pacientes encaminhados para PTX foi 76,3% maior que os idealmente indicados à cirurgia, o que ocorre devido à falta de opções terapêuticas.

Objectives: To estimate patient management patterns, associated medical resource utilization and use of cinacalcet for secondary hyperparathyroidism in chronic hemodialysis patients and much uncontrolled with conventional treatment, in the Unified Healthcare System (SUS) setting, in 2014. Methods: An expert panel was carried using the Delphi technique. The research was done by structured and unambiguous questionnaires that were sent by email to the entire Delphi panel, followed by a face meeting. Expense inputs were mainly obtained from government fee schedules and pharmaceutical price tables. Only medical direct costs were included under the perspective of SUS [in 2014 Brazilian Real (BRL)]. Data were analyzed using Microsoft Excel Worksheet version 2013. Results: The eligible population to cinacalcet treatment was 9,513 patients. Considering an ideal scenario, this number goes to 7,705 patients. The estimated population for parathyroidectomy was 7,691 patients in a real scenario and 1,822 in an ideal scenario (76.3% more patients than the ideally suited to the procedure). The estimated annual cost with cinacalcet treatment is 27,712.95 BRL (considering the label dose for cinacalcet) and 16,841.85 BRL for parathyroidectomy (including pre and post-operative period), respectively. A sensitivity analysis was performed considering the cost of cinacalcet treatment using the drug's dose of EVOLVE study (66.8 mg). This scenario showed a total cost of 11,924.13 BRL (57% less than label dose scenario). Conclusion: 76.3% more patients are indicated to the surgery due the absence of other therapeutic options for management of secondary hyperparathyroidism in chronic hemodialysis patients and much uncontrolled with conventional treatment, in the SUS setting.

El índice de masa corporal como predictor de morbimortalidad y consumo de recursos en pacientes internados en la unidad de terapia intensiva / The body mass index as a predictor of morbimortality and resource use in the patients in the intensive care unit / O índice de massa corporal como prognóstico da morbidade e mortalidade e o consumo de recursos em pacientes hospitalizados na unidade de terapia intensiva

Resumen: Introducción: No hay acuerdo en los reportes de la literatura sobre si un índice de masa corporal por arriba de 25 kg/m(2) incrementa, no modifica o disminuye la mortalidad en pacientes en estado crítico. Objetivo: Comparar la mortalidad, morbilidad y consumo de recursos entre individuos con peso normal o bajo (índice de masa corporal IMC < 25 kg/m(2)) versus sujetos con sobrepeso u obesidad (IMC > 25 kg/m(2)). Diseño: Estudio de cohorte prolectiva en una unidad de terapia intensiva. Pacientes: Se incluyeron 159 personas en el estudio. Método: Se colectaron variables demográficas y clínicas, incluyendo peso y talla para calcular el índice de masa corporal. Se registraron datos de escalas de gravedad de la enfermedad SAPS-3, de falla orgánica Bruselas y de intervención terapéutica NEMS (como subrogado de consumo de recursos). El análisis estadístico fue multivariado; fue considerada significativa una p < 0.05. Resultados: Al comparar individuos con IMC < 25 kg/m(2) con aquellos con un IMC mayor no hubo diferencia estadísticamente significativa en mortalidad y consumo de recursos. Sin embargo, al replantear el estudio y comparar sujetos con IMC < a 30 kg/m(2) con aquellos con un IMC mayor, se encontró diferencia significativa en mortalidad entre ambos grupos y un tamaño del efecto considerable en cuanto a consumo de recursos en personas con un IMC > 30 kg/m(2). Conclusiones: En México debemos cambiar el punto de corte del índice de masa corporal a 30 kg/m(2) cuando comparemos mortalidad y consumo de recursos en los enfermos internados en la UTI. Este estudio abre la posibilidad de realizar un estudio multicéntrico para confirmar estos resultados.

Abstract: Introduction: There is disagreement over if a body mass index (BMI) above 25 kg/m(2) increases, decreases or does not alter the mortality in critically ill patients. Objective: To compare the mortality, morbidity and resource use among patients with normal or low body mass index (< 25 kg/m(2)) versus patients with overweight or obesity (> 25 kg/m(2)). Design: Study of a prolective cohort in an intensive care unit. Patients: One hundred fifty-nine patients were included in the study. Methods: Demographic and clinical data (including weight and height for the calculation of the body mass index) were collected, as well as scores of severity of illness SAPS-3, organic failure (Brussels) and therapeutic intervention NEMS (as a surrogate marker of resource use). The statistical analysis was multivariate, with a significance of p < 0.05. Results: When we compared patients with a BMI < 25 kg/m(2) versus those with BMI above 25 kg/m(2), we did not find statistical differences in mortality and resource use. However, when we changed the cutoff point of BMI to 30 kg/m(2), we found statistically significant differences in mortality and an important effect size in the resource use between both groups. Conclusions: In México we should change the cutoff point of the body mass index to 30 kg/m(2) when we compare mortality and resource use in those patients in the ICU. This study suggests the possibility of making a multicenter study to confirm these findings.

Resumo: Introdução: Não há nenhum acordo nos relatos da literatura se um índice de massa corporal acima de 25 kg/m(2) incrementa, não altera ou diminui a mortalidade em pacientes em estado crítico. Objetivo: Comparar a mortalidade, morbidade e consumo de recursos entre os pacientes com peso normal ou baixo (índice de massa corporal IMC < 25 kg/m(2)) versus pacientes com sobrepeso e obesidade (IMC > 25 kg /m(2)). Desenho: Estudo prospectivo de coorte. Pacientes: 159 pacientes foram incluídos no estudo. Método: Foram coletadas variáveis demográficas clínicas, incluindo peso e altura para calcular o índice de massa corporal. Foram coletados dados da escala de gravidade da doença SAPS-3, a falha orgânica Bruselas e a intervenção terapêutica NEMS (como o consumo de recursos sub-rogado). A análise estatística foi multivariada considerando significativa uma p < .05. Resultados: Ao comparar os pacientes com IMC < 25 kg/m(2) com aqueles com um IMC superior não houve diferença estatisticamente significativa na mortalidade e consumo de recursos. No entanto, ao reformular o estudo e comparar pacientes com IMC < 30 kg/m(2) com aqueles com um IMC superior, se encontrou uma diferença significativa na mortalidade entre os dois grupos e um impacto significativo em termos de consumo de recursos em pacientes com IMC > 30 kg/m(2). Conclusões: No México temos que mudar o ponto de corte do índice de massa corporal à 30 kg/m(2) quando comparamos a mortalidade e o consumo de recursos em pacientes internados na UTI. Este estudo abre a possibilidade de um estudo multicêntrico para confirmar estes resultados.

Real-World Treatment Patterns among Patients with Advanced Gastric Cancer in South Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to understand patient treatment patterns, outcomes, and healthcare resource use in cases of metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in South Korea. MATERIALS AND METHODS: Thirty physicians reviewed charts of eligible patients to collect de-identified data. Patients must have received platinum/fluoropyrimidine first-line therapy followed by second-line therapy or best supportive care, had no other primary cancer, and not participated in a clinical trial following MGC diagnosis. Data were summarized using descriptive statistics. Kaplan-Meier analysis was used to describe survival. RESULTS: Of 198 patients, 73.7% were male, 78.3% were diagnosed with MGC after age 55 (mean, 61.3 years), and 47.0% were current or former smokers. The majority of tumorswere located in the antrum/pylorus (51.5%). Metastatic sites most often occurred in the peritoneum (53.5%), lymph nodes (47.5%), and liver (38.9%). At diagnosis, the mean Charlson comorbidity indexwas 0.4 (standard deviation, 0.6). The most common comorbidities were chronic gastritis (22.7%) and cardiovascular disease (18.7%). Most patients (80.3%) received second-line treatment. Single-agent fluoropyrimidine was reported for 22.0% of patients, while 19.5% were treated with irinotecan and a fluoropyrimidine or platinum agent. The most common physician-reported symptoms during second-line treatment were nausea/vomiting (44.7%) and pain (11.3%), with antiemetics (44.7%), analgesics (36.5%), and nutritional support (11.3%) most often used as supportive care. Two-thirds of inpatient hospitalizations were for chemotherapy infusion. Outpatient hospitalization (31.6%) and visits to the oncologist (58.8%) were common among second-line patients. CONCLUSION: Most patients received second-line treatment, although regimens varied. Understanding MGC patient characteristics and treatment patterns in South Korea will help address unmet needs.

CONSERVACIONISMO EN ERAS DE ESPECIEÍSMO / CONSERVATION IN SPECIESISM AGES

Los alcances acumulativos de la acción humana, aunados al poderío tecno-científico, llevan hoy a que nuestra especie no solo se cuestione los límites de la capacidad que tiene la Tierra para asimilar y reciclar luego los desechos de la actividad humana, sino también los límites de nuestro especieísmo en la trama de la existencia. No ha sido la excepción, sino más bien la regla, que en una constante nuestra especie haya aumentado en población, sobreutilizando el entorno y malogrando un desarrollo que deteriora el medio ambiente cada vez más. El ser humano ha escrito la historia de la humanidad de forma especieísta, ensalzando su rol histórico que ha hecho obra contra el ser ecológico. Sin embargo, aisladas y frágiles treguas entre animales humanos y no humanos posibilitan cuestionarnos el sentido y significado filosófico del conservacionismo en eras del más crudo especieísmo.

The cumulative scope of human action, combined with the techno-scientific power nowadays take our species not only to question the limits of the Earth capacity to assimilate and recycle the waste products of human activities, but also the limits of speciesism within the weave of existence. It has not been the exception but rather the rule, that our species has constantly increased its population, overusing the environment and ruining a development that deteriorates the environment increasingly. Human beings have written the history of humanity in a speciesist form, extolling their historic role which has made work against the ecological being. However, isolated and fragile truces between human and nonhuman animals allow questioning the meaning and philosophical significance of conservationism in an age of the crudest speciesism.

Conservation assumptions and development in Brazilian Cerrado / Pressupostos de conservação e desenvolvimento no Cerrado Brasileiro

This study reviews the debate concerning socioeconomic impacts of established protected areas on local populations. On one side, there are those who defend the idea that protected areas may assist in poverty reduction by generating alternative sources of income, and on the other hand, those who argue just the opposite, due to the eminent expropriation of the land. Thus, the relationship between protected areas and poverty is evaluated through development indexes (Human Development Index and Gini Coefficient) and by contrary assumptions. Through a disaggregated analysis method of "strict protected" and "sustainable use", the proposal was to evaluate, in the context of Brazilian Cerrado, if the presence of protected areas has influence on the local social conditions, and which protection methods have the greatest effect. In this evaluation, it was verified that despite the heterogeneity of income distribution, the municipalities with integrally protected areas of indirect-use have higher values of human development than those of direct-use.

Este trabalho retoma o debate a respeito dos impactos socioeconômicos da criação de unidades de conservação (UCs) sobre as populações locais. De um lado há aqueles que defendem que as UCs podem auxiliar na redução da pobreza através da geração de fontes alternativas de renda e, de outro, aqueles que falam justamente o oposto, devido à política de expropriação de terras. Assim, através de pressupostos contrários, avalia-se através de indicadores de desenvolvimento (Índices de Desenvolvimento Humano e de Gini) a relação entre unidades de conservação e pobreza. Por meio de um método de análise desagregada pelos grupos de unidades de conservação de proteção integral e uso sustentável o objetivo é avaliar se no contexto do cerrado brasileiro a presença de unidades de conservação influencia as condições sociais locais e, em caso positivo, quais formas de conservação afetam mais. Nesta interface, apesar da heterogeneidade da distribuição de renda, observou-se que os municípios com unidades de conservação de proteção integral apresentam melhores valores de desenvolvimento humano do que aquelas de uso direto.

Temporal and spatial resource use by female three-toed sloths and their young in an agricultural landscape in Costa Rica

The information on ecological behavior of wild sloths is very scarce. In this study we determined the home ranges and resources used by three adult female three-toed sloths (Bradypus variegatus) and their four young in an agricultural matrix of cacao (Theobroma cacao), pasture, riparian forests and living fencerows in Costa Rica. Births occurred during November-December and the young became independent at five to seven months of age. Initially, mothers remained fixed in one or a few trees, but expanded their use of resources as young sloths became independent from them. Mothers initially guided the young to preferred food and cover resources, but they gradually left their young in small nucleus areas and colonized new areas for themselves. Home range sizes for young sloths (up to seven months of age) varied between 0.04-0.6 hectares, while home range sizes for mothers varied from 0.04-25.0 hectares. During the maternal care period, 22 tree species were used, with the most common being Cecropia obtusifolia (30.9%), Coussapoa villosa (25.6%), Nectandra salicifolia (12.1%), Pterocarpus officinalis (5.8%) and Samanea saman (5.4%). However, young sloths used only 20 tree species, with the most common being C. villosa (18.4%), S. saman (18.5 %) and N. salicifolia (16.7%). The cacao agroforest was used only by mother sloths and never by their young following separation. However, in the riparian forest, both mother sloths and young used the tree species. A total of 28 tree species were used by the mother sloth; including the food species: C. obtusifolia, C. villosa, N. salicifolia and P. officinalis. However, the young used 18 trees species in this habitat with N. salicifolia and S. saman most commonly used, although they rested and fed during the day in C. obtusifolia, C. villosa and O. sinnuata. The cacao agroforest with adjacent riparian forests and fencerows provides an important habitat type that links the smaller secondary forests and other patches. Rev. Biol. Trop. 59 (4): 1743-1755. Epub 2011 December 01.

La información sobre el comportamiento ecológico de los perezosos silvestre es muy escasa. Determinamos los ámbitos de acción y uso de recursos para hembras adultas de perezosos de tres dedos (Bradypus variegatus) y sus crías en una matriz agroforestal compuesta de cacao (Theobroma cacao), potreros, bosques ribereños y cercas vivas en Costa Rica. Los nacimientos de las crías se presentan frecuentemente de noviembre a diciembre y entre 5 a 7 meses las crías se vuelven independientes. Inicialmente las madres utilizan pocos árboles y van expandiendo el uso de recursos conforme las crías se van haciendo independientes de la madre. Las madres en los primeros meses guían a sus crías para seleccionar recursos y coberturas de bosque preferidos, y gradualmente se van separando de la cría hasta dejarlos en lo que fue su área núcleo. Ámbitos de acción de las crías (de hasta 7 meses o más de edad) varían entre 0.04-0.6ha, mientras que los ámbitos de acción de las madres varían 0.04-25.0ha. Durante el cuido maternal, 22 especies de árboles fueron utilizadas entre las más comunes se encuentran: Cecropia obtusifolia (30.9%), Coussapoa villosa (25.6%), Nectandra salicifolia (12.1%), Pterocarpus officinalis (5.8%) y Samanea saman (5.4%). Los jóvenes utilizaron solo 20 especies entre las más comunes C. villosa (18.4%), S. saman (18.5 %) y N. salicifolia (16.7%). El sistema agroforestal del cacao fue únicamente utilizado por la madre y no por la cría después del periodo de separación. Sin embargo, en los bosques ribereños tanto la madre como la cría utilizaron árboles como recursos. Un total de 28 especies de árboles fueron utilizados por la madre incluyendo especies para su alimentación tales como: C. obtusifolia, C. villosa, N. salicifolia y P. officinalis. Los jóvenes solo utilizaron 18 especies de árboles como N. salicifolia and S. saman entre las más frecuentes; inclusive los árboles utilizados para descanso y alimentación durante el día fueron C. obtusifolia, C. villosa y O. sinnuata. Los sistemas agroforestales de cacao adyacentes a bosques ribereños y cercas vivas proveen un importante hábitat que une pequeños parches de bosques secundarios.

Development And Evaluation Of Korean Diagnosis Related Groups: Medical Service Utilization Of Inpatients / 예방의학회지

With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U. S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U. S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the difference in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated for its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed ad payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U. S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.