Asiatic Black Bear-Human Conflict: A Case Study from Guthichaur Rural Municipality, Jumla, Nepal.

Our study assessed patterns of Asiatic black bear (Ursus thibetanus)-human conflicts within the Guthichaur rural municipality, Jumla, Nepal. Through semi-structured interviews with villagers, focus group discussions (FGDs), and key informant interviews (KIIs), we gathered black bear-human conflict information from 2009 to 2019. We identified three primary types of black bear-human interactions: crop damage, livestock depredation, and human injuries. Of these, crop damage (77.03%) emerged as the most prevalent issue. Notably, peak occurrences were observed during autumn (September-October) typically between 9 PM and 3 AM. Livestock depredations were more frequent during nighttime in April-August, with cows/ox (70.12%) being the most depredated animal. Our data also revealed five recorded cases of black bear attacks on humans, which transpired from September to October, primarily in farmland areas in varying years. Despite a prevailing negative perception of bears, a notable level of support exists for their conservation efforts among local communities. Furthermore, these conflicts could be mitigated by reinforcing indigenous crop protection methods and implementing targeted mitigation strategies, as observed in other regions with successful black bear-human interaction management.

Efficacy of bariatric surgery in improving metabolic outcomes in patients with diabetes. A 24-month follow-up study from a single center in the UAE.

BACKGROUND: Owing to its impact on weight loss, remission of diabetes mellitus and metabolic syndrome, bariatric surgery has offered hope for grossly obese individuals. In recent years, obesity has increased in the UAE and the use of bariatric surgery has increased in-line with this trend. However, data regarding bariatric surgery outcomes in diabetic Emirati people is scarce. OBJECTIVE: To evaluate the effect of bariatric surgery in patients with diabetes mellitus. METHODS: This is a retrospective analysis of diabetic patients treated with bariatric surgery with a minimal follow-up of 1 year and extended for some patients (21) to 2 years follow up. A total of 80 patients underwent bariatric surgery. Two surgical procedures were used; laparoscopic sleeve gastrectomy (n=53) or mini-gastric bypass between January 1, 2015, and July 20, 2017. RESULTS: Mean baseline weight was 119.2±31.2 kg, this has significantly dropped to 100.1±23.1, 91.2±22.3, 82.3±17.5, and 81.3±15.3 kg at 3, 6, 12, and 24 months respectively, and this change was statistically significant P<0.001 at each time point. Mean baseline HbA1c was 8.6% ± 2.3% and this dropped significantly to 6.5±1.7, 5.9±1.2, 5.6±0.8, and 5.4±0.7 at 3, 6, 12, and 24 months respectively (P<0.000). In 49 (61.3%) we considered fatty liver based on ultrasound features either with or without elevation in alanine aminotransferase (ALT). We noticed a significant decrease in ALT at 3, 6, and 12 months after surgery. Furthermore, 11 patients (22.4%) showed sonographic features of improvement in fatty liver in addition to normalization of ALT. CONCLUSIONS: Bariatric surgery was effective over a follow-up period of 2 years in achieving significant weight loss as well as resulting in improvements in glycemic control, blood pressure, and fatty liver.

Improving Trauma Care in India: the Potential Role of the Rural Trauma Team Development Course (RTTDC).

The Rural Trauma Team Development Course (RTTDC) was devised to optimize trauma resuscitation training in under-resourced rural institutions. This program appears ideal for India because of its dense traffic, large population, and high frequency of rural trauma. We report on the feasibility and desirability of introducing RTTDC in India. An instructor course for 20 faculties and a provider course for 23 were conducted in New Delhi, India. The courses were evaluated by multiple choice question (MCQ) performance, by rating the modules on a three-point scale (1 = very relevant, 2 = relevant, and 3 = not relevant) for communication skills, principles of performance improvement and patient safety (PIPS), and clinical scenarios. Evaluation questionnaires including desirability of promulgation in India were completed using a five-point Likert Scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Overall written comments were also provided. Both faculty and providers improved post-course MCQ scores (p < 0.05) with lower scores in the provider group. Seventy-eight percent faculty and 74 % providers rated the communication module very relevant. PIPS was rated very relevant by 72 % faculty and 65 % providers. There were over 150 comments, generally positive with over 90 % of both faculty and providers rating strongly agree to agree that the course be promulgated widely in India. The RTTDC including plans for promulgation was enthusiastically received in India, and its potential for improving trauma care including communication skills and PIPS appears excellent.

Factors affecting success rate of Advanced Trauma Life Support (ATLS) courses.

BACKGROUND: The aim of the present study was to define the factors that affect passing the assessments for successful completion of the Advanced Trauma Life Support (ATLS) Provider Courses in the United Arab Emirates (UAE). METHODS: The ATLS Provider Course has been taught in three medical centers in the UAE since 2004. A total of 1,041 doctors completed the course during the period 2004-2010. A special protocol was designed to enter data accrued for each course, participants' demographics, and assessments, including the final results. Direct logistic regression was performed to define factors affecting success in multiple choice questions (MCQ) and in the practical initial assessment station exam. The studied variables included the year, the course site, speciality, level of practice, and pre-test score. RESULTS: The majority of participants were surgeons (33.2 %), followed by Emergency Medicine physicians (27.3 %). The logistic regression model showed that having a low pre-test score (p < 0.0001) and being a family medicine practitioner (p < 0.0001) increased the likelihood of failing the MCQ exam. The chance of passing the end of course practical exam increased with time (p = 0.002). A low pre-test score (p < 0.0001) and being examined in site A (p = 0.04) increased the chance of failing in the initial assessment exam. The pass rate for the ATLS exam significantly increased after adoption of the interactive approach to teaching. CONCLUSIONS: Prior knowledge and preparation is essential to passing the ATLS exam. Doctors who deal clinically with all aspects of airway, breathing, and circulation of the ATLS course are more likely to pass the MCQ exam in our setting, followed by those who usually manage only the circulation or disability aspects of ATLS. It is possible that the interactive approach to teaching ATLS has improved the overall ATLS success rate.

Advanced trauma life support, 8th edition, the evidence for change.

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.