A long-term, temporally consistent, gridded daily meteorological dataset for northwestern North America.

We describe a spatially contiguous, temporally consistent high-resolution gridded daily meteorological dataset for northwestern North America. This >4 million km2 region has high topographic relief, seasonal snowpack, permafrost and glaciers, crosses multiple jurisdictional boundaries and contains the entire Yukon, Mackenzie, Saskatchewan, Fraser and Columbia drainages. We interpolate daily station data to 1/16° spatial resolution using a high-resolution monthly 1971-2000 climatology as a predictor in a thin-plate spline interpolating algorithm. Only temporally consistent climate stations with at least 40 years of record are included. Our approach is designed to produce a dataset well suited for driving hydrological models and training statistical downscaling schemes. We compare our results to two commonly used datasets and show improved performance for climate means, extremes and variability. When used to drive a hydrologic model, our dataset also outperforms these datasets for runoff ratios and streamflow trends in several, high elevation, sub-basins of the Fraser River.

Efficacy of Preemptive Gabapentin for Lower Extremity Orthopedic surgery under Subarachnoid Block.

INTRODUCTION: Gabapentin is one of the adjuncts when given before surgery as a multi modal analgesia regimen has shown to decrease pain scores and opioid consumption in the first 24 hour after surgery. The aim of the study is to assess total opioid consumption in first 24 hour postoperatively after giving 600mg of preemptive oral Gabapentin in lower extremity orthopedic surgery done under subarachnoid block. METHODS: A randomized single blinded study was conducted for duration of 6 months after approval from institutional review board. A total of 52 American Society of Anesthesiology physical status grade I and II cases were included in the study of which 26 patients received oral Gabapentin two hours prior to surgery and 26 patients in the control group. They were evaluated postoperatively for total opioid consumption in first 24 hours, Visual Analogue Score after 2, 4, 6 and 24 hours at rest. RESULTS: Total opioid consumption in first 24 hours was 74.13 ± 27.78 mg in Gabapentin group versus 123.53 ± 64.48 mg in Control (p = 0.001). VAS score was 1.23 ± 1.47 in Gabapentin group versus 2.12 ± 1.58 in Control group (p=0.04) at 2 hours and 2.19 ± 0.40 in Gabapentin group versus 2.77 ± 1.17 in control group (p=0.02) at 24 hours postoperatively at rest which were found to be statistically significant. Incidence of sedation was minimal and comparable in both groups. CONCLUSIONS: Oral Gabapentin 600mg given two hours before surgery reduces total opioid consumption in first 24 hours after surgery and also reduces Visual Analogue score for pain postoperatively at rest in 2 and 24 hours with minimum sedation.

External validation of prognostic model of one-year mortality in patients requiring prolonged mechanical ventilation.

BACKGROUND: External validation of prognostic model for one-year mortality in patients ventilated for 21 days or more. A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognoses to patients or surrogate decision makers. Our objective was to validate a prognostic model developed by Carson et al in a different setting. METHODS: An observational study was conducted from September 2002 to September 2007 in 30 beds Medical/Surgical Intensive Care Unit (ICU) at Mercy Fitzgerald Hospital (MFH) and 20 beds Medical/Surgical ICU at Mercy Philadelphia Hospital (MPH). One hundred and fifty medical and surgical patients requiring mechanical ventilation after acute illness for at least 21 days after initial intubation were enrolled. RESULTS: One year mortality was 45.4%. Area under the receiver operating characteristic curve for three month mortality was 0.90 and for one year mortality was 0.92. For identifying patients who had ≥90% risk of death at 3 month had sensitivity of 40% and specificity of 95% and risk of death at 1 year had sensitivity of 70% and specificity of 99%. Four predictive variables, requirement of vasopressors, hemodalysis, platelet count ≤ 150 x 10 9/L and age ≥50 yrs can be used as a simple prognostic score that clearly identifies low-risk patients and high-risk patients. CONCLUSIONS: Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged mechanical ventilation.

Effectiveness of epidural steroid injection for the management of symptomatic herniated lumbar disc.

Low-back pain is a common clinical presentation of herniated lumbar disc. This is the most common presenting complain of the young adults. The incidence of low back pain is high in our part of the world. The reason may be hilly terrain, difficult working and living environment. The initial treatment of low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a simple, effective and minimally invasive treatment modality. The aim of this study is to assess the effectiveness of epidural steroid injection for low back and radicular pain. This is a Prospective observational study. It was carried out on the patients presenting with the complain of low back and radicular pain due to herniated lumbar disc not responding to conservative treatment. All the patients of herniated lumbar disc were proven by Magnetic Resonance Imaging (MRI). Injection Methyl prednisolone 80 mg and 2 ml of 0.5% bupivacaine was diluted in 8 ml of normal saline and injected into the affected lumbar epidural space. The functional status of the patient and the severity of pain were evaluated before injection and after injection during the follow-up period by using Ostrewy disability index and visual analogue score. Sixty two patients received the epidural steroid injections, but only fifty patients came for regular follow up till six months. Among the fifty patients, 26 were male and 24 were female. The functional status and pain response of the patients were improved significantly during all the follow-up periods (p < 0.001). The success rate of this study was 81%. No major complications were encountered. The ESI is a simple, safe, effective and minimally invasive modality for the management of symptomatic herniated discs.

Arsenic contamination of soils and agricultural plants through irrigation water in Nepal.

This study monitored the influence of arsenic-contaminated irrigation water on alkaline soils and arsenic uptake in agricultural plants at field level. The arsenic concentrations in irrigation water ranges from <0.005 to 1.014 mg L(-1) where the arsenic concentrations in the soils were measured from 6.1 to 16.7 mg As kg(-1). The arsenic content in different parts of plants are found in the order of roots>shoots>leaves>edible parts. The mean arsenic content of edible plant material (dry weight) were found in the order of onion leaves (0.55 mg As kg(-1))>onion bulb (0.45 mg As kg(-1))>cauliflower (0.33 mg As kg(-1))>rice (0.18 mg As kg(-1))>brinjal (0.09 mg As kg(-1))>potato (<0.01 mg As kg(-1)).

Comparative study of epidural administration of 10 ml of 0.1% bupivacaine with 2 mg butorphanol and 10 ml of 0.25% plain bupivacaine for analgesia during labor.

Analgesia during labor provided by two epidural drug regimens was compared in a double blind, randomized, prospective study. Group A (n = 12) received 10 ml bolus doses of 0.1% bupivacaine with butorphanol 2 mg while Group B (n = 8) received 10 ml of 0.25% plain bupivacaine. The objectives of this study was to compare, between the quality of an epidural labor analgesia using initial loading dose of 0.1% bupivacaine and 2 mg butorphanol with a initial loading dose of 0.25% bupivacaine. In Group A, incidence of motor block was 8.3% and that of prolong 2nd stage of labor was 16.7%, both were decreased in comparison with Group B, although they were not statistically significant. Hemodynamic variables were stable and no adverse neonatal and maternal outcome was observed in both groups. Addition of butorphanol to bupivacaine may be safe alternative to reduce motor block and decrease prolong 2nd stage for epidural labor analgesia.

Constructed wetland technology transfer to Nepal.

Constructed Wetland (CW) technology is still not wide spread in developing countries despite having great potential. This paper describes an approach carried out in Nepal to transfer CW technology for wastewater treatment. Three CWs (hospital wastewater treatment--20 m3/d, greywater treatment of a single household, septage treatment--40 m3/d) were built and two have been investigated so far. All systems are subsurface flow systems with at least one vertical flow stage. Their treatment efficiency turned out to be very high. Median load elimination rates of the hospital wastewater and greywater treatment plants were for TSS: 97 to 99%; BOD5: 97 to 99%; COD: 94 to 97%; NH4-N 80 to 99%; PO4-P: 5 to 69%; Total Coliforms: 99.87 to 99.999% (3-5 log steps). Beside the treatment task the plants play an important role as demonstration sites to make common people and especially decision makers aware of the existing environmental problems and one possible solution. Several recommendations are pointed out to promote the technology in developing countries.

Application of constructed wetlands for wastewater treatment in Nepal.

Surface water pollution is one of the serious environmental problems in urban centers in Nepal due to the discharge of untreated wastewater into the river-system, turning them into open sewers. Wastewater treatment plants are almost non-existent in the country except for a few in the Kathmandu Valley and even these are not functioning well. Successful implementation of a few constructed wetland systems within the past three years has attracted attention to this promising technology. A two-staged subsurface flow constructed wetland for hospital wastewater treatment and constructed wetlands for treatment of greywater and septage is now becoming a demonstration site of constructed wetland systems in Nepal. Beside these systems, five constructed wetlands have already been designed and some are under construction for the treatment of leachate and septage in Pokhara municipality, wastewater in Kathmandu University, two hospitals and a school. This paper discusses the present condition and treatment performance of constructed wetlands that are now in operation. Furthermore, the concept of the treatment wetlands under construction is also described here. With the present experience, several recommendations are pointed out for the promotion of this technology in the developing countries.