Farm size limits agriculture's poverty reduction potential in Eastern India even with irrigation-led intensification.

CONTEXT: Millions of people living in the Eastern Gangetic Plains (EGP) of India engage in agriculture to support their livelihoods yet are income poor, and food and climate insecure. To address these challenges, policymakers and development programs invest in irrigation-led agricultural intensification. However, the evidence for agricultural intensification to lift farmers' incomes above the poverty line remains largely anecdotal. OBJECTIVE: The main objective of this study is to use a large household survey (n = 15,572; rice: 8244, wheat: 7328; 2017/18) to assess the link between agricultural intensification and personal daily incomes from farming (FPDI) in the rice-wheat systems of the EGP - the dominant cropping system of the region. METHODS: We use the Intensification Benefit Index (IBI), a measure that relates farm size and household size to FPDI, to assess how daily incomes from rice-wheat production change with irrigation-led intensification across the EGP. RESULTS AND CONCLUSIONS: Relative to the international poverty line of 1.90 Purchasing Power Parity (PPP)$ day-1 and accounting for variations in HH size in the analysis, we found that small farm sizes limit the potential for agricultural intensification from irrigation to transform the poverty status of households in the bottom three quartiles of the IBI. The estimated median FPDI of households with intensified systems in the bottom three quartiles is only 0.51 PPP$ day-1 (a 0.15 PPP$ gain). The median FPDI increases to 2.10 PPP$ day-1 for households in the upper quartile of the IBI distribution (a 0.30 PPP$ gain). Irrigation-led agricultural intensification of rice-wheat systems in the EGP may provide substantial benefits for resilience to climatic change and food security but achieving meaningful poverty reduction will require complementary investments. SIGNIFICANCE: Transforming the poverty status of most smallholder farmers in the EGP requires diversified portfolios of rural on- and off-farm income-generating opportunities. While bolstering food- and climate security, agronomic intervention programs should consider smallholders' limited monetary incentives to invest in intensification. Irrigation-led agricultural intensification programs and policies should explicitly account for the heterogeneity in household resources, irrigation levels, and degree of dependence on agricultural income.

Enlarged vestibular aqueduct syndrome mimicking otosclerosis in adults.

INTRODUCTION: An enlarged vestibular aqueduct (EVA) results in hearing loss which is often progressive and heterogenous, the long-term natural history of which is not well understood. Patients born before the era of newborn hearing screening can present as adults with previously undiagnosed EVA. METHODS: A retrospective chart review of patients seen at a tertiary adult academic otologic clinic from 2004 to 2012 were reviewed and cases of EVA were identified. RESULTS: Adult EVA was found to present with a mixed progressive hearing loss with absent stapedial reflexes. CONCLUSION: Enlarged vestibular aqueduct abnormality can present in adulthood and mimic other more common pathology such as otosclerosis.

Successful desensitization to high dose rituximab for a child with nephrotic syndrome - The first report in the literature.

Rituximab is a chimeric monoclonal antibody, which is mainly used in the treatment of lymphoma and autoimmune disorders, but also has been recently approved for the treatment of nephrotic syndrome. The treatment dose is between 375 mg/m2 and 750 mg/m2. Rituximab has been associated with hypersensitivity reactions, which can be classified either into early and late infusion-associated adverse reactions. Different desensitization protocols have been described in adult patients who require rituximab, however, there is a limited experience in children and in patients with nephrotic syndrome. Additionally, all the published protocols for adults and children are based on the low-dose rituximab desensitization. We report the first case in the literature of desensitization to high-dose rituximab in a child with nephrotic syndrome, suggesting a well-tolerated protocol adjusted on the high dose and the clinical reaction to the drug. This protocol can be used for children with nephrotic syndrome and severe reaction that require 750 mg/m2 of rituximab.

Hazardous sound outputs of white noise devices intended for infants.

OBJECTIVES: To measure the sound intensity of popular infant white noise machines and Apple iPhone applications (apps) as they vary with volume setting and distance, and compare these output levels with current National Institute for Occupational Safety and Health (NIOSH) noise exposure threshold recommendations. METHODS: A total of eight infant white noise machines and six iPhone applications were included in the study based on product rating, number of ratings, and cost. The NIOSH Sound Level Meter application through the Apple App Store was used to measure output levels in A-weighted decibels (dBA). Each device was tested at its lowest and highest volume setting and at speaker-to-microphone distances simulating placement within a crib (10 cm), just outside of a crib rail (30 cm), and on a nightstand across the room (100 cm). RESULTS: At the minimum volume setting, no device exceeded the NIOSH recommended noise exposure threshold of 85 dBA at any distance tested. At maximum volume setting, nine out of fourteen (64.3%) devices exceeded output levels of 85 dBA at a speaker-to-microphone distance of 10 cm. No device exceeded the recommended threshold at its maximal volume when placed 30 cm or 100 cm away. CONCLUSION: Excessive white noise exposure has the potential to lead to noise-induced hearing loss and other adverse health effects in the neonatal and infant population. We recommend conservative use of white noise machines and apps by avoiding maximal volume setting and placing any device well outside of the crib or at least 30 cm away from the child. To promote safe use of white noise devices, future studies are needed to fully understand the association between early noise exposure and hearing loss in infants.

A data science challenge for converting airborne remote sensing data into ecological information.

Ecology has reached the point where data science competitions, in which multiple groups solve the same problem using the same data by different methods, will be productive for advancing quantitative methods for tasks such as species identification from remote sensing images. We ran a competition to help improve three tasks that are central to converting images into information on individual trees: (1) crown segmentation, for identifying the location and size of individual trees; (2) alignment, to match ground truthed trees with remote sensing; and (3) species classification of individual trees. Six teams (composed of 16 individual participants) submitted predictions for one or more tasks. The crown segmentation task proved to be the most challenging, with the highest-performing algorithm yielding only 34% overlap between remotely sensed crowns and the ground truthed trees. However, most algorithms performed better on large trees. For the alignment task, an algorithm based on minimizing the difference, in terms of both position and tree size, between ground truthed and remotely sensed crowns yielded a perfect alignment. In hindsight, this task was over simplified by only including targeted trees instead of all possible remotely sensed crowns. Several algorithms performed well for species classification, with the highest-performing algorithm correctly classifying 92% of individuals and performing well on both common and rare species. Comparisons of results across algorithms provided a number of insights for improving the overall accuracy in extracting ecological information from remote sensing. Our experience suggests that this kind of competition can benefit methods development in ecology and biology more broadly.

Graft histology characteristics in long-term survivors of pediatric liver transplantation.

The factors that influence the long-term histological outcome of transplanted liver allografts in children are not yet fully understood, and the role of surveillance biopsies in patients with normal graft function remains controversial. The aims of this study were to describe the long-term graft histology of pediatric liver transplant recipients surviving at least 3 years and to analyze factors correlating with long-term histological outcome. Histological slides of 63 long-term liver transplant recipients were assessed for inflammation and fibrosis. The histological findings were correlated with clinical, biochemical, serological, and radiological findings. A significant proportion of biopsies from these patients showed some type of histological abnormalities, with fibrosis being observed in 61 (97%) patients. Duration of transplantation of >6 years and > or =grade 2 inflammation were significantly associated with advanced fibrosis. We could not identify any correlation between > or =stage 3 fibrosis and donor age, cold and warm ischemia time, history of de novo autoimmune hepatitis, hepatic artery thrombosis, chronic rejection, or alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase values. In conclusion, liver fibrosis appears to be a common finding in long-term pediatric liver transplant survivors. The cause of this fibrosis is uncertain, and normal alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels do not exclude the presence of significant fibrosis.

Implantable hearing devices.

Implantable hearing devices are becoming more common practice in assisting hearing impaired patients who do not benefit enough from conventional amplification devices such as hearing aids. This article illustrates the benefits obtained by patients who are recipients of the BAHA (Bone Anchored Hearing Aid) or cochlear implants. Patients receive significant hearing benefit from implantable hearing devices and practitioners should be aware of the criteria for referral and the significant benefits that these devices can bring to their patients.

Potent and selective inhibitors of the Met [hepatocyte growth factor/scatter factor (HGF/SF) receptor] tyrosine kinase block HGF/SF-induced tumor cell growth and invasion.

The hepatocyte growth factor/scatter factor (HGF/SF) receptor, Met, mediates various cellular responses on activation with its ligand, including proliferation, survival, motility, invasion, and tubular morphogenesis. Met expression is frequently up-regulated in sarcomas and carcinomas. Experimental evidence suggests that Met activation correlates with poor clinical outcome and the likelihood of metastasis. Therefore, inhibitors of Met tyrosine kinase may be useful for the treatment of a wide variety of cancers that have spread from the primary site. We have discovered potent and selective pyrrole-indolinone Met kinase inhibitors and characterized them for their ability to inhibit HGF/SF-induced cellular responses in vitro. These compounds inhibit HGF/SF-induced receptor phosphorylation in a dose-dependent manner. They also inhibit the HGF/SF-induced motility and invasion of epithelial and carcinoma cells. Therefore, these compounds represent a class of prototype small molecules that selectively inhibit the Met kinase and could lead to identification of compounds with potential therapeutic utility in treatment of cancers.

Straight talk. New approaches in healthcare. Outsourcing in the business office increases cash.

Want more cash? Rather than simply sending old patient balances to collection agencies in knee-jerk fashion, sophisticated business offices are scrutinizing their days in accounts receivable, determining what types of accounts and dollar balances to outsource for collection and when to outsource them. In this installment of Straight Talk, we look at the outsourcing strategies in the business offices of three healthcare systems: 266-bed Tuomey Healthcare System, Sumter, S.C.' 3-hospital, 1,062-bed Montefiore Medical Center, New York; and 14,200-bed, 30-hospital New York Presbyterian Health System, New York. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on outsourcing of business office functions was held on September 23, 2004 at Modern Healthcare's Chicago headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.

Autoimmune inner ear disease preliminary case report: audiometric findings following steroid treatments.

PURPOSE: This study examined the audiometric findings following steroid treatment for autoimmune inner ear disease (AIED), which is characterized by bilateral subacute hearing loss, using oral and intratympanic treatment. METHOD: The charts of 9 patients with AIED who had been seen in the Saint Louis University School of Medicine's clinic between 2004 and 2011 were reviewed, with special focus on audiometric results. RESULTS: The majority of patients benefited from treatment for AIED. Four patients (6 ears) received intratympanic therapy as part of their treatment. CONCLUSION: Patients with AIED appeared to benefit from a clinical pathway using a prolonged course of oral steroids, followed by a trial of intratympanic steroids and/or immunosuppresants for refractory cases.

Alternative field methods for measuring hearing protector performance.

In comparison with the mandatory noise reduction rating (NRR) testing of every hearing protector sold in the United States, real-world tests of hearing protector attenuation are scarce. This study evaluated data from three potential field-test methods as compared with the subject-fit data from Method B of ANSI S12.6-1997 for the E.A.R(R) Express trade mark Pod Plug trade mark. The new field-test methods were the FitCheck headphone (FCH) method, FitCheck in sound field (FCSF) method, and bone-conduction loudness balance (BCLB) method, all of which can be administered in small single-person audiometric booths such as are commonly found in industry. Twenty normal-hearing and audiometrically competent subjects naive to hearing protector use were tested with the laboratory and the three field-test methods in a repeated-measures design. Repeated-measures models with structured covariance matrices were used to analyze the data. Significant effects were found for method, frequency, and first-order frequency-by-gender and frequency-by-method interactions. These effects and interactions were expected given the different psychophysical tasks. The FCSF and BCLB methods provided attenuations that were not significantly different from those found with Method B. Although the attenuations measured for the FCH method were statistically different (greater) than the attenuations from the other methods, the differences were within the magnitude of acceptable test-retest audiometric variability. The results suggest that the FCH and FCSF methods were both feasible and reliable methods for field testing. The FCH method is limited to testing earplugs, and the FCSF requires additional equipment to outfit the test booth, but could be used for testing all types of protectors.