Determinants of livelihood diversification in rural rain-fed region of Pakistan: evidence from fractional multinomial logit (FMLOGIT) estimation.

Sustainable livelihoods in less developed countries are threatened by human, natural, physical, social and financial factors. Pakistan is also facing severe negative impacts of these factors in the form of climate shocks, market imperfections and insufficient formal credit availability on rural livelihoods. This study explores rural Pakistani's adaptation to these threats by diversifying income sources and explores the determining factors for adopting specific livelihood diversification strategies. The study is based on a quantitative survey of 295 households in three districts of rain-fed rural regions of Pakistan's Punjab with differing annual rainfall. Results showed that households mitigated against threats to their livelihood by having a diversity of income sources (Simpson Diversity Index = 0.61). Moreover, fractional multinomial regression modelling revealed that greater education was associated with a more diversified livelihood strategy, where income was predominantly derived from off-farm and non-farm livelihood activities. On the other hand, households with older members, more livestock and larger farm size focused their livelihoods on their own farms, or primarily diversified into an off-farm strategy by working on other farms. These findings underscore the importance of improved access to education and infrastructure for livelihood diversification. A policy that focuses on reducing low literacy rates in rural Pakistan may also provide new avenues of livelihood diversifications with enhancement of rural literacy rate to mitigate the risks associated with livelihood strategies of smallholders.

Guidelines on the management of abnormal liver blood tests.

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease.

The impact of swidden decline on livelihoods and ecosystem services in Southeast Asia: A review of the evidence from 1990 to 2015.

Global economic change and policy interventions are driving transitions from long-fallow swidden (LFS) systems to alternative land uses in Southeast Asia's uplands. This study presents a systematic review of how these transitions impact upon livelihoods and ecosystem services in the region. Over 17 000 studies published between 1950 and 2015 were narrowed, based on relevance and quality, to 93 studies for further analysis. Our analysis of land-use transitions from swidden to intensified cropping systems showed several outcomes: more households had increased overall income, but these benefits came at significant cost such as reductions of customary practice, socio-economic wellbeing, livelihood options, and staple yields. Examining the effects of transitions on soil properties revealed negative impacts on soil organic carbon, cation-exchange capacity, and aboveground carbon. Taken together, the proximate and underlying drivers of the transitions from LFS to alternative land uses, especially intensified perennial and annual cash cropping, led to significant declines in pre-existing livelihood security and the ecosystem services supporting this security. Our results suggest that policies imposing land-use transitions on upland farmers so as to improve livelihoods and environments have been misguided; in the context of varied land uses, swidden agriculture can support livelihoods and ecosystem services that will help buffer the impacts of climate change in Southeast Asia.

Variability of physical performance and player match loads in professional rugby union.

OBJECTIVES: To examine the within- and between-player variability of physical performance and player match loads in professional rugby union. DESIGN: A single cohort, observational study. METHODS: Physical match performance data were collected from 28 male, professional, English Championship players over 15 competitive matches. Using microsensors, the variables selected for analysis were total distance, low-speed running distance, high-speed running distance, very high-speed running distance, total impacts, repeated high-intensity efforts, body load (PlayerLoad™), and low velocity (<7.2kmh(-1)) body load. Ratings of perceived exertion represented match internal loads. Variability was quantified using the coefficient of variation, with the meaningful interpretation of change in physical performance and match loads calculated using magnitude-based inferences. RESULTS: We found large between-match (within-player) variation for high-speed running distance (27.6%; ±90% confidence limits 6.9% [forwards], 20.1%; ±4.1% [backs]), very high-speed running distance (68%; ±19%, 34.1%; ±7.5%), total impacts (24.0%; ±5.9%, 36.4%; ±7.9%) and repeated high-intensity efforts (18.7%; ±4.4%, 39.5%; ±8.8%), with moderate variability for match ratings of perceived exertion (8.2%; ±1.8%, 10.8%; ±2.1%), body load (7.3%; ±1.7%, 10.0%; ±2.0%) and low velocity body load (8.9%; ±2.0%, 10.7%; ±2.1%). Threshold values for likely substantial between-match changes in high-intensity physical performance measures ranged from 21% to 76%, and were âˆ¼10% for match ratings of perceived exertion, body load and low velocity body load. CONCLUSIONS: Within- and between-player variability of high-intensity activity in professional rugby union is large, yet ratings of perceived exertion, body load and low velocity body load appear more stable by comparison and may be interpreted with greater accuracy.

Bleeding in cardiac surgery: the use of aprotinin does not affect survival.

OBJECTIVE: The antifibrinolytic drug aprotinin has been the most widely used agent to reduce bleeding and its complications in cardiac surgery. Several randomized trials and meta-analyses have demonstrated it to be effective and safe. However, 2 recent reports from a single database have implicated the use of aprotinin as a risk for postoperative complications and reduced long-term survival. METHODS: In this single-institution observational study involving 7836 consecutive patients (1998-2006), we assessed the safety of using aprotinin in risk reduction strategy for postoperative bleeding. RESULTS: Aprotinin was used in 44% of patients. Multivariate analysis identified aprotinin use in risk reduction for reoperation for bleeding (odds ratio, 0.51; 95% confidence interval, 0.36-0.72; P = .001) and need for blood transfusion postoperatively (odds ratio, 0.67; 95% confidence interval, 0.57-0.79; P = .0002). The use of aprotinin did not affect in-hospital mortality (odds ratio, 1.03; 95% confidence interval, 0.71-1.49; P = 0.73), intermediate-term survival (median follow-up, 3.4 years; range, 0-8.9 years; hazard ratio, 1.09; 95% confidence interval, 0.93-1.28; P = .30), incidence of postoperative hemodialysis (odds ratio, 1.16; 95% confidence interval, 0.73-1.85; P = .49), and incidence of postoperative renal dysfunction (odds ratio, 0.78; 95% confidence interval, 0.59-1.03; P = .07). CONCLUSION: This study demonstrates that aprotinin is effective in reducing bleeding after cardiac surgery, is safe, and does not affect short- or medium-term survival.

Cardiovascular morbidity and mortality after orthotopic liver transplantation.

BACKGROUND: Hyperlipidemia and hypertension have been reported in liver allograft recipients and contribute to an increased risk of ischemic heart disease (IHD) after orthotopic liver transplantation (OLT). The aims of the study were (1) to determine the prevalence of risk factors for IHD in these patients and (2) to compare the observed incidence of cardiovascular events and related mortality in allograft recipients with a matched population. METHODS: One hundred ten consecutive adults (50 male) who attended for review after OLT (median follow-up 3.9 years; range 0.1-17.9) were assessed for cardiovascular risk factors using current blood pressure, diabetic status, and smoking history and measurements of total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. Cardiovascular events and cardiovascular mortality data were collected from the prospective database of all adult liver allograft recipients and compared to matched data from myocardial infarction registries and Office for National Statistics data, respectively. RESULTS: Raised serum cholesterol (>5.0 mmol/L) was found in 48 (44%) patients (18 male), and systolic hypertension (>140 mmHg) was found in 69 (63%) patients (27 male). The relative risk of ischemic cardiac events was 3.07 (95% [confidence interval] CI, 1.98-4.53) and the relative risk for cardiovascular deaths was 2.56 (95% CI, 1.52-4.05) in allograft recipients compared to an age-matched population without transplants. CONCLUSIONS: Liver allograft recipients have a greater risk of cardiovascular deaths and ischemic events than an age- and sex-matched population. The prevalence of raised cholesterol concentrations in patients after OLT is similar to those in previous reports. Moderate hypertension and hyperlipidemia may be more detrimental in patients after OLT compared to non-transplant patients without these risk factors.