How resilient are farmers in Africa to climate shocks? A case study of Nigerian farmers.

Agriculture in sub-Saharan Africa remains highly vulnerable to climate related shocks, since most production relies on rainfall. It is important to accurately measure the resilience of farmers and farming communities to weather variabilities, for both government policy and farmer management responses. This paper develops a Resilience Index Framework, which is further used to assess the resilience of farmers to climate shocks in Nigeria. We conceptualized our Resilience Index (RI) in this study to be a composite function of 60 indicators encompassing four resilience domains namely, Economic & Financial Resilience (ER); Technical-know-how Resilience (TR); Social Resilience (SR); and Physical Resilience (PR). A three-stage standardization approach to construct the resilience index is taken in this study. In the first stage, each indicator is standardized. In the second stage, the resilience domain is computed by averaging the corresponding standardized indicators. In the final stage, the composite RI is computed by estimating the weighted average of all the resilience domains. The study uses the baseline survey data collected between 2021 and 2022 from a total of 5954 farmers in the rainforest, derived and guinea savannah agroecological zones of Nigeria. The result of the study shows that the majority (96.5%) of the farmers are less resilient to climate shocks, with only 0.9% economically & financially resilient, 1.4% socially resilient, 31.4% technically resilient, and 18.5% physically resilient. Finally, some recommend steps to be taken by the government and relevant stakeholders to improve the resilience of farmers through provision of good infrastructural facilities and subsidized improved resistant seed varieties are proposed.

Health Literacy Among Patients With Chronic Lung Disease Entering Pulmonary Rehabilitation and Their Resident Loved Ones.

PURPOSE: The objective of this study was determine the prevalence of low health literacy (HL) and low reading ability among patients with chronic lung disease referred for pulmonary rehabilitation (PR) in the Netherlands and their loved ones; and to understand whether low HL or low reading ability influence PR outcomes. METHODS: Health literacy was measured using the Health Literacy Survey-Europe Q16 (HLS-EU-Q16). Reading ability and cognitive functioning were measured using the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D) and the Montreal Cognitive Assessment. Exercise capacity, health status, and symptoms of anxiety and depression were assessed. RESULTS: Patients (n = 120) entering PR and loved ones (n = 41) participated. Of all patients, 51% had low HL and 29% had low reading ability. Also, 39% of all loved ones had low HL. PR outcomes were comparable between patients with low or adequate HL. Patients with adequate reading ability showed greater improvement in symptoms of depression than patients with low reading ability (P = .047). CONCLUSION: Low HL and low reading ability are common among patients entering PR and their loved ones. For patients with low or adequate HL, PR is an effective treatment. Whether considering low HL and low reading ability by offering tailored education during treatment could augment the benefits of PR warrants further study.

Clinical and genetic spectrum of SCN2A-associated episodic ataxia.

BACKGROUND: Pathogenic variants in SCN2A are associated with various neurological disorders including epilepsy, autism spectrum disorder and intellectual disability. Few reports have recently described SCN2A-associated episodic ataxia (EA). Our study identifies its broader clinical and genetic spectrum, and describes pharmacological approaches. RESULTS: We report 21 patients with SCN2A-associated EA, of which 9 are unpublished cases. The large majority of patients present with epileptic seizures (18/21, 86%), often starting within the first three months of life (12/18, 67%). In contrast, onset of episodic ataxia ranged from 10 months to 14 years of age. The frequency of EA episodes ranged from brief, daily events up to 1-2 episodes per year each lasting several weeks. Potential triggers include minor head traumas and sleep deprivation. Cognitive outcome is favorable in most patients with normal or mildly impaired cognitive development in 17/21 patients (81%). No clear genotype-phenotype correlations were identified in this cohort. However, two mutational hotspots were identified, i.e. 7/21 patients (33%) harbor the identical pathogenic variant p.A263V, whereas 5/21 (24%) carry pathogenic variants that affect the S4 segment and its cytoplasmic loop within the domain IV. In addition, we identified six novel pathogenic variants in SCN2A. While acetazolamide was previously reported as beneficial in SCN2A-associated EA in one case, our data show a conflicting response in 8 additional patients treated with acetazolamide: three of them profited from acetazolamide treatment, while 5/8 did not. CONCLUSIONS: Our study describes the heterogeneous clinical spectrum of SCN2A-associated EA, identifies two mutational hotspots and shows positive effects of acetazolamide in about 50%.

Crystallization processes in a nonvibrating magnetic granular system with short range repulsive interaction.

Applying an unsteady magnetic field to a 2D nonvibrating magnetic granular system induces a random motion in the steel beads with characteristics analogous to that of molecules in a fluid. We investigate the structural characteristics of the solid-like structures generated by different quenching conditions. The applied field is generated by the superposition of a constant field and a collinear sinusoidal field. The system reaches a quasi steady state in which the effective temperature is proportional to the amplitude of the applied field. By reducing the effective temperature at different rates, different cooling rates are produced. A slight inclination of the surface allows us to investigate the effects of small particle concentration gradients. The formation of a wide and rich variety of condensed solid structures, from gel-like and glass-like structures up to crystalline structures, is observed and depends on the cooling rate. We focus our attention on the crystallization process and found this process to be a collective phenomenon. We discuss our results in terms of the measured time evolution of the mean squared displacement, the effective diffusion coefficient, and the radial distribution function.

Is there association between human development index and tuberculosis mortality risk? Evidence from a spatial analysis study in the south of Brazil.

The goal of this study was to analyse the spatial pattern of tuberculosis (TB) mortality using different approaches, namely: mortality rates (MR), spatial relative risks (RR) and Bayesian rates (Global and Local) and their association with human development index (HDI), Global and its three dimensions: education, longevity and income. An ecological study was developed in Curitiba, Brazil based on data from Mortality Information System (2008-2014). Spatial scan statistics were used to compute RR and identify high-risk clusters. Bivariate Local Indicator of Spatial Associations was used to assess associations. MR ranged between 0 and 25.24/100.000 with a mean (standard deviation) of 1.07 (2.66). Corresponding values for spatial RR were 0-27.46, 1.2 (2.99) and for Bayesian rates (Global and Local) were 0.49-1.66, 0.90 (0.19) and 0-6.59, 0.98 (0.80). High-risk clusters were identified for all variables, except for HDI-income and Global Bayesian rate. Significant negative spatial relations were found between MR and income; between RR and HDI global, longevity and income; and Bayesian rates with all variables. Some areas presented different patterns: low social development/low risk and high risk/high development. These results demonstrate that social development variables should be considered, in mortality due TB.

Brownian motion of optically anisotropic spherical particles in polymeric suspensions.

We studied the rotational and translational diffusion of optically anisotropic liquid crystal particles embedded in semidiluted polymer solutions of Poly-Ethylene-Oxide (PEO) at different concentrations and different molecular weights. The polymer radius of gyration was chosen to be similar to the size of the probe particles and the polymer concentrations used are just above the crossover concentration. Thus, the system consists of solid probe particles moving in a sea of overlapping particles of similar size. We found that the behavior of both particle dynamics, rotational and translational, is similar in the range of concentrations considered here. In both cases, two linear diffusive regimes are observed, separated by a subdiffusive time interval. The spatial scale at which this intermediate regime appears shows a dependence on both the polymer concentration and molecular weight, and has a value similar to the thickness of the polymer-depleted layer usually found in this kind of systems. Additionally, we observe that the colloidal dynamic scales with the overlapping degree of the polymer particles.

Transition from diffusive to subdiffusive motion in colloidal liquids.

In this work we report experimental and theoretical results for the motion of single colloidal particles embedded in complex fluids with different interparticle interactions. The motion of particles is found to follow a similar behavior for the different systems. In particular, the transition from the short-time diffusive motion to the subdiffusive intermediate-time motion is found to occur when the square root of its mean squared displacement is in the order of 1 tenth of the neighbors' interparticle distance, thus following a quantitative criterion similar to Lindemann's criterion for melting.

Modifying RANKL/OPG mRNA expression in differentiating and growing human primary osteoblasts.

The OPG/RANKL system in primary cultures of human osteoblasts has been studied by different authors. However, very few studies have been performed on gene expression of RANKL and OPG at different stages of maturation on human osteoblast cultures. The effect of 17- beta-estradiol and 1,25dihydroxyvitamin D3 on the OPG/RANKL system is not known during the different states of cellular maturation. In this work we quantified OPG and RANKL protein levels (ELISA) and the mRNA of OPG, RANKL, collagen type I, alkaline phosphatase, and osteocalcin (semi-quantitative RT-PCR) in human osteoblasts. We analyzed these in basal conditions and after incubation with 17- beta-estradiol and 1,25dihydroxyvitamin D3 in the first and second phases. We found that OPG secretion and expression levels increased throughout cellular growth. RANKL proteins were detected only in the first stage, and the expression increased throughout the first phase. Thus, the RANKL/OPG ratio was higher in immature osteoblasts than in mature osteoblasts. The evolution of RANKL gene expression was related to collagen I and alkaline phosphatase, while OPG was related to osteocalcin. We observed no modifications after estradiol and 1,25dihydroxyvitamin D3 treatment. Our results suggest that the OB is a positive stimulator at precocious stages of differentiation on osteoclastogenic modulates.

[Ventilatory dysfunction in motor neuron disease: when and how to act?]. / Disfunção ventilatória na doença do neurónio motor: quando e como intervir?

Amyotrophic lateral sclerosis is a devastating progressive neurodegenerative disorder, involving motor neurons in the cerebral cortex, brainstem and spinal cord. Mean duration of survival from the time of diagnosis is around 15 months, being pulmonary complications and respiratory failure responsible for more than 85% of deaths. Albeit the inevitability of respiratory failure and short-term death, standardized intervention protocols have been shown to significantly delay the need for invasive ventilatory support, thus prolonging survival and enhancing quality of life. The authors present an intervention protocol based on clinical progression and respiratory parameters. Decisions regarding initiation of non-invasive positive pressure ventilation (NIPPV) and mechanically assisted coughing, depend on development of symptoms of hypoventilation and on objective deterioration of respiratory parameters especially in what concerns bulbar muscle function. These include maximum inspiratory capacity (MIC), difference between MIC and vital capacity (MIC-VC), and assisted peak cough flow (PCF). These standardized protocols along with patient and caregivers education, allow for improved quality of life, prolonged survival and delay or eventually prevent the need for tracheotomy and invasive ventilatory support. Supplemental oxygen should be avoided in these patients, since it precludes use of oxymetry as feedback for titrating NIPPV and MAC, and is associated with decreased ventilatory drive and aggravated hypercapnia.

[Alterations in bone mineral metabolism in patients with calcium kidney stone disease and polymorphism of vitamin D receptor. Preliminary results]. / Alteraciones en el metabolismo mineral óseo en pacientes con urolitiasis de repetición y polimorfismos del gen del receptor de la vitamina D. Resultados preliminares.

UNLABELLED: Bone health, within calcium kidney stone disease is a matter of controversy. On the other hand, some genetic studies have shown an association between some Vitamin D receptor polymorphisms and calcium kidney stone disease. MAIN OBJECTIVE: To study the possible association between calcium kidney stone disease with bone metabolism and some Vitamin D receptor polymorphisms. PATIENTS AND METHODS: This is a case-control study, with seventy-two subjects of both genders divided into two groups: Group I: cases, composed by 51 patients suffering from calcium kidney stone disease. Twenty-four of them had no hypercalciuria, 16 had absortive hypercalciuria and 11 had renal hypercalciuria. Group II: controls, composed by 21 people, without either urolithiasis or hypercalciuria. We performed a complete study including biochemical markers of bone mineral remodelling, bone mineral density (BMD) was estimated both in the lumbar spine (L2-L4) and femoral neck, and also VDR polymorphism for the loci b, a and t. RESULTS: Patients with urolithiasis had lower values of BMD both in the lumbar spine and femoral neck, compared to controls. Z-score were lower in the lumbar spine and femoral neck (p =0,045 y 0,031, respectively). Those patients with absorptive hypercalciuria had higher BMD in the femoral neck than those with renal hypercalciuria and non-hypercalciuria. Because they had more weight and height all the statistical study was performed alter adjusting by these two variables and statistical significance was then only stated between patients with hypercalciuria and without it. Patients with urolithiasis had higher values of 1,25 (OH)2 vitamin D (p=0,002), and lower of PTH (p=0,049), without any relationship to hypercalciuria and its subtypes. Seventy six percent of the patients had a daily calcium intake lower than 800 mg/day. The distribution of VDR alleles in patients with urolithiasis was similar to controls, although after grouping genotypes, a lower distribution of BB and tt polymorphisms were observed in patients suffering from urolithiasis. CONCLUSIONS: Calcium kidney stone disease by itself produces a decrease in BMD, more intense in femoral neck, independently the presence or absence of hypercalciuria. Patients suffering from urolitihiasis have higher values of 1,25 (OH)2 vitamin D than non-hypercalciuric patients and lower values of PTH probably due to a low dietary calcium intake. In our population studied there is no relationship between VDR polymorphisms and the presence of calcium kidney stone disease. Because the reduced number of patients of our study, more studies are needed to obtain definitely conclusions.

[Neuroimaging in preterm infants]. / Neuroimagen en el pretérmino.

INTRODUCTION: It is today well recognised that preterm infants are at risk of neurodevelopmental impairments later in life. The preterm brain is exposed to different stimuli that may affect its normal development. Develoment. Magnetic resonance imaging (MRI) offers the possibility of monitoring normal brain development and pathology in the preterm brain. The most frequent lesions are germinal matrix/intraventricular haemorrhages, periventricular hemorrhagic infarction and periventricular leukomalacia. Other changes especially in the white matter, less well known from ultrasound studies, can be depicted with MRI. Furthermore, quantitative MRI techniques have demonstrated differences between the normal appearing preterm brain at term-equivalent age and the brain of term-born infants. CONCLUSION: These studies confirm that the immature brain may develop differently in the extra uterine environment. Future studies with these techniques will improve our knowledge of the effects of prematurity on long term brain development.

Neuroimagen en el pretérmino / Neuroimaging in preterm infants

Introducción. Es bien sabido que el nacimiento prematurosupone un riesgo para el desarrollo cerebral. El cerebro inmaduroestá expuesto a estímulos diversos que, en consecuencia, puedenresultar nocivos para su adecuado desarrollo. Desarrollo. Laresonancia magnética (RM) es una técnica que ofrece la posibilidadde estudiar el cerebro inmaduro, tanto en relación con el desarrollonormal de éste y con las diferentes patologías cerebralescaracterísticas del niño prematuro, como las hemorragias intraventriculares,las hemorragias de parénquima cerebral y la leucomalaciaperiventricular. Mediante RM pueden constatarse otroscambios más sutiles y menos conocidos con los métodos tradicionales,como la ecografía. Además, las técnicas de RM cuantitativasy más sofisticadas permiten hoy apreciar las diferencias entreel cerebro del niño prematuro sin lesiones aparentes a la edad detérmino y el cerebro del niño recién nacido a término. Conclusión.Las diferentes técnicas de RM permiten el estudio del cerebro inmaduroy su desarrollo. Estudios recientes con RM muestran diferenciasen el cerebro del niño nacido prematuro comparado con eldel nacido a término. Esto confirma que el ambiente extrauterinoafecta al desarrollo del cerebro inmaduro. Futuros estudios con estastécnicas permitirán un mejor conocimiento de los efectos del nacimientoprematuro en el desarrollo cerebral a largo plazo

Introduction. It is today well recognised that preterm infants are at risk of neurodevelopmental impairments laterin life. The preterm brain is exposed to different stimuli that may affect its normal development. Develoment. Magneticresonance imaging (MRI) offers the possibility of monitoring normal brain development and pathology in the preterm brain.The most frequent lesions are germinal matrix/intraventricular haemorrhages, periventricular hemorrhagic infarction andperiventricular leukomalacia. Other changes especially in the white matter, less well known from ultrasound studies, can bedepicted with MRI. Furthermore, quantitative MRI techniques have demonstrated differences between the normal appearingpreterm brain at term-equivalent age and the brain of term-born infants. Conclusion. These studies confirm that the immaturebrain may develop differently in the extra uterine environment. Future studies with these techniques will improve ourknowledge of the effects of prematurity on long term brain development

[Pressure ulcer management--Evidence-based interventions]. / Abordagem terapêutica das úlceras de pressão--intervenções baseadas na evidência.

Despite improved awareness and quality of care among health care personnel, pressure ulcers prevalence remains high especially in the inpatient setting. Pressure ulcers are associated with increased morbidity and mortality, affecting the quality of life of patients and their caregivers, and significantly increasing direct and indirect healthcare costs. Early risk assessment for developing a pressure ulcer is essential to decide on the appropriate preventive measures and for initiation of a tailored therapeutic approach. Interventions include strategies to reduce extrinsic and intrinsic risk factors associated with tissue ischemia, optimization of patient's nutritional status, and local wound care. This revision intends to review current evidence-based therapeutic interventions in pressure ulcer care, and support implementation of management protocols in an inpatient ward.

Histerectomía vaginal asistida por laparoscopia (HVAL). Indicaciones y técnica / Laparoscopic assisted vaginal hysterectomy. Indications and technical procedure

Se discuten en este capítulo las indicaciones y técnica de la histerectomía vaginal asistida por laparoscopia

Indications and technical procedure of laparoscopic assisted vaginal hysterectomy are discussed in this chapter

Visual cortex reactivity in sedated children examined with perfusion MRI (FAIR).

Sleeping and sedated children can respond to visual stimulation with a decrease in blood oxygenation level dependent (BOLD) functional MRI signal response. The contribution of metabolic and hemodynamic parameters to this inverse signal response is incompletely understood. It has been hypothesized that it is caused by a relatively greater increase of oxygen consumption compared to rCBF (regional cerebral blood flow) increase. We studied the rCBF changes during visual stimulation in four sedated children, aged 4-71 months, and four alert adults, with an arterial water spin labeling technique (FAIR) and BOLD fMRI in a 1.5T MR scanner. In the children, FAIR signal decreased by a mean of 0.96% (range 0.77-1.05) of the baseline periods of the non-selective images, while BOLD signal decreased by 2.03% (range 1.99-2.93). In the adults, FAIR and BOLD signal increased by 0.88% (range 0.8-0.99) and 2.63% (range 1.99-2.93), respectively. Thus, in the children, an rCBF increase could not be detected by perfusion MRI, but indications of a FAIR signal decrease were found. An rCBF decrease in the primary visual cortex during stimulation has not been reported previously, but it is a possible explanation for the negative BOLD response. Future studies will have to address if this response pattern is a consequence of age or sleep/sedation.

Functional magnetic resonance imaging of the normal and abnormal visual system in early life.

Functional magnetic resonance imaging (fMRI) in young children may provide information about the development of the visual cortex, and may have predictive value for later visual performance. The purpose of this study was to evaluate the usefulness of fMRI for examining cerebral processing of vision in very young infants and in infants with brain damage. We examined 15 preterm infants, 12 children suspected of having a cerebral visual impairment and 10 children with a normal visual system, all of whom were either spontaneously asleep or sedated with chloral hydrate. Cortical response to stroboscopic light stimulation could be demonstrated in all technically acceptable data sets from children with a post-menstrual age (PMA) of > 41 weeks, but not in younger infants. Children < 60 weeks PMA showed either a blood oxygenation level-dependent (BOLD) signal increase or decrease, while all older children showed a signal decrease. The activated cortical volumes showed a linear relation to age for healthy children younger than 90 weeks PMA, but were small in children with visual impairment. In two children with unilateral damage to the optic radiations, activation was strongly asymmetrical with greatest activation on the healthy side. In future prospective studies, results from the period from birth to six months of age should be interpreted with caution, as inter-individual variation of cortical development may be confused with functional deficit.

Visual activation in infants and young children studied by functional magnetic resonance imaging.

The purpose of this study was to determine whether visual stimulation in sleeping infants and young children can be examined by functional magnetic resonance imaging. We studied 17 children, aged 3 d to 48 mo, and three healthy adults. Visual stimulation was performed with 8-Hz flickering light through the sleeping childs' closed eyelids. Functional magnetic resonance imaging was performed with a gradient echoplanar sequence in a l.5-T magnetic resonance scanner. Six subjects were excluded because of movement artifacts; the youngest infant showed no response. In 10 children, we could demonstrate areas of signal decrease during visual stimulation in the occipital cortex (mean decrease 2.21%), contrary to the signal increase observed in the adult controls (mean increase 2.82%). This decrease may be due to a higher proportional increase in oxygen extraction compared with increase in cerebral blood flow during activation. The different response patterns in young children and adults can reflect developmental or behavioral differences. Localization of the activation seemed to be age-dependent. In the older children and the adults, it encompassed the whole length of the calcarine sulcus, whereas it was restricted to the anterior and medial part of the calcarine sulcus in the younger infants. This may reflect a different functional organization of the young child's visual cortex or the on-going retinal development.

Anophthalmia-microphthalmia-oblique clefting syndrome: confirmation of the Fryns anophthalmia syndrome.

We describe a patient with bilateral extreme microphthalmia with bilateral congenital glaucoma, bilateral medial oblique facial cleft ending in lid colobomas, bilateral stenosis of the choanae, bifid uvula, frontal encephalocele, and premature craniosynostosis. The cause is unknown, but the phenotype resembles the Fryns anophthalmia-plus syndrome, which may be a recessive trait, although intrauterine environmental factors cannot be excluded.