The power of feedback.

Cause, conseguenze e strategie di mitigazione Proponiamo il primo di una serie di articoli in cui affronteremo l’attuale problema dei mutamenti climatici. Presentiamo il documento redatto, votato e pubblicato dall’Ipcc - Comitato intergovernativo sui cambiamenti climatici - che illustra la sintesi delle ricerche svolte su questo tema rilevante.

/pdf/climate-change-2007-the-physical-science-basis-1x93ttz9jt.pdf

Climate Change 2007: The Physical Science Basis.

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

/pdf/2019-esc-guidelines-for-the-diagnosis-and-management-of-5b7mv2v506.pdf

2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.

The talk with present the key results of the IPCC Working Group III 5th assessment report. Concluding four years of intense scientific collaboration by hundreds of authors from around the world, the report responds to the request of the world's governments for a comprehensive, objective and policy neutral assessment of the current scientific knowledge on mitigating climate change. The report has been extensively reviewed by experts and governments to ensure quality and comprehensiveness.

Climate change 2014 - Mitigation of climate change

Surgical Outcomes of Levator Resection in Moderate and Severe Ptosis With a Good Levator Function: A Retrospective Study

Introduction: The purpose of the present study was to determine the factors that affect the outcome of strabismus surgery in terms of improvement in stereopsis and binocularity. Methods: Data were collected prospectively from patients with childhood-onset, concomitant, constant strabismus greater than 30 prism diopters (PD) with postoperative alignment within 10 PD. Pre- and postoperative stereopsis and binocularity testing were performed using the Titmus fly test, random dot test, Bagolini striated glass test, and Worth four dot test at one, four, and 12 weeks postoperatively. Results: A total of 73 patients (55% males and 45% females) who underwent surgery at our center were studied. The mean age at the time of surgery was 16 ± 7.7 years (range: 5-35 years). We found that factors such as age of strabismus onset, type of deviation, and amblyopia had a statistically significant influence on the postoperative surgical outcome. A statistically insignificant relationship was noted with gender, refractive error, and duration of strabismus. Patients who had strabismus after six months of age noticed a significant improvement in stereopsis (p-value = 0.000) than those who had strabismus before six months of age (p-value = 0.660). Further, there was a statistically significant improvement in patients having exotropia (p-value = 0.018) or combined horizontal and vertical deviations (p-value = 0.000), but there was no significant improvement in patients with esotropia (p-value = 0.180). Moreover, non-amblyopes had a significantly better postoperative stereopsis than amblyopes (p-value = 0.006). Although there was no association between preoperative deviation and improvement in stereopsis (p-value = 0.081), patients having preoperative deviation in the range of 31-45 PD had a statistically significant improvement in stereopsis (p-value = 0.000). There was no significant difference between postoperative residual deviation and final stereopsis (p-value > 0.05). All the results were the same for both the Titmus test and the random dot test. Binocular fusion was observed in 34 subjects, and uniocular suppression was noted in 38 subjects preoperatively. It was observed that only one patient gained binocular single vision postoperatively. Conclusion: The presence of amblyopia, esotropia, early onset of strabismus (within six months of age), and a larger preoperative deviation (>45 PD) were associated with poorer stereopsis. In patients with horizontal strabismus, the coexistence of vertical deviation had a positive impact on the postoperative stereopsis. Gender, refractive error, and duration of strabismus did not influence the final stereopsis in our study.

/pdf/factors-determining-improvement-in-stereopsis-and-srin7h9k.pdf

Factors Determining Improvement in Stereopsis and Binocularity After Good Postoperative Alignment in Patients With Childhood-Onset Strabismus

Background Nasogastric tube insertion is a routinely performed technique in anesthetized and intubated patients. However, failure leads to repeated insertion attempts causing injury, which makes the situation cumbersome. Therefore, we introduce a simple technique of deflating endotracheal tube cuff for nasogastric tube insertion in such patients. Methods Eighty adult patients scheduled for elective abdominal surgeries were randomly allocated into two groups, Group A (nasogastric tube insertion without endotracheal cuff deflation) and Group B (nasogastric tube insertion with endotracheal tube cuff deflation) along with lateral pressure application at cricoid in both groups. The number of attempts required, overall success rate, the time taken, rescue maneuvers, and incidence of complications were compared between the groups. Results In Group B, the total success rate for nasogastric tube placement was significantly higher than in Group A (80% vs 55%, p=0.016). Group B had a 55% first attempt success rate, but only 25% of patients in Group A had a first attempt success rate (p=0.014). The overall time for successful nasogastric tube placement was longer in Group A than in Group B (65.4 ± 28.72 seconds vs 43.5 ± 25.37 seconds, p=0.0005). The differences in nasogastric tube kinking and coiling between Group B and Group A were not statistically significant (20% vs 22.5%, 10% vs 27.5%, p = 0.78 and 0.08, respectively). Mucosal bleeding was substantially higher in Group A than in Group B (30% vs 10%, p=0.025, respectively). Conclusions This study showed that endotracheal tube deflation significantly increased the first-attempt success rate, overall successful placement of the nasogastric tube in intubated patients, and incidence of complications like mucosal bleeding decreased.

https://www.cureus.com/articles/104849-role-of-endotracheal-tube-cuff-deflation-in-facilitating-passage-of-nasogastric-tube.pdf

Role of Endotracheal Tube Cuff Deflation in Facilitating Passage of Nasogastric Tube

ABSTRACT This study aims to assess the impacts of assimilating the clear-sky radiances from the Advanced Geosynchronous Radiation Imager (AGRI) onboard the Fengyun-4A (FY-4A) satellite on 72-h forecasts. First, we compare the water vapour (WV) brightness temperature (TB) in July 2018 from the National Centers for Environmental Prediction (NCEP) Global Data Assimilation System (GDAS) analyses and Weather Research and Forecasting (WRF) forecasts with the clear-sky AGRI WV channel observations. The results suggest that the NCEP GDAS analyses are more consistent with the AGRI observations than the WRF forecasts, and the AGRI observations can be utilized to improve the initial conditions of the WRF model by data assimilation, especially in water vapour and surface temperature. After the preliminary verification, two identical cycling assimilation experiments are performed with and without the AGRI WV TB assimilation for a month. The results reveal that the WRF forecasts with AGRI TB assimilation are closer to satellite observations than the first guess in both WV channels. The validation with WV channel data of the Microwave Humidity Sounder (MHS) and SAPHIR sensors indicates that after the AGRI data assimilation, the errors are smaller than in the control experiment (without AGRI assimilation). The assimilation of the TB observed by AGRI WV channels shows a remarkable positive impact on moisture forecasts at middle and upper levels. Comparison of the TB from the WRF forecasts with the MHS observations suggests that the AGRI WV channel assimilation can improve the predictions. Overall, assimilating AGRI WV observations can positively influence the WRF analyses and forecasts.

Impacts of Assimilating FY-4A AGRI Clear-Sky Water Vapor Radiance on Short-Range Weather Prediction during Indian Summer Monsoon

The field experiment was conducted during Kharif, 2020-21 at Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola (Maharashtra) to study the effect of fertigation and foliar spray of nutrients on soil fertility and yield of bottle gourd (Lagenaria siceraria L). The experiment was conducted in a factorial randomized block design with three replications. The two factors i.e., fertigation levels and foliar spray levels were evaluated against soil fertility and yield of bottle gourd. The results indicate, that the foliar spray of nutrients did not influence significantly the soil pH, EC, while with fertigation levels, significantly lowest pH was observed with S1 (200:100:100 kg ha-1 N, P2O5, K2O) while EC was not significant. The organic carbon content and major nutrient i.e., available nitrogen, phosphorus and potassium were increased by 11, 25, 22 and 5% with fertigation level of S1 (200:100:100 kg ha-1 N, P2O5, K2O) over S3 (100:50:50 kg ha-1 N, P2O5, K2O), and by 21, 7, 15 and 5% with foliar spray level of F3 (Two foliar spray of ZnSO4 @ 0.25% + FeSO4 @ 0.25%) over F0 (water spray). The micronutrient contents particularly Fe, Mn, and Zn were significantly increased by 32, 11, and 14% with foliar spray levels of S1 (200:100:100 kg ha-1 N, P2O5, K2O) over S3 (100:50:50 kg ha-1 N, P2O5, K2O) and by 52, 18, and 62% with foliar spray level of F3 (Two foliar sprays of ZnSO4 @ 0.25% + FeSO4 @ 0.25%) over F0 (water spray). The yield of bottle gourd was significantly higher with F3 (Two foliar sprays of ZnSO4 @ 0.25% + FeSO4 @ 0.25%) in combination with S1 (200:100:100 kg ha-1 N, P2O5, K2O) and S2 (150:75:75 kg ha-1 N, P2O5, K2O).

/pdf/effect-of-fertigation-and-foliar-spray-of-nutrients-on-soil-3vi0ot8v.pdf

Prashant Kumar

Papers

Surgical Outcomes of Levator Resection in Moderate and Severe Ptosis With a Good Levator Function: A Retrospective Study

Factors Determining Improvement in Stereopsis and Binocularity After Good Postoperative Alignment in Patients With Childhood-Onset Strabismus

Role of Endotracheal Tube Cuff Deflation in Facilitating Passage of Nasogastric Tube

Impacts of Assimilating FY-4A AGRI Clear-Sky Water Vapor Radiance on Short-Range Weather Prediction during Indian Summer Monsoon

Effect of fertigation and foliar spray of nutrients on soil fertility and yield of bottle gourd (Lagenaria siceraria L)