The Bakun-Murum (BM) catchment region of the Rajang River Basin (RRB), Sarawak, Malaysia, has been under severe threat for the last few years due to urbanization, global warming, and climate change. The present study aimed to evaluate the time series analysis and impact assessment of the temperature changes on the vegetation/agricultural lands and the water availability within the BM region. For this purpose, the Landsat data for the past thirty years (1990–2020) were used. Remote sensing techniques for estimating the surface temperatures and variation within the vegetation and water bodies were utilized, and validation was done using on-ground weather stations. Google Earth Engine (GEE) and other RS & GIS tools were used for analyzing the time series trends of land surface temperature (LST), normalized difference vegetation index (NDVI), and normalized difference water index (NDWI). The results exposed an overall rise of 1.06 °C in the annual mean temperatures over the last thirty years. A maximum annual mean NDVI of 0.48 was recorded for 2018 and 2019. The lowest annual mean NDVI (0.27) was observed in 2005. The annual mean NDWI increased to 0.48 in 2018 and 2019, respectively. The statistical correlation results revealed the coefficient of determination (R2) of 0.09 and 0.13 for the annual mean LST and annual mean NDVI and the annual mean LST and annual mean NDWI, respectively. Moreover, the Mann-Kendall trend test for the annual mean temperature series indicates a slightly increasing trend with Sen's slope of 0.03 °C/year. It is found that there is a positive trend in the annual mean rainfall patterns, as Sen's slope indicates a yearly increase of 50.58 mm/year. This study found significant changes in the LST, NDVI, and NDWI of the BM catchment region during the last thirty years, demanding the concerned authorities' instant attention to alleviate the adverse effects of such changes to protect the ecosystem.

Medieval Arabic algebra books intended for practical training generally have in common a first “book” which is divided into two sections: one on the methods of solving simplified equations and manipulating expressions, followed by one consisting of worked-out problems. By paying close attention to the wording of the problems in the books of al-Khwārizmī, Abū Kāmil, and Ibn Badr, we reveal the different ways the word māl was used. In the enunciation of a problem it is a common noun meaning “quantity,” while in the solution it is the proper noun naming the square of “thing” (shay '). We then look into the differences between the wording of enunciations and equations, which clarify certain problems solved without “thing,” and help explain the development of algebra before the time of al-Khwārizmī.

BACKGROUND: Because of logistical and economic issues, in Egypt, as in other resource-limited settings, decision makers should determine for which patients hepatitis C virus (HCV) treatment should be prioritized. We assessed the effectiveness and cost-effectiveness of different treatment initiation strategies.

METHODS: Using a Markov model, we simulated HCV disease in chronically infected patients in Egypt, to compare lifetime costs, quality-adjusted life expectancy (QALE), and the incremental cost-effectiveness ratio (ICER) of different treatment initiation strategies.

RESULTS: Immediate treatment of patients at stages F1/F2/F3 was less expensive and more effective than delaying treatment until more severe stages or not providing treatment (in patients diagnosed at F1: QALE = 18.32 years if treatment at F1 vs 18.22 if treatment at F2). Treatment of F4 patients was more effective than no treatment at all (QALE = 10.33 years vs 8.77 years) and was cost-effective (ICER = $1915/quality-adjusted life-year [QALY]). When considering that affordable triple therapies, including new direct-acting antivirals, will be available starting in 2016, delaying treatment until stage F2, then treating all patients regardless of their disease stage after 2016, was found to be cost-effective (ICER = $33/QALY).

CONCLUSIONS: In Egypt, immediate treatment of patients with fibrosis stage F1-F3 who present to care is less expensive and more effective than delaying treatment. However, immediate treatment at stage F1 is only slightly more effective than waiting for disease to progress to stage F2 before starting treatment and is sensitive to the forthcoming availability of new treatments. Treating patients at stage F4 is highly effective and cost-effective. In Egypt, decision makers should prioritize treatment for F4 patients and delay treatment for F1 patients who present to care.

Background and objective The effect of dexmedetomidine on
the duration of sensory blockade has not been studied in
humans. We evaluated the effect of adding dexmedetomidine to
bupivacaine on the duration of postoperative analgesia in
children who underwent repair of a cleft palate.
Methods Thirty children who were scheduled for repair of a
complete cleft palate using a combination of general
anaesthesia and greater palatine nerve block were allocated
randomly into one of two equal groups (n¼15). In both groups,
the greater palatine nerve block was performed bilaterally using
0.5 ml of solution on each side. The B group received
bupivacaine 0.25%, whereas the BD group received
bupivacaine 0.25% with 1mgkg
1 dexmedetomidine. Heart
rate, systolic blood pressure, pain score, the time to the first
request for analgesia, and the degree of sedation were
recorded.
Results There was no difference in haemodynamic variables
between the two groups. The pain score was significantly higher
in the B group as compared with the BD group. The time to the
first request for analgesia was significantly longer in children in
the BD group (mean 22 h, range 20.6–23.7 h) as compared
with those who received bupivacaine alone (14.2 h, 13–15 h).
Sedation scores in the postoperative period did not differ
between the study groups.
Conclusion Greater palatine nerve block with a combination of
dexmedetomidine and bupivacaine increased the duration of
analgesia after repair of a cleft palate by 50% with no clinically
relevant side effects.
Eur J Anaesthesiol 2010;27:280–284
Keywords: cleft palate, dexmedetomidine, palatine nerve block