Search results for: percent mortality

Authors: Mohammad A. Alolayan, John S. Evans, James K. Hammitt

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The value of statistical life has been estimated for a middle eastern country with high economical subsidization system. In this study, in-person interviews were conducted on a stratified random sample to estimate the value of mortality risk. Double-bounded dichotomous choice questions followed by open-ended question were used in the interview to investigate the willingness to pay of the respondent for mortality risk reduction. High willingness to pay was found to be associated with high income and education. Also, females were found to have lower willingness to pay than males. The estimated value of statistical life is larger than the ones estimated for western countries where taxation system exists. This estimate provides a baseline for monetizing the health benefits for proposed policy or program to the decision makers in an eastern country. Also, the value of statistical life for a country in the region can be extrapolated from this this estimate by using the benefit transfer method.

Keywords: mortality, risk, VSL, willingness-to-pay

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Authors: Sangram Dhumal, Anil Karale

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The effect of different pretreatments and modified atmosphere packaging on the quality of minimally processed pomegranate arils of Bhagwa cultivar was evaluated during storage at 1⁰C for 16 days. Hand extracted pomegranate arils were pretreated with different antioxidants and surfactants viz., 100ppm sodium hypochlorite plus 0.5 percent ascorbic acid plus 0.5 percent citric acid, 10 and 20 percent honey solution, 0.1 percent nanosilver stipulated food grade hydrogen peroxide alone and in combination with 10 percent honey solution and control. The disinfected, rinsed and air-dried pomegranate arils were packed in polypropylene punnets (135g each) with different modified atmospheres and stored up to 16 days at 1⁰C. Changes in colour, pH, total soluble solids, sugars, anthocyanins, phenols, acidity, antioxidant activity, microbial and yeast and mold count over initial values were recorded in all the treatments under study but highest on those without antioxidant and surfactant treatments. Pretreated arils stored at 1⁰C recorded decrease in L*, b* value, pH, levels of non-reducing and total sugars, polyphenols, antioxidant activity and acceptability of arils and increase in total soluble solids, a* value, anthocyanins and microbial count. Increase in anthocyanin content was observed in modified atmosphere packaged pretreated arils stored at 1⁰C. Modified atmosphere packaging with 100 percent nitrogen recorded minimum changes in physicochemical and sensorial parameters with minimum microbial growth. Untreated arils in perforated punnets and with air (control) gave shelf life up to 6 days only. The pretreatment of arils with 10 percent honey plus 0.1 percent nanosilver stipulated food grade hydrogen peroxide and packaging in 100 percent nitrogen recorded minimum changes in physicochemical parameters. The treatment also restricted microbial growth and maintained colour, anthocyanin pigmentation, antioxidant activity and overall fresh like quality of arils. The same dipping treatment along with modified atmosphere packaging extended the shelf life of fresh ready to eat arils up to 14 to 16 days with enhanced acceptability when stored at 1⁰C.

Keywords: anthocyanin content, pomegranate, MAP, minimally processed, microbial quality, Bhagwa, shelf-life, overall quality

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Authors: Shiva Osouli, Maryam Atapour, Mehrdad Ahmadi, Shima Shokri

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Citrus leaf miner (Phyllocnistis citrella Stainton) is native to Asia and one of the most serious pests of Iran’s citrus nursery stocks. In the present study, the possibility of insect mass rearing on four various citrus hosts and the effects of gamma irradiation on the pupal mortality and reproduction of this pest were studied. Trifoliate orange and grapefruit showed less infection, while the number of pupae in Valencia oranges and sweet lemons cages was so high. There was not any significant difference between weight of male and female pupae among different citrus hosts, but generally the weight of male pupae was less than females. Use of Valencia orange or sweet lemons seedlings in especial dark emergence and oviposition cages could be recommended for mass rearing of this pest. In this study, the effects of gamma radiation at doses 100 to 450 Gy on biological and reproductive parameters of the pest has been determined. The results show that mean percent of pupal mortality increased with increasing doses and reached to 28.67% at 450 Gy for male pupae and 38.367% for female pupae. Also, the mean values of this parameter were higher for irradiated female, which indicated the higher sensitivity of this sex. The gamma ray irradiation from 200 and 300 Gy caused decrease in male and female adult moth longevity, respectively. The eggs were laid by emerged females, and their hatchability was decreased by increasing gamma doses. The fecundity of females in both combinations of crosses (irradiated male × normal female and irradiated female × normal male) did not differ, but fertility of laid eggs by irradiated female × normal male affected seriously and the mean values of this parameter reached to zero at 300 Gy. The hatchability percentage of produced eggs by normal female × irradiated male at 300 Gy was 23.29% and reached to less than 2 % at 450 Gy as the highest tested dose. The results of this test show that females have more radio-sensitivity in comparison to males.

Keywords: citrus leaf miner, Phyllocnistis citrella, citrus hosts, mass rearing, Sterile Insect Technique (SIT)

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Authors: Philippe Dillien, Patrice Forget, Harald Engel, Olivier Cornu, Marc De Kock, Jean Cyr Yombi

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Introduction: Hip fracture precedes commonly death in elderly people. Identification of high-risk patients may contribute to target patients in whom optimal management, resource allocation and trials efficiency is needed. The aim of this study is to construct a predictive score of mortality after hip fracture on the basis of the objective prognostic factors available: Neutrophil-to-lymphocyte ratio (NLR), age, and sex. C-Reactive Protein (CRP), is also considered as an alternative to the NLR. Patients and methods: After the IRB approval, we analyzed our prospective database including 286 consecutive patients with hip fracture. A score was constructed combining age (1 point per decade above 74 years), sex (1 point for males), and NLR at postoperative day+5 (1 point if >5). A receiver-operating curve (ROC) curve analysis was performed. Results: From the 286 patients included, 235 were analyzed (72 males and 163 females, 30.6%/69.4%), with a median age of 84 (range: 65 to 102) years, mean NLR values of 6.47+/-6.07. At one year, 82/280 patients died (29.3%). Graphical analysis and log-rank test confirm a highly statistically significant difference (P<0.001). Performance analysis shows an AUC of 0.72 [95%CI 0.65-0.79]. CRP shows no advantage on NLR. Conclusion: We have developed a score based on age, sex and the NLR to predict the risk of mortality at one year in elderly patients after surgery for a hip fracture. After external validation, it may be included in clinical practice as in clinical research to stratify the risk of postoperative mortality.

Keywords: neutrophil-to-lymphocyte ratio, hip fracture, postoperative mortality, medical and health sciences

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Authors: Omid Naeemifar, Ibrahim Naeimifar, Roza Rahbari

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It has been shown that a certain collapse surface may be defined for loose sands in the three dimensional space in which the sample sand experiences collapse and instability leading to an unsteady and strain-softening behaviour. The unsteady state due to collapse surface may lead to such phenomena in the sand as liquefaction and flow behaviour during undrained loading. Investigating the existence of the collapse surface in Firoozkooh 161 sand and its different clay mixtures with various plasticities, the present study aims to carry out an in-depth investigation of the effects of clay percent and its plasticity on the clayey sand behaviours. The results obtained indicate that collapse surface characteristics largely depend on fine percent and its plasticity. Interesting findings are also reported in this paper on the effects of fine sand percent and its plasticity on the behavioural characteristics and liquefaction potential of clayey sands.

Keywords: critical state, collapse surface, liquefaction, clayey sand

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Authors: Narasimhulu Korrapati

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The objective of this present study is to optimize the process parameters for batch biosorption of Cr(VI) and Cu(II) ions by Bacillus subtilis using Response Surface Methodology (RSM). Batch biosorption studies were conducted under optimum pH, temperature, biomass concentration and contact time for the removal of Cr(VI) and Cu(II) ions using Bacillus subtilis. From the studies it is noticed that the maximum biosorption of Cr(VI) and Cu(II) was by Bacillus subtilis at optimum conditions of contact time of 30 minutes, pH of 4.0, biomass concentration of 2.0 mg/mL, the temperature of 32°C in batch biosorption studies. Predicted percent biosorption of the selected heavy metal ions by the design expert software is in agreement with experimental results of percent biosorption. The percent biosorption of Cr(VI) and Cu(II) in batch studies is 80% and 78.4%, respectively.

Keywords: heavy metal ions, response surface methodology, biosorption, wastewater

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Authors: Anshita Sharma

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India is one of the countries to initiate family planning with intention to control the growing population by reducing fertility. In effort to this, India had introduced the National family planning programme in 1952. The level of unmet need in India shows a reducing trend with increasing effectiveness of family planning services as in NFHS-1 the unmet need for limiting, spacing and total was 46 percent, 14 percent & 9 percent, respectively. The demand for spacing has reduced to at 8 percent, 8 percent for limiting and total unmet need was 16 percent in NFHS-2. The total unmet need has reduced to 13 percent in NFHS-3 for all currently married women and the demand for limiting and spacing is 7 percent and 6 percent respectively. The level of unmet need in India shows a reducing trend with increasing effectiveness of family planning services. Despite the progress, there is chunk of women who are deprived of controlling unintended and unwanted pregnancies. The present paper examines the socio-cultural and economic and demographic correlates of unmet need for contraception in India. It also examines the effect of women’s autonomy and unmet need for contraception on family size among different socio-economic groups of population. It uses data from national family health survey-3 carried out in 2005-06 and employs bi-variate techniques and multivariate techniques for analysis. The multiple regression analysis has done to seek the level and direction of relationship among various socio-economic and demographic factors. The result reveals that women with higher level of education and economic status have low level of unmet need for family planning. Women living in non-nuclear family have high unmet need for spacing and women living in nuclear family have high unmet need for limiting and family size is slightly higher of women of nuclear family. In India, the level of autonomy varies at different life point; usually women with higher age enjoy higher autonomy than their junior female member in the family. The finding shows that women with higher autonomy have large family size counter to women with low autonomy have low family size. Unmet need for family planning decrease with women’s increasing exposure to mass- media. The demographic factors like experience of child loss are directly related to family size. Women who experience higher child loss have low unmet need for spacing and limiting. Thus, It is established with the help that women’s autonomy status play substantial role in fulfilling demand of contraception for limiting and spacing which affect the family size.

Keywords: family size, socio-economic correlates, unmet need for limiting, unmet need for spacing, women`s autonomy

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Authors: Guo Yu, Haoming Ma, Peiru Zhou

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BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, a decrease in the time in the targeted blood glucose range (TIR) may be associated with an increased risk of death for critically ill patients. However, the relationship between the TIR and mortality may be influenced by the presence of diabetes and glycemic variability. METHODS: A total of 998 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9–10.0 mmol/L within 24 hours. The relationship between TIR and in-hospital in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. RESULTS: The binary logistic regression model showed that there was a significant association between the TIR as a continuous variable and the in-hospital death of severely ill non-diabetic patients (OR=0.991, P=0.015). As a classification variable, TIR≥70% was significantly associated with in-hospital death (OR=0.581, P=0.003). Specifically, TIR≥70% was a protective factor for the in-hospital death of severely ill non-diabetic patients. The TIR of severely ill diabetic patients was not significantly associated with in-hospital death; however, glycemic variability was significantly and independently associated with in-hospital death (OR=1.042, P=0.027). Binary logistic regression analysis of comprehensive indices showed that for non-diabetic patients, the C3 index (low TIR & high CV) was a risk factor for increased mortality (OR=1.642, P<0.001). In addition, for diabetic patients, the C3 index was an independent risk factor for death (OR=1.994, P=0.008), and the C4 index (low TIR & low CV) was independently associated with increased survival. CONCLUSIONS: The TIR of non-diabetic patients during ICU hospitalization was associated with in-hospital death even after adjusting for disease severity and glycemic variability. There was no significant association between the TIR and mortality of diabetic patients. However, for both diabetic and non-diabetic critically ill patients, the combined effect of high TIR and low CV was significantly associated with ICU mortality. Diabetic patients seem to have higher blood glucose fluctuations and can tolerate a large TIR range. Both diabetic and non-diabetic critically ill patients should maintain blood glucose levels within the target range to reduce mortality.

Keywords: severe disease, diabetes, blood glucose control, time in targeted blood glucose range, glycemic variability, mortality

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Authors: Lijun Wang, Zhen-Yu Chen

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A high-fat diet induces the accumulation of lipid hydroperoxides, accelerates the ageing process and causes a greater mortality in Drosophila melanogaster. The purple sweet potato is rich in antioxidant anthocyanin. The present study was to examine if supplementation of purple sweet potato anthocyanin (PSPA) could reduce the mortality of fruit flies fed a high-fat diet. Results showed that the mean lifespan of fruit fly was shortened from 56 to 35 days in a dose-dependent manner when lard in the diet increased from 0% to 20%. PSPA supplementation attenuated partially the lard-induced mortality. The maximum lifespan and 50% survival time were 49 and 27 days for the 10% lard control flies, in contrast, they increased to 57 and 30 days in the PSPA-supplemented fruit flies. PSPA-supplemented diet significantly up-regulated the mRNA of superoxide dismutase, catalase and Rpn11, compared with those in the control lard diet. In addition, PSPA supplementation could restore the climbing ability of fruit flies fed a 10% lard diet. It was concluded that the lifespan-prolonging activity of PSPA was most likely mediated by modulating the genes of SOD, CAT and Rpn11.

Keywords: purple sweet potato, anthocyanin, high-fat diet, oxidative stress

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Authors: Fathia Ehmouda Zaid, Reim Abudelnbi

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Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients and method: Cross-section study (68) patients diagnosed as systemic lupus erythematosus (SLE), who visited the outpatient clinic of rheumatology, these patients were interviewed with a structured questionnaire about their past and current clinically for presence of Cardiovascular disease in systemic lupus and use SLEDAI, specific tests [ECG –ECHO –CXRAY] the data are analyzed statistically by Pearson's correlation coefficient was calculated and statistical significance was defined as P< 0.05,during period (2013-2014). Objective: Estimation Cardiovascular disease manifestation of systemic lupus erythematosus, correlation with disease activity, morbidity, and mortality. Result: (68) Patients diagnosed as systemic lupus erythematosus' age range from (18-48 years), M=(13±29Y), Sex were female 66/68 (97.1%), male 2/68 (2.9%),duration of disease range[1-15year], M =[7±8y], we found Cardiovascular disease manifestation of systemic lupus erythematosus 32/68 (47.1%), correlation with disease activity use SLEDAI,(r= 476** p=0.000),Morbidity,(r= .554**; p=0.000) and mortality (r=.181; p=.139), Cardiovascular disease manifestations of systemic lupus erythematosus are pericarditis 8/68 (11.8%), pericardial effusion 6/68 (8.8%), myocarditis 4/68 (5.9 %), valvular lesions (endocarditis) 1/68 (1.5%), pulmonary hypertension (PAH) 12/68 (17.6%), coronary artery disease 1/68 (1.5%), none of patients have conduction abnormalities involvement. Correlation with disease activity use SLEDAI, pericarditis (r= .210, p=.086), pericardial effusion (r= 0.079, p=.520), myocarditis (r= 272*, p=.027), valvular lesions (endocarditis) (r= .112, p= .362), pulmonary hypertension (PAH) (r= .257*, p=.035) and coronary artery disease (r=.075, p=.544) correlation between cardiovascular disease manifestations of systemic lupus erythematosus and specific organ involvement we found Mucocutaneous (r=.091 p= .459), musculoskeletal (MSK) (r=.110 p=.373), Renal disease (r=.278*, p=.022), neurologic disease (r=.085, p=.489) and Hematologic disease (r=-.264*, p=.030). Conclusion: Cardiovascular manifestation is more frequent symptoms with systemic lupus erythematosus (SLE) is 47 % correlation with disease activity and morbidity but not with mortality. Recommendations: Focus research to evaluation and an adequate assessment of cardiovascular complications on the morbidity and mortality of the patients with SLE are still required.

Keywords: cardiovascular disease, systemic lupus erythematosus, disease activity, mortality

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Authors: Idowu Kemi Ruth, Adeyemo Adedayo Akinade, Iyanda Adegboyega Ibukun, Idowu Olubukola Precious Akinade

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Liveability and mortality rate is a germane aspect of product performance that cannot be overlooked in poultry production, while the disease is a major threat in the poultry industry which can cause a major loss for the farmer and a reduction in the total income generated from the stock. Therefore, efforts must be made to enhance the health status of chickens to reduce mortality. The study was conducted to investigate the effect of different biotic additives (prebiotic, probiotic and synbiotic ) on the performance of Noiler females at the growing phase (forty-nine days) till the point of the first egg across the biotic additive. A total of one hundred and twenty-eight female Noiler were used for the experiment. Experimental treatment consisted of prebiotic, probiotic, synbiotic and control at the inclusion rate of a gram into a kilogram of feed. Parameters measured are Feed intake, feed conversion ratio, the weight of the first egg, age of the first egg and livability. Data collected were subjected to a one-way analysis of variance. The result obtained revealed a better growth performance across the treatments than the control group with the least final weight at nineteen weeks of point of lay. Prebiotic treatment had the best age at first lay on day one hundred and thirty seven followed by other treatments on day one hundred and fifty four. However, the size of the eggs was not significantly influenced by the biotic additive. Hence, the experiment can be concluded that the inclusion of different biotic additives influenced the growth performance; likewise, the Prebiotic had a significant effect on the age of first laying in Noiler chicken, and livability was a hundred percent throughout the duration of the experiment.

Keywords: prebiotic, probiotic, synbiotic, noiler

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Authors: Getiye Dejenu Kibret, Daniel Demant, Andrew Hayen

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Introduction: In Ethiopia, more than half of newborn babies do not have access to Emergency Obstetric and Neonatal Care (EmONC) services. Understanding the effect of distance to health facilities on service use and neonatal survival is crucial to recommend policymakers and improve resource distribution. We aimed to investigate the effect of distance to health services on maternal service use and neonatal mortality. Methods: We implemented a data linkage method based on geographic coordinates and calculated straight-line (Euclidean) distances from the Ethiopian 2016 demographic and health survey clusters to the closest health facility. We computed the distance in ESRI ArcGIS Version 10.3 using the geographic coordinates of DHS clusters and health facilities. Generalised Structural Equation Modelling (GSEM) was used to estimate the effect of distance on neonatal mortality. Results: Poor geographic accessibility to health facilities affects maternal service usage and increases the risk of newborn mortality. For every ten kilometres (km) increase in distance to a health facility, the odds of neonatal mortality increased by 1.33% (95% CI: 1.06% to 1.67%). Distance also negatively affected antenatal care, facility delivery and postnatal counselling service use. Conclusions: A lack of geographical access to health facilities decreases the likelihood of newborns surviving their first month of life and affects health services use during pregnancy and immediately after birth. The study also showed that antenatal care use was positively associated with facility delivery service use and that both positively influenced postnatal care use, demonstrating the interconnectedness of the continuum of care for maternal and neonatal care services. Policymakers can leverage the findings from this study to improve accessibility barriers to health services.

Keywords: acessibility, distance, maternal health service, neonatal mortality

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Authors: Manal Al Bahri, Saif Al Mubahisi, Shamsa Al Shahaimi, Asma Al Qasabi, Jamal Al Aghbari

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Introduction: ILD is a common disease worldwide and in Oman. No previous Omani study was published regarding ILD prognosis based on baseline PFT results and other factors. This study aims to determine the severity of ILD by the baseline PFT, correlate between baseline PFT and outcome, and study other factors that influence disease mortality. Method: It is a retrospective cohort study; data was collected from January 2011 to December 2021 from electronic patient records (EPR). Means, Standard Deviations, frequencies, and Chi-square tests were used to examine the different variables in the study. Results: The total population of the study was 146 patients; 87 (59.6%) were females, and 59 (40.4%) were males. The median age was 59 years. Age at diagnosis, CVA, rheumatological disease, and baseline FVC were found to be statistically significant predictors of mortality .59.6% of the patients are diagnosed with IPF. Most of our study patients had mild disease based on baseline FVC. Death was higher with the more severe disease based on FVC. In mild disease (FVC >70%), 26.9% of the patients died. In moderate disease (FVC 50-69%),55.7% of the patients died, and in the severe group (FVC <50 %), 55.1% died. This was statistically significant with a P value of 0. 001. There is no statistically significant difference in the overall survival distribution between the different groups of DLCO. Conclusion: In our study, we found that ILD is more common among females, but death is more common among males. Based on baseline PFT, we can predict mortality by FVC level, as moderate to severe limitation is associated with a lower survival rate. DLCO was not a statistically significant parameter associated with mortality.

Keywords: PFT, ILD, FVC, DLCO, mortality

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Authors: Berger Saintius, Edna Ariste, Djeamsly Salomon

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Background: Maternal mortality is a preventable global health problem that affects developed, developing, and underdeveloped countries alike. Globally, maternal mortality rates have declined since 1990, but 830 women die every day from pregnancy and childbirth-related causes that are often preventable. Haiti, with a number of 529 maternal deaths per 100,000 live births, is one of the countries with the highest maternal mortality rate in the Caribbean. This study consists of analyzing maternal death surveillance data in Haiti from 2017-2020. Method : A descriptive study was conducted; data were extracted from the National Epidemiological Surveillance Network of maternal deaths from 2017 to 2020. Sociodemographic variables were analyzed. Excel and Epi Info 7.2 were used for data analysis. Frequency and proportion measurements were calculated. Results: 756 deaths were recorded for the study period: 42 (6%) in 2017, 168 (22%) in 2018, 265 (35%) in 2019, and 281 (37%) in 2020. The North Department recorded the highest number of deaths, 167 (22%). 83(11%) in Les Cayes. 96% of these deaths are people aged between 15 and 49. Conclusion. Maternal mortality is a major health problem in Haiti. Mobilization, participation, and involvement of communities, increase in obstetric care coverage and promotion of Family Planning are among the strategies to fight this problem.

Keywords: epidemiology, maternal death, hospital, Haiti

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Authors: Sara Alzahrani, Samia Bokari, Patan Khan, Muneera Alshareef, Rania Safwat, Mohammed Galal, Hamdi Alqadi, Ameerah Alzahrani, Rehab Alboraie

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Introduction & Background: Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality. Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality. Methods: Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol applied for all patients and blood sugars monitored closely and optimized .Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated via Microsoft Excel tool. Mortality rates were calculated by percentages. The results monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies. Discussion: Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study. Financial saving come from rapid turnover of beds. The mortality was 2.5 % compared to reported 7.3% in a major study, reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes. Conclusion: Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.

Keywords: diabetes, covid-19, management, mortality

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Authors: Marlone D. Severo

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A pre- and post-test quasi-experimental design was used to test the intervention of Trachtenberg Speed Math on the mathematical competency of sixty (60) matched-paired students with a poor performing grade in Mathematics from one of the biggest public national high school at the South of Metro Manila. Both control and experimental group were administered with the Attitude Towards Mathematics Inventory (ATMI) before the pretest were given and both group showed high dislike for Mathematics. Pretest showed a 53 percent accuracy for the control group and 51 percent for the experimental group using a 15-item long multiplication test without any aid of a computing device. The experimental group were taught how to use the Trachtenberg number-keys and techniques in multiplication between October 2014 to March 2015. Post-test showed an improvement in the experimental group with 96 percent accuracy for the control group and a dismal 57 percent for the control group in long-multiplication. Post-test ATMI were administered. The control group showed a great dislike towards Mathematics, while the experimental group showed a positive attitude towards the subject.

Keywords: attitude towards mathematics, mathematical competency, number-keys, trachtenberg speed math

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Authors: Siphat Lim

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The result of the study revealed that the interaction between money, exchange rate, and price level was mainly derived from the policy-induced by the central bank. Furthermore, the variation of inflation was explained weakly by exchange rate and money supply. In the period of twelfth-month, the variation of inflation which caused by exchange rate and money supply were not more than 1.78 percent and 9.77 percent, respectively.

Keywords: money supply, exchange rate, price level, VAR model

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Authors: Changaiz Khan

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Pakistan has the highest rates of maternal mortality in South Asia. From the year 2000 to 2017 the global rate of maternal mortality has decreased up to 39 %. In the context of South Asia, it has decreased by 59% since 2000s. Pakistan has also reduced the rate of maternal mortality, but there is a difference on the provincial level. According to the report of the National Institute of Population Studies (NIPS) conducted in 2020, the MMR in Balochistan has crossed the ratio of most of the South Asian countries, i.e., 298 maternal deaths per 100,000 live births. In comparison, the province of Punjab has the lowest maternal mortality rate i.e. 157 deaths (per 100,000 live births). The rate of maternal mortality is much higher in Balochistan as compared to the other provinces. This research is aimed to discuss the supply side barriers and utilization of maternal healthcare services in the District Gwadar. Likert scale survey method has been used to collect data from the Healthcare Professionals from hospitals -private and government- and the maternal healthcare receiver, that is patient. Semi-structured interviews of healthcare professionals such as doctors, nurses, and Lab technicians have also been conducted. It has been found in this research study that the hospitals in Gwadar district are lagging behind in providing modern maternal healthcare to women due to the lack of staff training, medicine supply, and Laboratories. Moreover, the system of the lady health worker is also not catering to the needs of the women in District Gwadar. It has been recommended in the study that first of all the government should fulfill the supply of the medicine in the hospital. Secondly, the government should open laboratories in the hospitals. Thirdly, the government should increase the funding of the government hospital and the allocation of lady health workers in District Gwadar, Balochistan should be increased.

Keywords: maternal mortality, neonatal, postnatal, supply barriers, patients, healthcare professionals, laboratory, medical supply, training

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Authors: Nasser Karami

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The Urmia grapes have been famous for centuries and have been among the most desirable in the production of wine. Interestingly, evidence shows that the Urmia region was the first place in the world where wine was produced and consumed. In fact, the grapes known as “Shiraz” and made popular by “Shiraz Wine” are the grapes cultivated as a local species especially in the West Azerbaijan watershed basin and exported to Europe. But after the Islamic Revolution, because the production, usage, and sale of wine were unlawful (under Islamic rule), they decided to cultivate apples instead of grapes. Before Islamic revolution, about 50 percent of the gardens were producing grapes, but the apple groves took up less than 1.5 percent (100 hectares). Three years after the revolution, in 1982, people were swept up in the revolutionary excitement and grape cultivation decreased, using less than 10 percent of the garden area. Important is the fact that an apple tree needs 12 times more water than a grapevine, it should be noted that in terms of water usage in the area, the agricultural area has not been increased by 2 or 4 times but rather by 12 times. Evaluation of this study showed that contrary to official reports, climate change isn’t major cause of drying up Urmia Lake and 65 percent of this environmental crisis happened due to spreading unsustainable agricultural in basin of this lake.

Keywords: cultivation pattern, unsustainable agriculture, urmia lake drying, water managment

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Authors: Arulselvi Subramanian, Albert Venencia, Sanjeev Bhoi

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Coagulopathy of trauma is an early endogenous coagulation abnormality that occurs shortly resulting in high mortality. In emergency trauma situations, viscoelastic tests may be better in identifying the various phenotypes of coagulopathy and demonstrate the contribution of platelet function to coagulation. We aimed to determine thrombin generation and clot strength, by estimating a ratio of Maximum amplitude and R-time (MA-R ratio) for identifying trauma coagulopathy and predicting subsequent mortality. Methods: We conducted a prospective cohort analysis of acutely injured trauma patients of the adult age groups (18- 50 years), admitted within 24hrs of injury, for one year at a Level I trauma center and followed up on 3rd day and 5th day of injury. Patients with h/o coagulation abnormalities, liver disease, renal impairment, with h/o intake of drugs were excluded. Thromboelastography was done and a ratio was calculated by dividing the MA by the R-time (MA-R). Patients were further stratified into sub groups based on the calculated MA-R quartiles. First sampling was done within 24 hours of injury; follow up on 3rd and 5thday of injury. Mortality was the primary outcome. Results: 100 acutely injured patients [average, 36.6±14.3 years; 94% male; injury severity score 12.2(9-32)] were included in the study. Median (min-max) on admission MA-R ratio was 15.01(0.4-88.4) which declined 11.7(2.2-61.8) on day three and slightly rose on day 5 13.1(0.06-68). There were no significant differences between sub groups in regard to age, or gender. In the lowest MA-R ratios subgroup; MA-R1 (<8.90; n = 27), injury severity score was significantly elevated. MA-R2 (8.91-15.0; n = 23), MA-R3 (15.01-19.30; n = 24) and MA-R4 (>19.3; n = 26) had no difference between their admission laboratory investigations, however slight decline was observed in hemoglobin, red blood cell count and platelet counts compared to the other subgroups. Also significantly prolonged R time, shortened alpha angle and MA were seen in MA-R1. Elevated incidence of mortality also significantly correlated with on admission low MA-R ratios (p 0.003). Temporal changes in the MA-R ratio did not correlated with mortality. Conclusion: The MA-R ratio provides a snapshot of early clot function, focusing specifically on thrombin burst and clot strength. In our observation, patients with the lowest MA-R time ratio (MA-R1) had significantly increased mortality compared with all other groups (45.5% MA-R1 compared with <25% in MA-R2 to MA-R3, and 9.1% in MA-R4; p < 0.003). Maximum amplitude and R-time may prove highly useful to predict at-risk patients early, when other physiologic indicators are absent.

Keywords: coagulopathy, trauma, thromboelastography, mortality

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Authors: Aytakin Huseynli

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The paper reports findings of the study which examined under-five mortality rate among resource-rich countries. Typically when countries obtain wealth citizens gain increased wellbeing. Societies with new wealth create equal opportunities for everyone including vulnerable groups. But scholars claim that this is not the case for developing resource-rich countries and natural resources become the curse for them rather than the blessing. Spillovers from natural resource curse affect the social wellbeing of vulnerable people negatively. They get excluded from the mainstream society, and their situation becomes tangible. In order to test this hypothesis, the study compared under-5 mortality rate among resource-rich countries by using independent sample one-way ANOVA. The data on under-five mortality rate came from the World Bank. The natural resources for this study are oil, gas and minerals. The list of 67 resource-rich countries was taken from Natural Resource Governance Institute. The sample size was categorized and 4 groups were created such as low, low-middle, upper middle and high-income countries based on income classification of the World Bank. Results revealed that there was a significant difference in the scores for low, middle, upper-middle and high-income countries in under-five mortality rate (F(3(29.01)=33.70, p=.000). To find out the difference among income groups, the Games-Howell test was performed and it was found that infant mortality was an issue for low, middle and upper middle countries but not for high-income countries. Results of this study are in agreement with previous research on resource curse and negative effects of resource-based development. Policy implications of the study for social workers, policy makers, academicians and social development specialists are to raise and discuss issues of marginalization and exclusion of vulnerable groups in developing resource-rich countries and suggest interventions for avoiding them.

Keywords: children, natural resource, extractive industries, resource-based development, vulnerable groups

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Authors: Okechukwu Odinaka Ajaegbu

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In the recent past, discussing about sex among children and youths was frowned at by traditional norms and as such sexual discussions and behavior were approached with great respect. Things are actually falling apart with the increasing number of young people that engage in premarital sex. Due to lack of experience and sex education, many young people are becoming increasingly exposed to the risk of HIV infection. In the light of the above, this study discussed premarital sex, HIV and use of condom among youths in Nigeria. Data for this study came from 2013 Nigeria Demographic and Health Survey and other secondary data. The survey revealed that only 18.5 percent of young women that had sex in the 12 months preceding the survey used condom. Out of 3306 never-married sexually active men and women, 1728 representing 52 percent live in urban areas and 43 percent of them did not use condom during sexual intercourse in the 12 months preceding the survey. This study concludes that for there to be reduction in prevalence of HIV/AIDS among Nigerian youths, there is need for concerted effort to be made towards educating youths on the expedient of the use of condom during sexual intercourse.

Keywords: condom, HIV, Nigeria, premarital sex, youths

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Authors: Alice Sanwald, Thomas Schober

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We analyze mortality and follow-up costs of heart attack patients using administrative data from Austria (2002-2011). As treatment intensity in a hospital largely depends on whether it has a catheterization laboratory, we focus on the effects of patients' initial admission to these specialized hospitals. To account for the nonrandom selection of patients into hospitals, we exploit individuals' place of residence as a source of exogenous variation in an instrumental variable framework. We find that the initial admission to specialized hospitals increases patients' survival chances substantially. The effect on 3-year mortality is -9.5 percentage points. A separation of the sample into subgroups shows the strongest effects in relative terms for patients below the age of 65. We do not find significant effects on longterm inpatient costs and find only marginal increases in outpatient costs.

Keywords: acute myocardial infarction, mortality, costs, instrumental variables, heart attack

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Authors: Dmitriy Syssoyev, Aslan Seitkamzin, Natalya Lim, Kamilla Mussina, Abduzhappar Gaipov, Dimitri Poddighe, Dinara Galiyeva

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Background: Data on the epidemiology of congenital heart defects (CHD) in Kazakhstan is scarce. Therefore, the aim of this study was to describe the incidence, prevalence and all-cause mortality of patients with CHD in Kazakhstan, using national large-scale registry data from the Unified National Electronic Healthcare System (UNEHS) for the period of 2014-2020. Methods: In this retrospective cohort study, the included data pertained to all patients diagnosed with CHD in Kazakhstan and registered in UNEHS between January 2014 and December 2020. CHD was defined based on International Classification of Diseases 10th Revision (ICD-10) codes Q20-Q26. Incidence, prevalence, and all-cause mortality rates were calculated per 100,000 population. Survival analysis was performed using Cox proportional hazards regression modeling and the Kaplan-Meier method. Results: In total, 66,512 patients were identified. Among them, 59,534 (89.5%) were diagnosed with a single CHD, while 6,978 (10.5%) had more than two CHDs. The median age at diagnosis was 0.08 years (interquartile range (IQR) 0.01 – 0.66) for people with multiple CHD types and 0.39 years (IQR 0.04 – 8.38) for those with a single CHD type. The most common CHD types were atrial septal defect (ASD) and ventricular septal defect (VSD), accounting for 25.8% and 21.2% of single CHD cases, respectively. The most common multiple types of CHD were ASD with VSD (23.4%), ASD with patent ductus arteriosus (PDA) (19.5%), and VSD with PDA (17.7%). The incidence rate of CHD decreased from 64.6 to 47.1 cases per 100,000 population among men and from 68.7 to 42.4 among women. The prevalence rose from 66.1 to 334.1 cases per 100,000 population among men and from 70.8 to 328.7 among women. Mortality rates showed a slight increase from 3.5 to 4.7 deaths per 100,000 in men and from 2.9 to 3.7 in women. Median follow-up was 5.21 years (IQR 2.47 – 11.69). Male sex (HR 1.60, 95% CI 1.45 - 1.77), having multiple CHDs (HR 2.45, 95% CI 2.01 - 2.97), and living in a rural area (HR 1.32, 95% CI 1.19 - 1.47) were associated with a higher risk of all-cause mortality. Conclusion: The incidence of CHD in Kazakhstan has shown a moderate decrease between 2014 and 2020, while prevalence and mortality have increased. Male sex, multiple CHD types, and rural residence were significantly associated with a higher risk of all-cause mortality.

Keywords: congenital heart defects (CHD), epidemiology, incidence, Kazakhstan, mortality, prevalence

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Authors: Zachary Pan

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Our general mission is to solve the problem of classifying images into different body part types and deciding if each of them is healthy or not. However, for now, we will determine healthiness for only one-sixth of the body parts, specifically the chest. We will detect pneumonia in X-ray scans of those chest images. With this type of AI, doctors can use it as a second opinion when they are taking CT or X-ray scans of their patients. Another ad-vantage of using this machine learning classifier is that it has no human weaknesses like fatigue. The overall ap-proach to this problem is to split the problem into two parts: first, classify the image, then determine if it is healthy. In order to classify the image into a specific body part class, the body parts dataset must be split into test and training sets. We can then use many models, like neural networks or logistic regression models, and fit them using the training set. Now, using the test set, we can obtain a realistic accuracy the models will have on images in the real world since these testing images have never been seen by the models before. In order to increase this testing accuracy, we can also apply many complex algorithms to the models, like multiplicative weight update. For the second part of the problem, to determine if the body part is healthy, we can have another dataset consisting of healthy and non-healthy images of the specific body part and once again split that into the test and training sets. We then use another neural network to train on those training set images and use the testing set to figure out its accuracy. We will do this process only for the chest images. A major conclusion reached is that convolutional neural networks are the most reliable and accurate at image classification. In classifying the images, the logistic regression model, the neural network, neural networks with multiplicative weight update, neural networks with the black box algorithm, and the convolutional neural network achieved 96.83 percent accuracy, 97.33 percent accuracy, 97.83 percent accuracy, 96.67 percent accuracy, and 98.83 percent accuracy, respectively. On the other hand, the overall accuracy of the model that de-termines if the images are healthy or not is around 78.37 percent accuracy.

Keywords: body part, healthcare, machine learning, neural networks

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Authors: Firouz Amani, Adalat Hoseinian, Sajjad Hakimian

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Background: The mortality due to Myocardial Infarction (MI) is often occur during the first hours after onset of symptom. So, for taking the necessary treatment and decreasing the mortality rate, timely visited of the hospital could be effective in this regard. The aim of this study was to investigate the impact of effective factors in mortality of MI patients by using Linear Logistic Regression. Materials and Methods: In this case-control study, all patients with Acute MI who referred to the Ardabil city hospital were studied. All of died patients were considered as the case group (n=27) and we select 27 matched patients without Acute MI as a control group. Data collected for all patients in two groups by a same checklist and then analyzed by SPSS version 24 software using statistical methods. We used the linear logistic regression model to determine the effective factors on mortality of MI patients. Results: The mean age of patients in case group was significantly higher than control group (75.1±11.7 vs. 63.1±11.6, p=0.001).The history of non-cardinal diseases in case group with 44.4% significantly higher than control group with 7.4% (p=0.002).The number of performed PCIs in case group with 40.7% significantly lower than control group with 74.1% (P=0.013). The time distance between hospital admission and performed PCI in case group with 110.9 min was significantly upper than control group with 56 min (P=0.001). The mean of delay time from Onset of symptom to hospital admission (patient delay) and the mean of delay time from hospital admissions to receive treatment (system delay) was similar between two groups. By using logistic regression model we revealed that history of non-cardinal diseases (OR=283) and the number of performed PCIs (OR=24.5) had significant impact on mortality of MI patients in compare to other factors. Conclusion: Results of this study showed that of all studied factors, the number of performed PCIs, history of non-cardinal illness and the interval between onset of symptoms and performed PCI have significant relation with morality of MI patients and other factors were not meaningful. So, doing more studies with a large sample and investigated other involved factors such as smoking, weather and etc. is recommended in future.

Keywords: acute MI, mortality, heart failure, arrhythmia

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Authors: Khalid Mujaljal, Hassan Alhajhoj

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This paper empirically investigates the influence of oil price fluctuations on the key macroeconomic variables of the Kingdom of Saudi Arabia using unrestricted VAR methodology. Two analytical tools- Granger-causality and variance decomposition are used. The Granger-causality test reveals that almost all specifications of oil price shocks significantly Granger-cause GDP and demonstrates evidence of causality between oil price changes and money supply (M3) and consumer price index percent (CPIPC) in the case of positive oil price shocks. Surprisingly, almost all specifications of oil price shocks do not Granger-cause government expenditure. The outcomes from variance decomposition analysis suggest that positive oil shocks contribute about 25 percent in causing inflation in the country. Also, contribution of symmetric linear oil price shocks and asymmetric positive oil price shocks is significant and persistent with 25 percent explaining variation in world consumer price index till end of the period.

Keywords: Granger causality, oil prices changes, Saudi Arabian economy, variance decomposition

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Authors: Maria L. G. Lourenço, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, João C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Orphaned is a risk factor for mortality in newborns since it is a condition with total or partial absence of maternal care that is essential for neonatal survival, including nursing (nutrition, the transference of passive immunity and hydration), warmth, urination, and defecation stimuli, and protection. The most common causes of mortality in orphans are related to lack of assistance, handling mistakes and infections. This study aims to describe the orphans rates in neonatal puppies, the main causes, and the mortality rates. The study included 735 neonates admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, between January 2018 and November 2019. The orphans rate was 43.4% (319/735) of all neonates included, and the main causes for orphaned were related to maternal agalactia/hypogalactia (23.5%, 75/319); numerous litter (15.7%, 50/319), toxic milk syndrome due to maternal mastitis (14.4%, 46/319), absence of suction/weak neonate (12.2%, 39/319), maternal disease (9.4%, 30/319), cleft palate/lip (6.3%, 20/319), maternal death (5.9%, 19/319), prematurity (5.3%, 17/319), rejection/failure in maternal instinct (3.8%, 12/319) and abandonment by the owner/separation of mother and neonate (3.5%, 11/319). The main consequences of orphaned observed in the admitted neonates were hypoglycemia, hypothermia, dehydration, aspiration pneumonia, wasting syndrome, failure in the transference of passive immunity, infections and sepsis, which happened due to failure of identifying the problem early, lack of adequate assistance, negligence and handling mistakes by the owner. The total neonatal mortality rate was 8% (59/735) and the neonatal mortality rate among orphans was 18.5% (59/319). The orphaned and mortality rates were considered high, but even higher rates may be observed in locations without adequate neonatal assistance and owner orientation. The survival of these patients is related to constant monitoring of the litter, early diagnosis and assistance, and the implementation of effective handling for orphans. Understanding the correct handling for neonates and instructing the owners regarding proper handling are essential to minimize the consequences of orphaned and the mortality rates.

Keywords: orphans, neonatal care, puppies, newborn dogs

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Authors: Njabulo Ncube, Elena Kulinskaya, Nicholas Steel, Dmitry Pshezhetskiy

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Life expectancy in the United Kingdom (UK) has been near constant since 2010, particularly for the individuals of 65 years and older. This trend has been also noted in several other countries. This slowdown in the increase of life expectancy was concurrent with the increase in the number of deaths caused by non-communicable diseases. Of particular concern is the world-wide exponential increase in the number of diabetes related deaths. Previous studies have reported increased mortality hazards among diabetics compared to non-diabetics, and on the differing effects of antidiabetic drugs on mortality hazards. This study aimed to estimate the all-cause mortality hazards and related life expectancies among type 2 diabetes (T2DM) patients in the UK using the time-variant Gompertz-Cox model with frailty. The study also aimed to understand the major causes of the change in life expectancy growth in the last decade. A total of 221 182 (30.8% T2DM, 57.6% Males) individuals aged 50 years and above, born between 1930 and 1960, inclusive, and diagnosed between 2000 and 2016, were selected from The Health Improvement Network (THIN) database of the UK primary care data and followed up to 31 December 2016. About 13.4% of participants died during the follow-up period. The overall all-cause mortality hazard ratio of T2DM compared to non-diabetic controls was 1.467 (1.381-1.558) and 1.38 (1.307-1.457) when diagnosed between 50 to 59 years and 60 to 74 years, respectively. The estimated life expectancies among T2DM individuals without further comorbidities diagnosed at the age of 60 years were 2.43 (1930-1939 birth cohort), 2.53 (1940-1949 birth cohort) and 3.28 (1950-1960 birth cohort) years less than those of non-diabetic controls. However, the 1950-1960 birth cohort had a steeper hazard function compared to the 1940-1949 birth cohort for both T2DM and non-diabetic individuals. In conclusion, mortality hazards for people with T2DM continue to be higher than for non-diabetics. The steeper mortality hazard slope for the 1950-1960 birth cohort might indicate the sub-population contributing to a slowdown in the growth of the life expectancy.

Keywords: T2DM, Gompetz-Cox model with frailty, all-cause mortality, life expectancy

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Authors: Muhammad Shahid Shah, Akram Maqbool, Samina Ashraf

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Since start of this century, world has adopted inclusion as a trend in special education. To meet the challenges of inclusion response, the Punjab government has developed a progressive policy to implement inclusive education. The objectives of this research were to analyze the administration and implementation process by consideration on the management, student’s admission process, screening and assessment, adaptations in curriculum and instruction along with an evaluation, government and nonprofit organizations support. The sample consisted of 50 schools both public and private with a total of 3000 students, 9 percent of which (270) were students with disabilities. Among all the students with disabilities, 63 percent (170) were male and 37 percent (100) were female. The concluded remarks regarding management revealed that a large number of inclusive schools was lacking in terms of developing a certain model for inclusion, including the managerial breakup of staff, the involvement of stakeholders, and conducted frequent meetings. Many of schools are not able to restructure their school organizations due to lack of financial resources, consultations, and backup. As for as student’s admission/identification/assessment was concerned, only 12 percent schools applied a selection process regarding student admission, half of which used different procedures for disable candidates. Approximately 5 percent of inclusive schools had modified their curriculum, including a variety of standards. In terms of instruction, 25 percent of inclusive schools reported that they modified their instructional process. Only a few schools, however, provided special equipment for students with visual impairment, physical impairment, speech and hearing problems, students with mild intellectual disabilities, and autism. In a student evaluation, more than 45 percent reported that test items, administration, time allocations, and students’ reports were modified. For the primary board examination conducted by the Education Department of Government of Punjab, this number decreased dramatically. Finally, government and nonprofit organizations support in the forms of funding, coaching, and facilities were mostly provided by provincial governments and by Ghazali Education Trust.

Keywords: inclusion, identification, assessment, funding, facilities, evaluation

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