Search results for: Shahid Imran

Authors: Jaleh Mohammad Aliha, Rezvan Razazi, Nasim Naderi

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Introduction: Despite the progress in new effective drugs in the treatment of heart failure, the disease still accompanied with frequent hospitalization, impaired quality of life, early mortality and significant economic burden. Patients with chronic disease and consequently patients with heart failure need the knowledge and optimal health literacy to improve the quality of life and minimize the rate of rehopitalizatio. So, considering to importance of knowledge and health literacy in this patients as well as contradictory literature, this study conducted to investigate the relationship between health literacy and Knowledge of heart failure with rehospitalization in patients with heart failure admitted to heart failure clinic in Rajai Heart center in 1394. Methods: The cross-sectional method with convenience sampling method was used in this study. After obtaining the necessary permissions from the ethics committee and the Shahid Rajai Heart center, 238 patients who were older than 18 years and had ejection fraction 35% or less with the ability to read and write and lack of psychiatric, neurological and cognitive disorders and signed the informed consent were recruited. Data collection were perfomed through demographic data questionnaire, short standard health literacy questionnaire 'Short-TOFHLA-16' and Vanderwall (2005) knowledge of heart failure questionnaire. Reliability was assessed by internal consistency method and Cronbach's alpha for both questionnaires was more than 0.7. Then data were analysed by SPSS-20 with descriptive statistic and analytical statistic such as T-test, Chi-square and ANOVA. Results: The majority of patients were male (66%), married (80%) and had age between 50 to 70 years old (42%). The majority of studied men and women have good health literacy and About half of them have adequate knowledge about heart failure. Fisher's exact test showed that there was a significant statistical correlation between health literacy and knowlegh about heart failure. In other words, higher health literacy associated with more knowledge about their condition. Also findings showed that there was no significant statistical correlation between health literacy and knowledge about heart failure and frequency of CCU and emergency admissions. Conclusion: The study results showed that the higher health literacy, associated with the greater knowledge about heart failure and patients' perception about caring recommendations and disease outcomes. Therefore, the knowledge about heart failure and factors which related to severity of the disease, is the important issue to problem identification and treatment and reduction of rehospitalization.

Keywords: health literacy, heart failure, knowlegde, rehospitalization

Procedia PDF Downloads 371

Authors: Md. Abdul Karim, Syed Imran Ahmed, Pandora T. Hardtman

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Informed consent is one of the basic human and ethical rights for childbearing women. It plays a central role in promoting informed decision making between patients and service providers during the labor process. It gives mothers rights to accept or reject any examination and/or procedure, increases the respect and dignity of the mother during pregnancy, delivery and postpartum care. To assess the practices of this right during normal vaginal delivery and immediate postpartum care in tertiary level hospital setting in Bangladesh, a quantitative study with cross-sectional design was conducted in Dhaka Medical College & Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in Dhaka in November 2015. A prevalence-based sample size of 190 was calculated where prevalence, confidence interval and level of significance were at 9.7%, 98% and 5% respectively. The respondents were the mothers who gave normal vaginal childbirth within past 24 hours and received postpartum care there. They were selected through systematic random sampling technique and their face-to-face interview of 190 mothers was done using a structured questionnaire. Data were entered into the spreadsheet (MS Excel 2013 version) and descriptive analysis of findings was done. The result shows the complete absence of informed consent practices and mostly absence of consented care such as right to information, respect for choices of preferences for examination and/or procedure of childbearing women. Although 95% of the mothers were informed that they were being proceeded with normal vaginal delivery, their choice of preference was absent during the process. Only consent (not informed consent) was taken from 50%-72% mothers for examination (except breast examination ‘0%’) and 8%-83% for any procedures during postpartum care. Only one-ninth (11%) of the mothers could ask service providers regarding the services they received. No consent was taken from 3% of the mothers- neither in the labor process nor in postpartum care. This current practice doesn’t comply with the Respectful Maternity Care (RMC) Charter 2011. The issue is not even clarified in the current Standard Clinical Management Protocols of the country. So, improvement of the existing protocol and increased awareness are essential to address this right of child-bearing women and to practice it during normal vaginal delivery and postpartum care.

Keywords: informed consent, normal vaginal delivery, respectful maternity care, tertiary level hospital

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Authors: Petr Daniel Edward Kovarik, Malcolm Jackson, Charles Kelly, Rahul Patil, Shahid Iqbal

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Introduction: Recognition of the presence of extra capsular spread (ECS) has been a major change in the TNM 8th edition published by the American Joint Committee on Cancer in 2018. Irrespective of the size or number of lymph nodes, the presence of ECS makes N3b disease a stage IV disease. The objective of this retrospective observational study was to conduct a comparative analysis of survival outcomes in patients with lymph node-positive cutaneous head and neck squamous cell carcinoma (CHNSCC) based on their TNM 7th and TNM 8th editions classification. Materials and Methods: From January 2010 to December 2020, 71 patients with CHNSCC were identified from our centre’s database who were treated with radical surgery and adjuvant radiotherapy. All histopathological reports were reviewed, and comprehensive nodal mapping was performed. The data were collected retrospectively and survival outcomes were compared using TNM 7th and 8th editions. Results: The median age of the whole group of 71 patients was 78 years, range 54 – 94 years, 63 were male and 8 female. In total, 2246 lymph nodes were analysed; 195 were positive for cancer. ECS was present in 130 lymph nodes, which led to a change in TNM staging. The details on N-stage as per TNM 7th edition was as follows; pN1 = 23, pN2a = 14, pN2b = 32, pN2c = 0, pN3 = 2. After incorporating the TNM 8th edition criterion (presence of ECS), the details on N-stage were as follows; pN1 = 6, pN2a = 5, pN2b = 3, pN2c = 0, pN3a = 0, pN3b = 57. This showed an increase in overall stage. According to TNM 7th edition, there were 23 patients were with stage III and remaining 48 patients, stage IV. As per TNM 8th edition, there were only 6 patients with stage III as compared to 65 patients with stage IV. For all patients, 2-year disease specific survival (DSS) and overall survival (OS) were 70% and 46%. 5-year DSS and OS rates were 66% and 20% respectively. Comparing the survival between stage III and stage IV of the two cohorts using both TNM 7th and 8th editions, there is an obvious greater survival difference between the stages if TNM 8th staging is used. However, meaningful statistics were not possible as the majority of patients (n = 65) were with stage IV and only 6 patients were stage III in the TNM 8th cohort. Conclusion: Our study provides a comprehensive analysis on lymph node data mapping in this specific patient population. It shows a better differentiation between stage III and stage IV in the TNM 8th edition as compared to TNM 7th however meaningful statistics were not possible due to the imbalance of patients in the sub-cohorts of the groups.

Keywords: cutaneous head and neck squamous cell carcinoma, extra capsular spread, neck lymphadenopathy, TNM 7th and 8th editions

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Authors: Imran Hanif, Amanda Persdotter, Sedigheh Bigdeli, Jesper Liske, Torbjorn Jonsson

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Renewable fuels such as biomass/waste for power production is an attractive alternative to fossil fuels in order to achieve a CO₂ -neutral power generation. However, the combustion results in the release of corrosive species. This puts high demands on the corrosion resistance of the alloys used in the boiler. Stainless steels containing nickel and/or nickel containing coatings are regarded as suitable corrosion resistance material especially in the superheater regions. However, the corrosive environment in the boiler caused by the presence of water vapour and reactive alkali very rapidly breaks down the primary protection, i.e., the Cr-rich oxide scale formed on stainless steels. The lifetime of the components, therefore, relies on the properties of the oxide scale formed after breakaway, i.e., the secondary protection. The aim of the current study is to investigate the role of varying nickel content (0–82%) on the high-temperature corrosion of model alloys with 18% Cr (Fe in balance) in the laboratory mimicking industrial conditions at 600°C. The influence of nickel is investigated on both the primary protection and especially the secondary protection, i.e., the scale formed after breakaway, during the oxidation/corrosion process in the dry O₂ (primary protection) and more aggressive environment such as H₂O, K₂CO₃ and KCl (secondary protection). All investigated alloys experience a very rapid loss of the primary protection, i.e., the Cr-rich (Cr, Fe)₂O₃, and the formation of secondary protection in the aggressive environments. The microstructural investigation showed that secondary protection of all alloys has a very similar microstructure in all more aggressive environments consisting of an outward growing iron oxide and inward growing spinel-oxide (Fe, Cr, Ni)₃O₄. The oxidation kinetics revealed that it is possible to influence the protectiveness of the scale formed after breakaway (secondary protection) through the amount of nickel in the alloy. The difference in oxidation kinetics of the secondary protection is linked to the microstructure and chemical composition of the complex spinel-oxide. The detailed microstructural investigations were carried out using the extensive analytical techniques such as electron back scattered diffraction (EBSD), energy dispersive X-rays spectroscopy (EDS) via the scanning and transmission electron microscopy techniques and results are compared with the thermodynamic calculations using the Thermo-Calc software.

Keywords: breakaway corrosion, EBSD, high-temperature oxidation, SEM, TEM

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Authors: Fatima Khurshid, Noor Ul Ain, Syed Abdul Rehman Kashif, Zainab Riaz, Abdullah Usman Khan, Muhammad Imran

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As the world is moving towards extra-high voltage (EHV) and ultra-high voltage (UHV) power systems, the performance requirements of power transformers are becoming crucial to the system reliability and security. With the transformers being an essential component of a power system, low health index of transformers poses greater risks for safe and reliable operation. Therefore, to meet the rising demands of the power system and transformer performance, researchers are being prompted to provide solutions for enhanced thermal and electrical properties of transformers. This paper proposes an approach to improve the health index of a transformer by using nano-technology in conjunction with bio-degradable oils. Vegetable oils can serve as potential dielectric fluid alternatives to the conventional mineral oils, owing to their numerous inherent benefits; namely, higher fire and flashpoints, and being environment-friendly in nature. Moreover, the addition of nanoparticles in the dielectric fluid further serves to improve the dielectric strength of the insulation medium. In this research, using the finite element method (FEM) in COMSOL Multiphysics environment, and a 2D space dimension, three different oil samples have been modelled, and the electric field distribution is computed for each sample at various electric potentials, i.e., 90 kV, 100 kV, 150 kV, and 200 kV. Furthermore, each sample has been modified with the addition of nanoparticles of different radii (50 nm and 100 nm) and at different interparticle distance (5 mm and 10 mm), considering an instant of time. The nanoparticles used are non-conductive and have been modelled as alumina (Al₂O₃). The geometry has been modelled according to IEC standard 60897, with a standard electrode gap distance of 25 mm. For an input supply voltage of 100 kV, the maximum electric field stresses obtained for the samples of synthetic vegetable oil, olive oil, and mineral oil are 5.08 ×10⁶ V/m, 5.11×10⁶ V/m and 5.62×10⁶ V/m, respectively. It is observed that for the unmodified samples, vegetable oils have a greater dielectric strength as compared to the conventionally used mineral oils because of their higher flash points and higher values of relative permittivity. Also, for the modified samples, the addition of nanoparticles inhibits the streamer propagation inside the dielectric medium and hence, serves to improve the dielectric properties of the medium.

Keywords: dielectric strength, finite element method, health index, nanotechnology, streamer propagation

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Authors: Muhammad Arif Khan, Haroon Idrees, Imran Aziz, Sidra Mushtaq

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The purpose of this study is to investigate the current level of knowledge mapping skills of the public sector employees in Pakistan. National Institute of Management is one of the premiere public sector training organization for mid-career public sector employees in Pakistan. This study is conducted on participants of fourteen weeks long training course called Mid-Career Management Course (MCMC) which is mandatory for public sector employees in order to ascertain how to enhance their knowledge mapping skills. Methodology: Researcher used both qualitative and quantitative approach to conduct this study. Primary data about current level of participants’ understanding of knowledge mapping was collected through structured questionnaire. Later on, Participant Observation method was used where researchers acted as part of the group to gathered data from the trainees during their performance in training activities and tasks. Findings: Respondents of the study were examined for skills and abilities to organizing ideas, helping groups to develop conceptual framework, identifying critical knowledge areas of an organization, study large networks and identifying the knowledge flow using nodes and vertices, visualizing information, represent organizational structure etc. Overall, the responses varied in different skills depending on the performance and presentations. However, generally all participants have demonstrated average level of using both the IT and Non-IT K-mapping tools and techniques during simulation exercises, analysis paper de-briefing, case study reports, post visit presentation, course review, current issue presentation, syndicate meetings, and daily synopsis. Research Limitations: This study is conducted on a small-scale population of 67 public sector employees nominated by federal government to undergo 14 weeks extensive training program called MCMC (Mid-Career Management Course) at National Institute of Management, Peshawar, Pakistan. Results, however, reflects only a specific class of public sector employees i.e. working in grade 18 and having more than 5 years of work. Practical Implications: Research findings are useful for trainers, training agencies, government functionaries, and organizations working for capacity building of public sector employees.

Keywords: knowledge management, km in public sector, knowledge management and professional development, knowledge management in training, knowledge mapping

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Authors: Imran Aziz Tunio

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Islamkot is an underdeveloped sub-district (Taluka) in the Tharparkar district Sindh province of Pakistan located between latitude 24°25'19.79"N to 24°47'59.92"N and longitude 70° 1'13.95"E to 70°32'15.11"E. The Islamkot has an arid desert climate and the region is generally devoid of perennial rivers, canals, and streams. It is highly dependent on rainfall which is not considered a reliable surface water source and groundwater is the only key source of water for many centuries. To assess groundwater’s potential, an electrical resistivity survey (ERS) was conducted in Islamkot Taluka. Groundwater investigations for 128 Vertical Electrical Sounding (VES) were collected to determine the groundwater potential and obtain qualitatively and quantitatively layered resistivity parameters. The PASI Model 16 GL-N Resistivity Meter was used by employing a Schlumberger electrode configuration, with half current electrode spacing (AB/2) ranging from 1.5 to 100 m and the potential electrode spacing (MN/2) from 0.5 to 10 m. The data was acquired with a maximum current electrode spacing of 200 m. The data processing for the delineation of dune sand aquifers involved the technique of data inversion, and the interpretation of the inversion results was aided by the use of forward modeling. The measured geo-electrical parameters were examined by Interpex IX1D software, and apparent resistivity curves and synthetic model layered parameters were mapped in the ArcGIS environment using the inverse Distance Weighting (IDW) interpolation technique. Qualitative interpretation of vertical electrical sounding (VES) data shows the number of geo-electrical layers in the area varies from three to four with different resistivity values detected. Out of 128 VES model curves, 42 nos. are 3 layered, and 86 nos. are 4 layered. The resistivity of the first subsurface layers (Loose surface sand) varied from 16.13 Ωm to 3353.3 Ωm and thickness varied from 0.046 m to 17.52m. The resistivity of the second subsurface layer (Semi-consolidated sand) varied from 1.10 Ωm to 7442.8 Ωm and thickness varied from 0.30 m to 56.27 m. The resistivity of the third subsurface layer (Consolidated sand) varied from 0.00001 Ωm to 3190.8 Ωm and thickness varied from 3.26 m to 86.66 m. The resistivity of the fourth subsurface layer (Silt and Clay) varied from 0.0013 Ωm to 16264 Ωm and thickness varied from 13.50 m to 87.68 m. The Dar Zarrouk parameters, i.e. longitudinal unit conductance S is from 0.00024 to 19.91 mho; transverse unit resistance T from 7.34 to 40080.63 Ωm2; longitudinal resistance RS is from 1.22 to 3137.10 Ωm and transverse resistivity RT from 5.84 to 3138.54 Ωm. ERS data and Dar Zarrouk parameters were mapped which revealed that the study area has groundwater potential in the subsurface.

Keywords: electrical resistivity survey, GIS & RS, groundwater potential, environmental assessment, VES

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Authors: Waheed Anwar, Kiran Nawaz, Muhammad Saleem Haider, Ahmad Ali Shahid, Sehrish Iftikhar

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The whitefly, Bemisia tabaci (Gennadius), is a complex insect species, including many cryptic species or biotypes. Whitefly causes damage to many ornamental and horticultural crops through directly feeding on phloem sap, resulting in sooty mould and critically decreases the rate of photosynthesis of many host plants. Biological control has emerged as one of the most important methods for the management of soil-borne plant pathogens. Among the natural enemies of insects different entomopathogenic fungi are mostly used as biological control of the pest. The purpose of this research was to find indigenous insect-associated fungi and their virulence against Bemisia tabaci. A detailed survey of cotton fields in sample collection was conducted during July and August 2013 from the central mixed zone of Punjab, Pakistan. For the isolation of T. longibrachiatum, sabouraud dextrose peptone yeast extract agar (SDAY) media was used and morphological characterization of isolated T. longibrachiatum was studied using different dichotomous keys. Molecular Identification of the pathogen was confirmed by amplifying the internal transcribed spacer region. Blastn analysis showed 100% homology with already reported sequences on the database. For these bioassays, two conidial concentrations 4 × 108/mL & 4 × 104/mL of T. longibrachiatum was sprayed in clip cages for nymph and adult B. tabaci respectively under controlled environmental conditions. The pathogenicity of T. longibrachiatum was tested on nymph and adult whitefly to check mortality. Mortality of B. tabaci at nymphal and adult stages were observed after 24-hour intervals. Percentage mortality of nymphs treated with 4 x 104/mL conidia of T. longibrachiatum was 20, 24, 36 and 40% after 48, 72, 96, 72, 96, 120 and 144 hours respectively. However, no considerable difference was recorded in percentage mortality of whitefly after 120 and 144 hours. There were great variations after 24, 48, 72 and 96 hours in the rate of mortality. The efficacy of T. longibrachiatum as entomopathogenic fungi was evaluated in adult and nymphal stages of whitefly. Trichoderma longibrachiatum showed maximum activity on nymphal stages of whitefly as compared to adult stages. The percentage of conidial germination was also recorded on the outer surface of adult and nymphal stages of B. tabaci. The present findings indicated that T. longibrachiatum is an entomopathogenic fungus against B. tabaci and many species of Trichoderma were already reported as an antagonistc organism against a wide range of bacterial and fungal pathogens.

Keywords: efficacy, Trichoderma, virulence, bioassay

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Authors: Mahboobe Daneshvar

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Introduction: Clinical studies on the effect of systemic conditions on periodontal diseases have shown that some systemic deficiencies may provide grounds for the onset of periodontal diseases. One of these systemic problems is osteoporosis, which may be a risk factor for the onset and exacerbation of periodontitis. This study tends to evaluate periodontal indices in osteoporotic menopausal women and compare them with healthy controls. Materials and Methods: In this case-control study, participants included 45-75-year-old menopausal women referred to rheumatology wards of the Khatamolanbia Clinic and Shahid Sadoughi Hospital in Yazd; Their bone density was determined by DEXA-scan and by imaging the femoral-lumbar bone. Thirty patients with osteoporosis and 30 subjects with normal BMD were selected. Then, informed consent was obtained for participation in the study. During the clinical examinations, tooth loss (TL), plaque index (PI), gingival recession, pocket probing depth (PPD), clinical attachment loss (CAL), and tooth mobility (TM) were measured to evaluate the periodontal status. These clinical examinations were performed to determine the periodontal status by catheter, mirror and probe. Results: During the evaluation, there was no significant difference in PPD, PI, TM, gingival recession, and CAL between case and control groups (P-value>0.05); that is, osteoporosis has no effect on the above factors. These periodontal factors are almost the same in both healthy and patient groups. In the case of missing teeth, the following results were obtained: the mean of missing teeth was 22.173% of the total teeth in the case group and 18.583% of the total teeth in the control group. In the study of the missing teeth in the case and control groups, there was a significant relationship between case and control groups (P-value = 0.025). Conclusion: In fact, since periodontal disease is multifactorial and microbial plaque is the main cause, osteoporosis is considered a predisposing factor in exacerbation or persistence of periodontal disease. In patients with osteoporosis, usually pathological fractures, hormonal changes, and aging lead to reduced physical activity and affect oral health, which leads to the manifestation of periodontal disease. But this disease increases tooth loss by changing the shape and structure of bone trabeculae and weakening them. Osteoporosis does not seem to be a deterministic factor in the incidence of periodontal disease, since it affects bone quality rather than bone quantity.

Keywords: plaque index, Osteoporosis, tooth mobility, periodontal packet

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Authors: Muhammad Imran

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In recent times, terrorism has been a major area of concern globally. Terrorism is ranked the number one concern across many countries, followed by political violence and poverty. The natural response to terrorism and violence across the countries is to increase expenditure on counterterrorism. This project study aims to explore the importance of job creation through the China-Pakistan Economic Corridor (a leading mega-project of the Belt and Road Initiative) to help Pakistan’s socio-economic situation and lead to minimize terrorism and violence across the country and help Chinese companies complete their multi-billion dollar projects peacefully. During the last two decades, Pakistan has been through severe insurgencies, political violence, and terrorism, which also caused a disturbance in delaying many developmental projects, including the CPEC project, and killed dozens of Chinese citizens working in Pakistan. One major area of debate is whether or not economic factors have any role to play in determining the extent of political violence and terrorism in Pakistan. The notion of a China-Pakistan economic corridor across the Karakorum Mountains to Gawadar faces severe challenges. Counterterrorism concerns are likely to be a persistent source of tension across the CPEC projects in different regions across the CPEC route in Pakistan. China’s promise to help industrialize Pakistan will ultimately lead to youth employment and prosperity. We hypothesize that youth unemployment can explain incidences of terrorism in Pakistan in the recent past. One of the main causes of these adverse situations is the unemployment of youth, who can become readily accessible to militant organizations for recruitment and training. This research project builds on existing research investigating the root causes of political violence and terrorism by considering youth unemployment as a measure of economic deprivation. We focus on the terrorism incident count data for 2001–2022, using negative binomial regression models. Literature suggests that, in the exogenous model, youth unemployment tends to increase political violence and domestic terrorism. Given concerns about the endogeneity of youth unemployment in these models, we will use two kinds of corrections: instrumental variables and lagged variables. To control for endogeneity, we intend to incorporate total population, military expenditure, foreign direct investment, and CPEC investment as instrumental variables.

Keywords: regional terrorism, political violence, youth employment, CPEC, belt and road initiative, Pakistan, China

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Authors: Asim Abbasi, Muhammad Sufyan, Iqra, Muhammad Ibrahim Shahid, Muhammad Ashfaq

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The foundation of human life on earth relies on many ecosystem services provided by insects of which pollination owes a vital role. The pollination service offered by insects has annual worth of approximately €153 billion. The majority of the flowering plants depends on entomophiles pollination for their reproduction and formation of seeds and fruits. The quantity and quality of insect pollination have multiple implications for stable ecosystem, diverse species level, food security and climate change resilience. The rapidly mounting human population, depletion of natural resources and the global climate change forced us to enter an era of pollination crisis. Climate change not only alters the phenology, population abundance and geographic ranges of different pollinators but also hinders their pollination activities. The successful pollination process relies heavily on the synchronization of biological events of pollinators with the phenological stages of the flowering plants. However, there are possibilities that impending climatic changes may result in asynchrony between plant-pollinators interactions and also mitigate the extent of pollination. The trophic mismatch mostly occurs when pollinators and plants inhabiting the same environment use different environmental cues to regulate their biological events, as these cues are not equally affected by climate change. Synchrony has also been disrupted when one of the interacting species has migratory nature and depend on cues for migration. Moreover, irregular rainfalls and up-surging temperature also disrupts the foraging behaviour of pollinators resulting in reduced flowers visits by insect. Climate change has a direct impact on the behavior and physiology of honey bees, the best known pollinators owing to their extreme floral fidelity. Rising temperature not only alleviates the quantity and quality of floral environment but also alters the bee’s colony harvesting and development ability. Furthermore, a possible earlier decline of flowers is expected in a growing season due to this rising temperature. This may also lead to disrupt the efficiency bumblebee queen that require a constant and adequate nectar and pollen supply throughout the entire growing season for healthy colony production. Considering the role of insect pollination in our ecosystem, their associated risks regarding climate change should be addressed properly for devising a well-focused research needed for their conservation.

Keywords: climate change, phenological, pollination, synchronization

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Authors: H. Shahid

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Due to Ozone layer depletion on earth, the incoming ultraviolet (UV) radiation is recorded at its high index levels such as 25 in South Peru (13.5° S, 3360 m a.s.l.) Also, the planning of human inhabitation on Mars is under discussion where UV radiations are quite high. The exposure to UV is health hazardous and is avoided by UV filters. On the other hand, artificial UV sources are in use for water thermolysis to generate Hydrogen and Oxygen, which are later used as fuels. This paper presents the utility of employing UVA (315-400nm) and UVB (280-315nm) electromagnetic radiation from the solar spectrum to design and implement an optically active, Hydrogen and Oxygen generation system via thermolysis of desalinated seawater. The proposed system finds its utility on earth and can be deployed in the future on Mars (UVB). In this system, by using Fresnel lens arrays as an optical filter and via active tracking, the ultraviolet light from the sun is concentrated and then allowed to fall on two sub-systems of the proposed system. The first sub-system generates electrical energy by using UV based tandem photovoltaic cells such as GaAs/GaInP/GaInAs/GaInAsP and the second elevates temperature of water to lower the electric potential required to electrolyze the water. An empirical analysis is performed at 30 atm and an electrical potential is observed to be the main controlling factor for the rate of production of Hydrogen and Oxygen and hence the operating point (Q-Point) of the proposed system. The hydrogen production rate in the case of the commercial system in static mode (650ᵒC, 0.6V) is taken as a reference. The silicon oxide electrolyzer cell (SOEC) is used in the proposed (UV) system for the Hydrogen and Oxygen production. To achieve the same amount of Hydrogen as in the case of the reference system, with minimum chamber operating temperature of 850ᵒC in static mode, the corresponding required electrical potential is calculated as 0.3V. However, practically, the Hydrogen production rate is observed to be low in comparison to the reference system at 850ᵒC at 0.3V. However, it has been shown empirically that the Hydrogen production can be enhanced and by raising the electrical potential to 0.45V. It increases the production rate to the same level as is of the reference system. Therefore, 850ᵒC and 0.45V are assigned as the Q-point of the proposed system which is actively stabilized via proportional integral derivative controllers which adjust the axial position of the lens arrays for both subsystems. The functionality of the controllers is based on maintaining the chamber fixed at 850ᵒC (minimum operating temperature) and 0.45V; Q-Point to realize the same Hydrogen production rate as-is for the reference system.

Keywords: hydrogen, oxygen, thermolysis, ultraviolet

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Authors: Mumtaz Ali, Hamzullah Khan, Khalid Khanzada, Shahid Ayub, Aurangzeb Wazir

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Objective: To analyse the death of patients treated in neuro-surgical ICU for severe head injuries from different perspectives. The evaluation of the data so obtained to help improve the health care delivery to this group of patients in ICU. Study Design: It is a descriptive study based on retrospective analysis of patients presenting to neuro-surgical ICU in Lady Reading Hospital, Peshawar. Study Duration: It covered the period between 1st January 2009 to 31st December 2009. Material and Methods: The Clinical record of all the patients presenting with the clinical radiological and surgical features of severe head injuries, who expired in neuro-surgical ICU was collected. A separate proforma which mentioned age, sex, time of arrival and death, causes of head injuries, the radiological features, the clinical parameters, the surgical and non surgical treatment given was used. The average duration of stay and the demographic and domiciliary representation of these patients was noted. The record was analyzed accordingly for discussion and recommendations. Results: Out of the total 112 (n-112) patients who expired in one year in the neuro-surgical ICU the young adults made up the majority 64 (57.14%) followed by children, 34 (30.35%) and then the elderly age group: 10 (8.92%). Road traffic accidents were the major cause of presentation, 75 (66.96%) followed by history of fall; 23 (20.53%) and then the fire arm injuries; 13 (11.60%). The predominant CT scan features of these patients on presentation was cerebral edema, and midline shift (diffuse neuronal injuries). 46 (41.07%) followed by cerebral contusions. 28 (25%). The correctable surgical causes were present only in 18 patients (16.07%) and the majority 94 (83.92%) were given conservative management. Of the 69 (n=69) patients in which CT scan was repeated; 62 (89.85%) showed worsening of the initial CT scan abnormalities while in 7 cases (10.14%) the features were static. Among the non surgical cases both ventilatory therapy in 7 (6.25%) and tracheostomy in 39 (34.82%) failed to change the outcome. The maximum stay in the neuro ICU leading upto the death was 48 hours in 35 (31.25%) cases followed by 31 (27.67%) cases in 24 hours; 24 (21.42%) in one week and 16 (14.28%) in 72 hours. Only 6 (5.35%) patients survived more than a week. Patients were received from almost all the districts of NWFP except. The Hazara division. There were some Afghan refugees as well. Conclusion: Mortality following the head injuries is alarmingly high despite repeated claims about the professional and administrative improvement. Even places like ICU could not change the out come according to the desired aims and objectives in the present set up. A rethinking is needed both at the individual and institutional level among the concerned quarters with a clear aim at the more scientific grounds. Only then one can achieve the desired results.

Keywords: Glasgow Coma Scale, pediatrics, geriatrics, Peshawar

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Authors: Muhammad Qamar Masood, Syed Abbas Raza, Umar Yousaf Raja, Imran Hassan, Bilal Afzal, Muhammad Aleem Zahir, Atika Shaheer

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Background: Cardiovascular disease (CVD) is a major burden among people with type 2 diabetes (T2D) with 1 in 3 reported to have CVD. Therefore, understanding real-world clinical characteristics and prescribing patterns could help in better care. Objective: The CONVERGE (Cardiovascular Outcomes and Value in the Real world with GLP-1RAs) study characterized demographics and medication usage patterns in T2D intensified (add-on to metformin) overall population. The data were further divided into subgroups {dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), insulins, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is)}, according to the latest prescribed antidiabetic agent (ADA) in India/Pakistan/Thailand. Here, we report findings from Pakistan. Methods: A multi-center retrospective study utilized data from medical records between 13-Sep-2008 (post-market approval of GLP-1RAs) and 31-Dec-2017 in adults (≥18-year-old). The data for this study were collected from 05 centers / institutes located in major cities of Pakistan, including Karachi, Lahore, Islamabad, and Multan. These centers included National Hospital, Aga Khan University Hospital, Diabetes Endocrine Clinic Lahore, Shifa International Hospital, Mukhtar A Sheikh Hospital Multan. Data were collected at start of medical record and at 6 or 12-months prior to baseline based on variable type; analyzed descriptively. Results: Overall, 1,010 patients were eligible. At baseline, overall mean age (SD) was 51.6 (11.3) years, T2D duration was 2.4 (2.6) years, HbA1c was 8.3% (1.9) and 35% received ≥1CVD medications in the past 1-year (before baseline). Most frequently prescribed ADAs post-metformin were DPP-4is and SUs (~63%). Only 6.5% received GLP-1RAs and SGLT-2is were not available in Pakistan during the study period. Overall, it took a mean of 4.4 years and 5 years to initiate GLP-1RAs and SGLT-2is, respectively. In comparison to other subgroups, more patients from GLP-1RAs received ≥3 types of ADA (58%), ≥1 CVD medication (64%) and had higher body mass index (37kg/m2). Conclusions: Utilization of GLP-1RAs and SGLT-2is was low, took longer time to initiate and not before trying multiple ADAs. This may be due to lack of evidence for CV benefits for these agents during the study period. The planned phase 2 of the CONVERGE study can provide more insights into utilization and barriers to prescribe GLP-1RAs and SGLT-2is post 2018 in Pakistan.

Keywords: type 2 diabetes, GLP-1RA, treatment intensification, cardiovascular disease

Procedia PDF Downloads 28

Authors: Shahid Razzaq

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The governments around the globe have started taking into considerations the knowledge management dynamics while formulating, implementing, and evaluating the strategies, with or without the conscious realization, for the different public sector organizations and public policy developments. Health Department of Punjab province in Pakistan is striving to deliver quality healthcare services to the community through an efficient and effective service delivery system. Despite of this struggle some employee performance issues yet exists in the form of challenge to government. To overcome these issues department took several steps including HR strategies, use of technologies and focus of hard issues. Consequently, this study was attempted to highlight the importance of soft issue that is knowledge management in its true essence to tackle their performance issues. Knowledge management in public sector is quite an ignored area in the knowledge management-a growing multidisciplinary research discipline. Knowledge-based view of the firm theory asserts the knowledge is the most deliberate resource that can result in competitive advantage for an organization over the other competing organizations. In the context of our study it means for gaining employee performance, organizations have to increase the heterogeneous knowledge bases. The study uses the cross-sectional and quantitative research design. The data is collected from the knowledge workers of Health Department of Punjab, the biggest province of Pakistan. A total of 341 sample size is achieved. The SmartPLS 3 Version 2.6 is used for analyzing the data. The data examination revealed that knowledge management processes has a strong impact on knowledge worker performance. All hypotheses are accepted according to the results. Therefore, it can be summed up that to increase the employee performance knowledge management activities should be implemented. Health Department within province of Punjab introduces the knowledge management infrastructure and systems to make effective availability of knowledge for the service staff. This knowledge management infrastructure resulted in an increase in the knowledge management process in different remote hospitals, basic health units and care centers which resulted in greater service provisions to public. This study is to have theoretical and practical significances. In terms of theoretical contribution, this study is to establish the relationship between knowledge management and performance for the first time. In case of the practical contribution, this study is to give an insight to public sector organizations and government about role of knowledge management in employ performance. Therefore, public policymakers are strongly advised to implement the activities of knowledge management for enhancing the performance of knowledge workers. The current research validated the substantial role of knowledge management in persuading and creating employee arrogances and behavioral objectives. To the best of authors’ knowledge, this study contribute to the impact of knowledge management on employee performance as its originality.

Keywords: employee performance, knowledge management, public sector, soft issues

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Authors: Imran, Murad Ali Rahat

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One of the factors affecting crop production and nutrient availability is acidic stress. The most important element decreasing under acidic stress conditions is phosphorus deficiency, which results in stunted growth and yield because of inefficient nutrient cycling. At the Agriculture Research Institute Mingora Swat, Pakistan, tests were carried out for the first time throughout the course of two consecutive summer seasons in 2016 (year 1) and 2017 (year 2) with the goal of increasing crop productivity and nutrient availability under acidic stress. Three organic supplies (peach nano-black carbon, compost, and dry-based peach wastes), three phosphorus rates, and two advantageous microorganisms (Trichoderma and PSB) were incorporated in the experimental treatments. The findings showed that, in conditions of acid stress, peach organic sources had a significant impact on yield and yield components. The application of nano-black carbon produced the greatest thousand seed weight of 164.6 g among organic sources, however the use of phosphorus solubilizing bacteria (PSB) for seed inoculation increased the thousand seed weight of beneficial microbes when compared to Trichoderma soil application. The thousand seed weight was significantly impacted by the quantities of phosphorus. The treatment of 100 kg P ha-1 produced the highest thousand seed weight (167.3 g), which was followed by 75 kg P ha-1 (162.5 g). Compost amendments provided the highest seed yield (2,140 kg ha-1) and were comparable to the application of nano-black carbon (2,120 kg ha-1). With peach residues, the lowest seed output (1,808 kg ha-1) was observed.Compared to seed inoculation with PSB (1,913 kg ha-1), soil treatment with Trichoderma resulted in the maximum seed production (2,132 kg ha-1). Applying phosphorus to the soybean crop greatly increased its output. The highest seed yield (2,364 kg ha-1) was obtained with 100 kg P ha-1, which was comparable to 75 kg P ha-1 (2,335 kg ha-1), while the lowest seed yield (1,569 kg ha-1) was obtained with 50 kg P ha-1. The average values showed that compared to control plots (3.3 g kg-1), peach organic sources produced greatest SOC (10.0 g kg-1). Plots with treated soil had a maximum soil P of 19.7 mg kg-1, while plots under stress had a maximum soil P of 4.8 mg kg-1. While peach compost resulted in the lowest soil P levels, peach nano-black carbon yielded the highest soil P levels (21.6 mg kg-1). Comparing beneficial bacteria with PSB to Trichoderma (18.3 mg/kg-1), the former also shown an improvement in soil P (21.1 mg kg-1). Regarding P treatments, the application of 100 kg P per ha produced significantly higher soil P values (26.8 mg /kg-1), followed by 75 kg P per ha (18.3 mg /kg-1), and 50 kg P ha-1 produced the lowest soil P values (14.1 mg /kg-1). Comparing peach wastes and compost to peach nano-black carbon (13.7 g kg-1), SOC rose. In contrast to PSB (8.8 g kg-1), soil-treated Trichoderma was shown to have a greater SOC (11.1 g kg-1). Higher among the P levels.

Keywords: acidic stress, trichoderma, beneficial microbes, nano-black carbon, compost, peach residues, phosphorus, soybean

Procedia PDF Downloads 39

Authors: Shamim Mushtaq, Moazzam Shahid

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Breast cancer (BC) claims the lives of half a million women every year and is the most common cause of death in the developing world. In 2019, it was estimated that BC alone accounts for 15% of all cancer deaths in younger women (aged < 45 years old) with advanced-stage lung metastasis. According to the World Health Organization & International Union against Cancer, in Asia, a high number of cancer-related deaths will be observed in 2020, whereas the burden will be reduced in Western countries due to awareness about the disease, better health facilities and advanced treatments. In the last 15 years, it has been reported that the incidence of BC has increased by 1.1% among Asian compared to the US population from 2003 to 2012. To date, several BC biological subtypes have been reported so far, which are associated with different treatment responses. The heterogeneity and diversity of BC reflected these different subtypes, including Luminal A (23.7% prevalence) and B (38.8% prevalence) that have pathological estrogen receptor (ER+)-positive tumors, the human epidermal growth factor receptor 2 (HER2) (11.2% prevalence) and triple-negative breast cancer (TNBC) (25% prevalence). According to Shaukat Khanum Memorial Cancer Hospital and Research Centre – Pakistan, ten years of data showed that among 636 BC patients, 30.5% had TNBC who were <40 years of age, which is an extremely alarming situation. Therefore, there is a dire need to explore and develop therapeutic targets for the treatment of early TNBC. Since the last decade, unfortunately, there has been little success in understanding the complexity of TNBC and in discovering new biological therapeutic targets. However, conventional chemotherapy is the only choice of treatment for TNBC patients. Many investigators revealed advances in multi-omics (multiple "omes", e.g., genome, proteome, transcriptome, epigenome, and microbiome) which were later identified as actionable targets and increased prevalence in TNBC patients. However, various drugs have been identified so far which are related to a particular diagnostic and prognostic biomarker. For example, Epidermal growth factor receptor ( EGFR or ErbB-1), HER-2/neu (ErbB-2), HER-3 (ErbB-3), and HER-4 (ErbB-4). Protein Transglin-2 (TAGLN 2 ) and Profilins-1 (Pfn-1 ) are the ubiquitously expressed large family of proteins present in all eukaryotes, enabling actin cytoskeletal reorganization. It is known that the oncogenic transformation of cells is accompanied by alteration in the actin cytoskeleton. There are causal connections between altered expression of actin cytoskeletal regulators and cancer progression. Our case-control study identified TAGLN-2 and Pfn-1 proteins in TNBC blood by mass spectrometry. Both TAGLN-2 and Pfn-1 proteins are differentially expressed in early and advanced stages of TNBS patients, which could be potential predictors or therapeutic targets for TNBC.

Keywords: TNBC, blood biomarkers, mass spectrometry, qPCR, ELISA

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Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

Procedia PDF Downloads 73

Authors: Shahid Noor, Kazim Najjad, Muhammad Nasir, Irshad Bhutto, Abdul Samad Memon, Khurram Anwar, Tehseen Riaz, Mian Muhammad Hanif, Nauman A. Mallik, Saeed Ahmed, Israr Ahmed, Ali Yasir

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Background: Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives: This study was conducted across 10 sites in six (6) major cities of Pakistan to evaluate the tolerability, safety, and the clinical response of Nuberol Forte® (Paracetamol 650 mg + Orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Design & Methods: This NFORT-EFFECT observational, prospective multicenter study was conducted in compliance with Good Clinical Practice guidelines and local regulatory requirements. The study sponsor was "The Searle Company Limited, Pakistan. To maintain the GCP compliances, the sponsor assigned the CRO for the site and data management. Ethical approval was obtained from an independent ethics committee. The IEC reviewed the progress of the study. Written informed consent was obtained from the study participants, and their confidentiality was maintained throughout the study. A total of 399 patients with known prescreened musculoskeletal conditions and pain who attended the study sites were recruited, as per the inclusion/exclusion criteria (clinicaltrials.gov ID# NCT04765787). The recruited patients were then prescribed Paracetamol (650 mg) and Orphenadrine (50 mg) combination (Nuberol Forte®) for 7 to 14 days as per the investigator's discretion based on the pain intensity. After the initial screening (visit 1), a follow-up visit was conducted after 1-2 weeks of the treatment (visit 2). Study Endpoints: The primary objective was to assess the pain management response of Nuberol Forte treatment and the overall safety of the drug. The Visual Analogue Scale (VAS) scale was used to measure pain severity. Secondary to pain, the patients' health-related quality of life (HRQoL) was also assessed using the Muscle, Joint Measure (MJM) scale. The safety was monitored on the first dose by the patients. These assessments were done on each study visit. Results: Out of 399 enrolled patients, 49.4% were males, and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with Knee Osteoarthritis (OA), i.e., 148(38%), followed by backache 70(18.2%). A significant reduction in the mean pain score was observed after the treatment with the combination of Paracetamol and Orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only ten patients reported mild adverse events (AEs). Conclusion: The combination of Paracetamol and Orphenadrine (Nuberol Forte®) exhibited effective pain management among patients with musculoskeletal conditions and also improved their QoL.

Keywords: musculoskeletal pain, orphenadrine/paracetamol combination, pain management, quality of life, Pakistani population

Procedia PDF Downloads 140

Authors: Shahid Ali

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Leadership and management are essential components of running successful organizations. Both concepts are closely related but serve different purposes in the overall management of a company. Leadership focuses on inspiring and motivating employees towards a common goal, while management involves coordinating and directing resources to achieve organizational objectives efficiently. Objectives of Leadership and Management: Inspiring and motivating employees: A key objective of leadership is to inspire and motivate employees to work towards achieving the organization’s goals. Effective leaders create a vision that employees can align with and provide the necessary motivation to drive performance. Setting goals and objectives: Both leadership and management play a crucial role in setting goals and objectives for the organization. Leaders create a vision for the future, while managers develop plans to achieve specific objectives within the given timeframe. Implementing strategies: Leaders come up with innovative strategies to drive the organization forward, while managers are responsible for implementing these strategies effectively. Together, leadership and management ensure that the organization’s plans are executed efficiently. Contributions of Leadership and Management: Employee Engagement: Effective leadership and management can increase employee engagement and satisfaction. When employees feel motivated and inspired by their leaders, they are more likely to be engaged in their work and contribute to the organization’s success. Organizational Success: Good leadership and management are essential for navigating the challenges and changes that organizations face. By setting clear goals, inspiring employees, and making strategic decisions, leaders and managers can drive organizational success. Talent Development: Leaders and managers are responsible for identifying and developing talent within the organization. By providing feedback, training, and coaching, they can help employees reach their full potential and contribute effectively to the organization. Research Type: The research on leadership and management is typically quantitative and qualitative in nature. Quantitative research involves the collection and analysis of numerical data to understand the impact of leadership and management practices on organizational outcomes. This type of research often uses surveys, questionnaires, and statistical analysis to measure variables such as employee satisfaction, performance, and organizational success. Qualitative research, on the other hand, involves exploring the subjective experiences and perspectives of individuals related to leadership and management. This type of research may include interviews, observations, and case studies to gain a deeper understanding of how leadership and management practices influence organizational behavior and outcomes. In conclusion, leadership and management play a critical role in the success of organizations. Through effective leadership and management practices, organizations can inspire and motivate employees, set goals, and implement strategies to achieve their objectives. Research on leadership and management helps to understand the impact of these practices on organizational outcomes and provides valuable insights for improving leadership and management practices in the future.

Keywords: empowering, leadership, management, adaptability

Procedia PDF Downloads 21

Authors: Shanza Akram, Sameen Toor, Heba Harb Abu Alkass, Zainab Abdulsalam Altaha, Sara Taha Abdulla, Saleem Imran

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Acute pulmonary embolism (PE) is a common disease and can be fatal. The clinical presentation is variable and nonspecific, making accurate diagnosis difficult. Testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly CT and D-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. CTPA is the investigation of choice for PE. Its easy availability, accuracy and ability to provide alternative diagnosis has lowered the threshold for performing it, resulting in its overuse. Guidelines have recommended the use of clinical pretest probability tools such as ‘Wells score’ to assess risk of suspected PE. Unfortunately, implementation of guidelines in clinical practice is inconsistent. This has led to low risk patients being subjected to unnecessary imaging, exposure to radiation and possible contrast related complications. Aim: To study the diagnostic yield of CT PA, clinical pretest probability of patients according to wells score and to determine whether or not there was an overuse of CTPA in our service. Methods: CT scans done on patients with suspected P.E in our hospital from 1st January 2014 to 31st December 2014 were retrospectively reviewed. Medical records were reviewed to study demographics, clinical presentation, final diagnosis, and to establish if Wells score and D-Dimer were used correctly in predicting the probability of PE and the need for subsequent CTPA. Results: 100 patients (51male) underwent CT PA in the time period. Mean age was 57 years (24-91 years). Majority of patients presented with shortness of breath (52%). Other presenting symptoms included chest pain 34%, palpitations 6%, collapse 5% and haemoptysis 5%. D Dimer test was done in 69%. Overall Wells score was low (<2) in 28 %, moderate (>2 - < 6) in 47% and high (> 6) in 15% of patients. Wells score was documented in medical notes of only 20% patients. PE was confirmed in 12% (8 male) patients. 4 had bilateral PE’s. In high-risk group (Wells > 6) (n=15), there were 5 diagnosed PEs. In moderate risk group (Wells >2 - < 6) (n=47), there were 6 and in low risk group (Wells <2) (n=28), one case of PE was confirmed. CT scans negative for PE showed pleural effusion in 30, Consolidation in 20, atelactasis in 15 and pulmonary nodule in 4 patients. 31 scans were completely normal. Conclusion: Yield of CT for pulmonary embolism was low in our cohort at 12%. A significant number of our patients who underwent CT PA had low Wells score. This suggests that CT PA is over utilized in our institution. Wells score was poorly documented in medical notes. CT-PA was able to detect alternative pulmonary abnormalities explaining the patient's clinical presentation. CT-PA requires concomitant pretest clinical probability assessment to be an effective diagnostic tool for confirming or excluding PE. . Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered. Combining Wells scores with clinical and laboratory assessment may reduce the need for CTPA.

Keywords: CT PA, D dimer, pulmonary embolism, wells score

Procedia PDF Downloads 195

Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

Procedia PDF Downloads 146

Authors: Rowshan Mamtaz, Shuvo Ahmed, Imran Noor, Sumaiya Rahman, Prithvi Shams, Fahmida Gulshan

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Last few decades have witnessed a phenomenal rise in the use of electrical and electronic equipment globally in our everyday life. As these items reach the end of their lifecycle, they turn into e-wastes and contribute to the waste stream. Bangladesh, in conformity with the global trend and due to its ongoing rapid growth, is also using electronics-based appliances and equipment at an increasing rate. This has caused a corresponding increase in the generation of e-wastes. Bangladesh is a developing country; its overall waste management system, is not yet efficient, nor is it environmentally sustainable. Most of its solid wastes are disposed of in a crude way at dumping sites. Addition of e-wastes, which often contain toxic heavy metals, into its waste stream has made the situation more difficult and challenging. Assessment of generation of e-wastes is an important step towards addressing the challenges posed by e-wastes, setting targets, and identifying the best practices for their management. Understanding and proper management of e-wastes is a stated item of the Sustainable Development Goals (SDG) campaign, and Bangladesh is committed to fulfilling it. A better understanding and availability of reliable baseline data on e-wastes will help in preventing illegal dumping, promote recycling, and create jobs in the recycling sectors and thus facilitate sustainable e-waste management. With this objective in mind, the present study has attempted to estimate the amount of e-wastes and its future generation trend in Bangladesh. To achieve this, sales data on eight selected electrical and electronic products (TV, Refrigerator, Fan, Mobile phone, Computer, IT equipment, CFL (Compact Fluorescent Lamp) bulbs, and Air Conditioner) have been collected from different sources. Primary and secondary data on the collection, recycling, and disposal of the e-wastes have also been gathered by questionnaire survey, field visits, interviews, and formal and informal meetings with the stakeholders. Material Flow Analysis (MFA) method has been applied, and mathematical models have been developed in the present study to estimate e-waste amounts and their future trends up to the year 2035 for the eight selected electrical and electronic equipment. End of life (EOL) method is adopted in the estimation. Model inputs are products’ annual sale/import data, past and future sales data, and average life span. From the model outputs, it is estimated that the generation of e-wastes in Bangladesh in 2018 is 0.40 million tons and by 2035 the amount will be 4.62 million tons with an average annual growth rate of 20%. Among the eight selected products, the number of e-wastes generated from seven products are increasing whereas only one product, CFL bulb, showed a decreasing trend of waste generation. The average growth rate of e-waste from TV sets is the highest (28%) while those from Fans and IT equipment are the lowest (11%). Field surveys conducted in the e-waste recycling sector also revealed that every year around 0.0133 million tons of e-wastes enter into the recycling business in Bangladesh which may increase in the near future.

Keywords: Bangladesh, end of life, e-waste, material flow analysis

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Authors: Faruk Inaltekin, Imran Gurakan

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This paper will aim to discuss the importance of value-added services provided by Science and Technology Parks for entrepreneurship development in Turkey. Entrepreneurship is vital subject for all countries. It has not only fostered economic development but also promoted innovation at local and international levels. To foster high tech entrepreneurship ecosystem, Technopark (Science and Technology Park/STP) concept was initiated with the establishment of Silicon Valley in the 1950s. The success and rise of Silicon Valley led to the spread of technopark activities. Developed economies have been setting up projects to plan and build STPs since the 1960s and 1970s. To promote the establishment of STPs, necessary legislations were made by Ministry of Science, Industry, and Technology in 2001, Technology Development Zones Law (No. 4691) and it has been revised in 2016 to provide more supports. STPs’ basic aim is to provide customers high-quality office spaces with various 'value added services' such as business development, network connections, cooperation programs, investor/customers meetings and internationalization services. For this aim, STPs should help startups deal with difficulties in the early stages and to support mature companies’ export activities in the foreign market. STPs should support the production, commercialization and more significantly internationalization of technology-intensive business and foster growth of companies. Nowadays within this value-added services, internationalization is very popular subject in the world. Most of STPs design clusters or accelerator programs in order to support their companies in the foreign market penetration. If startups are not ready for international competition, STPs should help them to get ready for foreign market with training and mentoring sessions. These training and mentoring sessions should take a goal based approach to working with companies. Each company has different needs and goals. Therefore the definition of ‘success' varies for each company. For this reason, it is very important to create customized value added services to meet the needs of startups. After local supports, STPs should also be able to support their startups in foreign market. Organizing well defined international accelerator program plays an important role in this mission. Turkey is strategically placed between key markets in Europe, Russia, Central Asia and the Middle East. Its population is young and well educated. So both government agencies and the private sectors endeavor to foster and encourage entrepreneurship ecosystem with many supports. In sum, the task of technoparks with these and similar value added services is very important for developing entrepreneurship ecosystem. The priorities of all value added services are to identify the commercialization and growth obstacles faced by entrepreneurs and get rid of them with the one-to-one customized services. Also, in order to have a healthy startup ecosystem and create sustainable entrepreneurship, stakeholders (technoparks, incubators, accelerators, investors, universities, governmental organizations etc.) should fulfill their roles and/or duties and collaborate with each other. STPs play an important role as bridge for these stakeholders & entrepreneurs. STPs always should benchmark and renew services offered to how to help the start-ups to survive, develop their business and benefit from these stakeholders.

Keywords: accelerator, cluster, entrepreneurship, startup, technopark, value added services

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Authors: Ahmad Ali, Muhammad Imran Ghani, Haiyan Ding, Zhihui Cheng, Muhammad Iqbal

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Background and Aims: In recent years, protected cultivation trend, especially in the northern parts of China, spread dynamically where production area, structure, and crops diversity have expanded gradually under plastic greenhouse vegetable cropping (PGVC) system. Under this growing system, continuous monoculture with excessive synthetic fertilizers inputs are common cultivation practices frequently adopted by commercial producers. Such long-term cumulative wild exercise year after year sponsor the continuous cropping obstacles in PGVC soil, which have greatly threatened the regional soil eco-sustainability and further impose the continuous assault on soil ecological diversity leading to the exhaustion of agriculture productivity. The aim of this study was to develop new allelopathic insights by exploiting available biological resources in the favor of sustainable PGVC to illuminate the continuous obstacle factors in plastic greenhouse. Method: A greenhouse study was executed under plastic tunnel located at the Horticulture Experimental Station of the College of Horticulture, Northwest A&F University, Yangling, Shaanxi Province, one of the prominent regions for intensive commercial PGVC in China. Post-harvest garlic residues (stalk, leaves) mechanically smashed, homogenized into powder size and incorporated at the ratio of 1:100; 3:100; 5:100 as a soil amendment in a replanted soil that have been used for continuous cucumber monoculture for 7 years (annually double cropping system in a greenhouse). Results: Incorporated C-rich garlic stalk significantly influenced the soil condition through various ways; organic matter decomposition and mineralization, moderately adjusted the soil pH, enhanced the soil nutrient availability, increased enzymatic activities, and promoted 20% more cucumber yield in short-time. Using Illumina MiSeq sequencing analysis of bacterial 16S rRNA and fungal 18S rDNA genes, the current study revealed that addition of garlic stalk/residue could also improve the microbial abundance and community composition in extensively exploited soil, and contributed in soil functionality, caused prosper changes in soil characteristics, reinforced to good crop yield. Conclusion: Our study provided evidence that addition of garlic stalk as soil fertility amendment is a feasible, cost-effective and efficient resource utilization way for renovation of degraded soil health, ameliorate soil quality components and improve ecological environment in short duration. Our study may provide a better scientific understanding for efficient crop residue management typically from allelopathic source.

Keywords: garlic stalk, microbial community dynamics, plant growth, soil amendment, soil-plant system

Procedia PDF Downloads 101

Authors: Saeed Abbas, Rahilla Tabassum, Haider Abbas, Babar Khan, Shahid Hussain, Muhammad Zafar Khan, Fazal Karim, Yawar Abbas, Rizwan Karim

Abstract:

Human–carnivore conflict is considered to be a major conservation and rural livelihood concern because many carnivore species have been heavily victimized due to elevated conflict levels with communities. Like other snow leopard range countries, this situation prevails in Pakistan, where WWF is currently working under Asia High Mountain Project (AHMP) in Gilgit-Baltistan of Pakistan. To mitigate such conflicts requires a firm understanding of grazing and predation pattern including human-carnivore interaction. For this purpose we conducted a survey in Hoper valley (one of the AHMP project sites in Pakistan), during August, 2013 through a questionnaire based survey and unstructured interviews covering 647 households, permanently residing in the project area out of the total 900 households. The valley, spread over 409 km2 between 36°7'46" N and 74°49'2"E, at 2900m asl in Karakoram ranges is considered to be one of an important habitat of snow leopard and associated prey species such as Himalayan ibex. The valley is home of 8100 Brusho people (ancient tribe of Northern Pakistan) dependent on agro-pastoral livelihoods including farming and livestock rearing. The total number of livestock reported were (N=15,481) out of which 8346 (53.91%) were sheep, 3546 (22.91%) goats, 2193 (14.16%) cows, 903 (5.83%) yaks, 508 (3.28%) bulls, 28 (0.18%) donkeys, 27 (0.17%) zo/zomo (cross breed of yak and cow), and 4 (0.03%) horses. 83 percent respondent (n=542 households) confirmed loss of their livestock during the last one year July, 2012 to June, 2013 which account for 2246 (14.51%) animals. The major reason of livestock loss include predation by large carnivores such as snow leopards and wolf (1710, 76.14%) followed by diseases (536, 23.86%). Of the total predation cases snow leopard is suspected to kill 1478 animals (86.43%). Among livestock sheep were found to be the major prey of snow leopard (810, 55%) followed by goats (484, 32.7%) cows (151, 10.21%), yaks (15, 1.015%), zo/zomo (7, 0.5%) and donkey (1, 0.07%). The reason for the mass depredation of sheep and goats is that they tend to browse on twigs of bushes and graze on soft grass near cliffs. They are also considered to be very active as compared to other species in moving quickly and covering more grazing area. This makes them more vulnerable to snow leopard attack. The majority (1283, 75%) of livestock killed by predators occurred during the warm season (May-September) in alpine and sub-alpine pastures and remaining (427, 25%) occurred in the winter season near settlements in valley. It was evident from the recent study that Snow leopard kills outside the pen were (1351, 79.76%) as compared to inside pen (359, 20.24%). Assessing the economic loss of livestock predation we found that the total loss of livestock predation in the study area is equal to PKR 11,230,000 (USD 105,797), which is about PRK 17, 357 (USD 163.51) per household per year. Economic loss incurred by the locals due to predation is quite significant where the average cash income per household per year is PKR 85,000 (USD 800.75).

Keywords: carnivores, conflict, predation, livelihood, conservation, rural, snow leopard, livestock

Procedia PDF Downloads 315

Authors: Margareth S. Zanchetta, Kateryna Metersky, Valerie Tan, Charissa Cordon, Stephanie Lucchese, Yana Siganevich, Prasha Sivasundaram, Truong Binh Nguyen, Imran Qureshi

Abstract:

Due to a new area of practice, Canadian nurses possess knowledge gaps regarding the use of cannabis-based therapies by clients/patients. Education related to medical cannabis (MC) and recreational cannabis (RC) is required to promote nurses’ competency and confidence in supporting clients/patients using MC/RC toward the improvement of health outcomes. A team composed of nursing researchers and undergraduate/graduate students implemented a national survey to explore this theme with the population of undergraduate, graduate (MN and NP), and Post-Diploma (RN Bridging) nursing students enrolled in Canadian Universities Nursing Programs. Upon Research Ethics Board approval, survey recruitment was supported by major nursing stakeholders. The research questions were : (a) Which are the most preferred sources of information on MC/RC for nursing students? (b) Which are the factors and preferred learning modalities that could increase interest in learning about MC/RC, and (c) What are the future career plans among nursing students, and how would they consider the prospective use of cannabis in their practice? The survey was available from Sept. 2022 to Feb. 2023, hosted by a remote platform. An original questionnaire (English-French) was composed of 18 multiple choice questions and 2 open-ended questions. Sociodemographic information and closed-ended responses were compiled as descriptive statistics, while narrative accounts will be analysed through thematic analysis. Respondents (n=153) were from 7 Canadian provinces, national (99%) and international students (1%); the majority of respondents (61%) were in the age range of 21-30 years old. Results indicated that respondents perceive a gap in the undergraduate curriculum on the topics of MC/RC (91%) and that their learning needs include regulations (90%), data on effectiveness (88%), dosing best practices (86%), contraindications (83%), and clinical and medical indications (76%). Respondents reported motivation to learn more about MC/RC through online lectures/videos (65%), e-learning modules or online interactive training (61%), workshops (51%), webinars (36%), and social media (35%). Their primary career-related motivations regarding MC/RC knowledge include enhancing nursing practice (76%), learning about this growing scope of practice (61%), keeping up-to-date responding to scientific curiosity (59%), learning about evidence-based practice (59%), and utilizing alternative forms of medical treatment (37%). Respondents indicated that the integration of topics on cannabis in any course in the undergraduate and/or graduate curriculum would increase their desire to learn about MC/RC as equally as exposure within a clinical setting (75%). The emerging trend in the set of narrative responses (n=130) suggests that respondents believe educational MC/RC content should be integrated into core nursing courses. Respondents also urged educators to be well-informed about evidence-based practice related to MC/RC and to reflect upon stigma and biases surrounding its use. Future knowledge dissemination and translation activities include scholarly products and presentations to stimulate discussion amongst nursing faculty and students, as well as nurses in clinical settings. The goal is to mobilise talents and build collaboration for the development of a socially responsive curriculum on MC/RC competency to address the education-related expectations of all these social actors.

Keywords: Canada, medical cannabis, nursing education, nursing graduate student, nursing undergraduate student, online survey, recreational cannabis

Procedia PDF Downloads 62