Studying biodiversity of spiders species in seven different localities of Charsadda District, Khyber Pakhtunkhwa, Pakistan

Abstract The current research work aims to provide knowledge about the diversity of spiders’ fauna and their occurrence throughout the year from District Charsadda Khyber Pakhtunkhwa, Pakistan. Research data were collected from March-2015 to January-2017 from seven different localities of Charsadda District by using the camera, bottle, plastic bags, paraffin films, field book and 70% of ethylene alcohol and 20% of glycerine were used as chemicals. By using special identification keys, spiders were differentiated into families, genera and species. During the study time, a total of 2734 specimens of spiders were collected belonging from 35 genera, 15 families and 44 species were identified. Salticidae was the dominant family according to genera studied plus spiders samples numbers collected with 10 genera and 616 species specimens count. The high occurrence of spiders was studied during July. The result of the current study also shows a reduction of spider’s species in December due to lowering the temperature. The current study shows that Salticidae were the dominant family as capered to other species. The occurrence of spiders species greatly depends on changing the weather condition. The present study also shows great fluctuation in spider’s occurrence with changing of hot climate to colder during the study duration. Moreover, the wet season plays a great role in spiders’ population increase and growth.

Development of Population-Based Pediatric Computational Phantoms for Radiotherapy Applications

PURPOSE/OBJECTIVE(S)

Age-specific pediatric computational phantoms are used in radiotherapy (RT) for quality assurance and for reconstruction of historical RT doses (within others). Phantoms are typically developed from healthy patients and may not effectively represent those with cancer due to pathology and/or treatment effects. This study evaluated a set of population-based pediatric computational phantoms developed in-house in terms of anatomical plausibility.

MATERIALS/METHODS

Planning CTs and contours from historical craniospinal irradiation (CSI) patients (n = 74, median age 7y, range: 1-17y) were used to generate and evaluate a set of in-house age-specific population-based RT phantoms (RT-P). The RT-P were generated by combining a sub-set of clinical CTs and contours through groupwise deformable image registration, generating average models of CSI sub-populations (n = 74, median age 7y, range: 3-14y). Models were then compared against clinical data and two libraries of phantoms representing healthy populations: the International Commission on Radiological Protection (ICRP) pediatric reference computational phantoms (n = 8, median age 8y, range: 1-15y) and a variety of default 4D extended cardiac torso (XCAT) phantoms (n = 75, median age 9y, range: 1-18y). Variation between organ volumes for the different datasets was assessed through a linear fit of organ volume with age, reporting the slope (∑) of each fit [y-1]. Average difference between the volume datapoints and the linear fit for clinical data (Δ) [%] were also reported. This allowed for comparisons of the RT-P to clinical and reference data in terms of organ volumes across developmental stages.

RESULTS

The table shows 9 of the 19 investigated organs. The ∑ reported for RT-P models were of similar magnitude as the clinical data and other phantoms, effectively modelling changes with age. The greatest and least ∑ were reported from lungs and thyroid respectively, in agreement with expected relative sizes between organs. Larger values for Δ were likely due to differences in organ filling and segmentation strategy between datasets, limitations of RT-P methodology, and/or anatomical differences between healthy and cancer populations.

CONCLUSION

The RT-P models show promise in representing the RT cohort that may benefit from specialized anatomical phantoms. Further work is needed to address the limitations of the current methodology and its applicability to other RT cohorts.

Effect of foliar application of bio-stimulants on growth, yield and nutritional quality of broccoli

Broccoli is one of important cole crop grown all over the world due to its unique nutritional profile consumed fresh as well as processed. It contains a wide range of nutrients, vitamins, minerals and specific anti-cancer compounds such as glucosinolates. Broccoli cultivation in Pakistan is increasing rapidly, however, till now there is no standardized cropping technology for broccoli cultivation under local climate. Considering research gap (lack of suitable varieties, poor growth, and unavailability of optimized crop technology), trial was conducted at Vegetable research area, Institute of Horticultural Sciences, University of Agriculture, Faisalabad to evaluate the impact of bio-stimulants on different broccoli cultivars under local climatic conditions. The set of experimental treatments was laid out in Randomized Complete Block Design (RCBD) with three replications. Pre-harvest application of Isabion and Seaweed extract significantly enhanced the plant height (11%), dry weight (4%), leaf area (7%), and yield plant-1 (5%). Moreover, Isabion and seaweed extract application led to the increase in antioxidant enzymes i.e., superoxide dismutase (18%), peroxidase (38%) and catalase (12%). In crux, the foliar application of bio-stimulants (Isabion and seaweed extract) on broccoli enhanced the growth, yield, and contents of antioxidant enzymes.

Developing day-case units: imperative for optimal patient care in interventional radiology

As interventional radiology (IR) treatments have evolved, they have become less invasive, enabling rapid recovery, which expedites ambulation and promotes same-day discharge. As a result of this, a significant proportion of IR elective work can be provided using a day-case service model. Reconfiguration of IR services to increase day-case procedures using a dedicated IR day-case unit (RDU) to facilitate the passage of patients is vital to ensure best medical practice. The aim of this review is to discuss the benefits of day-case IR procedures, the optimal structure of an RDU, and to inform radiologists how to introduce and/or improve day-case IR services in their IR practice.

Access to beds for interventional radiology patients: improving patient care

This review describes the rationale in support of admitting rights for interventional radiologists and presents options for the management of interventional radiology (IR) inpatients. The manuscript also discusses wider aspects of IR involvement in inpatient treatment, such as income and funding for IR services, and the implications for IR as a clinical specialty.

Head-neck dissection course during COVID-19 pandemic: challenges, adaptations and how we did it

INTRODUCTION

Cadaveric dissection courses have come to a standstill since the onset of the COVID-19 pandemic. In addition to limited operative opportunities, cancellation of such courses has severely impacted surgical training, especially in a craft-based specialty such as head-neck surgery. The aim of this educational project was to: (1) study the feasibility of an in-person head-neck cadaveric dissection course during COVID-19 pandemic; and (2) validate the educational benefit of this teaching method to ear, nose and throat (ENT) trainees.

METHODS

We developed a 2-day head-neck cadaveric dissection course for ENT trainees. The course programme covered essential head-neck open surgical procedures. Content validity (subjective feedback) was assessed using a 5-point Likert scale. Construct validity (objective usefulness) was evaluated via two pre- and post-course questionnaires, estimating knowledge of head-neck surgical anatomy and self-assessment of levels of confidence with head-neck procedures, respectively.

RESULTS

A risk assessment was conducted and a protocol developed (risk was deemed to be low/tolerable). Content validity showed high satisfaction compared with a median Likert score of 3, 'average' (p=0.000002). For construct validity, the mean score per question improved significantly (p=0.001). Overall levels of confidence showed a trend towards improvement (p=0.08). There was significant improvement in laryngectomy (p=0.01) and level I dissection (p=0.01), with an indication of improvement in level II-V dissection (p=0.07).

CONCLUSIONS

We demonstrated that a cadaveric dissection course, using thorough risk assessment and protocol, could be safely conducted with high content and construct validation during these unprecedented times. This is an invaluable learning environment that needs to be encouraged despite infection control restrictions.

Spatiotemporal variational neural network for reconstruction of highly accelerated cardiac cine MRI

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Siemens Healthcare GmbH; NIH Grant.

Background

Acquisition of cardiac cine MRI usually requires the subject to repeatedly hold their breath for several seconds. Deep learning-based reconstruction of highly undersampled data could allow higher accelerations and has been proposed for several applications. The variational network [1] (VN) was one of the first network architectures for MRI reconstruction, replicating iterative reconstruction with a regularization term learnt from training data.

Purpose

To expand the concept of VNs to spatiotemporal data from cardiac cine acquisitions. Reconstructions are presented and compared using 3D, 2D spatial-only, and 2D+t spatiotemporal convolutions.

Methods

A VN with intermediate quantities in k-space [2] was trained to reconstruct cine sequences from retrospectively undersampled data. The network architecture is illustrated in Fig. 1. It consisted of 10 cascades, each resembling a gradient descent step of an iterative reconstruction. Each refinement step contained a Residual U-Net (cf. Fig. 1d). Pre-estimated coil sensitivity maps were used in all transformations between k-space and image space.

The convolution operations were implemented as either 2D spatial-only, 3D, or separable 2D+t spatiotemporal convolutions. A 2D+t convolution consisted of a 2D spatial convolution followed by an activation function and a 1D temporal convolution (cf. Fig. 1e).

The OCMR dataset [3] was used for training and evaluation. It contains 183 fully sampled cine slices from 74 subjects in different imaging planes with 15 to 38 coils and 15 to 31 temporal frames at 1.5T and 3T. The training set contained 142 slices from 33 individuals, which includes all multi-slice acquisitions from the dataset. The validation set consisted of 22 single slices and the network performance was evaluated on the remaining, previously unseen 19 single-slice acquisitions.

The k-space data was retrospectively undersampled using a variable density mask [4]. Sensitivity-based coil combination of the fully sampled k-space was used as ground truth. Coil sensitivity maps were estimated with ESPIRiT. Six networks were trained using the different convolution types mentioned above, each for acceleration factors R=8 and R=12.

Results

Exemplary reconstructions and quantitative results are given in Fig. 2. At R=8, reconstruction with 2D+t and 3D convolutions reached high structural similarity (SSIM) scores of around 0.95, while the 2D convolutions only reached 0.74. Artifacts are clearly visible in reconstructions learnt with 2D kernels. At R=12, reconstruction quality degraded most considerably with 2D convolution kernels.

Conclusion

Reconstruction of highly accelerated cardiac cine data using VNs yielded very good preliminary results. Convolutions that exploit temporal correlations are clearly beneficial over spatial-only convolutions. 2D+t spatiotemporal convolutions may be preferable over 3D convolutions due to reduced model capacity with similar reconstruction capability. Network design with 2D+t convolutionExample reconstruction and time profiles

Fabrication of alginate@silver nanoparticles (Alg@AgNPs) bionanocomposite for the sequestration of crystal violet dye from aqueous solution

In the present study, alginate@silver nanoparticles (Alg@AgNPs) bionanocomposite has been fabricated successfully and further explored for the removal of crystal violet (CV) dye from the aqueous solution. The surface morphology of the (Alg@AgNPs) bionanocomposite was characterized by various modern analytical techniques such as SEM-EDX, TEM, FTIR and XRD. The maximum adsorption was observed at optimum condition of (pH 7, adsorbent dose 0.01 g, equilibrium time 240 min and initial concentration 20 mg L^-1). The maximum monolayer adsorption capacity was found to be 186.93 mg g^-1 at 30 °C. The experimental data were further validated by various isotherm models and on the basis of highest correlation coefficient (R², 0.99), Langmuir model was found to be best fitted model. Pseudo-second order kinetic model obeyed best for the experimental data with a highest correlation coefficient (R², 0.99) at all studied temperature. In thermodynamic studies, the positive value of enthalpy change (∆H⁰) and entropy change (∆S⁰) confirmed the process to be endothermic and spontaneous in nature. Desorption studies shows that 83 % of the adsorbed CV can be desorbed in first cycle and can be regenerated up to 4th cycle effectively with 0.1 M HCl. Therefore, (Alg@AgNPs) bionanocomposite could be harnessed as a potential adsorbent for the removal of hazardous CV dye from the waste water.

A new classification system of trifid mandibular canal derived from Malaysian population

BACKGROUND

The purpose of this study was to identify and classify the anatomic variation of mandibular canal among Malaysians of 3 ethnicities.

MATERIALS AND METHODS

The courses of the mandibular canal in 202 CBCT scanned images of healthy Malaysians were evaluated, and trifid mandibular canal (TMC) when present, were recorded and studied in detail by categorizing them to a new classification (comprising of 12 types). The diameter and length of canals were also measured, and their shape determined.

RESULTS

TMC were observed in 12 (5.9%) subjects or 16 (4.0%) hemi-mandibles. There were 10 obvious categories out the 12 types of TMCs listed. All TMCs (except one) were observed in older than 30 years. The prevalence according to ethnicity is 6 in Malays, 5 in Chinese and 1 in Indian. Four (33.3%) patients had bilateral TMCs, which was not seen in any Indian subject. More than half (56.3%) of the accessory canals were located above the main MC. Their mean diameter was 1.32mm and 1.26mm for the first and second accessory canal, and the corresponding lengths were 20.42mm and 21.60mm, respectively. Most canals (62.5%) had irregularly shaped lumen; there were more irregularly shaped canals in the second accessory canal than the first branch. None of the second accessory canal was oval (in shape).

CONCLUSIONS

This new classification can be applied for the variations in the branching pattern, length and shape of TMCs for better clinical description.

135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS

Background

Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.

Methods

We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged >60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level < 30 nmol/l.

Results

2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P < 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P < 0.001).

Conclusion

Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.

130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE

Background

The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment.

Methods

Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models.

Results

1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P < 0.001), male gender (P < 0.001), married status (P = 0.01), higher socioeconomic status (P < 0.0001) while negative predictors included physical frailty (TUG, P < 0.001), visual impairment (P = 0.01), stroke (P < 0.001), depression (P < 0.001) and self reported loneliness (P = 0.01).

Conclusion

One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.

A novel, eco-friendly bio-nanocomposite (Alg-Cst/Kal) for the adsorptive removal of crystal violet dye from its aqueous solutions

Herein, we report the synthesis of a novel bio-nanocomposite (Alg-Cst/Kal) for the effective removal of the dye "Crystal Violet" from its aqueous solutions. In order to observe the surface morphology and functional groups, the bio-nanocomposite was characterized using various techniques such as SEM, EDX, TEM, FTIR, XRD, and TGA. The effect of parameters like contact time, pH, concentration and temperature on the adsorption of the dye over adsorbent has been studied in detail. The dye - adsorbent system has been tested over various isotherm models and found to follow the Freundlich adsorption isotherm model at 303 K. The developed bio-nanocomposite material exhibits an excellent adsorption toward Crystal Violet with a maximum adsorption capacity of 169.49 mg.g^-1. The experimental data has been further validated by applying various kinetic models and the pseudo-second order kinetic model was the best suited model. The calculated rate constant values ranged from 0.0046 to 0.0204 g.mg^-1.min^-1 for different dye concentrations. The positive values of change in enthalpy, ΔH° (9.765 kJ.mol^-1) and change in entropy, ΔS° (0.0565 kJ.mol^-1.K^-1) obtained through thermodynamic studies demonstrate the endothermic nature and spontaneity of the adsorption process, respectively. The adsorption capacity of the adsorbent for the removal of the Crystal Violet dye was also compared with other adsorbents and found maximum. Novelty statement A novel bio-nanocomposite is synthesized by modifying the biopolymer alginate, cysteine and mixing the clay, kaolinite (Kal). The adsorption abilities of the material was tested the on the cationic hazardous dye, Crystal Violet. The material is novel and no attempt has so far been made to examine its batch adsorption abilities to remove hazardous dyes from the wastewater. The results are highly encouraging as out of all the adsorbents tested so far highest adsorption of the dye is observed in the present studies.

Antecedents and consequences of green supply chain management practices: a study of Indian food processing industry

Purpose

This study aims to empirically test a comprehensive green supply chain management (GSCM) practices model. This paper incorporates green intellectual capital (GIC) and green supply chain orientation (GSCO) as antecedents to the successful implementation of GSCM practices and organizational performance as its consequence.

Design/methodology/approach

This study has been conducted in the Indian food processing industry. The respondents of this study include 139 plant-level managers working in the food processing industry. The managers were contacted using a combination of personal visits, phone and mail. Structural equation modeling was performed using SPSS AMOS v26 to test the hypothesized model.

Findings

The findings of this study reveal that GIC and GSCO positively impact the implementation of GSCM practices. Further, GSCM practices improve economic and operational performance, leading to improved organizational performance.

Practical implications

This study provides implications for managers suggesting that GSCM practices should be implemented in phases. The first phase must reflect the organization's commitment toward building GIC and the second phase must reflect managerial orientation toward implementation for GSCM practices.

Originality/value

This study adds to the existing literature by linking GIC to GSCM practices; second, this study provides a framework for implementation of GSCM practices in the food processing industry.

Rapid cardiovascular magnetic resonance protocol utilizing compressed sensing real-time imaging during the COVID-19 pandemic

Funding Acknowledgements

Type of funding sources: None.

Background

Coronavirus Disease 2019 (COVID-19) poses many workflow challenges for healthcare systems. Elective cardiovascular magnetic resonance (CMR) exams were postponed until safety protocols were instituted. Since reopening, imaging labs are managing COVID-19 safety triaging, exam backlog, and increased referrals, thus innovative solutions for process improvement are needed.

Purpose

An accelerated compressed sensing (CS) real-time (RT) technique offers dynamic cardiac imaging with high spatial and temporal resolution without image degradation. We sought to evaluate the efficiency of a rapid RT CMR protocol with a goal to decrease scan time without compromising study quality and comprehensiveness.

Methods

We retrospectively evaluated 219 CMRs (Siemens Magnetom Sola 1.5T) performed 09/01/2020 - 10/15/2020. After excluding 81 exams due to heterogeneous protocols (Figure 1), we analyzed 138 CMR exams using standard cardiomyopathy or myocarditis protocols. CMR studies utilized either a rapid RT short axis (SAX) cine (spatial resolution of 2.5 mm2 or better and temporal resolution of 55 ms or better) or standard breath-held (BH) SAX cine protocol (Figure 2).  Protocols were chosen by the interpreting physician. Previous internal quality control demonstrated similar volumetric quantification between RT and BH SAX cines. RT cines were reconstructed inline using a CS-based method.  We analyzed the length of time needed to complete each protocol and the number of series performed. Statistical analysis included student t-test with p value <0.05 considered significant.

Results

Of 138 analyzed CMR exams, there were 23 rapid protocols and 115 standard protocols performed. The mean image acquisition time for the rapid protocol was significantly shorter at 26 ± 6 minutes (range 18-44 min) vs 33 ± 6 minutes (range 22-49 min) for the standard protocol, p < 0.001. This represents a mean relative reduction in scan time of 21%. More time was saved in rapid myocarditis (scan time 25 ± 6 min vs 34 ± 6 min, p = 0.01; relative time reduction 26%) vs rapid cardiomyopathy protocols (scan time 27 ± 6 min vs 31 ± 6 min, p = 0.04; relative time reduction 13%). There was no significant difference in the number of series performed (62 ± 14 series in rapid vs 67 ± 11 series in standard protocols, p = 0.09).  T1 and T2 maps constituted the same percentage of acquired images regardless of protocol used (T1 maps 1.8% vs 1.7% for cardiomyopathy, 1.4% vs 1.4% for myocarditis in standard vs rapid protocols respectively; T2 maps 1.8% vs 1.7% for cardiomyopathy, 5.6% vs 5.8% for myocarditis in standard vs rapid protocols respectively).

Conclusions

A rapid CMR protocol utilizing a CS-based RT imaging is significantly shorter as compared to the standard protocol with adequate diagnostic quality. Rapid CMR protocols are an effective tool for process improvement during the COVID-19 pandemic.

Pediatric Ovarian Torsion: A Diagnostic Challenge in COVID-19 Times

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary.

Fabrication of a lead ion selective membrane based on a polycarbazole Sn(iv) arsenotungstate nanocomposite and its ion exchange membrane (IEM) kinetic studies

A polycarbazole-Sn(iv) arsenotungstate (Pcz-SnAT) nanocomposite cation exchanger membrane (CEM) was prepared via the casting solution technique utilizing polycarbazole-Sn(iv) arsenotungstate and PVC (polyvinyl chloride) as a binder. The synthesis of the Pcz-SnAT membrane was confirmed via various characterization methods such as EDX, SEM, TGA, XRD, and FTIR spectroscopy. This membrane having a 4.5 : 1 composition ratio of composite by PVC exhibited the most effective outcomes for swelling, thickness, porosity, and water content. Our research indicates that the present ion selective membrane electrode is selective towards Pb(ii) ions, with the detection limit ranging from 1 × 10-7 mol L-1 to 1 × 10-1 mol L-1 where 20 s is the response time and 3-7 is the working value pH. The mechanism of the Pcz SnAT ion exchange membrane was obtained by kinetic studies by utilizing the equation given by Nernst Planck at 40-80 °C. As a result, activation energy and thermodynamic studies were done. The analytical utility of this electrode is conventional by utilizing it as an electrode indicator within the potentiometric titration.

A reference high-pressure CH4 adsorption isotherm for zeolite Y: results of an interlaboratory study

This paper reports the results of an international interlaboratory study led by the National Institute of Standards and Technology (NIST) on the measurement of high-pressure surface excess methane adsorption isotherms on NIST Reference Material RM 8850 (Zeolite Y), at 25 °C up to 7.5 MPa. Twenty laboratories participated in the study and contributed over one-hundred adsorption isotherms of methane on Zeolite Y. From these data, an empirical reference equation was determined, along with a 95% uncertainty interval (Uk=2). By requiring participants to replicate a high-pressure reference isotherm for carbon dioxide adsorption on NIST Reference Material RM 8852 (ZSM-5), this interlaboratory study also demonstrated the usefulness of reference isotherms in evaluating the performance of high-pressure adsorption experiments.

Detection, quantification and genotype distribution of HCV patients in Lahore, Pakistan by real-time PCR

BACKGROUND

Hepatitis C virus (HCV) is considered as "Viral Time Bomb" suggested by the World Health Organization and if it is not treated timely, it will lead towards cirrhosis and hepatocellular carcinoma (HCC).

OBJECTIVE

The purpose of the present research is to study possible risk factors, frequent genotypes of HCV and its association with different age groups.

METHODS

Suspected blood samples from HCV patients were collected from different hospitals of Lahore, Pakistan. Out of 1000 HCV suspected samples, 920 samples were found HCV positive detected by Anti-HCV ELISA, CobasR. kit. The quantification of HCV load was determined by HCV quantification kit and LINEAR ARRAY KIT (Roche) was used for genotype determination by Real-Time PCR (ABI). Statistical analysis was done by using Microsoft Excel.

RESULTS

Out of 920 subjects, 77 subjects (8.4%) were false positive and they were not detected by nested PCR. Three PCR positive samples were untypeable. Genotype 3 was predominant in Lahore which was 83.5%, whereas type 1 and 2 were 5.1% and 0.7% respectively. There were also mixed genotypes detected, 1 and 3 were 0.4%, 2 and 3 were 1.41% and 3 and 4 were 0.2% only. Male were more infected of HCV in the age <40 years and females >40years.

CONCLUSION

The major risk factor for HCV transmission is by use of unsterilized razors/blades. It is necessary to spread awareness among the general population of Pakistan about HCV transmission risk factors. Regular physical examination at least once a year is recommended, so that early detection of HCV could be done.

Improving cardiopulmonary resuscitation (CPR) performance using an audio-visual feedback device for healthcare providers in an emergency department setting in Malaysia: a quasi-experimental study

INTRODUCTION

Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers.

METHODS

This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models.

RESULTS

The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44).

CONCLUSION

The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.

Building resilient and responsive research collaborations to tackle antimicrobial resistance-Lessons learnt from India, South Africa, and UK

Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.

The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

BACKGROUND

Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties.

METHODS

An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015-May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings.

RESULTS

In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use.

CONCLUSIONS

In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges.

Sequestration of toxic congo red dye from aqueous solution using ecofriendly guar gum/ activated carbon nanocomposite

In the present study, a potential Guar gum/activated carbon nanocomposite as an adsorbent was synthesized and utilized for the sequestration of toxic congo red dye from synthetic wastewater. The nanocomposite was characterized using different techniques such as SEM, EDX, TEM, FTIR and XRD. Various physico-chemical parameters such as influence of contact time, pH, adsorbent dose, temperature and initial dye concentration were investigated to optimize conditions for maximum adsorption of congo red. Equilibrium data fitted well with Langmuir isotherm model having maximum adsorption capacity of 831.82 mgg-1 at 313 K. The kinetic studies demonstrated that the adsorption followed a pseudo-second order kinetic model. The thermodynamic study showed that the adsorption of congo red onto nanocomposite was spontaneous, exothermic with decreased in randomness at solid/liquid interface. The regeneration study indicated that the nanocomposite could be reused successfully upto five consecutive cycles. Therefore, the present material can be effectively and efficiently urilized for the removal of congo red dye from aqueous solution as well as industrial wastewater.

The effect of gestational age on women's preference for quality goods

Background

It is a well-established fact that hormonal changes significantly influence the consumer behaviors and their purchase intentions. However, attention to the conspicuous buying due to the mood swings, as a result of hormonal changes, during the pregnancy have been largely ignored in the literature.

Aims

The current research aims to examine the prospective association of conspicuous purchase intentions with hormonal changes and mood swings during the pregnancy.

Methods

An experimental procedure was used to assess the data collected from pregnant women (n = 116) and the hypotheses were analyzed using recall probability and recall position measures.

Results

The hormonal changes during the pregnancy were analyzed in three stages known as pregnancy trimesters suggested by the relevant literature (Trimester-1 = 39, Trimister-2 = 36 and Trimester-3 = 41). The respondents were exposed to visual attention of specifically designed images with a unique combination of the status and functional products. The ROC values for Trimester 2 is higher in all 4 graphs (0.923, 0.960, 0.892, and 0.923) respectively than Trimester 1 and 3.

Conclusion

Findings revealed that the women purchase preferences shift as pregnancy move from one trimester to another. Women pay more attention to status products during the 2^nd trimester as compared to 1^st and 3^rd trimesters of pregnancy.

Comparison of data-driven respiratory signal extraction methods from cone-beam CT (CBCT)

In Cone-Beam CT (CBCT) imaging, respiratory motion needs to be considered to mitigate motion artifacts thus increasing the accuracy of reconstructed images. Data driven methods can be used to extract respiratory signal directly from projection data without requiring any additional equipment or surrogate devices. Digital phantoms provide an adequate option to evaluate developing methods prior to clinical implementation. In this study, four data driven methods are used to extract respiratory signal from simulated projections. An in-house 4D MRI-based CBCT digital phantom is used, where actual respiratory signal is available as ground truth. In comparing all four data driven methods, the respiratory signal extracted using the Local Principal Component Analysis (LPCA) method is found to be robust and yielded the highest correlation coefficient of 0.8644 compared to the ground truth.

IntraperitonealInsulin: A Protocol for Administration during CAPD and Review of Published Protocols

For many diabetics in end-stage renal failure, the initial therapy they receive will be continuous ambulatory peritoneal dialysis (CAPD) together with i.p. insulin. To date, all published protocols rely on empirical dosages based upon predialysis insulin requirements. A practical regimen for the institution of i.p. insulin administration during CAPD is described. The only endpoints used to determine insulin dosage were fasting plasma glucose 5 to 10 mmol/L and 2 h postprandial plasma glucose 8 to 15 mmol/L. An initial protocol related to body weight, dextrose content, volume, and timing of dialysate was based on a retrospective analysis of the results in our first 10 patients. Subsequently, a prospective assessment in an additional 22 patients confirmed the effectiveness of the regimen. The following protocol is recommended for the institution of i.p. insulin therapy in patients undergoing CAPD: Preprandial exchanges 1.36% dextrose-0.175 U/L dialysate/kg body weight 3.86% dextrose-0.25 U/L/kg Overnight exchanges 1.36% dextrose-0.1 U/L/kg 3.86% dextrose-0.15 U/L/kg Further adjustment of insulin dosage is then made on the basis of four hourly plasma glucose profiles. Self-monitoring of capillary blood glucose is recommended.

Machine learning for clinical decision support in infectious diseases: a narrative review of current applications

BACKGROUND

Machine learning (ML) is a growing field in medicine. This narrative review describes the current body of literature on ML for clinical decision support in infectious diseases (ID).

OBJECTIVES

We aim to inform clinicians about the use of ML for diagnosis, classification, outcome prediction and antimicrobial management in ID.

SOURCES

References for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, ACM Digital Library, arXiV and IEEE Xplore Digital Library up to July 2019.

CONTENT

We found 60 unique ML-clinical decision support systems (ML-CDSS) aiming to assist ID clinicians. Overall, 37 (62%) focused on bacterial infections, 10 (17%) on viral infections, nine (15%) on tuberculosis and four (7%) on any kind of infection. Among them, 20 (33%) addressed the diagnosis of infection, 18 (30%) the prediction, early detection or stratification of sepsis, 13 (22%) the prediction of treatment response, four (7%) the prediction of antibiotic resistance, three (5%) the choice of antibiotic regimen and two (3%) the choice of a combination antiretroviral therapy. The ML-CDSS were developed for intensive care units (n = 24, 40%), ID consultation (n = 15, 25%), medical or surgical wards (n = 13, 20%), emergency department (n = 4, 7%), primary care (n = 3, 5%) and antimicrobial stewardship (n = 1, 2%). Fifty-three ML-CDSS (88%) were developed using data from high-income countries and seven (12%) with data from low- and middle-income countries (LMIC). The evaluation of ML-CDSS was limited to measures of performance (e.g. sensitivity, specificity) for 57 ML-CDSS (95%) and included data in clinical practice for three (5%).

IMPLICATIONS

Considering comprehensive patient data from socioeconomically diverse healthcare settings, including primary care and LMICs, may improve the ability of ML-CDSS to suggest decisions adapted to various clinical contexts. Currents gaps identified in the evaluation of ML-CDSS must also be addressed in order to know the potential impact of such tools for clinicians and patients.

A prospective study of evaluation of operative duration as a predictor of mortality in pediatric emergency surgery: Concept of 100 minutes laparotomy in resource-limited setting

INTRODUCTION

Operative duration is an important but under-studied predictor of mortality in emergency laparotomies.

AIMS AND OBJECTIVES

The primary objective of this study was to quantify the effect of duration of emergency laparotomy in children on mortality; and to identify a rough cut-off duration of laparotomy to serve as a guide so that a laparotomy can be planned to optimize pediatric surgical patient outcome.

MATERIALS AND METHODS

This is a prospective study conducted in a government tertiary teaching institution over a period of 24 months. All children in the age group of 5-10 years presenting in the emergency department with Pediatric Risk of Mortality III score ≤8, undergoing emergency laparotomy in emergency operation theater, were included.

OBSERVATIONS AND RESULTS

In all, 213 children were included in the study. The mean time from presentation to shifting to the operating room was 3.7 h. The mean operative duration was 108 min. The mean operative time in survived patients was 102 min as compared to 135 min in expired patients (P < 0.05). The 30-day in-hospital mortality rate was 17.4%. After application of binary logistic regression analysis, it was found that time to laparotomy and operative duration were significant risk factors (<0.05) predicting post-operative mortality. Kaplan-Meier survival curve showed a decrease at a mean weighted operative duration of approximately 100 min. Receiver operating characteristic curve analysis yielded operative duration of 123.5 min at which Youden's index maximized.

CONCLUSION

This 100-min duration of laparotomy might appear a long duration but in casualty setup of a government hospital with limited resources, there are so many hurdles for optimal working that completion of an emergency laparotomy in children in 100 min can be considered a realistic target for improving post-operative outcome. At an operative duration of <123.50 min, mortality rates within acceptable limits can be achieved.