Morphology of the proximal femur in a Pakistani population

Purpose: To measure the morphology of the proximal femur in a Pakistani population. Methods: Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. Results: Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0-4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI,2.7). Conclusions: Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population

Exploring Managerial Perspectives of Using Building Management System through TAM: An Empirical Study of Commercial Sector of Pakistan

A cursory review of the Building Management System (BMS) which optimizes building performance as a move towards smart cities has been presented in the present study. The extant study is an effort to distinguish and analyze the circumstances as if the underdeveloped economies are less likely to be benefitted by the contemporary trends of BMS as compare to the developed countries. Moreover, the current study identifies the factors which may cause to render the managerial acceptance for using BMS through the Technology Acceptance Model (TAM). TAM was used to measure four behaviors (latent factors) namely subjective norms, organization support, compatibility, and technology complexity. The data were statistically evaluated via multiple regression analysis using the Statistical Package for Social Sciences (SPSS). Results suggested that organization support and compatibility have a significant influence on managerial intentions to use BMS while subjective norms, technology complexity have no significant influence. The findings of this study may serve as guidelines for improvement in the acceptance process and using building management systems in commercial sectors of developing countries

Immunity and field efficacy of type 2-containing polio vaccines after cessation of trivalent oral polio vaccine: A population-based serological study in Pakistan

Background: In Pakistan and other countries using oral polio vaccine (OPV), immunity to type 2 poliovirus is now maintained by a single dose of inactivated polio vaccine (IPV) in routine immunization, supplemented in outbreak settings by monovalent OPV type 2 (mOPV2) and IPV. While well-studied in clinical trials, population protection against poliovirus type 2 achieved in routine and outbreak settings is generally unknown.Methods: We conducted two phases of a population-based serological survey of 7940 children aged 6-11 months old, between November 2016 and October 2017 from 13 polio high-risk locations in Pakistan.Results: Type 2 seroprevalence was 50% among children born after trivalent OPV (tOPV) withdrawal (April 2016), with heterogeneity across survey areas. Supplementary immunization activities (SIAs) with mOPV2 followed by IPV improved population immunity, varying from 89% in Pishin to 64% in Killa Abdullah, with little observed marginal benefit of subsequent campaigns. In the other high-risk districts surveyed, a single SIA with IPV was conducted and appeared to improve immunity to 57% in Karachi to 84% in Khyber.Conclusions: Our study documents declining population immunity following trivalent OPV withdrawal in Pakistan, and wide heterogeneity in the population impact of supplementary immunization campaigns. Differences between areas, attributable to vaccination campaign coverage, were far more important for type 2 humoral immunity than the number of vaccination campaigns or vaccines used. This emphasizes the importance of immunization campaign coverage for type 2 outbreak response in the final stages of polio eradication. Given the declining type 2 immunity in new birth cohorts it is also recommended that 2 or more doses of IPV should be introduced in the routine immunization program of Pakistan

Assessing Crop Water Requirements and a Case for Renewable-Energy-Powered Pumping System for Wheat, Cotton, and Sorghum Crops in Sudan

Climate change is changing global weather patterns, with an increase in droughts expected to impact crop yields due to water scarcity. Crops can be provided with water via underground pumping systems to mitigate water shortages. However, the energy required to pump water tends to be expensive and hazardous to the environment. This paper explores different sites in Sudan to assess the crop water requirements as the first stage of developing renewable energy sources based on water pumping systems. The crop water requirements are calculated for different crops using the CROPWAT and CLIMWAT simulation tools from the Food and Agriculture Organization (FAO) of the United Nations. Further, the crop water requirements are translated into electrical energy requirements. Accurate calculations of the energy needed will help in developing cost-effective energy systems that can help in improving yields and reducing carbon emissions. The results suggest that the northern regions tend to have higher energy demands and that the potential for renewable energy should be explored in these regions, which are more susceptible to drought and where crops tend to be under higher stress due to adverse climate conditions

Performance Assessment and Working Fluid Selection for Novel Integrated Vapor Compression Cycle and Organic Rankine Cycle for Ultra Low Grade Waste Heat Recovery

This paper presents the performance assessment and working fluid selection for a novel integrated vapor compression cycle-organic Rankine cycle system (i-VCC-ORC), which recovers ultra-low-temperature waste heat rejected (50 °C) by the condenser of a vapor compression cycle (VCC). The analyses are carried out for a vapor compression cycle of a refrigeration capacity (heat input) of 35kW along with the component sizing of the organic Rankine cycle (ORC). The effects of the operational parameters on integrated system performance were investigated. The integrated system performance is estimated in terms of net COP, cycle thermal efficiency and exergy efficiency by completely utilizing and recovering the heat rejected by the condenser of the VCC system. R600a-R141b with COPnet (3.54) and ORC thermal efficiency (3.05%) is found to be the most suitable VCC-ORC working fluid pair. The integration of the vapor compression refrigeration cycle with the organic Rankine cycle increases the COP of the system by 12.5% as compared to the standalone COP of the vapor compression system. Moreover, the sensitivity analysis results show that there exists an optimum operating condition that maximizes the thermal performance of the integrated system

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Experimental study on biological damage in bone in vibrational drilling

BACKGROUND: Drilling is a well-known mechanical operation performed for fixing fracture at required locations in bone. The process may produce mechanical and thermal alterations in the structure of the bone and surrounding tissues leading to irreversible damage known as osteonecrosis. OBJECTIVE: The main purpose of this study was to measure the level of biological damage in bone when a drill assisted by low and high levels of vibrations is penetrated into bone tissue. METHODS: Histopathology examination of sections of bones has been performed after drilling the bone using a range of vibrational frequency and rotational speed imposed on the drill with and without supply of saline for cooling. RESULTS: Cell damage in bone was caused by the combined effect of drill speed and frequency of vibrations. Histopathology examination revealed more damage to bone cells when a frequency higher than 20 kHz was used in the absence of cooling. Cooling the drilling region helped minimize cell damage more at a shallow depth of drilling compared to deep drilling in the cortex of cortical bone. The contribution of cooling in minimizing cell damage was higher with a lower drill speed and frequency compared to a higher drill speed and frequency. CONCLUSION: Vibrational drilling using a lower drill speed and frequency below 25 kHz in the presence of cooling was found to be favorable for safe and efficient drilling in bone.</jats:p