Knowledge of primary paediatric care providers regarding attention deficit hyperactivity disorder and learning disorder: a study from Pakistan

Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. Methods: A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Results: Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for / diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. Conclusion : We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan

Analysis of temperature variations in fixed-bed columns using non-isothermal and non-equilibrium transport model

A non-isothermal and non-equilibrium two-component lumped kinetic model of fixed-bed column liquid chromatography is formulated with the linearized isotherm and solved analytically to study the influence of temperature variations on the process. The model equations constitute a system of convection-diffusion PDE for mass and energy balances in the bulk phase coupled with differential equations for mass and energy balances in the stationary phase. The analytical solutions are derived for Dirichlet boundary conditions by implementing the Laplace transformation, Tschirnhaus-Vieta approach, the linear decomposition technique and an elementary solution technique of ODE. An efficient and accurate numerical Laplace inversion technique is applied to bring back the solution in the actual time domain. In order to validate the derived analytical solutions for concentration and temperature fronts, the high resolution upwind finite volume scheme is applied to approximate the model equations numerically. Various case studies are carried out assuming realistic model parameters. The results obtained will be beneficial for interpreting mass and energy profiles in non-equilibrium and non-isothermal liquid chromatographic columns and provide deeper insight into the sensitivity of the separation process without performing costly and time-consuming laboratory experiments

With No Deliberate Speed: The Segregation of Roma Children in Europe

In this study, by taking the advantage of both inorganic ZnO nanoparticles and the organic material chitosan as a composite seed layer, we have fabricated well-aligned ZnO nanorods on a gold-coated glass substrate using the hydrothermal growth method. The ZnO nanoparticles were characterized by the Raman spectroscopic techniques, which showed the nanocrystalline phase of the ZnO nanoparticles. Different composites of ZnO nanoparticles and chitosan were prepared and used as a seed layer for the fabrication of well-aligned ZnO nanorods. Field emission scanning electron microscopy, energy dispersive X-ray, high-resolution transmission electron microscopy, X-ray diffraction, and infrared reflection absorption spectroscopic techniques were utilized for the structural characterization of the ZnO nanoparticles/chitosan seed layer-coated ZnO nanorods on a gold-coated glass substrate. This study has shown that the ZnO nanorods are well-aligned, uniform, and dense, exhibit the wurtzite hexagonal structure, and are perpendicularly oriented to the substrate. Moreover, the ZnO nanorods are only composed of Zn and O atoms. An optical study was also carried out for the ZnO nanoparticles/chitosan seed layer-coated ZnO nanorods, and the obtained results have shown that the fabricated ZnO nanorods exhibit good crystal quality. This study has provided a cheap fabrication method for the controlled morphology and good alignment of ZnO nanorods, which is of high demand for enhancing the working performance of optoelectronic devices

using management information system to evaluate quality of care at tertiary care hospital’s stroke centre

To find out the average length of stay, the rate of I/V catheter cellulites, the rate of bed sores among patients in stroke centre and determine the mortality rates. Methodology: This is a descriptive study, carried out at a tertiary care hospital over the period of six months. Data was analyzed by SPSS version 15.0. Result: Total numbers of patients were 36 from January 1 to June 30, 2007 at Stroke Center Liaquat National Hospital. The mean length of stay was 8.17 ±5.81 days. Patients had cellulitis (intravenous) 97.2%, only 2.8% of patients did not develop. The rate of bed sore was 41.7%. Conclusion: By effective implementation of the Management Information System (MIS) in health care delivery system we can find patients clinical issues and can reduce their length of stay

Motion of a Vector Particle in a Curved Spacetime. II First Order Correction to a Geodesic in a Schwarzschild Background

The influence of spin on a photon's motion in a Schwarzschild and FRW spacetimes is studied. The first order correction to the geodesic motion is found. It is shown that unlike the world-lines of spinless particles, the photons world-lines do not lie in a plane.Comment: 14 pages, LaTeX2e, second paper in the series (the first one: gr-qc/0110067), replaced with typos and style corrected version, accepted in MPL

The maintenance of elevated active chlorine levels in the Antarctic lower stratosphere through HCl null cycles

The Antarctic ozone hole arises from ozone destruction driven by elevated levels of ozone destroying ("active") chlorine in Antarctic spring. These elevated levels of active chlorine have to be formed first and then maintained throughout the period of ozone destruction. It is a matter of debate how this maintenance of active chlorine is brought about in Antarctic spring, when the rate of formation of HCl (considered to be the main chlorine deactivation mechanism in Antarctica) is extremely high. Here we show that in the heart of the ozone hole (16–18 km or 85–55 hPa, in the core of the vortex), high levels of active chlorine are maintained by effective chemical cycles (referred to as HCl null cycles hereafter). In these cycles, the formation of HCl is balanced by immediate reactivation, i.e. by immediate reformation of active chlorine. Under these conditions, polar stratospheric clouds sequester HNO3 and thereby cause NO2 concentrations to be low. These HCl null cycles allow active chlorine levels to be maintained in the Antarctic lower stratosphere and thus rapid ozone destruction to occur. For the observed almost complete activation of stratospheric chlorine in the lower stratosphere, the heterogeneous reaction HCl + HOCl is essential; the production of HOCl occurs via HO2 + ClO, with the HO2 resulting from CH2O photolysis. These results are important for assessing the impact of changes of the future stratospheric composition on the recovery of the ozone hole. Our simulations indicate that, in the lower stratosphere, future increased methane concentrations will not lead to enhanced chlorine deactivation (through the reaction CH4 + Cl  ⟶  HCl + CH3) and that extreme ozone destruction to levels below  ≈ 0.1 ppm will occur until mid-century

BRICS: Is the Group Really Creating Impact?

In 2001, Jim O'Neill coined the acronym for Brazil, Russia, India and China as the largest emerging markets economies. He expected them to grow faster than the developed countries and to play an increasingly important role in the world. In 2009, BRIC countries held their first summit which in its 3rd summit turned into BRICS with the addition of South Africa. The BRICS now represent 3 billion people and a combined GDP of $16 trillion. The group is the third giant after the EU and the US. Analysts predict that the BRICS will overtake US in terms of GDP this year and the G7 by 2030. In the summit in July 2014, BRICS leaders have approved creating the BRICS New Development Bank which would fund long-term investment in infrastructure and more sustainable development. The economics projections show that till 2040, the BRICS is expected to rule the world market

Fine needle aspiration cytology in parotid lumps

Over a period of two years, Fine Needle Aspiration Cytology (FNAC) was performed on 33 patients presenting with a parotid lump. Five patients were excluded as they were treated medically after FNAC report. The FNAC results of 28 cases were compared with histopathological diagnoses of surgically resected specimens. There were 8 true positive, 17 true negative, 1 false positive and 2 false negative cases. Sensitivity was 80%, specificity 94.4% and diagnostic accuracy 89.3%. FNAC is a simple quick, accurate and virtually complications free investigative modality. It is also helpful adjunct to assess preoperatively the suitability and extent of the surgical treatment

Recent developments in the reduction of oxidative stress through antioxidant polymeric formulations

Reactive oxygen and nitrogen species (RONS) are produced endogenously in our body, or introduced through external factors, such as pollution, cigarette smoke, and excessive sunlight exposure. In normal conditions, there is a physiological balance between pro-oxidant species and antioxidant molecules that are able to counteract the detrimental effect of the former. Nevertheless, when this homeostasis is disrupted, the resulting oxidative stress can lead to several pathological conditions, from inflammation to cancer and neurodegenerative diseases. In this review, we report on the recent developments of different polymeric formulations that are able to reduce the oxidative stress, from natural extracts, to films and hydrogels, and finally to nanoparticles (NPs)

An audit of head trauma care and mortality

Objective: To analyze the factors contributing to deaths from head trauma by using standardized assessment parameters and to provide a peer-review of head injury deaths with focus on identifying deficiencies and analyzing contributory factors.Design: Descriptive study.Place and duration of study: The study was carried out at the Emergency, Aga Khan University Hospital during January 1998 to December 1999.Subjects and method: One hundred and three patients above the age of 15 years presenting alive to the Aga Khan University Hospital (AKUH) emergency with head injury were included in this study. Identified deaths data was reviewed by the Hospital Trauma Peer Review Committee and consensus arrived at for categorization of deaths. The potential deficiencies in care were identified and final recommendations made. The data was computed on CDC Trauma Registry (V 3.0) and SPSS (V 8.0).Results: Mean age was 31.9 years (n=103) with predominant male population (4:1). Severe head injury (GCS\u3c8) accounted for 21.3 % (n=22) of all cases with a total number of deaths being 12.6 % (n=13). Deaths were categorized preventable in 3 cases with non-preventable and potentially preventable in 4 and 6 cases respectively. Road traffic accidents were the predominant mechanism (n=8) in all deaths (n=13). The time interval in relation to mortality was biphasic, most deaths occurring either within 24 hours or between 3-7 days of injury. Inappropriate pre-hospital treatment, pre-hospital delays and inappropriate mode of transportation without inter-hospital communication were the process-related defects in pre-hospital care with major determinant of deaths outside AKUH (n=5). Prolonged emergency stay, delayed intensive care availability were the process-related deficiencies whereas inappropriate initial resuscitation, inappropriate initial head injury management were provider-related deficiencies in in-hospital care.Conclusion: Transfer of inappropriately managed patients, lapses in inter-hospital communications, delayed transfers were identified as the major pre-hospital factors whereas lack of ICU beds, portable ventilators in emergency room, delays in CT scan facilities were the deficiencies in the hospital services. Opportunities for improvement in head trauma care are needed to focus on initial resuscitation and appropriate surgical management