Professionalism in medical students at a private medical college in Karachi, Pakistan

Objective: To determine levels of professionalism in undergraduate medical students at a private medical college and assess how changes emerge during their training. Methods: The study was conducted at Aga Khan University, a tertiary care teaching hospital, during November and December 2011. Freshmen, Year 3 and Year 5 students were requested to fill out a questionnaire. It was designed to assess the participants\\u27 levels of professionalism and how they perceived the professional environment around them by incorporating previously described scales. The questionnaire was re-validated on a random sample of practising clinicians at the same hospital. SPSS 17 was used for statistical analysis. Results: The study sample comprised 204 participants. The mean score for level of individual professionalism was 7.72±3.43. Only 13 (6.4%) students had a score one standard deviation above the faculty mean. About 24 (11.8%) were one standard deviation and 35 (17.2%) were 2 standard deviations below the faculty mean. The remaining 130 (63.7%) were \u3e2 standard deviations below the faculty mean. Considering the level of education, the mean score for level of professionalism was 8.00±3.39 for freshmen, 6.85±3.41 for year 3 students, and 8.40±3.34 for year 5 students. Conclusion: The currently employed teaching practices inculcating the values of professionalism in medical students are serving as a buffer to maintain the pre-training levels of professionalism from declining

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Thermal performance enhancement of novel integrated vapor compression and organic rankine cycle for electricity production: a full-condensing vs. desuperheating approach comparison in ultra-low-grade waste heat recovery

This paper presents the thermodynamic analysis, performance assessment and working fluid selection for a novel integrated vapor compression cycle and the organic Rankine cycle system, which recovers ultra-low-temperature waste heat (50°C) rejected by the condenser of a vapor compression cycle (VCC). The study is conducted on a vapor compression system of a 35 kW cooling capacity, followed by the component sizing of the organic Rankine cycle (ORC) based on the available waste heat in the condenser of the refrigeration system. The effect of the operational parameters of the vapor compression cycle on the overall system performance are investigated. The system performance of the integrated system is estimated in terms of coefficient of performance, cycle thermal efficiency and exergy efficiency. The novel integrated systems has been analyzed thermodynamically for 36 pairs of pure refrigerants. Results show that the working fluid pair R600a/R141b with combined coefficient of performance (3.54), ORC thermal efficiency (3.05 %), electricity saving ratio (13.34 %) and total exergy destruction (6.94 kW) is the most suitable VCC/ORC working fluid pair in full condensing method. R407c-R141b is found to be the best working fluid pair in desuperheating method for the same integrated system. The performance analysis for full condensation and desuperheating methods are also investigated. The results indicate a 12.5 % improvement in the coefficient of performance of the integrated system using the full condensation method and a 2.5 % improvement using the desuperheating method compared to the standalone air conditioning system. Additionally, the sensitivity analysis results show that there exists optimum operating condition that maximize the system performance of the integrated system

An Integrated Multicriteria Decision-Making Approach to Evaluate Traveler Modes’ Priority: An Application to Peshawar, Pakistan

The transport planning is essential to meeting passengers’ needs for fast, safe, and reliable transport. The research goals of this study are to determine the most suitable mode of transport between predetermined alternatives according the criteria related to the transport planning. The research method combines GIS analysis, SWOT analysis, BEM method, and PROMETHEE II method in an integrated approach for decision-making. The methodology is applied to the city of Peshawar city. It includes six steps. First, a passenger questionnaire is used to establish passenger preferences when making a trip in the city. Secondly, alternative modes of urban transportation are defined. In the case of Peshawar, the following alternatives are considered: a new BRT service, BRT with five additional stops, old bus service, wagon, carpooling, and Careem/Uber. Thirdly, there is GIS analysis to investigate the stops of the BRT alternative transportation. GIS and satellite analysis have been completed for each stop. Fourthly, criteria for the assessment of urban transport modes are determined based on SWOT analysis. A total of twenty four subcriteria are proposed. Fifthly, the best-worst method (BWM) which is based on linear programming method is applied to determine the weightings that should be given to the main criteria and subcriteria. Sixthly, alternative modes of transportation are ranked by applying preference ranking organization method for enrichment evaluations’ (PROMETHEE II) method. The results show that the main important criteria greater than 5% are small movement interval: S4 (6%), security: S7 (13%), reliability: S8 (8%), accessibility:O1 (15%), possibility of special services: O2 (5%), possibility of including insurance in the travel tariff: O3 (8%), possibility of the modernization of the infrastructure: O4 (7%), and environmental pollution: T3 (5%). The implications of this study propose a BRT service with five additional stops is the best urban transport plan for Peshawar. The originality of this research consists in integration of a strategic planning technique SWOT analysis, GIS analysis, and multicriteria analysis in complete methodology to evaluate traveler’s modes priority. The methodology used in this research can be applied to evaluate different transport alternatives for transport networks worldwide

Axial Compressive Behavior of Reinforced Concrete (RC) Columns Incorporating Multi-Walled Carbon Nanotubes and Marble Powder

In this study, Multiwalled Carbon Nanotubes (MWCNTs) and Marble Powder (MP) have been utilized in reinforced concrete columns to assess their structural behavior. The nanotubes from 0.025% to 0.20% and 5% MP by weight of cement were used. The compressive strength of reinforced concrete columns and cubes was analyzed as the main property. The incorporation of MWCNTs and marble powder was able to increase the compressive strength of columns by 72.69% and mortar by 42.45% as compared to reference concrete. The ductility was noted to be improved by 42.04%. The load-deformation and stress-strain behaviors were also analyzed. The Scanning Electron Microscopy (SEM) analysis revealed the formation of a strong compact bridge (90–100 layers), Calcium Silicate Hydrate (C-S-H) gel, evenly dispersion, and bridging effect caused by MWCNTs. The incorporation of 0.20% MWCNTs by weight of cement was recommended to be effectively used as a reinforcing agent in concrete

Prevalence of Post-Heart Transplant Malignancies: A Systematic Review and Meta-Analysis

The prevalence of different cancers after heart transplant (HT) is unclear due to small and conflicting prior studies. Herein, we report a systematic review and meta-analysis to highlight the prevalence and pattern of malignancies post-HT. We conducted an extensive literature search on PubMed, Scopus, Cochrane databases for prospective or retrospective studies reporting malignancies after HT. The proportions from each study were subjected to random effects model that yielded the pooled estimate with 95% confidence intervals (CI). Fifty-five studies comprising 60,684 HT recipients reported 7759 total cancers during a mean follow-up of 9.8 ± 5.9 years, with an overall incidence of 15.3% (95% CI = 12.7%-18.1%). Mean time from HT to cancer diagnosis was 5.1 ± 4 years. The most frequent cancers were gastrointestinal (7.6%), skin (5.7%), and hematologic/blood (2.5%). Meta-regression showed no association between incidence of cancer and mean age at HT (coeff: -0.008; P = 0.25), percentage of male recipients (coeff: -0.001; P = 0.81), donor age (coeff: -0.011; P = 0.44), 5-year (coeff: 0.003; P = 0.12) and 10-year (coeff: 0.02; P = 0.68) post-transplant survival. There is a substantial risk of malignancies in HT recipients, most marked for gastrointestinal, skin, and hematologic. Despite their occurrence, survival is not significantly impacted