119 research outputs found

    Understanding the Impact of the Economic Crisis on Child and Maternal Health among the Poor: Opportunities for South Asia

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    The economic crisis hit many countries in 2007 and the effects are still being felt, especially in poorer developing nations. Much of the debate surrounding the economic crisis and its impacts has focused on the financial and economic aspects—import/export impacts, economic growth losses, labor force cutbacks, and fiscal imbalances. The social impact, especially on poor and vulnerable groups, has received less mention. Yet, if countries are to address the overall impacts of the economic crisis, it is vital that they also consider investing time and money to deal with social impacts more effectively. There are fears, however, that a reduction in spending on vital sectors (including the healthcare sector) to ensure economic recovery could affect poor and vulnerable populations and, in turn, erase the progress that has been made thus far. The decision to reduce such spending could also come from donors, who tend to favor a market-led recovery process in economic crises, thereby neglecting vital social service sectors that cater to the needs of poor populations. This spending can supplement government services or fill resource gaps and as a result reductions could have negative impacts on beneficiary populations, particularly the poor and vulnerable. Addressing child and maternal health issues within the context of the economic crisis is one key area to consider given its short, medium, and long-term effects on populations in developing countries. In South Asian countries, child and maternal health-related indicators tend to be disturbing despite the rapid growth rates in many of these countries. The number of infant deaths is still quite high, nutrition of children and women continues to be problematic, and maternal health and pre/post natal care remains poor. This paper presents an overview of child and maternal health in the South Asia region, but also recommends that interventions take into account a series of factors if the impacts of the economic crisis are to be minimized: There is a need for more information and research on the impacts of the crisis; Investing in social protection and safety nets is imperative; Food security should be integrated into social protection; Vulnerable households require support to cope with the crisis despite their own efforts and coping strategies; State investments that support vulnerable populations should be protected in times of crisis.poverty reduction; economic crisis impact; social impact; child maternal health; south asia poverty; social protection

    An Analysis of Nontechnical Game Theory on Laboratory Sales Trainees in Saudi Arabia

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    The purpose of this case study was to analyze 6 months of training application in a nontechnical game theory setting. Three laboratory sales trainees were studied using training reports that logged their strategic decisions and the amount of sales they obtained from their clients. A pure strategy game theory analysis was conducted on the decisions by the sales trainees. Two types of strategies were derived from the study: (a) allocentric and (b) egocentric. The egocentric strategies yielded higher personal payoffs, while the allocentric strategies yielded higher organizational payoffs. Training intervention was withheld during the 6-month period in order to allow sales trainees to select their own strategies. The conclusions from the study indicated that if training lacks strategic alignment with organizational goals, sales trainees might select egocentric strategies that yield higher personal payoffs more often than higher company payoffs

    Motivational Issues of Faculty in Saudi Arabia

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    This study focused on the factors that affect motivation of faculty in Saudi Arabia. It included two surveys and open-ended queries to a focus group of five academic managers and 25 faculty members of varying nationalities, rank, and institutes in Saudi Arabia. The research showed that the faculties in Saudi Arabia’s higher education industry feel disconnected from the program development. The faculty members did not feel motivated to participate in the development and improvement of the academic program due to: (a) lack of monetary and non-monetary incentives, (b) management not involving faculty in decision-making, and (c) lack of recognition and moral support. However, the faculties were intrinsically motivated to perform their best within the confines of the classroom. The results of the study indicated that there was a greater interest in intrinsic motivation as a personal measure for success inside the classroom, but extrinsic motivation was a factor that needed greater improvement from the management of the universities for faculty to partake in development of the program

    Post transplant lymphoproliferative disorder

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    Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a recognized complication exclusive to solid organ transplant recipients and carries a high mortality. Methods: We retrospectively reviewed records of all renal transplant recipients under follow up at our institution over the last seven years (2005-2011). We reviewed the patient characteristics, immunosuppression regimen and risk factors for the development of PTLD and its outcomes in our transplant cohort. Results: Four out of 63 patients were diagnosed with PTLD. PTLD was incidentally diagnosed on a transplant biopsy that was performed for an unexplained rise in serum creatinine in three patients. The fourth patient presented with left submandibular lymphadenopathy. Majority presented within 18 months of renal transplantation. After the diagnosis of PTLD on graft biopsy, all patients were fully investigated and two patients had systemic involvement. In the patients with systemic involvement, reduction of immunosuppression and anti B cell therapy with Rituximab was used with good success. The patient with submandibular lymphadenopathy received chemotherapy in addition to reduction of immunosuppression. Three PTLD cases were polyclonal and diagnosed early whereas the fourth case was monoclonal. Conclusion: PTLD can sometimes be incidentally diagnosed on an allograft biopsy performed for rejection. The incidence of PTLD in our centre is higher than reports from other centres but our outcome is good if recognised and treated early

    Predictive Technique Of Security Data Breaches In Ai Powered Mobile Cloud Application Using Deep Random Forest Algorithm

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    With the rapid integration of artificial intelligence (AI) in mobile cloud applications, ensuring robust security mechanisms is vital to safeguard sensitive user data. The proliferation of AI technologies in mobile cloud applications has brought unprecedented efficiency and convenience, accompanied by an escalating risk of security breaches. As the threat landscape evolves, traditional security measures fall short in providing comprehensive protection. This research recognizes the critical need for a predictive approach to security data breaches in AI-powered mobile cloud applications. Existing security frameworks often lack the adaptability to detect and pre-emptively address emerging threats specific to AI-enhanced mobile cloud environments. This study employs the Deep Random Forest Algorithm, an advanced machine learning technique known for its ability to handle complex and dynamic datasets. The algorithm combines the power of deep learning with the versatility of random forest classifiers to predict security breaches in real-time. The results demonstrate the efficacy of the proposed Deep Random Forest Algorithm in predicting and mitigating security breaches in AI-powered mobile cloud applications. The model exhibits high accuracy and sensitivity, showcasing its potential to enhance the security posture of mobile cloud ecosystems

    Hearing Benefit in Middle Ear Reconstructive Surgery: A Comparative Study of the Current Methods

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    INTRODUCTION: Discharging ear and deafness are perpetual source of misery to humankind. Chronic suppurative otitis media is found to be the single major cause of conductive deafness manifesting in 66.3% of cases. The other causes being trauma, otosclerosis, congenital malformations, neoplastic causes etc. Auditory sensation is one of the vital sensations for existence. Deafness upsets the tranquility of life. When such a great vital sensation is lost, life naturally loses its charm. In last 50 years, various researches have been carried out for repair of ossicular chain defects alone or those associated with tympanic membrane perforations. A number of materials have been used with varying results. Right from Hall and Rytzer of 1957 till today, several pioneers have revolutionized the outlook of ossiculoplasty. Several materials have been used for ossiculoplasty. Some of the materials are autograft/homograft ossicles, autograft/homograft cartilage, teflon, hydroxyapatite, titanium, gold, bioglass etc. The goal of otologists performing middle ear surgery to correct conductive hearing loss is to improve hearing as well as to provide a functional benefit to the patient. Unilateral conductive hearing loss is associated with various disabilities including difficulty in sound localization and in hearing and understanding speech. Traditionally, otologists have reported the results of middle ear surgery as the closure of the air - bone gap or the reduction in air conduction thresholds. The closure of the air-bone gap refers to improvement of the air conduction thresholds (involving conductive and sensorineural components) to the level of the bone conduction thresholds (sensorineural component). While these provide a measure of the technical success of the operation, they may not always translate into real life benefit for the patient. Hence standardization of results of treatment should be by a method based on subjective perception which benefits patients in real life. Other methods have been used to evaluate the effectiveness of middle ear surgery including questionnaires that evaluate a patient's subjective benefit from surgery. Using questionnaires to evaluate benefit is complicated by the fact that both surgeons and patients want to believe that the operation has succeeded. The two most common methods found in the otologic literature to evaluate benefit from middle ear surgery are the Belfast 15/30 dB rule of thumb and the Glasgow benefit plot. These methods facilitates the assessment of subjective benefit as well as objective achievement, we have employed these two most common methods to estimate patient benefit from middle ear surgery in our study. AIMS AND OBJECTIVES: 1. To compare two methods of predicting the level of hearing benefit following middle ear surgery, namely Glasgow benefit plot and Belfast 15/30 dB rule of Thumb. 2. To correlate hearing benefit as measured by using the above methods with patients' self assessment of his/her hearing status 3. To analyze the differences in hearing improvement by various ossiculoplasties like incus interposition, tragal/ conchal cartilage and autograft malleus. 4. To compare the success rates with surgery on dry and wet ears. 5. To compare success rates with cavity mastoidectomy cases versus those without cavity. MATERIALS AND METHODS: Sixty patients undergoing middle ear surgery were selected at random with no age or sex bias. Only patients with conductive hearing loss were selected. The minimum age was 11 years and maximum age was 48 years. Those cases requiring myringoplasty were excluded from the study. Any allergic or septic focus was ruled out preoperatively. Cases with bilateral ear disease were also taken up and revision cases were also subjected to surgery on 7 occassions. Both wet and dry ears were taken up. Patients were admitted one day before the surgery. Mastoid shaving and local preparation were done in the ward. All cases were operated under general anaesthesia. The types of surgery included in the study were mastoid exploration, tympanoplasty and ossiculoplasty. Apart from a detailed case history, patients were assessed clinically with the help of otoscopy, tuning fork tests, pure tone audiometry, free field hearing tests, X-ray Mastoids and CT Temporal bone were done where applicable. A detailed questionnaire was used (separately to be filled in by the patient and the close first relative of the patient) pre and post operatively, to assess the level of hearing. Patients were followed post operatively for 3 & 6 months. RESULTS AND OBSERVATIONS: There were 38 males and 22 females. Age range was from 11-48 years. The younger patients were more aware of their hearing loss and consisted of 76.6 % of all the patients. The commonest disease was CSOM - tubotympanic (14 cases) and atticoantral (46 cases). Group 1 : Unilateral hearing impairment, asymmetric threshold 12 patients were included in this group. All had pure tone average above 30 dB in one ear; all had interaural difference of more than 10 dB. Preoperative self assessment of hearing loss by patients : Patients presented with varying degrees of subjective hearing impairment, such as diminished hearing from a distance, in group conversation, on telephone, discharge and diminished hearing. Post operatively: Hearing from operated and non-operated ear was same in 6 patients (3 patients had inter aural difference of 12, 12 & 18 dB but claimed symmetric hearing). Group 2 : Bilateral hearing impairment, asymmetric threshold. 40 patients were included in this group and 37 patients had pure tone averages above 30 dB in both ears. 29 patients had inter aural difference of more than 10dB. Patients claimed significant benefit post operatively. Hearing from operated and non-operated ear was same in 33 patients. The prediction by both methods in this group was 100%. 19 patients fell in category 'c' and claimed significant benefit. Group 3 : Bilateral hearing impairment - symmetric threshold 8 patients were included in this group. Pure tone average was less than 30 dB in six cases and interaural difference within 10 dB in 2 cases and 12,12,15,16,25,28,26 dB in 6 patients. They had significant benefit following surgery and claimed that the operated ear was the better hearing ear. As per audiometry, 2 patients fell in category 'c' and claimed significant benefit. As per subjective benefit all these patients claimed significant benefit. Comparing the same with 15/30 dB rule of thumb as per audiometry, the overall positive predictive value was 80% and as per subjective benefit 84%. Applying Z test for significance of difference between the predictive values by pure Tone Audiometry and subjective benefit in both the methods, the difference is not significant since Z is <1.96 at 95% confidence interval. 10 out of 12 patients (83%) in Group I had no difficulty in localizing sound, as only one ear is actually sufficient to localize sound. According to Browning GG (1993), minor head movement can achieve the necessary variation in speech perception level. In Group 3, 8 patients had bilateral symmetric hearing loss as per pure tone audiometry. Pure tone averages in the 0.5,1,2 kHz were same in both ears. This correlates with observations of G.G.Browning (1993), audiometric tests do not measure all aspects of hearing; hence the ear being operated upon should be as per patient's choice. CONCLUSION: 1. The overall success rate of ossiculoplasty in the present study is 80%. 2. In this study its found that Glasgow benefit plot is more sophisticated, graphical, providing a good visual impression whereas Belfast Rule of thumb is easy and simple to use, but, it suffers from the disadvantages of 'all or none phenomenon' with no place for marginal benefit. 3. Hearing improvement with Incus transposition is better followed by tragal and conchal cartilage ossiculoplasty, Homograft Malleus (in descending order). 4. Hearing improvement is better when minimal ossicular disruption is present. (All present > Incus absent > M-I-> M-I-S-) 5. Hearing improvement is better when cholesteatoma is absent (when compared to cholesteatoma cases). 6. Hearing improvement is better with dry ears. 7. Hearing improvement is better when cavity mastoidectomy was not done (when compared to cavity mastoidectomy cases.) 8. Fresh cases do better than revision cases. 9. Cases without granulations do better than those with granulations

    Coupled plasma filtration adsorption (CPFA) plus continuous veno-venous haemofiltration (CVVH) versus CVVH alone as an adjunctive therapy in the treatment of sepsis

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    To compare the efficacy of Coupled Plasma Filtration and Adsorption (CPFA) plus Continuous Veno-Venous Haemofiltration (CVVH) versus CVVH alone as an adjunct treatment of sepsis in terms of haemodynamic stability, inotropic requirement and inflammatory mediators. Design and Methods: Prospective randomized controlled trial involving septic patients with/without acute kidney injury (AKI) whom were randomized to receive CPFA + CVVH or CVVH alone. Haemodynamic parameters including inotropic requirements and inflammatory mediators [procalcitonin (PCT) and C reactive protein (CRP)] were measured. Results: Twenty-three patients [CPFA + CVVH (n = 11), CVVH (n = 12)] were enrolled. Haemodynamic stability occurred earlier and sustained in the CPFA + CVVH group with an increase in diastolic blood pressure (p = 0.001 vs. p = 0.226) and mean arterial pressure (p = 0.001 vs. p = 0.575) at the end of treatment with no increment in inotropic requirement. Both groups had a reduction in PCT and CRP (CPFA + CVVH: p = 0.003, p = 0.026 and CVVH: p = 0.008, p = 0.071 respectively). The length of intensive care unit stay, hospital stay and 30 day outcomes were similar between the groups. There was an inverse association between serum albumin and CRP (p = 0.018). Serum albumin positively correlated with systolic blood pressure (p = 0.012) and diastolic blood pressure (p = 0.009). We found a trend between CRP and length of hospital stay (p = 0.056). Patients with a lower PCT at 24 h had a better outcome (survival) than those with a higher PCT (p = 0.045). Conclusion: CPFA is a feasible, albeit expensive adjunctive extracorporeal treatment that may be superior to CVVH alone in the treatment of severe sepsis

    Blood pressure profile in contiuous ambulatory peritoneal dialysis patients

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    Background: Cardiovascular mortality is the leading cause of death in end stage renal disease. Despite being on continuous ambulatory peritoneal dialysis (CAPD), blood pressure (BP) remains poorly controlled. A higher pulse pressure and non dipping are associated with increased cardiovascular mortality. We studied BP control and the prevalence of non dipping in CAPD patients. Methods: All patients undergoing CAPD at our institution who met the inclusion criteria were recruited. We compared BP control and dipping status in diabetic and non diabetic pa-tients on CAPD. We also determined whether BP and peritoneal membrane permeability were associated. Results: Forty six patients with a mean age 45 ± 13 years were enrolled. Diabetic patients were older (mean age 54 ± 13 vs. 40 ± 11 yrs, p <0.001), had a lower mean diastolic BP (80 ± 14 vs. 90 ± 14 mmHg, p = 0.025) and a higher mean pulse pressure (59 ± 17 vs. 49 ± 14 mmHg, p = 0.035). They were also non dippers (n = 15 vs. n = 1, p = 0.007). The low and low average transporters tended to have a higher systolic BP (p = 0.054) and a higher pulse pressure (p = 0.058). On multivariate analysis, age was the main predictor of pulse pressure. Conclusion: Despite being on chronic maintenance PD, BP was not well controlled. Diabetic patients had a higher pulse pressure and were non dippers thereby increasing their cardiovascular risk. We should therefore optimize BP control and aim to restore the nocturnal dip in these patients

    Regulatory T cells (CD4+CD25+FOXP3+) in lupus nephritis

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    Background: Systemic lupus erythromatosus (SLE) is an autoimmune disease with 20–65% of patients developing lupus nephritis (LN). Studies have reported 10% of LN patients will end up with end stage renal disease and their mortality rate is higher compared to patients without LN. Abnormality of regulatory T cells (Tregs) level is thought to be a potential factor for this LN development. The aim of study was to evaluate the percentage of Tregs in LN patients.Methods: This was a comparative cross sectional study involving LN patients and age and gender matched controls with a 2:1 ratio. The patients were grouped into active and inactive LN based on their lupus activity index; complement levels, ANA, dsDNA antibodies, ESR, SLE Disease Activity Index (SLEDAI2K) score and also urine PCI (uPCI>0.05 for active group). Disease history, demographic data, routine blood test, peripheral blood for differentials count were taken and recorded. Peripheral blood mononuclear cells were stained with CD4, CD25 and Foxp3 antibodies and percentage of Tregs was analysed using BD fluorescence-activated cell sorting (FACS) cytometer. We compared demographic and laboratory parameters between healthy controls and LN patients as well as active and inactive LN patients.Results: A total of 34 LN patients (32 females, 2 males) were recruited. Their mean age and disease duration were 37.97±11.14 years and 110.95±65.07 months respectively.  Thirteen matched controls with mean age 35.23±7.89 years were enrolled. There was no demographic difference between 2 groups of LN patients. Tregs were significantly lower in active LN compared to inactive LN and healthy control (0.44±0.37% vs. 1.89±0.46% vs. 3.12±0.56% of the CD4+, P<0.001). C3 and C4 complement fragments were significantly reduced in patients with active disease (C3; 50.92±28.43 vs. 76.31±25.63, P=0.011) and (C4; 11.17±8.41 vs. 16.70±6.50 P=0.044). Proteinuria was significantly higher while serum albumin levels were significantly lower in active patients compared to inactive patients and healthy control (urine PCI; 0.25(0.15-0.3) vs. 0.03(0.01-0.05) vs. 0.01, P<0.001) and (albumin; 29.89±6.87 vs. 36.87±3.58 vs. 40.62±1.89mmol/L, P<0.001). We found positive inversely correlation between Tregs with SLEDAI2K (r = -0.572, P=0.011) and proteinuria (r = -0.451, P=0.007).Conclusions: Tregs, C3 and C4 complements, and albumin were significantly lower while proteinuria was significantly higher in active LN. There was positive inversely correlation between the percentage of Tregs with SLEDAI2K score and proteinuria
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