A patient satisfaction survey and educational package to improve the care of people hospitalised with COVID-19: a quality improvement project, Liverpool, UK

Background: The perspectives and experiences of people hospitalised with COVID-19 have been under-reported during the coronavirus pandemic. We developed and conducted a COVID-19 patient satisfaction survey in a large university-affiliated secondary healthcare centre in Liverpool, UK, during Europe’s first coronavirus wave (April-June 2020). The survey found that care was rated highly, including among people of Black Asian and Minority Ethnic (BAME) background. However, sleep-quality and communication about medications and discharge-planning were identified as areas for improvement. Methods: To improve care for people with COVID-19 admitted to our centre, we designed an educational package for healthcare professionals working on COVID-19 wards. The package, implemented in August 2020, included healthcare worker training sessions on providing holistic care and placement of “Practice Pointers” posters. Patient satisfaction was re-evaluated during the second/third COVID-19 waves in Liverpool (September 2020 - February 2021). Results: Across waves, most (95%) respondents reported that they would recommend our hospital to friends and/or family and rated overall care highly. Comparison of the responses of second/third-wave respondents (n=101) with first-wave respondents (n=94) suggested improved patient satisfaction across most care domains but especially those related to having worries and fears addressed and being consulted about medications and their side-effects. Conclusions: People admitted with COVID-19 to our centre in Liverpool, including those from BAME background, rated the care they received highly. A simple education package improved the feedback on care received by respondents between the first and second/third waves. These UK-first findings are informing regional strategies to improve person-centred care of hospitalised people with COVID-19

Environmental, Energy, and Water Footprints of Marble Tile Production Chain in a Life Cycle Perspective

The marble industry is growing in Pakistan, and Khyber Pakhtunkhwa province is the largest producer of marble tiles in Pakistan. Marble production consumes a considerable amount of water during its life cycle stages and impacts various environmental compartments, such as air, water, and soil; therefore, this study aimed to quantify the environmental impacts, water footprint, and cumulative energy demand of one-tonne marble tile manufactured in a small industrial estate Mardan (SIEM), Pakistan, and provide recommendations to improve its environmental impact profile. The study covers water consumption, energy use, and associated environmental impacts of raw materials and processes through different stages of the marble life-cycle during 2017–2018. The cradle-to-gate (extraction to factory gate or store house) life cycle assessment approach was followed in this study. The functional unit for the current study was one tonne of finished marble tile produced. Primary data from the field surveys and secondary data were modeled using the water scarcity index (WSI), CML 2000 v.2.05 methodology, and the cumulative energy demand indicator present by default in SimaPro v.8.3 software. The total water footprint required for one tonne of finished marble tile was 3.62 cubic meters per tonne (m3/t), with electricity consumed at processing units contributing to environmental burdens the most. Similarly, electricity consumed (at processing units and during polishing) and transportation of finished marble tile to the local market were responsible for global warming potential (388 kg CO2 eq/tonne tile), human toxicity (84.34 kg 1,4-DB-eq/tonne), freshwater aquatic ecotoxicity (94.97kg 1,4-DB eq/tonne) and abiotic depletion (7.1 × 10−5 kg Sb eq/tonne). The results of our study follow other marble tile LCA studies conducted globally (such as in Turkey and Italy), which also reported a high contribution to GWP, AP, EP, and HT due to electricity and fossil fuels consumption. The total cumulative energy demand (CED) was calculated as 5863.40 MJ (Mega Joule), with most energy usage associated with non-renewable fossil fuel sources. The results indicated that reducing electricity (using standard automatic machinery) and waste materials, especially paper and plastic wastes, can reduce environmental impacts. Most of the surveyed industrial units did not have wastewater treatment and recycling plants, and wastewater directly flows to nearby freshwater bodies and terrestrial ecosystems. These wastewaters should be adequately treated before being discharged into freshwater aquatic bodies. Environmental impacts must be improved by using the latest automatic machinery, reducing waste materials generation, reducing the distance between processing units and the market, and installing wastewater recycling plants

Effect of Different Levels of Zinc and Compost on Yield and Yield Components of Wheat

Management of organic matter and micronutrients is very important for the sustainable improvement of soil health. Poor soil organic matter usually results in lower availability of zinc (Zn) micronutrients in plants. Such deficiency in Zn causes a significant decrease in the growth and yield of crops. The need at the current time is to balance the application of organic amendments with Zn micronutrients to achieve optimum crop yields. Thus, the current study was conducted to investigate wheat, using compost as organic matter and Zn as a micronutrient. There were three levels of compost (i.e., control (0C), 5 t/ha (5C) and 10 t/ha (10C)) and four levels of Zn (control (0Zn), 2.5 kg Zn/ha (2.5Zn), 5.0 kg Zn/ha (5.0Zn) and 10.0 kg Zn/ha (10.0Zn)) applied with three replicates. The addition of 10C under 10.0Zn produced significantly better results for the maximum enhancement in plant height (8.08%), tillers/m2 (21.61%), spikes/m2 (22.33%) and spike length (40.50%) compared to 0C. Significant enhancements in 1000-grain weight, biological yield and grain yield also validated the effectiveness of 10C under 10.0Zn compared to 0C. In conclusion, application of 10C with 10.0Zn showed the potential to improve wheat growth and yield attributes. The addition of 10C with 10.0Zn also regulated soil mineral N, total soil N and extractable soil P. Further investigation is recommended with different soil textures to verify 10C with 10.0Zn as the best amendment for the enhancement of wheat yield in poor organic matter and Zn-deficient soils

Effects of Farmyard Manure and Different Phosphorus Inorganic Fertilizer Application Rates on Wheat Cultivation in Phosphorus-Deficient Soil

Less phosphorus (P) availability in calcareous alkaline soils is one of the major problems in achieving an optimum crop yield. Its deficiency in plants adversely affects growth and yield attributes. To overcome this issue, growers incorporate inorganic P fertilizers. However, the need for time in the sustainable management of soil fertility in terms of P. Farmyard manure (FYM) application is one of the most popular organic amendments in this regard. Thus, the current study was conducted to explore the best application rate of FYM in combination with inorganic P fertilizer single super phosphate (SSP). There were six treatments i.e., control (0F), 100%SSP (100P), 25% FYM and 75% SSP (25F+75P), 50% FYM and 50% SSP (50F+50P), 75% FYM and 25% SSP (75F+25P), and 100% FYM (100F+0P), applied in three replications. The design of the experiment was a randomized complete block design. For assessment of treatment response, two wheat cultivars (V1 = Pirsabak and V2 = Atta Habib) were used. Results showed that the application of 50F+50P significantly improved the plant height (20.69 and 32.01%), spike/m2 (35.19 and 30.10%), grain (41.10 and 38.16%), and leaf P (49.82 and 71.32%) compared to control in V1 and V2, respectively. A significant improvement in the grain and the biological yield of wheat V2 also validated the efficacious functioning of 50F+50P over control. In conclusion, 50F+50P has the potential to enhance wheat growth and nutrient concentration over control. More investigations are required for a more precise and balanced synchronization of FYM and SSP for the achievement of maximum wheat yield

Comparing the phosphorus use efficiency of pre-treated (organically) rock phosphate with soluble P fertilizers in maize under calcareous soils

In calcareous soils, phosphorus (P) availability to plant is impaired due to the formation of insoluble complexes with calcium and magnesium. Therefore, this study was executed to compare the P use efficiency (PUE) of four different P sources [rock phosphate (RP), acidulated rock phosphate (ARP), single super phosphate (SSP) and di ammonium phosphate (DAP)] alone or pre-treated with organic amendments (farm yard manure (FYM) enriched compost, simple compost and humic acid (HA)) along with control in maize crop under calcareous soils. All treatments irrespective of P sources received 90 kg P2O5 ha−1. Phosphorus application regardless of its sources and combination with organic amendments significantly improved maize growth, yield as well as P uptake and PUE. Rock phosphate when applied alone was recorded inferior but its performance significantly improved with compost or its pre-addition with FYM and HA, that further enhanced upon acidulation. Maize grain yield increased by 21, 22.2, 67.9 and 94% with RP, ARP, ARP enriched compost and ARP+ compost respectively, over control. Similarly, PUE of DAP improved from 31.7 to 43.1 and 39 with sample and enriched compost correspondingly. Post-harvest soil and grain P were at par for SSP, ARP and DAP alone or in conjugation with organic amendments when averaged across the amendments. These results suggested that pretreatment of P sources with organic amendments is an economical and more feasible approach to improve maize yield and PUE. Moreover, on-farm acidulation of RP may give at par results with SSP and DAP with cheaper rate and hence recommended for P management in maize in alkaline calcareous soils

Soil Fertility, N2 Fixation and Yield of Chickpea as Influenced by Long-Term Biochar Application under Mung–Chickpea Cropping System

A research study was established at the research farm of the University of Agriculture, Peshawar during winter 2018–2019. Commercial biochars were given to the experimental site from 2014 to summer 2018 and received 0.95, 130 and 60 tons ha−1 of biochar by various treatments viz., (Biochar1) BC1, (Biochar2) BC2, (Biochar3) BC3 and (Biochar4) BC4, respectively. This piece of work was conducted within the same study to find the long-term influence of biochar on the fertility of the soil, fixation of N2, as well as the yie1d of chickpea under a mung–chickpea cropping system. A split plot arrangement was carried out by RCBD (Randomized Complete Block Design) to evaluate the study. Twenty-five kilograms of N ha−1 were given as a starter dosage to every plot. Phosphorous and potassium were applied at two levels (half (45:30 kg ha−1) and full (90:60 kg ha−1) recommended doses) to each of the four biochar treatments. The chickpea crop parameters measured were the numbers and masses of the nodules, N2 fixation and grain yield. Soil parameters recorded were Soil Organic Matter (SOM), total N and mineral N. The aforementioned soil parameters were recorded after harvesting. The results showed that nodulation in chickpea, grain yield and nutrient uptake were significantly enhanced by phosphorous and potassium mineral fertilizers. The application of biochar 95 tons ha−1 significantly enhanced number of nodules i-e (122), however statistically similar response in terms of nodules number was also noted with treatment of 130 tons ha−1. The results further revealed a significant difference in terms of organic matter (OM) (%) between the half and full mineral fertilizer treatments. With the application of 130 tons ha−1 of biochar, the OM enhanced from 1.67% in the control treatment, to 2.59%. However, total and mineral nitrogen were not statistically enhanced by the mineral fertilizer treatment. With regard to biochar treatments, total and mineral N enhanced when compared with the control treatment. The highest total N of 0.082% and mineral nitrogen of 73 mg kg−1 in the soil were recorded at 130 tons ha−1 of biochar, while the lowest total N (0.049%) and mineral nitrogen (54 mg kg−1) in the soil were recorded in the control treatment. The collaborative influence of mineral fertilizers and biochars was found to be generally non-significant for most of the soil and plant parameters. It could be concluded that the aforementioned parameters were greater for treatments receiving biochar at 95 tons or more per hectare over the last several years, and that the combination of lower doses of mineral fertilizers further improved the performance of biochar

Self-reported health and smoking status, and body mass index: a case-control comparison based on GEN SCRIP (GENetics of SChizophRenia In Pakistan) data

Introduction Individuals with schizophrenia are at a high risk of physical health comorbidities and premature mortality. Cardiovascular and metabolic causes are an important contributor. There are gaps in monitoring, documenting and managing these physical health comorbidities. Because of their condition, patients themselves may not be aware of these comorbidities and may not be able to follow a lifestyle that prevents and manages the complications. In many low-income and middle-income countries including Pakistan, the bulk of the burden of care for those struggling with schizophrenia falls on the families.Objectives To determine the rate of self-reported physical health disorders and risk factors, like body mass index (BMI) and smoking, associated with cardiovascular and metabolic disorders in cases of schizophrenia compared with a group of mentally healthy controls.Design A case-controlled, cross-sectional multicentre study of patients with schizophrenia in Pakistan.Settings Multiple data collection sites across the country for patients, that is, public and private psychiatric OPDs (out patient departments), specialised psychiatric care facilities, and psychiatric wards of teaching and district level hospitals. Healthy controls were enrolled from the community.Participants We report a total of 6838 participants’ data with (N 3411 (49.9%)) cases of schizophrenia compared with a group of healthy controls (N 3427 (50.1%)).Results BMI (OR 0.98 (CI 0.97 to 0.99), p=0.0025), and the rate of smoking is higher in patients with schizophrenia than in controls. Problems with vision (OR 0.13 (0.08 to 0.2), joint pain (OR 0.18 (0.07 to 0.44)) and high cholesterol (OR 0.13 (0.05 to 0.35)) have higher reported prevalence in controls. The cases describe more physical health disorders in the category ‘other’ (OR 4.65 (3.01 to 7.18)). This captures residual disorders not listed in the questionnaire.Conclusions Participants with schizophrenia in comparison with controls report more disorders. The access in the ‘other’ category may be a reflection of undiagnosed disorders