Socio-economic analysis of the interventions aimed at improving water and sanitation condition of rural community

Present research has been aimed to assess the socio-economic analysis of the water and sanitation interventions made by the government in rural areas of District Abbottabad, KPK, Pakistan. A cross-sectional study design was employed to collect data from the relevant actors with the help of interviews, questionnaires and focus group discussions. Respondents were satisfied with the cost of the water delivery at home and the quality of water was also appreciable. Majority of the people described the strengthened pardha system (Privacy), as major advantage of the interventions. In terms of economic benefits by the interventions it was quiet good. But still top down approach is used for implementation of water supplies schemes and sanitation interventions by the government which is not satisfactory indicator for maximizing the benefits. Keywords: Water and sanitation, Rural, Interventions, , socio-economi

EVOLUTION OF ENGLISH IN THE INTERNET AGE

Although the Internet came into existence in the second half of the twentieth century, its influence on language began to escalate in 1990 onwards. It has drastically changed the way people communicate and use English both in writing and speaking. Consequently, the world has become increasingly interconnected through synchronous and asynchronous communicational scripts, such as SMS, online chat, Yahoo messengers, emails, blogs, and wikis, which have become retrievable as accessible corpora for analysis. These corpora can yield anecdotal evidence of historical language change. The arrival of Web 2.0 tools and applications, such as Facebook, Twitter, Skype, WhatsApp, and Viber, can likewise reveal changes that English has recently undergone. The Internet has given rise to what is arguably a new variety of English that differs from standard varieties. This article provides an account of the development of English from dialects spoken by a small number of people in the British Isles to an international and global language. It emphasizes the language shifts that have taken place more recently since the widespread use of the Internet. The pervasiveness of the Internet has led to new changes in form and usage described as Internet English

Popularity of the Consumption of Dietary Supplements and its Associated Factors among Students in an Egyptian University: A Cross-sectional Study

BACKGROUND: Dietary supplements (DS) use has substantially become prevalent worldwide. However, a limited number of studies have addressed the consumption of DS among college students. AIM: The objective of the study was to explore the prevalence of DS use among college students in an Egyptian college, their motives for DS use, and the association with sociodemographic and lifestyle factors. METHODS: A cross-sectional study was conducted on 180 (18–25 years) college students at Helwan University. A self-administered questionnaire that included sociodemographic and lifestyle characteristics, DS use, commonly used types, reasons for use, and sources of information was employed. RESULTS: More than two-thirds of the participants (117 students) have used DS with no difference among sex except for the types and motives for use (p < 0.001). The most used types were amino acids and proteins, multivitamins and minerals, and weight-loss herbals. Male students mainly used amino acids and proteins (54.7%), multivitamins, and minerals (17.2%), for building muscles (50%), gaining more energy (14%), and maintaining good health (14%). Female students consumed multivitamins and minerals (35.8%), weight-loss herbals (28.3%), for health promotion (34%) and weight management (28.3%). The main sources of information were the internet, health-care providers, and coaches. Male users depended primarily on the internet; however, female users received information from health-care providers (p < 0.001). Practicing exercise, non-smoking, and dietary patterns were associated with DS use. CONCLUSION: DS use is remarkably common among college students in Egypt since their freshmen year. The findings highlight an urgent need to raise students’ awareness regarding the appropriate use of DS from reliable sources to control DS use and prevent adverse effects

Mixed convective boundary layer flow over a vertical wedge embedded in a porous medium saturated with a nanofluid: Natural Convection Dominated Regime

A boundary layer analysis is presented for the mixed convection past a vertical wedge in a porous medium saturated with a nano fluid. The governing partial differential equations are transformed into a set of non-similar equations and solved numerically by an efficient, implicit, iterative, finite-difference method. A parametric study illustrating the influence of various physical parameters is performed. Numerical results for the velocity, temperature, and nanoparticles volume fraction profiles, as well as the friction factor, surface heat and mass transfer rates have been presented for parametric variations of the buoyancy ratio parameter Nr, Brownian motion parameter Nb, thermophoresis parameter Nt, and Lewis number Le. The dependency of the friction factor, surface heat transfer rate (Nusselt number), and mass transfer rate (Sherwood number) on these parameters has been discussed

The effect of vitamin D deficiency on glycemic control in patients with type 2 diabetes mellitus

Multiple factors are involved in the development of type 2 diabetes mellitus (T2DM), but an imbalance between free radical formation and antioxidant removal is the main cause of diabetic complications. Micronutrients with antioxidant properties may have a role in the development of diabetes mellitus (DM) and its complications. Vitamin D has recently been found to have membrane antioxidant effect and a relationship to the development of T2DM, as it can modify its risk. Whether vitamin D deficiency has an effect on hyperglycemia in diabetic patients or not need further study. Our aim was to examine the effect of vitamin D deficiency on glycemic control in T2DM. We examined the vitamin D levels of 100 patients with T2DM and correlated them with fasting blood sugar and glycated hemoglobin A1c (HbA1c) levels. High levels of fasting blood sugar and HbA1c levels were significantly associated with vitamin D deficiency. Vitamin D deficiency negatively affects glycemic control in patients with T2DM

Value of biochemical markers in predicting outcome of COVID-19 infection in University Hospital, Alexandria, Egypt

This paper aims to examine the value of different biochemical markers in predicting the outcome of COVID-19 infection. A total of 140 patients with confirmed COVID-19 infection by polymerase chain reaction (PCR), different biochemical markers were tested, their relation to the outcome of the disease was monitored, and the most reliable tests were determined. The study found a significant correlation between all evaluated biochemical markers and severity of the disease, including C-reactive protein (CRP), D-dimer, alanine aminotransferase (ALT), Aspartate aminotransferase (AST), prothrombin time (PT), activated partial thromboplastin time (aPTT). In addition, ferritin, lactate dehydrogenase (LDH), procalcitonin (PCT) and Pro- Brain natriuretic peptide (proBNP) demonstrated highly sensitivity and specificity as well as significant prognostic performance. These markers were also independently significant in predicting mortality. Early assessment of biochemical markers in patients with COVID-19 can help clinicians in tailoring treatment and providing more intensive care to those with greater mortality risk. In particular, the assessment of ferritin, LDH, procalcitonin and proBNP can independently predict mortality

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data

Objective To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.Design Systematic review and meta-analysis of individual patient data.Data sources Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013.Eligibility Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival.Results the search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. the most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls.Conclusions Sirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. the benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high risk of cancer, might benefit from sirolimus.PfizerOttawa Hosp, Res Inst, Ottawa, ON K1H 7W9, CanadaUniv Ottawa, Ottawa, ON, CanadaCairo Univ, Cairo Kidney Ctr, Cairo, EgyptLimites Med Res, Vacallo, SwitzerlandUniv Manitoba, Dept Pediat & Childs Hlth, Winnipeg, MB, CanadaLund Univ, Dept Nephrol & Transplantat, Malmo, SwedenUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilAddenbrookes Hosp, Dept Renal Med, Cambridge, EnglandNorthwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USAMaastricht Univ, Med Ctr, Maastricht, NetherlandsSt Louis Hosp, Dept Nephrol, Paris, FranceHosp JW Goethe, Div Nephrol, Frankfurt, GermanyUniv Munich, Dept Surg, Munich, GermanyGoethe Univ Frankfurt, JW Goethe Clin, Clin Dermatol Venerol & Allergol, Frankfurt, GermanyInst Klin Expt Med, Dept Nephrol, Prague, Czech RepublicUniv Cambridge, Addenbrookes Hosp, Dept Surg, NIHR Cambridge Biomed Res Ctr, Cambridge CB2 2QQ, EnglandUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, São Paulo, BrazilWeb of Scienc

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely