Management Outcomes of Lymphadenopathy among the Children

Background: Lymphadenopathy refers to the enlargement of lymph nodes due to various causes, and its appropriate management is crucial for optimal patient outcomes. Objective: To analyze the onset of lymphadenopathy (LAP) in children in terms of gender and age, explore its clinical manifestations and the specific lymph node areas  affected, identify prevalent causes, and assess the outcomes of various treatment approaches. Patients and Methods: This cross-sectional study conducted between October 2021 and March 2023 at Rapareen Teaching Hospital for Children in Erbil City, which examined the  lymphadenopathy in 40 children . The study included children aged 0-15 years with a lymphadenopathy diagnosis. Data collection involved recording demographic information, lymphadenopathy site and characteristics, clinical symptoms, antibiotic usage and response, reactive diagnoses, and treatment outcomes. Additional laboratory measurements were also taken. The collected data were analyzed using descriptive statistics, statistical tests, and logistic regression analysis. The study adhered to ethical principles, obtained informed consent, and ensured data confidentiality. Results: The mean age of the children was 3.397 ± (2.192) years. 23 (59%) children had a single lymphadenopathy, and 16 (41%) had multiple lymphadenopathies. The most common site of lymphadenopathy with a frequency of 10 (25%) was in the posterior cervical region, while  7 (17.5%) was observed in the submental area. 38 (95%) children received antibiotic treatment. Out of this number, 23 (60.5%) responded positively to the treatment, while 15 (39.5.5%) did not respond.  Conclusion: The results of this study showed that in the patients who were treated with antibiotics, the drug was able to lead to some degree of recovery

Human Capital Outflow and Economic Misery:Fresh Evidence for Pakistan

This paper visits the impact of economic misery on human capital outflow using time series data over the period of 1975-2012. We have applied the combined cointegration tests and innovative accounting approach to examine long run and causal relationship between the variables. Our results affirm the presence of cointegration between the variables. We find that economic misery increases human capital outflow. Foreign remittances add in human capital outflow from Pakistan. The migration from Pakistan to rest of world is boosted by depreciation in local currency. Income inequality is also a major contributor to human capital outflow. The present study is comprehensive effort and may provide new insights to policy makers for handling the issue of human capital outflow by controlling economic misery in Pakistan

Human Capital Outflow and Economic Misery:Fresh Evidence for Pakistan

This paper visits the impact of economic misery on human capital outflow using time series data over the period of 1975-2012. We have applied the combined cointegration tests and innovative accounting approach to examine long run and causal relationship between the variables. Our results affirm the presence of cointegration between the variables. We find that economic misery increases human capital outflow. Foreign remittances add in human capital outflow from Pakistan. The migration from Pakistan to rest of world is boosted by depreciation in local currency. Income inequality is also a major contributor to human capital outflow. The present study is comprehensive effort and may provide new insights to policy makers for handling the issue of human capital outflow by controlling economic misery in Pakistan

Performance of Shariah vs Non-Shariah Firms: A Study of Manufacturing Sector in Malaysia

This research aims to examine the differences in the determinants of performance between Shariah-compliant and non-Shariah-compliant firms. The changes in the Shariah screening technique in Malaysia since 2013 have significantly affected how firms that comply with the Shariah principles, as opposed to non-compliant firms, leading to the motivation of this research being conducted. This research employs panel data regression analysis to test its hypotheses. Compiling data from 142 manufacturing firms (71 Shariah-compliant and 71 non-Shariah-compliant firms) from 2012 to 2021, this research found that Shariah-compliant firm performance is significantly influenced by firm size, leverage, tangibility and efficiency. In contrast, non-Shariah-compliant firm performance is significantly influenced by leverage, tangibility, working capital and efficiency. This research contributes to relevant parties, such as the manufacturing firms and policymakers, in providing insights on the most relevant indicators affecting firm performance, specifically those in the manufacturing sector

A review of wireless pavement system based on the inductive power transfer in electric vehicles

The proliferation of electric vehicles (EVs) hinges upon the availability of robust and efficient charging infrastructure, notably encompassing swift and convenient solutions. Among these, dynamic wireless charging systems have garnered substantial attention for their potential to revolutionize EV charging experiences. Inductive power transfer (IPT) systems, in particular, exhibit a promising avenue, enabling seamless wireless charging through integrated pavements for EVs. This review engages in an in-depth exploration of pertinent parameters that influence the inductivity and conductivity performance of pavements, alongside the assessment of potential damage inflicted by IPT pads. Moreover, the study delves into the realm of additive materials as a strategic approach to augment conductivity and pavement performance. In essence, the review consolidates a diverse array of studies that scrutinize IPT pad materials, coil dimensions, pavement characteristics (both static and dynamic), and adhesive properties. These studies collectively illuminate the intricate dynamics of power transfer to EVs while considering potential repercussions on pavement integrity. Furthermore, the review sheds light on the efficacy of various additive materials, including metal and nanocomposite additives with an SBS base, in amplifying both conductivity and pavement performance. The culmination of these findings underscores the pivotal role of geometry optimization for IPT pads and the strategic adaptation of aggregate and bitumen characteristics to unlock enhanced performance within wireless pavements

A comprehensive study on the performance of various tracker systems in hybrid renewable energy systems, Saudi Arabia

To compensate for the lack of fossil fuel-based energy production systems, hybrid renewable energy systems (HRES) would be a useful solution. Investigating different design conditions and components would help industry professionals, engineers, and policymakers in producing and designing optimal systems. In this article, different tracker systems, including vertical, horizontal, and two-axis trackers in an off-grid HRES that includes photovoltaic (PV), wind turbine (WT), diesel generator (Gen), and battery (Bat) are considered. The goal is to find the optimum (OP) combination of an HRES in seven locations (Loc) in Saudi Arabia. The proposed load demand is 988.97 kWh/day, and the peak load is 212.34 kW. The results of the cost of energies (COEs) range between 0.108 to 0.143 USD/kWh. Secondly, the optimum size of the PV panels with different trackers is calculated. The HRES uses 100 kW PV in combination with other components. Additionally, the size of the PVs where 100% PV panels are used to reach the load demand in the selected locations is found. Finally, two sensitivity analyses (Sens) on the proposed PV and tracker costs and solar GHIs are conducted. The main goal of the article is to find the most cost-effective tracker system under different conditions while considering environmental aspects such as the CO2 social penalty. The results show an increase of 35% in power production from PV (compared to not using a tracker) when using a two-axis tracker system. However, it is not always cost-effective. The increase in power production when using vertical and horizontal trackers (HT) is also significant. The findings show that introducing a specific tracker for all locations depends on renewable resources such as wind speed and solar GHI, as well as economic inputs. Overall, for GHIs higher than 5.5 kWh/m2/day, the vertical tracker (VT) is cost-effective

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

Real world patterns of antimicrobial use and microbiology investigations in patients with sepsis outside the Critical Care Unit: Secondary analysis of three nation-wide point prevalence studies

Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial