From Fiscal Decentralisation to Economic Growt The Role of Complementary Institutions

Decentralisation is theoretically expected to be a platform towards efficient provision of the local public goods and services. This is expected to boost economic growth due to efficient and effective utilisation of scarce fiscal resources. Nevertheless, the existing empirical studies present mixed results on this expected positive relationship among decentralisation and economic growth. Recently, the theories of fiscal federalism have also pressed upon the enabling environment for effective decentralisation; talking explicitly, an enabling institutional setup is required. The current study explores the complementarity between fiscal decentralisation and other institutions for stimulating growth and the study uses rich crosscountry panel data for the period 1984 to 2012, covering both the developing and developed countries of the world. The results suggest that positive relationship exist between fiscal decentralisation and economic growth for the developed countries while evidence was not found in the case of developing countries. Further, it was found that fiscal decentralisation and quality institutions are complementary for economic growth. JEL Classification: C22, H11, H77, O40 Keywords: Fiscal Decentralisation, Institutions, Economic Growth, Panel Data, unequally spaced panel dat

Experimental validation of bulk-graphene as a thermoelectric generator

Quest for alternate energy sources is the core of most of the research activities these days. No matter how small or large amount of energy can be produced by utilizing the non-conventional techniques and sources, every bit of innovation can reshape the future of energy. In this work, experimental analysis of the thermoelectric (TE) properties of bulk-graphene in the temperature range of (303 to 363) K is presented. Graphene powder was pressed to form a pellet which was used to fabricate the TE device. The effects of temperature on the Seebeck coefficient, electrical and thermal conductivities, and the dimensionless figure of merit (FOM) were measured. The increasing value of the Seebeck coefficient (thermopower) with temperature is indicant of the metallic behavior. Additionally, the observed thermopower (TEP) is positive, which shows that the majority charge carriers are holes and peaked to a value of 56 μV K-1 at 363 K. The thermopower of the pellet is four times larger than the previously reported values for single layer graphene (SLG) and few layer graphene (FLG). In addition to this, low values of the thermal conductivity were observed for the pellet which is one of the requirements of a good TE material. Besides this, an upward trend is observed with increasing temperature for FOM, which attains a peak value of 0.0016 at 363 K, which is almost ten times that of the previously reported values

Reporting of mycetoma cases from skin and soft tissue biopsies over a period of ten years: A single center report and literature review from Pakistan

Background: Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan.Method: This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009-2018 of skin and soft tissue biopsies with positive findings of mycetoma were retrieved from hospital information system. The variables for statistical analysis were age and gender of patient, anatomical site of lesion, residence of patient (geographical location) in the country, etiologic agents of mycetoma and significant gross and microscopic histopathological findings. The data was entered, and descriptive epidemiologic assessment was carried out using MS excel 2013. Geographical information system was used for mapping the location. Literature review of mycetoma cases reported from Pakistan was done on PubMed, Google search and PakMediNet from 1980 till April 2019.Result: During ten years of study period, 89 skin and soft tissue biopsies were reported as mycetoma, majority were eumycetoma [n = 66/89 (74%)] followed by actinomycetoma [n = 23/89 (26%)]. Involvement of lower limb was predominantly observed [n = 74/89 (83%)] in which foot had significant contribution [n = 65/74 (88%)]. Only 18 specimens were submitted for microbiological assessment and six grew agents of mycetoma, with Madurella mycetomatis reported in only three. Well-formed granuloma formation was observed in only 26%[n = 23/89] of cases. Specific geographical location was not identified, and cases were reported from across the country. From Pakistan, only two original papers and 7 case reports were available in published literature.Conclusion: This single center study reports a handful of cases of mycetoma from Pakistan. We conclude that the index of suspicion should remain high among treating surgeons and physicians and clinical laboratories should improve their diagnostic capacity and skills. This will have a great impact on disease outcome and patient\u27s life

Proactive Personality, Motivation and Employee Creativity in the Public Sector Hospitals of Peshawar City

Numerous practitioner-oriented investigations have argued that employees should be more proactive and creative on their jobs, as these behaviors are significant for job performance. Organizational investigations on the antecedents of proactivity and creativity have appeared differently and have explored various approaches in defining, determining and understanding proactivity and creativity. This investigation examines the mediating role of motivation between proactivity and creativity among the doctors in the public sector hospitals. To give a rigorous test of the hypotheses, a grounded study is conducted taking a sample of 220 doctors. The results confirm a positive significant relationship between proactive personality and creativity, and report a significant relationship with motivation too. Additionally, the study demonstrates that motivation does not mediate the relationship of these variables. The study discusses the implications of the findings for enhancing motivation. Keywords: Proactivity, Motivation, Creativity, Doctors JEL Classifications: G22, G12 DOI: https://doi.org/10.32479/irmm.951

Efficacy of Azadirachta indica (Neem) leaf extract and hypertonic saline solution as intratesticular chemical sterilizing agents in dogs

A castração consiste na indução da esterilidade por meio físico, químico ou hormonal. A castração química é uma técnica eficiente e confiável, em contraste com outros procedimentos de esterilização, pois é menos dolorosa para os métodos físicos e econômicos para os métodos hormonais. Azadirachta indica (neem), é uma planta carismática, pois possui folhas anti-inflamatórias, antimicrobianas e antiandrogênicas. Para diminuir a crescente população humana no sul da Ásia, o óleo de nim e o extrato de folhas de nim têm sido efetivamente usados como agente contraceptivo. O principal determinante deste estudo atual foi avaliar o Neem como um agente esterilizante químico (necrótico ou apoptótico) em cães injetados intratesticularmente em comparação com uma solução salina hipertônica. O tamanho da largura testicular pré e pós-injeção e as amostras de sangue para os níveis séricos de testosterona foram colhidas em dias alternados. Os resultados obtidos revelaram alterações substanciais no tamanho da largura testicular, perfil histopatológico e nível sérico de testosterona. Observou-se uma leitura não significativa (P> 0,05) da largura testicular da pré-injeção, em contraste com um aumento significativo (P <0,05) três dias após a injeção em todos os grupos competitivos. Os valores médios registrados para o tamanho da largura testicular no final do estudo via extrato de folhas de nim, HSS a 30% e grupos controle foram 27,7362 ± 2,3315 mm, 30,9594 ± 4,6861 mm e 24,5023 ± 2,5387 mm, respectivamente. Uma tendência decrescente, com relação ao nível sérico de testosterona sendo estatisticamente significante (P <0,05), foi registrada nos grupos tratados (A, B), em contraste com o grupo controle (C), pois os valores eram 1,5357 ± 0,7819ng, 1,2669 ± 0,9095ng e 2,4517 ± 0,1827ng nos grupos A, B e C, respectivamente. Os achados histopatológicos advogaram a presença de corpos apoptóticos no grupo tratado com nim, enquanto a presença de células intersticiais degeneradas, túbulos seminíferos necrosados, epitélio germinativo danificado e espermatogênese interrompida também foi estudada nos dois grupos competitivos. Assim, o efeito apoptótico e a propriedade anti-inflamatória do extrato de folhas de nim resultaram em uma castração menos dolorosa e confirmaram que a Azadirachta indica foi um melhor substituto para a castração química do que a solução salina hipertônica.Castration refers to induced sterility via physical, chemical, or hormonal methods. Chemical castration is an efficient and reliable technique in contrast to other sterilization procedures as it is less painful to physical methods and cost‑effective to hormonal methods. Azadirachta indica (neem), is a charismatic plant as its leaves possess anti-inflammatory, anti‑microbial, and anti-androgenic chattels. To abate the escalating human population in South Asia, neem oil and neem leaf extract have been effectively used as a contraceptive agent. The key determinant of the current study was to evaluate Neem as a chemical sterilizing agent, (either necrotic or apoptotic), in dogs injected intratesticular in comparison to a hypertonic saline solution. Pre- and post-injection testicular width size and blood samples for serum testosterone levels were collected on alternative days. Results disclosed substantial changes in testicular width size, histopathological profile, and serum testosterone level. A non-significant (P > 0.05) pre-injection testicular width readings in contrast to a significant increase (P < 0.05) three days post-injection was noted in all the competitive groups. The mean values recorded for testicular width size at the end of the trial study via neem leaf extract, 30% HSS and, control groups were 27.7362 ± 2.3315mm, 30.9594 ± 4.6861mm, and 24.5023 ± 2.5387mm, respectively. A declining trend, regarding serum testosterone level being statistically significant (P < 0.05) was recorded in treated groups (A, B) in contrast to the control group (C) as the values were 1.5357 ± 0.7819ng, 1.2669 ± 0.9095ng, and 2.4517 ± 0.1827ng in groups A, B, and C, respectively. Histopathological findings advocated the presence of apoptotic bodies in the neem treated group whereas the presence of degenerated interstitial cells, necrosed seminiferous tubules, damaged germinal epithelium, and ceased spermatogenesis was also studied in both competitive groups. Thus, the apoptotic effect and anti-inflammatory property of neem leaf extract resulted in less painful castration and verified Azadirachta indica as a better substitute for chemical castration in contrast to hypertonic saline solution

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Histopathology of urinary system

This chapter addresses in sufficient detail, the light microscopic features of ‘primary glomerulopathies’ and utility of ‘special stains’ as well as ‘immunofluorescence (IF)’ for precise categorization of these common lesions mostly autoimmune in nature. Renal allograft biopsies are also routine in centres where renal transplantation is done. These biopsies do require meticulous morphological scrutiny as many at times changes are subtle and easily overlooked. Ancillary testing may be necessary in some cases. Neoplasms of kidney and urinary bladder are also common in any general surgical pathology service. In recent years several new renal tumor entities are described and included. An attempt is made to not only provide salient diagnostic features and immunophenotype of common neoplastic entities but also of new entries along with non-neoplastic lesions which may affect these organs

Monitoring Subsidence in Urban Area by PSInSAR: A Case Study of Abbottabad City, Northern Pakistan

Globally, major cities are experiencing fast settlement growth, which threatens the equilibrium of socio-ecosystems. In Pakistan, Abbottabad city in particular is experiencing fast urban growth. The main source of daily water usage for the population in these types of cities is groundwater (tube–wells). Excessive pumping and the high need for ground water for the local community are affecting the subsurface sustainability. In this study, the persistent scatterer interferometry synthetic aperture radar (PSInSAR) technique with synthetic aperture radar (SAR) images acquired from the Sentinel-1 were used to monitor ground subsidence in Abbottabad City, Northern Pakistan. To estimate the ground subsidence in Abbottabad City, SARPROZ software was employed to process a series of Sentinel-1 images, acquired from March 2017 to September 2019, along both descending and ascending orbit tracks. The subsidence observed in the results shows a significant increase from 2017 to 2019. The subsidence map shows that, during 2017, the subsidence was −30 mm/year and about −85 mm/year in 2018. While during 2019, the subsidence reached −150 mm/year. Thus, it has seen that, in the study area, the subsidence during these years increased with mean subsidence 60 mm/year. The overall trend of subsidence showed considerably high values in the center of the city, while areas away from the center of the city experienced low subsidence. Overall, the adopted methodology can be used successfully for detecting, mapping, and monitoring land surfaces vulnerable to subsidence. This will facilitate efficient planning, designing of surface infrastructure, and mitigation management of subsidence-induced hazards