Simulation and Modelling of Maximum and Minimum Temperature of Karachi

In the recent past weather derivatives have developed significant interest in surface air temperature and its modeling. In this work, we modelled and simulated daily average temperature. We used three different methods to model and simulate the recorded data at Karachi airport from 2010-2014. The methods used in this work are moving average method, polynomial fitting and maximum entropy method. Both polynomial fitting and maximum entropy methods can be used to find missing data. The simulated graphs and graphs of recorded data are in good agreement.  Keywords: Karachi airport, surface air temperature, moving average, polynomial curve fitting. Maximum Entropy method

Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery

We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome

Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication of Spinal Surgery

We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome

Health systems changes after decentralisation: Progress, challenges and dynamics in Pakistan

Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan\u27s radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system. Our narrative draws on secondary data sources from the PRIMASYS study, supplemented with policy roundtable notes from Pakistan. Our analysis shows that in decentralised Pakistan, health became prioritised for increased government resources and achieved good budgetary use, major strides were made contextualised sector-wide health planning and legislations, and a proliferation seen in governance measures to improve and regulate healthcare delivery. Despite a disadvantaged and abrupt start to devolution, high ownership by politicians and bureaucracy in provincial governments led to resourcing, planning and innovations. However, effective translation remained impeded by weak institutional capacity, feeble federal-provincial coordination and vulnerability to interference by local elites. Building on this illustrative example, we propose (1) political management of decentralisation for effective national coordination, sustaining stable leadership and protecting from political interfere by local elites; (2) investment in stewardship capacity in the devolved structures as well as the central ministry to deliver on new roles

Sublethal and transgenerational effects of synthetic insecticides on the biological parameters and functional response of Coccinella septempunctata (Coleoptera: Coccinellidae) under laboratory conditions

Synthetic insecticides have been an inevitable part of plant protection throughout the world. Sublethal effects of these chemicals on beneficial insect species are one of the contemporary issues these days. Using the age-stage, two-sex life table model, this study evaluated the sublethal and transgenerational effects of six synthetic insecticides (imidacloprid, thiamethoxam, lambda-cyhalothrin, cypermethrin, chlorpyrifos and profenofos) commonly applied to winter vegetables, on the fitness and predation of the seven-spotted ladybeetle, Coccinella septempunctata, which is an efficient predator of aphids worldwide. According to results, all insecticides at their sublethal doses (LC30) significantly suppressed the emergence of adults, adult weight, fertility and fecundity of the parental generation compared to control treatment. The larval stage was prolonged and oviposition, fecundity and total longevity of the adult beetles were decreased in unexposed progeny whose parents were exposed to sublethal doses of all insecticides. Moreover, the biological parameters of adults, including the intrinsic rate of increase (r), finite rate of increase (λ) and net reproductive rate (R0) were significantly reduced when exposed to sublethal doses of insecticides. The predation rate of the F1 generation adults was also decreased after exposure to the sublethal doses of insecticides. However, chlorpyrifos, profenofos, lambda-cyhalothrin and cypermethrin exhibited more deleterious effects on the fitness and population parameters of beetles than imidacloprid and thiamethoxam

A multidisciplinary approach to triage patients with breast disease during the COVID-19 pandemic: Experience from a tertiary care center in the developing world

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.Methods and results: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers\u27 schedules, operating room reallocation, and protocols. We also describe the Virtual Blended Clinics , a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine.Conclusion: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians\u27 clinical judgment to provide the best quality care

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

ゾレドロン酸処理した腫瘍に対するγδ型Ｔ細胞反応性とファーネシル二リン酸合成酵素阻害の比較

京都大学0048新制・課程博士博士(医科学)甲第17786号医科博第45号新制||医科||3(附属図書館)30593京都大学大学院医学研究科医科学専攻(主査)教授 生田 宏一, 教授 杉田 昌彦, 教授 長田 重一学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Bioassays of <i>Beauveria bassiana</i> Isolates against the Fall Armyworm, <i>Spodoptera frugiperda</i>

The control of Spodoptera frugiperda, the key invasive pest of maize, is a serious concern due to its biology and the current global restriction on applying synthetic pesticides. Entomopathogenic fungi are considered to be a potential biological control strategy. The pathogenicity of 12 isolates of Beauveria bassiana in the immature stages and feeding efficacy of S. frugiperda were evaluated. The B. bassiana isolates QB-3.45, QB-3.46 and QB-3.428 caused the highest egg mortality rates of 87.3, 82.7 and 79.3%, respectively, when applied at a concentration of 1 × 108 conidia/mL and measured at 7 days post-treatment. Neonate mortality rates of 45.6 to 53.6% were observed with the same isolates. The B. bassiana isolates caused significant cumulative mortality rates ranging from 71.3 to 93.3% at 14 days post-treatment and reduced larval feeding efficacy from 69.4 to 77.8% at 48 h post-treatment. This study supports using the effective B. bassiana isolates as a biological control agent against S. frugiperda. The significant mortality of the eggs and neonatal larvae and the reduction in the feeding efficacy of the second instar larvae of the S. frugiperda that were treated with isolates of B. bassiana supports the application of entomopathogenic fungi as a biocontrol agent for the effective control of the S. frugiperda population