Availability and affordability of essential medicines: Exploring the health seeking behaviours and health service utilisation for children under-5 years living in squatter settlement of Karachi, Pakistan

Background: Child health outcomes in the poor communities are largely affected by the non-availability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours and health service utilisation patterns of the families of the children.Methods: Using observational visits, we examined the shelf-availability of medicines for children less than 5 years of age at a rural health centre and conducted focus group discussions with the mothers to explore the effects of non-availability and non-affordability of medicines. We also validated all information by interviewing the health care providers of the area.Results: We found that erratic and insufficient supply of essential medicines at the government health facility and a limited purchasing power to buy medicines from a retail pharmacy, led to considerable \u27financial burden\u27 on the poor people, non-compliance with the treatment, health care seeking from informal health providers and healer shopping. This trend has a serious repercussion on the health seeking behaviours and of course the health outcomes, especially among children.Conclusion: On the users\u27 side, health education and health promotion campaign must be instituted to explain the adverse effects on child health ensure appropriate health care seeking behaviours. For the supply side, the health care authorities must ensure the availability of essential medicines for the children at the government facilities. Local community representatives must be involved in the matters related to medicines stock management at the facility

productivity improvement through time study approach a case study from an apparel manufacturing industry of pakistan

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Estimation of Salivary Candida Count Among Pregnant and Non-Pregnant Women

Objective: Comparison of Candida count in the saliva of pregnant and non-pregnant women to determine how much salivary Candida count increases in pregnancy as compared to non-pregnant women. Study Design: Cross-sectional study. Place and Duration of Study: Pathology Dental Department, HITEC-IMS Hospital Taxila Cantt from 2 December 2021-30 May 2022. Materials and Methods: The study included 60 pregnant and 60 non-pregnant women of age group ranging from 18 to 40 years. The unstimulated whole saliva of the subjects was collected in sterile plastic containers. The sample was inoculated on Sabouraud dextrose agar. The grown colonies were counted after 48 to 72 hours. Gram staining was performed to confirm the presence of Gram-positive oval budding Candida. Results: The Candida count from the saliva of pregnant women was two times greater in number than saliva of non-pregnant women. The mean value in pregnant women was 237.7 CFU/ml while in non-pregnant, it was 103 CFU/ml. Conclusion: The changes during pregnancy make the oral cavity of pregnant women more vulnerable leading to increased growth of Candida and that increase is twice more than that of non-pregnant wome

Decentralized Consensus in Robotic Swarm for Collective Collision and Avoidance

In this paper, a decentralized consensus algorithm for a robotic swarm is presented, which enable agents to escape collisions and avoid obstacles collectively. To achieve consensus, we have used neighboring clusters and extreme function for data dissemination and consensus in agents to avoid obstacles respectively. The main challenge is to make fast and accurate collective decision by improving data propagation in presence of Byzantine agents. To improve data dissemination in local interactions of agents in decentralized fashion, an iterative rumor-based data propagation model is proposed. Due to presence of Byzantine robots, the LCP and the W-MSR algorithm cannot achieve consensus for obstacle avoidance in artificial swarms. We establish the Expectation-based Extreme Value (EEV) algorithm using the local expectation and the extreme function to solve these problems. The experiments conducted in simulations demonstrate that the rumor spreading method has better results than the Peer-to-Peer method in randomly connected swarm signaling network (SSN) with complex environmental circumstance, the EEV algorithm is more effective than the LCP and the W-MSR for the swarm navigation and consensus in agent on large obstacles / environmental features. Furthermore, in presence of malicious / hacked agents in a swarm it is very difficult to reach consensus. The result show that proposed algorithm can handle the Byzantine agents effectively

Use of reprocessed external fixators in orthopaedic surgery: a survey of 243 orthopaedic trauma surgeons

Abstract Background The increasing financial burden of orthopaedic implants on our health care system has prompted cost-control measures, such as implant reprocessing. The purpose of this study was to describe the current usage by orthopaedic trauma surgeons of reprocessed external fixators (EFs) for treatment of complex fractures. Methods A 16-question survey about use and perceptions of reprocessed EFs was distributed to 894 Orthopaedic Trauma Association members between August 2016 and June 2017 using a web-based survey system. Results The authors received 243 responses (27%). Thirty-seven percent of respondents reported using reprocessed EFs. Nonprofit hospitals used reprocessed EFs more commonly than did for-profit hospitals (41% vs 15%, P = .0004). Eighty-seven percent of respondents believed reprocessing could be cost-effective. The most common reason (32%) for not using reprocessed EFs was coordination/logistics of reprocessing. Concern about litigation was also reported as a main reason for not using (20%) or having recently stopped using (21%) reprocessed EFs. Conclusions Many orthopaedic traumatologists are interested in the reprocessing of EF components but few have reprocessing systems in place at their institutions. A major barrier to implementation is concern about litigation, which is likely unwarranted on the basis of Food and Drug Administration approval and a lack of previous litigation. Reprocessing by the original device manufacturers has yielded substantial savings at our institution and is an example of the cost savings that can be expected when implementing an EF reprocessing system

Earning Management and the Likelihood of Financial Distress in Banks — Evidence from Pakistani Commercial Banks

This research studies the relationship between financial distress (FD) and usage of discretion by employing earning management practices in twenty commercial banks of Pakistan, listed at Pakistan Stock Exchange (PSX). The study utilizes the data spread over from the year 2010 to 2015. Altman Z-Score has been employed to assess financial distress. Further, the value of Z-score has been used for the classification of banks into distressed and non-distressed banks. Moreover, earning management has also been categorized into non-discretionary (NDA) and discretionary accruals (DA). The logistic approach has been used to study the relationship among variables. The findings reveal that banks use non-discretionary and discretionary accruals to manage their financial distress. This research study provides useful insights for investors, auditors and regulators as it identifies usage of specific provisions by management despite strict regulations

Open versus minimally invasive fixation of a simulated syndesmotic injury in a cadaver model

Abstract Background Malreduction of unstable syndesmotic ankle fractures is common. This study compared the reduction quality of an anterolateral open technique (OT) versus a conventional minimally invasive technique (MIT). Methods Fourteen fresh-frozen lower torso specimens with 28 matched lower extremities underwent computed tomography (CT) to measure syndesmosis position before dissection. Reduction was performed using direct visualization and fluoroscopy for the OT group (right-sided specimens) and fluoroscopy only for the MIT group (left-sided specimens). Fixation was achieved with 2 cortical screws. Measurements were repeated with postfixation CT scans. Statistical analysis used a two-tailed t test (α = 0.05). Results Mean posterior fibula-tibia distance decreased after OT by 0.3 ± 0.5 mm and increased after MIT by 0.7 ± 0.6 mm (P = 0.025 for difference between techniques). Mean anterior fibula-tibia distance decreased after OT by 0.4 ± 0.2 mm (P = 0.007) and did not change significantly after MIT (− 0.01 ± 0.4 mm (P = 0.686). Mean anterior translation after OT was 0.04 ± 0.4 mm (P = 0.856), and mean posterior translation after MIT was 0.3 ± 0.7 mm (P = 0.434). Mean medialization after OT was 0.3 ± 0.4 mm (P = 0.132), and mean lateralization after MIT was 0.2 ± 0.6 mm (P = 0.446). Conclusions Both techniques produced near-anatomic reduction of the fibula, with MIT producing significantly more internal rotation malreduction than OT. OT appears to restore near-anatomic fibula position, although this did not differ significantly from the results of MIT. We conditionally recommend OT when closed reduction of the syndesmosis cannot be obtained

Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank

Abstract Background There have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients. Methods We retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16–85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010. The primary outcome of interest was rate of in-hospital complications. Secondary outcomes were length of hospital stay and discharge disposition. Unadjusted differences in complication rates were evaluated using Student t tests and Chi-squared analyses. Multiple logistic and Poisson regression were used to analyze binary outcomes and length of hospital stay, respectively, adjusting for several variables. Statistical significance was defined as p < 0.05. Results We included 46,450 patients in our study. Of these patients, 1331 (3%) were morbidly obese (body mass index ≥40) and 45,119 (97%) were used as controls. Morbidly obese patients had significantly higher odds of complication and longer hospital stay in all groups considered except those with pelvic fractures that were treated operatively. In all groups, morbidly obese patients were more likely to be discharged to a skilled nursing/rehabilitation facility compared with control patients. Conclusions Morbidly obese patients had higher rates of complications and longer hospital stays and were more likely to be discharged to rehabilitation facilities compared with control patients after pelvic ring or acetabular fracture

The distal femur is a reliable guide for tibial plateau fracture reduction: a study of measurements on 3D CT scans in 84 healthy knees

Abstract Background Limited data have been published regarding the typical coronal dimensions of the femur and tibia and how they relate to each other. This can be used to aid in judging optimal operative reduction of tibial plateau fractures. The purpose of the present study was to quantify the width of tibial plateau in relation to the distal femur. Methods We reviewed 3D computed tomography (CT) scans taken between 2013 and 2016 of 42 patients (84 knees). We measured positions of the lateral tibial condyle with respect to the lateral femoral condyle (dLC) and the medial tibial condyle with respect to the medial femoral condyle (dMC) in the coronal plane. Positions of the articular edges of the lateral and medial tibia were also measured with respect to the femur (dLA and dMA). Results The mean (± standard deviation) measurements were as follows: dLC, − 0.1 ± 1.9 mm; dMC, − 4.7 ± 4.1 mm; dLA, 0.9 ± 1.0 mm; and dMA, 0.1 ± 1.5 mm. The mean (± standard deviation) ratio of tibial to femoral condylar width was 0.91 ± 0.03, and the ratio of tibial to femoral articular width was 1.01 ± 0.04. Conclusions The articular width of the tibia laterally and medially was slightly wider than the femoral articular width. These small differences and deviations indicate that the femur might be used as a reference to judge tibial plateau width reduction