Developing a framework to train community in life threatening emergencies (LTEs)

This Masters Project is a small piece which fits into the bigger vision of my life which is to make Pakistan a nation of life savers. Inspired by my mother’s death due to sudden cardiac arrest I decided to train my community in life saving skills like “CPR” and “Hemorrhage Control” so that they can help save lives by taking appropriate actions and doing immediate interventions. Knowing my passion, I was asked by a professor at my hospital to lead a project where we can develop and implement a framework to train our community in life saving skills like CPR and Hemorrhage Control. To achieve our goal we established a consortium of major stakeholders including the major hospitals, emergency medical services (EMS) and an NGO, and developed a curriculum to train 10 million Pakistani citizens in these life saving skills. Although we want to incorporate this curriculum in schools, the current pandemic has posed certain challenges like lockdowns due to which we are not able to test this curriculum with our intended population. Hence we decided to test our curriculum with the non-clinical staff from the hospitals of our consortium including the security and Human Resource (HR) staff. We have collected their valuable feedback so that we can refine our curriculum before this will become a part of the national school curriculum in Pakistan. Although it is an ongoing process, we are hopeful that once the pandemic is over we will be able to train our community in these life saving skills and make Pakistan a nation of life savers. Keywords: Training framework, Curriculum, Community, CPR, Hemorrhage Contro

A Parent-Teacher View of Teens Behaviors in Nuclear and Joint Family Systems in Pakistan

This research work tries to unveil the changing teen’s behaviors in nuclear and joint family systems in Pakistan. Pakistan enjoys the social values of joint families; and, where grandparents are very important constituent of the family, the family structure is an important component in shaping the teens behaviors. Therefore, this paper focuses the sample of parents and teachers of the teens in the postmodern urban society and tried to better point out the eminent changes in the attitudes and behaviors of teens. This study follows a qualitative approach of research that pursues a phenomenological inquiry describing lived experience of the respondents regarding teen’s behavior in Pakistan

Role of Strategic Thinking in Corporate Identity

In this paper, an attempt has been made to unveil how strategic thinking contributes to corporate identity and survival. The instrument used to collect the data was a questionnaire which included a scale on creativity, pragmatic opportunism and intellectual informatism. The sample included the middle and top management of the telecom organizations in Pakistan. The questionnaires were distributed to 125 respondents and an 80% response was received. Results showed that strategic thinking has a fairly positive effect on corporate identity (CI). Among the creativity, intellectual informatism and pragmatic opportunism and when regressed with CI, pragmatic opportunism has the strongest effect on CI; creativity has a fairly positive impact on CI, whereas, intellectual informatism does not show significant impact on CI. Hopefully, this study will be informative for management about learning how they can use the available yet unfound opportunities and information within their creativity to build and maintain a good corporate identity

Validation of Vis-Screen Mobile Application for Easy Vision Test by General Public: A pilot study

Visual impairment and blindness is a serious global concern. Poor awareness and late detection are significant factors contributing to the vast number of visually impaired people worldwide. The ubiquitous use of smartphone devices enables the general public to access various services provided easily. Our Vis-Screen mobile application is developed based on the necessity for early detection of any vision problem to avoid further vision loss. Simple built-in algorithm and user-friendly features of this application suits any laypersons to do vision testing among themselves with only minimal training needed, therefore promoting the importance of healthy vision within the community.Keywords: visual acuity; mobile application; vision screening; blindnesseISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v4i12.189

How vital are the vital signs? a multi-center observational study from emergency departments of Pakistan.

BACKGROUND: Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints. METHODS: Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final disposition. Patients who were \u3e12 years of age were included in the analysis. The data were analyzed to describe the proportion of patients with documented vitals signs, which was then crossed-tabulated with top the ten presenting complaints to identify high-acuity patients and correlation with their admission status. RESULTS: A total of 274,436 patients were captured in the Pakistan National Emergency Department Surveillance (Pak-NEDS), out of which 259,288 patients were included in our study. Vital signs information was available for 90,569 (34.9%) patients and the most commonly recorded vitals sign was pulse (25.7%). Important information such as level of consciousness was missing in the majority of patients with head injuries. Based on available information, only 13.3% with chest pain, 12.8% with fever and 12.8% patients with diarrhea could be classified as high-acuity. In addition, hospital admission rates were two- to four-times higher among patients with abnormal vital signs, compared with those with normal vital signs. CONCLUSION: Most patients seen in the EDs in Pakistan did not have any documented vital signs during their visit. Where available, the presence of abnormal vital signs were associated with higher chances of admission to the hospital for the most common presenting symptoms

A novel missense mutation in TNNI3K causes recessively inherited cardiac conduction disease in a consanguineous Pakistani family

Cardiac conduction disease (CCD), which causes altered electrical impulse propagation in the heart, is a life-threatening condition with high morbidity and mortality. It exhibits genetic and clinical heterogeneity with diverse pathomechanisms, but in most cases, it disrupts the synchronous activity of impulse-generating nodes and impulse-conduction underlying the normal heartbeat. In this study, we investigated a consanguineous Pakistani family comprised of four patients with CCD. We applied whole exome sequencing (WES) and co-segregation analysis, which identified a novel homozygous missense mutation (c.1531T\u3eC;(p.Ser511Pro)) in the highly conserved kinase domain of the cardiac troponin I-interacting kinase (TNNI3K) encoding gene. The behaviors of mutant and native TNNI3K were compared by performing all-atom long-term molecular dynamics simulations, which revealed changes at the protein surface and in the hydrogen bond network. Furthermore, intra and intermolecular interaction analyses revealed that p.Ser511Pro causes structural variation in the ATP-binding pocket and the homodimer interface. These findings suggest p.Ser511Pro to be a pathogenic variant. Our study provides insights into how the variant perturbs the TNNI3K structure-function relationship, leading to a disease state. This is the first report of a recessive mutation in TNNI3K and the first mutation in this gene identified in the Pakistani population

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field. Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors\u27 affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country. Results: There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author. Conclusions: There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs

Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: A systematic literature review comparing different training methodologies

Background: Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training.Methods: We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts.Results: Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology.Conclusion: AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training

First Comprehensive In Silico

GalNAc-T1, a key candidate of GalNac-transferases genes family that is involved in mucin-type O-linked glycosylation pathway, is expressed in most biological tissues and cell types. Despite the reported association of GalNAc-T1 gene mutations with human disease susceptibility, the comprehensive computational analysis of coding, noncoding and regulatory SNPs, and their functional impacts on protein level, still remains unknown. Therefore, sequence- and structure-based computational tools were employed to screen the entire listed coding SNPs of GalNAc-T1 gene in order to identify and characterize them. Our concordant in silico analysis by SIFT, PolyPhen-2, PANTHER-cSNP, and SNPeffect tools, identified the potential nsSNPs (S143P, G258V, and Y414D variants) from 18 nsSNPs of GalNAc-T1. Additionally, 2 regulatory SNPs (rs72964406 and #x26; rs34304568) were also identified in GalNAc-T1 by using FastSNP tool. Using multiple computational approaches, we have systematically classified the functional mutations in regulatory and coding regions that can modify expression and function of GalNAc-T1 enzyme. These genetic variants can further assist in better understanding the wide range of disease susceptibility associated with the mucin-based cell signalling and pathogenic binding, and may help to develop novel therapeutic elements for associated diseases

Intra-operative applications of augmented reality in glioma surgery: a systematic review

BackgroundAugmented reality (AR) is increasingly being explored in neurosurgical practice. By visualizing patient-specific, three-dimensional (3D) models in real time, surgeons can improve their spatial understanding of complex anatomy and pathology, thereby optimizing intra-operative navigation, localization, and resection. Here, we aimed to capture applications of AR in glioma surgery, their current status and future potential.MethodsA systematic review of the literature was conducted. This adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Embase, and Scopus electronic databases were queried from inception to October 10, 2022. Leveraging the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) framework, study eligibility was evaluated in the qualitative synthesis. Data regarding AR workflow, surgical application, and associated outcomes were then extracted. The quality of evidence was additionally examined, using hierarchical classes of evidence in neurosurgery.ResultsThe search returned 77 articles. Forty were subject to title and abstract screening, while 25 proceeded to full text screening. Of these, 22 articles met eligibility criteria and were included in the final review. During abstraction, studies were classified as “development” or “intervention” based on primary aims. Overall, AR was qualitatively advantageous, due to enhanced visualization of gliomas and critical structures, frequently aiding in maximal safe resection. Non-rigid applications were also useful in disclosing and compensating for intra-operative brain shift. Irrespective, there was high variance in registration methods and measurements, which considerably impacted projection accuracy. Most studies were of low-level evidence, yielding heterogeneous results.ConclusionsAR has increasing potential for glioma surgery, with capacity to positively influence the onco-functional balance. However, technical and design limitations are readily apparent. The field must consider the importance of consistency and replicability, as well as the level of evidence, to effectively converge on standard approaches that maximize patient benefit