Analysis of single nucleotide polymorphisms encompassing toll like receptor (TLR) -7 (rs179008) and (TLR)-9 (rs352140) in systemic lupus erythematosus patients

Background: Multiple documentary evidence comprising genome wide association studies have established association of TLR7 and TLR9 gene polymorphisms with systemic lupus erythematosus (SLE). Present study was aimed to deduce and compare single nucleotide polymorphism (SNP) in TLR7 (rs179008) and TLR9 (rs352140) genes between local population of SLE patients and healthy controls.Methods: A case control study; blood samples from 80 controls (Group1) and 80 SLE subjects (Group2) were collected in EDTA tubes and processed for the analysis of gene polymorphism of TLR7 (rs179008) and TLR9 (rs352140) by PCR-RFLP after DNA extraction. Complete blood counts were also determined. Statistical analysis was carried out using Chi-square test for SNPs analysis and allele frequencies between two groups. TLR 7 and TLR 9 genes polymorphism with SLE alongside clinical parameters were assessed.Results: Genotypes of TLR7, AT and TT are not significantly associated with SLE. Whereas, TLR9 CT and TT genotypes, especially T allele are significantly associated with SLE reflecting noticeable interdependence of TLR9 gene polymorphism with respect to SLE subjects.Conclusion: TLR9 (rs352140) gene variation might be a key factor to etiology and pathogenesis of SLE.Keywords: Toll-like receptors; Restriction site; Single nucleotide polymorphism; Systemic lupus erythematosu

WOMEN EMPOWERMENT, MICROFINANCE AND POVERTY NEXUS: AN EMPIRICAL ESTIMATION PERSPECTIVE

Deprivation and poverty are worldwide challenges for poorer countries. Poor people especially women were excluded from financial services until microfinance institutions (MFIs) emerged. During the past few decades microcredit has enjoyed tremendous growth and women continue to be the major beneficiaries. The main objective of this study is to check weather microfinance helped women to attain decent work and strengthen their empowerment or not. This study is based on primary data and respondents were taken from First Microfinance Bank. A sample of 125 respondents was taken through simple random sampling. The study area was Faisalabad.SPSS 22 software was used for analysis. Logit model was applied to get and analyze results. Results showed significant positive relationship between women empowerment and different socio-economic independent variables i.e. income, investment, self-confidence, free movement. All the variables are statistically significant other than education. It is cleared that women enjoy more freedom, self-confidence and learn more skills to enhance their income. By investing in people and empowering individual women and men with education and generation of equal opportunities can create the conditions to allow the poor to break out of the poverty

Overhead Based Cluster Scheduling of Mixed Criticality Systems on Multicore Platform

The cluster-based technique is gaining focus for scheduling tasks of mixed-criticality (MC) real-time multicore systems. In this technique, the cores of the MC system are distributed in groups known as clusters. When all cores are distributed in clusters, the tasks are partitioned into clusters, which are scheduled on the cores within each cluster using a global approach. In this study, a cluster-based technique is adopted for scheduling tasks of real-time mixed-criticality systems (MCS). The Decreasing Criticality Decreasing Utilization with the worst-fit (DCDU-WF) technique is used for partitioning of tasks to clusters, whereas a novel mixed-criticality cluster-based boundary fair (MC-Bfair) scheduling approach is used for scheduling tasks on cores within clusters. The MC-Bfair scheduling algorithm reduces the number context switches and migration of tasks, which minimizes the overhead of mixed-criticality tasks. The migration and context switch overhead time is added at the time of each migration and context switch respectively for a task. In low critical mode, the low mode context switch and migration overhead time is added to task execution time, while the high mode overhead time of migration and context switch is added to the execution time of a task in high critical mode. The results obtained from experiments show the better schedulablity performance of proposed cluster-based technique as compared to cluster-based fixed priority (CB-FP), MC-EKG-VD-1, global and partitioned scheduling techniques e.g., for target utilization U=0.6, the proposed technique schedule 66.7% task sets while MC-EKG-VD-1, CB-FP, partitioned and global techniques schedule 50%, 33.3%, 16.7% and 0% task sets respectively

A taxonomy of grid resource selection mechanism

Resources in grid systems are heterogeneous, geographically distributed, belong to different administrative domains and apply different management policies. The roles of resource selection mechanisms are to identify, select and allocate the most suitable resources for a given set of tasks. This paper presents a taxonomy that facilitates identifying and classifying the mechanisms used in the implementation of grid resource selection process, as well as describing the most significant features of grid resource selection mechanisms. The benefit of this taxonomy is to highlight the main aspects of the selection mechanisms, which can help researchers and developers of grid resource management systems

A Deployable and Cost-Effective Kirigami Antenna for Sub-6 GHz MIMO Applications

In this work, a low-cost, deployable, integratable, and easy-to-fabricate multiple-input multiple-output (MIMO) Kirigami antenna is proposed for sub-6 GHz applications. The proposed MIMO antenna is inspired by Kirigami art, which consists of four radiating and parasitic elements. The radiating and parasitic elements are composed of a rectangular stub. These elements are placed in such a way that they can provide polarization diversity. The proposed MIMO antenna is designed and fabricated using a soft printed board material called flexible copper-clad laminate (FCCL). It is observed from the results that the proposed MIMO antenna resonates in the 2.5 GHz frequency band, with a 10 dB reflection coefficient bandwidth of 860 MHz ranging from 2.19 to 3.05 GHz. It is worthwhile to mention that the isolation between adjacent radiating elements is higher than 15 dB. In addition, the peak realized gain of the MIMO antenna is around 11 dBi, and the total efficiency is more than 90% within the band of interest. Moreover, the envelope correlation coefficient (ECC) is noted to be less than 0.003, and the channel capacity is ≥17 bps/Hz. To verify the simulated results, a prototype was fabricated, and excellent agreement between the measured and computed results was observed. By observing the performance attributes of the proposed design, it can be said that there are many applications in which this antenna can be adopted. Because of its low profile, it can be used in 5G small-cell mobile MIMO base stations, autonomous light mobility vehicles, and other applications

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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely