Health-seeking behavior of Karachi women with reproductive tract infections

To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit for treatment, mainly allopathic doctors and hakims. The different treatments prescribed to women ranged from oral and intravaginal medications to various home remedies including refraining from specific foods. Causes of reproductive tract infections reported were melting bones , consuming foods with perceived hot composition, poor personal hygiene and procedures like dilatation and curettage, delivery and induced abortions. None reported sexually transmitted diseases as the perceived cause of their problem. Interference with religious activities, sexual relationships or socializing was reported as consequences of reproductive tract infections, in addition to lower abdominal pain, menstrual irregularities, backache and kamzori (weakness). Pakistani women seek care for reproductive tract infections and visit a variety of providers, though causes and treatments offered are usually not related to sexually transmitted diseases. We therefore suggest training of healthcare providers for appropriate counseling and that treatment management protocols be advocated

Confidence ellipsoids based on a general family of shrinkage estimators for a linear model with non-spherical disturbances

AbstractThis paper considers a general family of Stein rule estimators for the coefficient vector of a linear regression model with nonspherical disturbances, and derives estimators for the Mean Squared Error (MSE) matrix, and risk under quadratic loss for this family of estimators. The confidence ellipsoids for the coefficient vector based on this family of estimators are proposed, and the performance of the confidence ellipsoids under the criterion of coverage probability and expected volumes is investigated. The results of a numerical simulation are presented to illustrate the theoretical findings, which could be applicable in the area of economic growth modeling

Dynamic S-BOX using Chaotic Map for VPN Data Security

A dynamic SBox using a chaotic map is a cryptography technique that changes the SBox during encryption based on iterations of a chaotic map, adding an extra layer of confusion and security to symmetric encryption algorithms like AES. The chaotic map introduces unpredictability, non-linearity, and key dependency, enhancing the overall security of the encryption process. The existing work on dynamic SBox using chaotic maps lacks standardized guidelines and extensive security analysis, leaving potential vulnerabilities and performance concerns unaddressed. Key management and the sensitivity of chaotic maps to initial conditions are challenges that need careful consideration. The main objective of using a dynamic SBox with a chaotic map in cryptography systems is to enhance the security and robustness of symmetric encryption algorithms. The method of dynamic SBox using a chaotic map involves initializing the SBox, selecting a chaotic map, iterating the map to generate chaotic values, and updating the SBox based on these values during the encryption process to enhance security and resist cryptanalytic attacks. This article proposes a novel chaotic map that can be utilized to create a fresh, lively SBox. The performance assessment of the suggested S resilience Box against various attacks involves metrics such as nonlinearity (NL), strict avalanche criterion (SAC), bit independence criterion (BIC), linear approximation probability (LP), and differential approximation probability (DP). These metrics help gauge the Box ability to handle and respond to different attack scenarios. Assess the cryptography strength of the proposed S-Box for usage in practical security applications, it is compared to other recently developed SBoxes. The comparative research shows that the suggested SBox has the potential to be an important advancement in the field of data security.Comment: 11 Page

New approach to forecasting agro-based statistical models

This paper uses various forecasting methods to forecast future crop production levels using time series data for four major crops in Pakistan: wheat, rice, cotton and pulses. These different forecasting methods are then assessed based on their out-of-sample forecast accuracies. We empirically compare three methods: Box- Jenkins’ ARIMA, Dynamic Linear Models (DLM) and exponential smoothing. The best forecasting models are selected from each of the methods by applying them to various agricultural time series in order to demonstrate the usefulness of the models and the differences between them in an actual application. The forecasts obtained from the best selected exponential smoothing models are then compared with those obtained from the best selected classical Box-Jenkins ARIMA models and DLMs using various forecast accuracy measures

Investigating the non-work antecedents of workplace deviance

Deviance in the workplace, which has a huge destructive and harmful impact on the organization, is of key concern to academicians and practitioners. Existing literature focuses on the work-related antecedents of workplace deviance. However, the non-work-related antecedents have received little attention. Hence, the present research attempts to understand, the non-work antecedents that aggravate deviant behavior among employees at a workplace. The Gioia qualitative research approach was used to understand, examine, analyze, and interpret the views of respondents. A semi-structured interviewing technique was adopted. The respondents were encouraged to share their own experiences, thoughts, and understanding regarding the phenomenon. A sample of 25 experienced respondents from public and private organisations in Pakistan were interviewed. The results indicate that commuting factors (road hindrances, conflict behaviors, traffic discipline, and over-speeding), social factors (family-work conflict, and disturbed social relations), and an individual's lifestyle (attitude, physical inactivity, and sleep deprivation) are the contributing factors pertaining to the non-work antecedents of workplace deviance. The current study contributes to the literature by focusing on the non-work antecedents of workplace deviance

Managerial ability and firm value: A new perspective

Using a sample of U.S. firms over three decades, we examine whether the efficiency with which managers generate revenue has an impact on firm value. We find that managerial ability is positively related to firm value such that one standard deviation increase in ability is associated with a 5.7% increase in firm value relative to the mean level. Importantly, by exploiting exogenous CEO turnover, we establish causality between managerial ability and firm value. This relation is stronger in the presence of corporate governance mechanisms, such as institutional investors and financial analysts. We also document a reduction in value-destroying practices - such as earnings management - in firms with more efficient managers

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks