Cyclability in Lahore, Pakistan. Looking into Potential for Greener Urban Traveling

Measuring perceived or objective cyclability or bikeability has drawn less attention compared to walkability, particularly in developing countries like those in South Asia and the Middle East. This paper presents the results of a survey about cyclability in Lahore, Pakistan, focusing on human perceptions rather than the built environment. The overall sample included a total of 379 respondents from three socio-economic classes: those from lower socioeconomic backgrounds accessing traditional/older bazaars, respondents from the middle socio-economic class accessing uptown bazaars, and respondents of higher socio-economic status accessing pedestrian shopping malls. The exploratory data collection was conducted in spring 2018 in Lahore by means of a short standard questionnaire with 19 questions, resulting in 17 categorical/dummy variables, two openended variables, and two continuous variables targeting socio-economics, bike trip characteristics, biking barriers, and preferred travel specifications. The results showed that the middle socio-economic group was more inclined, flexible, and willing to bike compared to the lower and higher socioeconomic- groups. The lower socio-economic group used the bicycle more frequently than the middle socio-economic group. Around half of the middle socio-economic group commutes via bike compared to the lower socio-economic group. There was little to no representation of 55-64 and 65+ age groups in the data. The descriptive findings of this survey indicate some preliminary signs of differences of decisions and perceptions about biking compared to high-income and European countries. These differences need to be tested in future statistical analyses

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

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

Logistic models explaining the determinants of biking for commute and non-commute trips in Lahore, Pakistan

The determinants of biking behaviour are less studied in a wide range of developing countries including South Asia. This study takes Lahore, Pakistan as a case-study city to explore the factors defining commute and non-commute bike trips as well as commuting by bike. These issues were analysed by collecting data from 379 subjects accommodating in three socio-economic statuses (lower, medium, and higher) in Lahore in spring 2018. The data were analysed by applying multinomial logistic regression for investigating biking frequency and binomial logistic regression for examining commuting by bike. The results show that gender, age, education, income, purpose of majority of trips, preferred distance to travel using cycle, preferred time to travel using cycle, and preferred bike trip purpose are significantly correlated with biking frequency. The significant determinants of bicycle commuting included categories of education, the purpose of the majority of trips, using bike in combination with other modes, preferred distance to bike, preferred biking time, and preferred bike trip purpose are associated with bicycle commuting. Commuting by bike is more popular in socio-economically weaker neighbourhoods. The discussion of this study shows that the determinants of biking in the sample in Lahore are different from those that have already been addressed by studies undertaken in high-income countries. &nbsp

Cyclability in Lahore, Pakistan: Looking into Potential for Greener Urban Traveling

Measuring perceived or objective cyclability or bikeability has drawn less attention compared to walkability, particularly in developing countries like those in South Asia and the Middle East. This paper presents the results of a survey about cyclability in Lahore, Pakistan, focusing on human perceptions rather than the built environment. The overall sample included a total of 379 respondents from three socio-economic classes: those from lower socio-economic backgrounds accessing traditional/older bazaars, respondents from the middle socio-economic class accessing uptown bazaars, and respondents of higher socio-economic status accessing pedestrian shopping malls. The exploratory data collection was conducted in spring 2018 in Lahore by means of a short standard questionnaire with 19 questions, resulting in 17 categorical/dummy variables, two open-ended variables, and two continuous variables targeting socio-economics, bike trip characteristics, biking barriers, and preferred travel specifications. The results showed that the middle socio-economic group was more inclined, flexible, and willing to bike compared to the lower and higher socio-economic-groups. The lower socio-economic group used the bicycle more frequently than the middle socio-economic group. Around half of the middle socio-economic group commutes via bike compared to the lower socio-economic group. There was little to no representation of 55-64 and 65+ age groups in the data. The descriptive findings of this survey indicate some preliminary signs of differences of decisions and perceptions about biking compared to high-income and European countries. These differences need to be tested in future statistical analyses

The present danger of New Delhi metallo-β-lactamase: a threat to public health

The evolution of antimicrobial-resistant Gram-negative pathogens is a substantial menace to public health sectors, notably in developing countries because of the scarcity of healthcare facilities. New Delhi metallo-β-lactamase (NDM) is a potent β-lactam enzyme able to hydrolyze several available antibiotics. NDM was identified from the clinical isolates of Klebsiella pneumoniae and Escherichia coli from a Swedish patient in New Delhi, India. This enzyme horizontally passed on to various Gram-negative bacteria developing resistance against a variety of antibiotics which cause treatment crucial. These bacteria increase fatality rates and play an integral role in the economic burden. The efficient management of NDM-producing isolates requires the coordination between each healthcare setting in a region. In this review, we present the prevalence of NDM in children, fatality and the economic burden of resistant bacteria, the clonal spread of NDM harboring bacteria and modern techniques for the detection of NDM producing pathogens