Examining Teacher Performance In Ghana

This study used longitudinal data on 444 teachers and 3,435 students to examine teacher performance in Ghana. The study is divided into two parts. The first part of the study examined factors that mediate the causal effects of a kindergarten teacher training program on classroom quality and student outcomes. Specifically, it examined whether teachers’ knowledge of the learning content, teachers’ implementation quality of behavioral and instructional practices and teachers’ professional well-being were significant mediators of the treatment effect. It utilized a causal mediation approach, which allowed the average causal mediation effects to be parametrically and nonparametrically identified under a set of minimum conditions. The study found that implementation quality was a significant mediator of positive treatment effect on classroom quality across time. This effect persisted even when teacher knowledge and professional well-being were accounted for. The study also found small marginal mediation effects on student outcomes, including a positive mediation effect on literacy and a negative mediation effect on executive functioning in the presence of all mediators. Overall, this study provides empirical evidence to design future interventions that place more emphasis on the influential pathway of implementation quality to yield positive impacts, particularly in early education contexts. The second part of the study examined teacher profiles that provide diagnostic information about teachers’ instructional strengths and weaknesses. It applied stage-wise cluster analysis to reveal different subpopulations of teachers and study how they relate to student outcomes. The study found six profiles of teachers with varying professional well-being and classroom practices, including two that were significantly associated with positive student learning across all four domains of numeracy, literacy, socioemotional development and executive functioning. Overall, the results allow easy identification of growth opportunities for each profile of teachers that helps provide formative feedback and targeted support to facilitate high quality teaching and maximize positive student learning outcomes

Maternal health expenditures and health seeking behavior among lowest wealth quintile of the rural population in an under developed district of the Punjab, Pakistan

Background: Expenditures on maternal health is important factor to determine the health seeking behavior in pregnant women among the lowest economical section of Pakistan. This study was carried out determine the maternal health expenditures and health seeking behavior among lowest wealth quintile of rural Rahim Yar Khan.Methods: Sample Size: For this cross- sectional study, a total of 230 subjects were involved in the study from rural areas of Rahim Yar Khan including Basti Bahishti, Bah-o-Bahar and Chak 83/P. This study was comprised of duration of 06 months from 02/03/2016 to 04/09/2016. The head of Family (Husband) with monthly income less than 15000 Pakistani rupees (PKR) were included and marriage with in last 5 years with at alive delivery. While subjects having income more than 15000 PKR and not willing to participate in study were excluded from the study.Results: People with mean monthly income of PKR. 1176±4109 spent mean amount of PKR. 146442 ± 7747 on their marriages. While the mean expenses on treatment of complication in the last pregnancy were PKR. 35808±6771 and the amount saved for the treatment of complication was PKR. 2750±1157 only. Mean antenatal expenses were PKR. 1807±3335, Mean expenses on delivery were PKR. 7351±855 as compared to the money saved for delivery was PKR. 6115±1460. Mean expenses on complications during delivery were PKR. 1692±523. Mean expenses on postnatal care were PKR.8596±3597 while the mean amount used for treatment of postnatal complications were of PKR. 2451±560. Mean expenses on birth celebrations were of PKR. 7697±832.Conclusions: Present study reveals that there is a high financial cost of maternal health expenditures paid by the lowest wealth quintile in rural areas of Rahim Yar Khan when compared with the income of this quintile. Access of the people to the health sector is still limited due to low income of people, low health education and unavailability of health services in rural areas and even in 2017

Clinical Decision Support System for Unani Medicine Practitioners

Like other fields of Traditional Medicines, Unani Medicines have been found as an effective medical practice for ages. It is still widely used in the subcontinent, particularly in Pakistan and India. However, Unani Medicines Practitioners are lacking modern IT applications in their everyday clinical practices. An Online Clinical Decision Support System may address this challenge to assist apprentice Unani Medicines practitioners in their diagnostic processes. The proposed system provides a web-based interface to enter the patient's symptoms, which are then automatically analyzed by our system to generate a list of probable diseases. The system allows practitioners to choose the most likely disease and inform patients about the associated treatment options remotely. The system consists of three modules: an Online Clinical Decision Support System, an Artificial Intelligence Inference Engine, and a comprehensive Unani Medicines Database. The system employs advanced AI techniques such as Decision Trees, Deep Learning, and Natural Language Processing. For system development, the project team used a technology stack that includes React, FastAPI, and MySQL. Data and functionality of the application is exposed using APIs for integration and extension with similar domain applications. The novelty of the project is that it addresses the challenge of diagnosing diseases accurately and efficiently in the context of Unani Medicines principles. By leveraging the power of technology, the proposed Clinical Decision Support System has the potential to ease access to healthcare services and information, reduce cost, boost practitioner and patient satisfaction, improve speed and accuracy of the diagnostic process, and provide effective treatments remotely. The application will be useful for Unani Medicines Practitioners, Patients, Government Drug Regulators, Software Developers, and Medical Researchers.Comment: 59 pages, 11 figures, Computer Science Bachelor's Thesis on use of Artificial Intelligence in Clinical Decision Support System for Unani Medicine

Prevalence of Colibacillosis in Young Broiler Chicks and Antibiogram of Escherichia coli in Different Areas of Hazara Region

Background: Poultry sector is a vital zone of Pakistan economy and is a feasible source of animal derivative protein.  In term of mortality and morbidity the development of this segment is significantly affected by a lot of problems. Hazara region is well known for poultry in Pakistan. Colibacillosis, caused by Escherichia coli is vital disease among poultry of all ages resulting in huge economic losses. The aim of this study was to evaluate the prevalence of colibacillosis in young broiler chickens and antibiogram of E. coli in different areas of Hazara region.Methods: The current study was conducted to evaluate the prevalence of colibacillosis in young broiler chickens and antibiogram of E. coli. This study was done during February 2019 to June 2019; a total of 200 (n=200) liver samples of freshly dead young broiler chicks were randomly collected from the postmortem section of Veterinary research and disease investigation center Abbottabad (VRDICA). The identification of E. coli was confirmed by gram staining and biochemical tests. Susceptibility pattern to 13 antibiotics was also checked.Results: Total of 200 (n=200) samples were brought to the VRDICA for the diagnosis of disease and antibiotic susceptibility testing. Out of these 130 were positive (Overall prevalence =65%).Area wise prevalence varied from area to area and highest prevalence was recorded in Abbottabad (81.11%) followed by Havelian (75%), Manghal (72.22%), Mansehra (60%), Qalandarabad (50%) and Haripur (28.57%). About age group, highest mortality was found in 11-15 days old chicks (93%) as compared to 6-10days (83.33%) and 1-5 days old chicks (21.42%). Antibiogram showed highest sensitivity to Gentamicin (100%) afterward Colistin Sulphate (92.30%). However, lincomycin (92%) and streptomycin (96%) display highest resistance.Conclusion:  In this study, the highest prevalence of infection was observed in young chicks that play a crucial role in their mortality. E. coli had showed resistance to commonly recommended antibiotic so care should be taken while prescribing the drugs.Keywords: Young broiler chicks; E. coli; Colibacillosis; Prevalence; Antibiogram

Variation of hepatic enzymes with Vitamin B12 and D3 levels in cirrhotic patients

OBJECTIVE: To determine variation of hepatic enzymes Vitamin B12 and D3 levels in cirrhotic patients.DESIGN: Cross sectional study.SETTING: Cirrhotic patients in Abbasi Shaheed Hospital.PARTICIPANTS: 250 patients in Abbasi Shaheed Hospital with diagnosis of cirrhosis including 141 males and 109 females.VARIABLE PARAMETERS: They include mean ALT, GGT, Alkaline phosphatase levels along with Vitamin B12 and D3 levels in blood.RESULTS: Vitamin B12 levels were 1249.59±487.01pg/ml and 1422.28±627.75pg/ml in males and females respectively while Vitamin D3 levels were found to be 17.15±10.45 nmol/L in males and 14.80±14.24 nmol/L in females. Vitamin B12 levels were found to be positively correlated with the elevation of ALT and were negatively correlated with elevation of ALT, GGT and Alkaline Phosphatase. The ALT levels were 50.0±21.88 in males and 14.80±14.24 in females, Alkaline phosphatase to be 311.46±107.98 in males while female Alkaline phosphatase were 346.47±101.60. GGT levels to be 41.70±10.62 in males and 45.01±13.74 in females.CONCLUSION: Cirrhotic patients suffering from severe hepatocellular damage have their elevated levels of Vitamin B12 and depressed Vitamin D3 levels in plasma accompanied by a positive association with elevated ALT and GGT plasma level

Probiotics for the prevention of ventilator-associated pneumonia: an updated systematic review and meta-analysis of randomised controlled trials

Background: Presently, there is conflicting evidence regarding the efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). This meta-analysis was conducted to update current clinical evidence and evaluate the efficacy and safety of probiotics for the prevention of VAP. Methods: We searched three databases and two trial registers to retrieve randomised controlled trials (RCTs) comparing probiotics or synbiotics with placebo or standard treatment for the prevention of VAP in adult patients receiving mechanical ventilation in the intensive care unit (ICU). Results: Our meta-analysis included 18 RCTs involving 4893 patients. Our results showed that probiotics may reduce the incidence of VAP (RR 0.68, 95% CI: 0.55–0.84; low certainty). However, in our subgroup and sensitivity analyses, the effect was not significant in double-blind studies, and in studies with a low risk of bias in the randomisation process. Probiotics reduced the length of ICU stay (MD −2.22 days, 95% CI: −4.17 to −0.28; moderate certainty) and the duration of antibiotic use (MD −1.25 days, 95% CI −1.86 to −0.64; moderate certainty). Conclusions: Probiotics may reduce the incidence of VAP but due to the low quality of pooled evidence, the use of probiotics warrants caution. Further, large-scale, high-quality RCTs need to be conducted to provide conclusive evidence

Variation of PEFR with height, weight and waist-hip ratio in medical students

OBJECTIVE: The primary aim of our study was to assess the variation of PEFR with various medical students of Karachi, PakistanDESIGN: Cross-sectional studySetting: Medical students of Karachi Medical and Dental CollegeParticipants: 276 non-smoker healthy medical students composed of 168 females and 108 males.VARIABLE PARAMETERS: They include mean age, body height and body weight and PEFR. They were marked separately for each genderRESULTS: The mean waist hip ratio in females was observed to be 0.843±0.111in relation with that of mean PEFR value 452.97±65.84 L/min, whereas in males the mean waist hip ratio was 0.864±0.028 in relation with that of mean PEFR value 445.93±66.49 L/min. Also there is a statistically significant variation in PEFR with an increase in waist hip ratio. The mean height of males was 173.63 ±7.5 cm and weight was 61.81 ±11.25 Kg while mean height of females was 158.56±7.3 cm and weight was 49.33±9.04 Kg. PEFR is positively correlated with increase in height and weight up to a certain limit.CONCLUSION: The study concludes that PEFR is affected positively by variation in waist hip ratio; moreover young females have more waist hip ratio and PEFR values than their young male counterparts. A large sample size with accurate peak flow meter is required along with ethnic consideration of the study population for better, accurate and clear results

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

Maternal health expenditures and health seeking behavior among lowest wealth quintile of the rural population in an under developed district of the Punjab, Pakistan

Background: Expenditures on maternal health is important factor to determine the health seeking behavior in pregnant women among the lowest economical section of Pakistan. This study was carried out determine the maternal health expenditures and health seeking behavior among lowest wealth quintile of rural Rahim Yar Khan.Methods: Sample Size: For this cross- sectional study, a total of 230 subjects were involved in the study from rural areas of Rahim Yar Khan including Basti Bahishti, Bah-o-Bahar and Chak 83/P. This study was comprised of duration of 06 months from 02/03/2016 to 04/09/2016. The head of Family (Husband) with monthly income less than 15000 Pakistani rupees (PKR) were included and marriage with in last 5 years with at alive delivery. While subjects having income more than 15000 PKR and not willing to participate in study were excluded from the study.Results: People with mean monthly income of PKR. 1176±4109 spent mean amount of PKR. 146442 ± 7747 on their marriages. While the mean expenses on treatment of complication in the last pregnancy were PKR. 35808±6771 and the amount saved for the treatment of complication was PKR. 2750±1157 only. Mean antenatal expenses were PKR. 1807±3335, Mean expenses on delivery were PKR. 7351±855 as compared to the money saved for delivery was PKR. 6115±1460. Mean expenses on complications during delivery were PKR. 1692±523. Mean expenses on postnatal care were PKR.8596±3597 while the mean amount used for treatment of postnatal complications were of PKR. 2451±560. Mean expenses on birth celebrations were of PKR. 7697±832.Conclusions: Present study reveals that there is a high financial cost of maternal health expenditures paid by the lowest wealth quintile in rural areas of Rahim Yar Khan when compared with the income of this quintile. Access of the people to the health sector is still limited due to low income of people, low health education and unavailability of health services in rural areas and even in 2017

Students Anxiety and Its Causes in Mathematics: A Sequential Explanatory Mixed Method Design

From the last few decades, math anxiety has become the major concern of educationists. Students’ academic achievement especially in mathematics has been considered as a crucial factor in determining the future progress of students. But unfortunately, the participation rate of students in mathematics is decreasing day by day. The main objectives of the study were to assess secondary school students’ anxiety in mathematics and to explore the causes of students’ anxiety in mathematics.  A sequential explanatory mixed method research design was used. The data was collected through both quantitative and qualitative methods. A five-point rating scale questionnaire was developed for quantitative data collection. The tool was validated through pilot testing. 100 students participated in pilot testing. Internal consistency of the instrument was assessed by Croanbach’s alpha which was 0.7. The targeted population of the study was both male and female secondary school students from the district Bahawalpur, Punjab.  Out of the whole population, 726 male and female students were approached via multi-stage sampling technique.  After quantitative data collection data was entered in SPSS version 20 and percentage, frequency distribution and mean score was calculated.  Based on the quantitative data results it was observed that secondary school students were numerophobic and had moderately a high level of anxiety in mathematics. On the basis of quantitative results, interviews of secondary school teachers were conducted to explore the causes of students’ anxiety in mathematics. 20 teachers were approached via purposive sampling. The qualitative data revealed that major causes of students’ anxiety in mathematics were lack of practice, lack of previous knowledge, communication gap between student and teacher, and lack of interest in mathematics