Prognostic significance of ischaemic electrocardiographic changes during stress testing in patients with normal nuclear myocardial perfusion imaging

Objective: To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted. Data was analysed using STATA 14.2.Results: Of the 2770 patients whose data was initially checked, 296(10.6%) developed ischaemic electrocardiogram changes during the stress test but had normal myocardial perfusion scan. Of them, 181(61%) patients were male, and the overall mean age was 62±15 years. Follow-up data was available for 280(94.5%) of these patients, with a mean follow-up of 48±7 months. Of these patients, 8(2.8%) died, and 1(0.3%) of them died due to inferior wall myocardial infarction. Myocardial infarction was found in 2(0.7%) patients, and 1(0.3%) patient was hospitalised with heart failure. Also, 12(4.3%) patients underwent revascularization for stable angina, 9(3.2%) underwent percutaneous transluminal coronary angioplasty, and 3(1.07%) needed coronary artery bypass grafting.Conclusions: Ischaemic electrocardiographic changes during stress testing in patients with normal myocardial perfusion scan were not associated with adverse outcomes, and the risk of cardiovascular events was relatively low for an intermediate follow-up period

Reorganising for COVID-19 pandemic: A review of structural modifications by the department of internal medicine in low to middle-income countries

Scientists classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a novel coronavirus on January 7, 2020. The World Health Organization (WHO) acknowledged the SARS-CoV-2 outburst a public health emergency of international concern on January 30, 2020. Since its origin, this virus has disrupted the best healthcare systems, economies, and strained financial resources; and for underdeveloped countries\u27 healthcare systems, the virus has become a crisis. To tackle the potential hazards from this virus, our Department restructured the services that not only helped us to cope with the pandemic, but also provided an example to copy for other contemporary institutes. This article aims to describe the measures and structural changes undertaken by the Internal Medicine Department, Aga Khan University Hospital (AKUH), Karachi, Pakistan. Key Words: COVID-19, Internal medicine, Structural modifications, Pandemic

Key Enablers of Resilient and Sustainable Construction Supply Chains: A Systems Thinking Approach

In the globalized world, one significant challenge for organizations is minimizing risk by building resilient supply chains (SCs). This is important to achieve a competitive advantage in an unpredictable and ever-changing environment. However, the key enablers of such resilient and sustainable supply chain management are less explored in construction projects. Therefore, the present research aims to determine the causality among the crucial drivers of resilient and sustainable supply chain management (RSSCM) in construction projects. Based on the literature review, 12 enablers of RSSCM were shortlisted. Using the systems thinking (ST) approach, this article portrays the interrelation between the 12 shortlisted resilience enablers crucial for sustainability in construction projects. The causality and interrelationships among identified enablers in the developed causal loop diagram (CLD) show their dynamic interactions and impacts within the RSSCM system. Based on the results of this study, agility, information sharing, strategic risk planning, corporate social responsibility, and visibility are the key enablers for the RSSCM. The findings of this research will enable the construction managers to compare different SCs while understanding how supply chain characteristics increase or decrease the durability and ultimately affect the exposure to risk in the construction SCs

Aferição de pressão arterial em crianças e adolescentes pelo odontopediatra: Um Relato de caso

ABSTRACT   The approach to arterial hypertension (AH) in children and teenagers is outlined within the Brazilian Guidelines on Arterial Hypertension, published in 2020, and the importance of this topic becomes necessary since the prevalence of AH in children and adolescents has been demonstrating a significant growth. The current prevalence of hypertension is between 3% and 5% and high blood pressure is between 10% and 15%. The aim of this work is to report a case of an overweight, sedentary 10-year-old patient who sought dental care at the Institute of Dentistry of the Americas for dental treatment, with emphasis on indications, measurement technique and interpretation of measured values. We conclude that every patient must have their blood pressure measured at the initial consultation, validated oscillometric devices must be used, the measurement technique must strictly follow the guidance of the Brazilian Guideline on Arterial Hypertension 2022 and be interpreted according to the height, age, and sex tables, from the Disease Control and Prevention (DCP).A abordagem sobre a hipertensão arterial (HA) na criança e no adolescente está contida dentro das Diretrizes Brasileiras de Hipertensão Arterial, publicada em 2020 e a importância sobre este tema se torna necessária uma vez que a prevalência de HA em crianças e adolescentes vem demonstrando um crescimento significativo. A prevalência atual da hipertensão arterial se encontra entre 3% a 5% e a pressão arterial elevada se apresenta entre 10% a 15%. O objetivo deste trabalho é o relato de caso de um paciente de 10 anos de idade com sobrepeso, sedentário, que procurou atendimento odontológico no instituto de odontologia das américas para tratamento odontológico, com ênfase nas indicações, técnica de aferição e interpretação dos valores aferidos. Concluímos que todo paciente deve ter sua PA aferida na consulta inicial, aparelhos oscilométricos validados devem ser utilizados, a técnica de aferição deve seguir rigorosamente a orientação da diretriz Brasileira de hipertensão arterial 2022 e interpretada de acordo com as tabelas de estatura, idade, e sexo, do Controle e Prevenção de Doenças (CDC). 

Impact of Behavioral Biases and Decision Analysis Methods on Investment Performance of Individual Investors at PSX

Purpose: Market bubbles and crashes remain unexplainable by classical finance theories. Because the history of the Pakistan Stock Exchange has been marked by occasional market bubbles and crashes, a behavioral study is conducted to investigate the impact of investor’s behavioral biases on investment performance. Design/Methodology/Approach: Our research investigates behavioral biases and examines the role of such biases in the selection of investment decision methods. We then investigate the direct impact of behavioral biases on investors' investment performance, as well as how investment analysis methods play a role in mediating the impact of behavioral biases on investment performance. We identified 11 irrational behavior biases based on existing literature and in-depth interviews with brokers, and two decision analysis methods are used: fundamental and technical. Findings: Our findings show that PSX investors exhibit moderately high levels of irrational behavior. Despite their moderately high level of irrationality, investors can use fundamental analysis to make better decisions and achieve better results. Since they use fundamental analysis method, they are boundedly rational rather than completely irrational. Implications/Originality/Value: The fundamental analysis does not fully mediate three determinants of irrationality, namely anchoring, control, and overconfidence. Individual investors and brokers are concerned about reducing the impact of these three biases in order to achieve optimal performance. Brokerage firms and fund managers are recommended to consider the behavioral aspects of investors to predict the future because behavioral factors of investors can not only shape the investment trend of individuals but also the market at large

Prognostic significance of ischemic electrocardiographic changes during stress testing in patients with normal nuclear myocardial perfusion imaging

Objectives: The main objective of this study was to evaluate cardiovascular outcome in patients with normal nuclear myocardial perfusion imaging but ischemic ECG changes during pharmacological or exercise stress test. Methods: In this retrospective study, we included a cohort of patients who underwent either pharmacological or exercise stress MPS and have a normal scan with ischemic EKG changes at Aga Khan University Hospital, from January 2013 to December 2014. All cardiac events including angina, myocardial infarction, heart failure, coronary revascularization and cardiac death as well as non-cardiac death were determined for the whole follow up period. Results: Among 2770 eligible patients, 296 patients (10.6%) developed ischemic EKG changes during stress test but myocardial perfusion scan was normal. Out of 296 patients 181(61%) were male and mean age was 61.98 + 15 years. We were able to follow 280 patients (94.5%). During a mean follow-up of 4 years + 7 months, 8 patients (2.8 %) died, of which only one patient (0.3%) died due to cardiac cause. Angina occurred in 25patients (8.9%), myocardial infarction in 2 patients (0.7%) and one patient hospitalized with heart failure (0.3%). We performed coronary angiography of 16 patients (5.7%), of which nine underwent percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was done in three patients. Conclusion: The ischemic electrocardiographic changes during stress testing in patients with normal MPI are not associated with poor out come and the risk of cardiovascular events is relatively low for an intermediate follow up period.  Continuous...

A Review on the Way Forward in Construction through Industrial Revolution 5.0

The growing concept of Industry 5.0 (IR 5.0) has enhanced the study horizon of the technology-centered Industry 4.0 (IR 4.0) to an intelligent and balanced socioeconomic change powered mutually by people and technologies. The role of humans in the technological revolution is largely focused on IR 5.0, which is already a future trend. IR 4.0’s cyber–physical systems revolution has evolved into IR 5.0, or in other words, from machine-to-machine integration to human-to-machine integration, which is radically altering how people live, work, and interact with one another. Therefore, the current study aims to comprehensively review transformation through industrial revolutions and provide a way forward in the construction industry with the incorporation of IR 5.0. This study has used a narrative-based research methodology in which multiple databases such as Scopus, Web of Sciences, Google Scholar, and Science Direct have been utilized for extracting articles related to the subject area of the current study. Moreover, through narrative-based methodology, which is a generic-based review technique, the information gathered from multiple sources has been summarized and synthesized. The findings of the review indicate that resilience, human-centricity, economic efficiency, and sustainable development are the key characteristics of IR 5.0. Moreover, the adoption of IR 5.0 in the construction industry also faces some major challenges such as a shortage of IR 5.0-related technical skills, investment-hesitancy among investors, security, and cultural concerns for human-to-machine integration, and an unavailability of data for effective decision-making for governments and stakeholders. The study results also highlight that with selective technology adoption, project teams embracing IR 5.0 for improved collaboration and coordination, more environmentally friendly technology adoption through human-to-machine collaboration, and stakeholders leveraging the power of human knowledge and innovative proficiency through machines, reforms can be brought into the construction industry through the incorporation of IR 5.0. It is also important to keep in mind that adopting IR 4.0 is still difficult in some areas and it may seem like achieving IR 5.0 will require years of effort and significant cultural change; however, it needs to be considered right away. The effects of disruptive technologies on Industry 4.0 are covered in several studies; however, IR 5.0 is a novel idea that is still in its early stages, thus its consequences have not been well examined in the construction industry. Therefore, the current study has expanded the body of knowledge on this important subject in detail and has comprehensively explained the transformation by providing a way forward for the adoption of IR 5.0 in the construction industry

Differing radiation exposure in scrub technicians and rotating staff in Cardiac catheterization laboratory: occupation matters

Abstract Background Radiation exposure is a significant hazard associated with invasive Cardiology, with most studies based on primary operator exposure. This prospective, observational study aimed to find out over lead radiation exposure as effective dose acquired by non-physician staff comprising scrub technicians and rotating staff in the cath laboratory. Effective dose (ED) measured per procedure via Raysafe i2®dosimeter badges worn by both rotating staff and scrub technicians over lead aprons along with dose area product (DAP), fluoroscopy time (FT) and procedure time (PT) in minutes was collected prospectively over forty-six invasive Cardiology procedures. Results This study shows that rotating staff acquire higher ED in comparison with their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. However, a statistically significant difference in radiation exposure of both staff groups was demonstrated in diagnostic and interventional Cardiology procedures, with p values of 0.04 and 0.01, respectively. Conclusions These findings highlight occupational role and mobility around fluoroscopic sources as major factors in radiation exposure, which should be addressed within current radiation protection practices