Self-care Practices of Type 2 Diabetes Patients by Socio-demographic and Clinical Factors: An Ordered Probit Model

Background: Diabetes prevalence has risen more rapidly in middle- and low-income countries and has emerged as the seventh highest cause of death in such countries. Socio-demographics, patient knowledge and clinical factors, such as family history of diabetes, have a vital effect on the disease outcomes. This study assessed self-care practices among patients with type 2 diabetes to determine the probability of self-care by predictor variables, including socio-economic and clinical factors, and quantify the marginal effects of these independent variables on different self-care practices among diabetic patients. Methods: This exploratory study collected data from 200 type 2 diabetes patients at a branch of private pharmacy in Pakistan using a convenient sampling technique and a semi-structured questionnaire. An ordered probit regression model was used to analyze the different self-care practices among diabetic patients. With self-practices ordered in four classes from poor to good, the marginal effects of each socio-economic and clinical factors were also calculated on the likelihood of aforesaid self-care practices among diabetic patients. Results: Results showed that the relationships of household income, patient’s choice of private or public hospital for treatment, and patient’s weight with self-care probability were statistically significant. These socio-demographics and clinical indicators significantly influenced each category of self-care practices. Conclusion: Socio-demographic and clinical factors played a decisive role in the healthcare practices among type-2 diabetes patients. Monthly household income, patient’s choice of private or public hospital for treatment, and patient’s weight influenced different levels of self-care practices. Income had a negative contribution in poor and fair self-care levels of practices, whereas it had a positive role in average and good self-care levels of practices. Keywords: type 2 diabetes; self-care practices; socio-economic factors; developing countr

Neurological involvement associated with plasmodium vivax malaria from Pakistan

Plasmodium vivax is the most common specie causing malaria outside Africa with approximately 13.8 million reported cases worldwide. We report case of P. vivax infection with cerebral involvement. A nine year old boy presented with high grade fever accompanied by projectile vomiting and abnormal behavior later he developed seizures, shock, and unconsciousness. P. vivax monoinfection was diagnosed based on peripheral smears and PCR. After antimalarial therapy, patient made full recovery. Current case highlights increasing trend of cerebral complications caused by P. vivax

Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff

INTRODUCTION: Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. METHODS: Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. RESULTS: We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. CONCLUSIONS: Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs

Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol.

INTRODUCTION: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. METHODS: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. EXPECTED OUTCOMES: Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518)

Experimental Investigation of Vertical Density Profile of Medium Density Fiberboard in Hot Press

This research investigates the performance of medium density fiberboard (MDF) with respect to hot press parameters. The performance of the board, type of glue, and production efficiency determine the optimum temperature and pressure for hot pressing. The actual temperature of the hot press inside the MDF board determines the properties of the final product. Hence, the optimal hot press parameters for the desired product are experimentally obtained. Moreover, MDF is experimentally investigated in terms of its vertical density profile, bending, and internal bonding under the various input parameters of temperature, pressure, cycle time, and moisture content during the manufacturing process. The experimental study is carried out by varying the temperature, pressure, cycle time, and moisture content in the ranges of 200–220 °C, 145–155 bar, 260–275 s, and 8–10%, respectively. Consequently, the optimum input parameters of a hot-pressing temperature of 220 °C, pressure of 155 bar, cycle time of 256 s, and moisture content of 8% are identified for the required internal bonding (0.64 N/mm2), bending (32 N/mm2), and increase in both the core and peak density of the vertical density profile as per the ASTM standard

Transboundary Water Governance in the Kabul River Basin: Implementing Environmental and Public Diplomacy Between Pakistan and Afghanistan

This research highlights the outcomes of the environmental diplomacy workshop held between members of civil society from Afghanistan and Pakistan on water cooperation in the Kabul River Basin, one of the most heavily conflicted transboundary river basins in the world. Lack of trust among these upstream and downstream riparian partners and persistent failures of Track 1 diplomacy initiatives has led to an absence of governance mechanisms for mitigating the water security concerns in the region. This research shows that science and public diplomacy, democratic participation, and social learning may pave a way to clear local misconceptions, improve transboundary water cooperation, and increase ecological stewardship in the Kabul River Basin

QUALINET white paper on definitions of Immersive Media Experience (IMEx)

With the coming of age of virtual/augmented reality and interactive media, numerous definitions, frameworks, and models of immersion have emerged across different fields ranging from computer graphics to literary works. Immersion is oftentimes used interchangeably with presence as both concepts are closely related. However, there are noticeable interdisciplinary differences regarding definitions, scope, and constituents that are required to be addressed so that a coherent understanding of the concepts can be achieved. Such consensus is vital for paving the directionality of the future of immersive media experiences (IMEx) and all related matters. The aim of this white paper is to provide a survey of definitions of immersion and presence which leads to a definition of immersive media experience (IMEx). The Quality of Experience (QoE) for immersive media is described by establishing a relationship between the concepts of QoE and IMEx followed by application areas of immersive media experience. Influencing factors on immersive media experience are elaborated as well as the assessment of immersive media experience. Finally, standardization activities related to IMEx are highlighted and the white paper is concluded with an outlook related to future developments

Affects of Perceived-Actions within Virtual Environments on User Behavior on the Outside

3D visualization has witnessed exponential growth driven by advances in computer-generated imagery that now include immersive technologies enabling first-person experiences with depth perception and spatial awareness. We investigated two popular uses of VR in 3D architectural visualization: a “passive walkthrough” vs. an “interactive walkthrough”. We designed a within-subject experiment to measure the user-perceived quality and conduct a behavior analysis of users in both experiences. All participants (N=34) were exposed to both conditions and afterwards responded to a post-experience questionnaire. We recorded the physical activity of all participants while they were immersed within the virtual environments and each session was logged in a time diary. So far QoE measurements have relied on subjective and objective evaluations. In this paper, we discuss the behavioral analysis of the effects of immersion and interaction on the simple active behaviors (movements + gestures) of the users. We apply quantitative behavioral observation to cross-examine user behavior against their self-reported responses to a “presence” questionnaire. We conclude that there is significant potential for applying cross-disciplinary behavior analysis tools to overall Quality of Experience within virtual environments

Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data

Introduction: Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women\u27s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods: We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results: We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women\u27s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44-2.43) and 2.78 (95% CI 2.04-3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60-2.44) and 1.56 (95% CI 2.17-1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. Conclusion: The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women\u27s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan

Numerical investigation of blade roughness impact on the aerodynamic performance and wake behavior of horizontal axis wind turbine

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