Constraint-based Query Distribution Framework for an Integrated Global Schema

Distributed heterogeneous data sources need to be queried uniformly using global schema. Query on global schema is reformulated so that it can be executed on local data sources. Constraints in global schema and mappings are used for source selection, query optimization,and querying partitioned and replicated data sources. The provided system is all XML-based which poses query in XML form, transforms, and integrates local results in an XML document. Contributions include the use of constraints in our existing global schema which help in source selection and query optimization, and a global query distribution framework for querying distributed heterogeneous data sources.Comment: The Proceedings of the 13th INMIC 2009), Dec. 14-15, 2009, Islamabad, Pakistan. Pages 1 - 6 Print ISBN: 978-1-4244-4872-2 INSPEC Accession Number: 11072575 Date of Current Version : 15 January 201

Door to Needle Time in Acute Myocardial Infarction Patients

To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency room.Methods: In this cross sectional study patients presenting with acute myocardial infarction (AMI) were included. Time interval from patient’s presentation to administration of streptokinase to the patient, was calculated . The total door-to-needle time was calculated and patient demographics and presentation, physician’s experience, clinical symptomology and reasons for delays in thrombolytic administration were analysed.Results: Sixty six patients, presented with AMI, were given streptokinase. Out of these, 6% received streptokinase within 15 minutes of arrival in emergency, 22.7%received streptokinase in 30 minutes, 33.33% received thrombolytic agent in 45 minutes, 27.27% received thrombolytic therapy in 60 minutes, and 10.7% received thrombolytic therapy in 90 minutes. The mean door to needle time calculated was 44.8 minutes. Patients receiving reperfusion therapy within 30 minutes were 28.7%.Conclusion: A significant number of patients were not thrombolysed within 30 minutes of presentation.The non-availability of senior doctors, difficulty in interpreting ECGs, atypical presentations and ER system delays, prolonged the door-to-needle time in this stud

Nutritional Interventions and Their Effects on Athletic Performance and Recovery

Nutrition plays an important role not only in athletic performance but also in the recovery period. In terms of micronutrients, macronutrient intake and hydration and dietary supplements enhance both performance and recovery among athletes. Adequate nutrition influence muscles work, higher energy endurance and muscle strength besides supporting the recovery period after the exercise.  The purpose of this research is to investigate the impact for various nutritional modifications in sports enthusiasts for carbohydrates and protein consumption, hydration, and supplementation on the martial arts’ performance and recovery, as well as other sporting activities.  A randomized controlled trial (RCT) was conducted with 60 athletes from diverse sports, assigned to four intervention groups: carbohydrate loading, protein intake, proper fluid intake, and dietary supplementations including creatine, beta- alanine and branch chain amino acids. All the endurance, strength and recovery assessments such as time-to-exhaustion, one-repetition maximum (1RM) and blood lactate clearance were measured at baseline, halfway through the intervention and at the end. To evaluate the effectiveness of each intervention, data that were collected were also subjected to repeated measures ANOVA.  Improvements were recorded in all the groups; however, the high carbohydrate group recorded the most pronounced improvement in endurance performance with time to exhaustion improving by 8. 2%. The high-protein group lifts significantly their strength by 9. 5% in 1RM squat whereas the supplementation group recorded the greatest enhancement in strength, power and recovery facets up to 12. 5% in 1RM bench press and muscle soreness decrease by 4. 2 points. These findings indicate that specific modifications in the diet in the form of carbohydrates for endurance runners and protein/creatine monohydrate for strength performers, can increase performance. Positive effects of hydration also became significant for endurance though their effects on the strength parameters were slightly smaller. The aids like creatine and beta-alanine are said to have shown significant results in enhancing strength, power and recovery. Proper nutrition really counts in an athlete’s abilities and even the time he takes to recuperate from an exercise. The best results can be achieved when nutritional strategies used are in line with sport and the athlete’s individual physiological adaptations. These findings make it beneficial for athletes and coaches to positively adopt sound progressive meal’s plan to enhance performance plus recovery time.  Keywords- Nutritional Interventions and Their Effects on Athletic Performance and Recover

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Frequency of Musculoskeletal Discomforts and its Association with Various Breastfeeding Positions among Nursing Mothers

Objective: To determine the association between musculoskeletal discomforts and breastfeeding positions among nursing mothers.Methodology: It was an analytical cross-sectional conducted from January 2023 to June 2023 at Imran Idrees Teaching Hospital and Idrees Hospital, Cantt Sialkot. The participants were selected using a convenient sampling technique. All 232 participants were recruited after the informed consent who met the inclusion criteria for the study. A musculoskeletal discomfort form developed from the Nordic Musculoskeletal Questionnaire was used as an outcome measuring tool. The data were analyzed using SPSS version 22. Descriptive statistics and chi-square tests were used to analyze the data. Results: The mean age of participants is 28.91±4.10 years. The majority of the participants had 1 breastfeeding child N=181 (78.0%), postpartum duration 1-3 months N=86 (37.1%), with the frequency of breastfeeding 1-3 sessions/day N= 87(37.5%) respectively. Most nursing mothers had a caesarian section as their mode of delivery N=120 (51.7%) and cross-cradle hold was the most common breastfeeding position N=83 (35.8%) causing musculoskeletal discomfort among N=213 (91.8%) of participants. Chi-square showed a significant association for ache/pain and discomfort in the regions of shoulders, elbows, wrist/hands as (p=0.00); upper back (p=0.01) and neck (p=0.02) at significance level 0.05. For prevention scale regions of the neck (p=0.00), wrist/hand, low back (p=0.01)and trouble scale regions of the upper back (p=0.01), shoulder, wrist/hand (p=0.02) respectively. Conclusion: The Musculoskeletal discomforts were more pronounced in regions of the neck, shoulders, elbows, and wrists, upper/lower back with the breastfeeding positions among nursing mothers.Key Words: Breastfeeding positions, musculoskeletal pain, nursing mothers, postur

Potential of Indigenous Plants for Skin Healing and Care

The outer protective layer of body is skin which not only guards it from external fluctuations and effects but also performs its thermoregulation. Its functioning may get affected due to several factors like dermal wounds, injuries, aging and many other disorders. These dermal ailments can be cured with the help of indigenous flora to get economical pharamcognosal benefits with no side effects which is a serious concern of synthetic drugs now days. Furthermore, research efforts are necessary for their proper dose optimization and administration to achieve low cost and side effects free pharamcognosal skin cure and care gains

Estimation of Finite Population Mean by Utilizing the Auxiliary and Square of the Auxiliary Information

This article fundamentally aims at the proposition of new family of estimators using auxiliary information to assist the estimation of finite population mean of the study variable. The objectives are achieved by devising dual use of supplementary information through straightforward manner. The additional information is injected in mean estimating procedure by considering squared values of auxiliary variable. The utility of the proposed scheme is substantiated by providing rigorous comparative account of the newly materialized structure with the well celebrated existing family of Grover and Kaur (2014). The contemporary advents of the new family are documented throughout the article

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely