Does empowerment matter? Perceptions of nursing leaders in Pakistan through qualitative approach.

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect. Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment. Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management. Conclusions: Nurses’ empowerment is essential for enhancing the image and status of nursing profession in Pakistan. The study identified various personal and professional factors affecting nurses’ empowerment in the country and suggests various strategies, such as access to higher nursing education, development of enhanced nursing leadership competencies and understanding of power and politics of the organization, through which nurses can achieve empowerment

Hepatocellular carcinoma in Pakistan: where do we stand?

Context: From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease. Evidence Acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC. Results: Majority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden. Conclusions: Measures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Cattaneo-Christov dual diffusive non-Newtonian nanoliquid flow featuring nonlinear convection

A theoretical study is presented of the transport characteristics in double diffusive tangent hyperbolic (non-Newtonian) nanofluid boundary layer flow from a stretching flat surface. The Cattaneo– Christov (non-Fourier and non-Fickian) double diffusion model is deployed in the formulations for energy and species conservation, to determine more precisely temperature and concentration distributions with thermal and solutual relaxation times. Non–linear mixed convection and heat generation/absorption are included. The nanofluid approach combines Brownian motion and thermophoresis. Suitable transformations are deployed to render the nonlinear partial differential system into a system of dimensionless coupled ordinary nonlinear differential equations. The non-dimensional boundary value problem is then solved with the homotopic analysis method (HAM). The distributions of velocity, temperature and concentration of nanoparticles are depicted and investigated for the effects of multiple emerging parameters. Velocity is reduced (and momentum boundary layer thickness elevated) with increasing power–law index and Weissenberg number whereas velocity is elevated (and momentum boundary layer thickness reduced) with increment in mixed convection variable. Temperature is suppressed (and thermal boundary layer thickness depleted) with increasing thermal relaxation variable, heat sink parameter, Prandtl number whereas temperature is enhanced (and thermal boundary layer thickness boosted) with greater heat source parameter, Brownian motion parameter and thermophoresis parameter. Nanoparticle concentration is depleted (and concentration boundary layer thickness reduced) with greater Schmidt number and Brownian motion parameter whereas the opposite effect is induced with greater thermophoresis parameter and solutal relaxation time. Skin friction is strongly reduced with increasing values of nonlinear thermal and concentration convection variables. The simulations are relevant to nano- polymer coating operations

The Agroforestry Potential and Analysis of Growth and Yield of different Vegetables Grown Under Olive Orchard to Mitigate Climate Change Effects

Olive is a drought-tolerant plant, making it suitable for cultivation in various dry regions of Pakistan. By applying the principles and regulations of agroforestry, we can increase crop yields, thereby creating a self-sustained farming ecosystem. Agroforestry is a technique that integrates the production of trees, vegetation, and livestock on the same land to achieve financial, environmental, ecological, and cultural benefits. A field experiment was conducted on six winter vegetables—cabbage, Chinese cabbage, kohlrabi, leafy green lettuce, leafy red lettuce, and broccoli—grown under three olive orchards of different ages (10, 20, and 30 years) with varying shading capacities at the Horticultural Research Institute, National Agricultural Research Center, Islamabad. The study focused on intercropping vegetables within olive orchards of different ages. Critical parameters were monitored, and strict plant inspections were carried out during the experimentation period. Plant samples were tested for morphology and chemical composition. It was found that more vigorous olive trees significantly decreased the growth, leaf chlorophyll content, nutrient uptake, and yield of the intercropped vegetables. Maximum shading from the 30-year-old olive orchard severely reduced plant growth and yield. The extent to which growth is limited by intercropping or shade intensity may vary with the genetic makeup of different crops. The results showed that plants grown under optimal light conditions exhibited greater plant height, spread, and stem diameter, attributed to the stimulation of cellular expansion and cell division under adequate sunlight, which increases photosynthetic efficiency. Cabbage and kohlrabi were identified as the most viable crops under the experimental conditions

The Agroforestry Potential and Analysis of Growth and Yield of different Vegetables Grown Under Olive Orchard to Mitigate Climate Change Effects

Olive is a drought-tolerant plant, making it suitable for cultivation in various dry regions of Pakistan. By applying the principles and regulations of agroforestry, we can increase crop yields, thereby creating a self-sustained farming ecosystem. Agroforestry is a technique that integrates the production of trees, vegetation, and livestock on the same land to achieve financial, environmental, ecological, and cultural benefits. A field experiment was conducted on six winter vegetables—cabbage, Chinese cabbage, kohlrabi, leafy green lettuce, leafy red lettuce, and broccoli—grown under three olive orchards of different ages (10, 20, and 30 years) with varying shading capacities at the Horticultural Research Institute, National Agricultural Research Center, Islamabad. The study focused on intercropping vegetables within olive orchards of different ages. Critical parameters were monitored, and strict plant inspections were carried out during the experimentation period. Plant samples were tested for morphology and chemical composition. It was found that more vigorous olive trees significantly decreased the growth, leaf chlorophyll content, nutrient uptake, and yield of the intercropped vegetables. Maximum shading from the 30-year-old olive orchard severely reduced plant growth and yield. The extent to which growth is limited by intercropping or shade intensity may vary with the genetic makeup of different crops. The results showed that plants grown under optimal light conditions exhibited greater plant height, spread, and stem diameter, attributed to the stimulation of cellular expansion and cell division under adequate sunlight, which increases photosynthetic efficiency. Cabbage and kohlrabi were identified as the most viable crops under the experimental conditions

Family ethnographic approach to explore the causes of suicide among married women of 20-40 years in Chitral, Khberpakhtunkhawa, Pakistan

The study was conducted to discover the factors that contribute to the suicide among married women in Chitral, through exploring the experiences of 24 immediate family members of six women who had committed suicide during the last one year. A qualitative study using the family ethnographic approach was employed. The data was collected between Aprils - July, 2016, largely through semi-structured in depth interviews and observation in the homes of participants. The study was conducted in district Chitral KPK, PakistanParticipants: 24 immediate family members of 6 women who were dead because of suicide were interviewed and observed. The key findings revealed that poverty and domestic violence were the key themes for committing suicide among married women. The sub themes were: lack in education ; psychological and physical problem (depression) ; lack of parental support; poor spousal relationship; lack of supportive structure; socio-cultural values /gender norms ; high expectations from women; and lack of supportive legislation in the area. Implications for practice: The findings of this study will offer guidelines for planning structured interventional research, poverty alleviation and suicide prevention programs. Moreover, the study findings will be useful to develop structured social and legal support system at individual, community and societal level

Medical education and training: responding to community needs.

At its inception in 1987, the Aga Khan University introduced the idea of community-based medical education in Pakistan, at a time when this model was being introduced and adapted internationally. Human resource development has been a major objective in the Department of Community Health Sciences (CHS). CHS has contributed to developing a medical curriculum that addresses the health needs of the community at large. This paper narrates the department\u27s experience in working directly with under-served communities, leading to the development of specialized courses and degree programs. CHS emphasizes operational research and development of managerial skills among front-line public health professionals, in both the public and private sectors. Training is provided by people from diverse backgrounds, such as public health, community development, social sciences, law, epidemiology, economy, biostatistics, demography, theater, and film. The lessons we have learned show that the mode of training depends on the overall objectives of the program, the clients and the setting. However, in the spirit of the participatory approach, the recipients of the training must be involved during all stages so as to ensure the sustainability of the training program. Training must focus on the communities at the grass roots level or community based organizations, where the communities identify their own capacity and needs. Wide dissemination of training materials, courses and manuals is also useful to replicate successful experience

Computational analysis of magnetized Casson liquid stretching flow adjacent to a porous medium with Joule heating, stratification, multiple slip and chemical reaction aspects

This article aims to investigate the characteristics of thermo-solutal magnetohydrodynamic (MHD) non-Newtonian smart coating boundary layer flow of a stretching substrate adjacent to a porous medium, considering the influence of chemical reactions and thermal radiation subject to a transverse static magnetic field. A non-Darcy drag force model is deployed to capture both Darcy bulk drag and inertial Forchheimer (quadratic) drag effects. A diffusion flux model is deployed for radiative heat transfer. The Casson viscoplastic model has been utilized to simulate rheological characteristics. Due to polymeric slip effects, three slip phenomena are included at the wall (hydrodynamic, thermal and concentration) in the formulation. Furthermore, viscous dissipation and Ohmic heating (Joule dissipation) are also included. Robust scaling similarity variables are deployed to transform the governing partial differential equations into ordinary differential equations. Subsequently, the emerging dimensionless coupled nonlinear boundary value problem is solved utilizing the Bvp4c method in MATLAB version 2022. This numerical approach allows for a logical parametric examination of all key control parameters on the transport phenomena, enabling a comprehensive understanding of the system behavior. Validation with previous studies is included. Detailed graphical and tabular computations are included for velocity, temperature, concentration, skin friction, Nusselt number and Sherwood number, for the influence of Darcian parameter, Forchheimer inertial parameter, mixed convection, velocity (momentum) slip, magnetic number, Casson parameter, nonlinear thermal convection parameter, nonlinear concentration convection parameter, radiation parameter, thermal stratification parameter, Prandtl number, heat source/sink parameter, Eckert number, thermal slip parameter, Schmidt number, chemical reaction, solutal stratification parameter and solutal slip parameter. Detailed interpretation of the physics associated with these multiple effects is included. Flow deceleration is observed with increment in Darcy parameter, Forchheimer parameter, Hartmann number, Casson parameter and momentum slip whereas flow acceleration is computed with increasing mixed convection parameter. Temperatures are accentuated with elevation in Rosseland radiative parameter, magnetic parameter, thermal stratification parameter, heat source parameter and Eckert (dissipation) number, whereas it is depleted with thermal slip (jump) parameter, heat sink, Prandtl number and mixed convection parameter. An increment in Schmidt number, first order homogenous chemical reaction parameter, solutal stratification parameter and mass slip parameters induce a reduction in concentration magnitudes and species boundary layer thickness. Skin friction is elevated with Darcian parameter. Nusselt number is boosted with mixed convection parameter whereas it is suppressed with radiation parameter, magnetic number, Casson parameter, thermal stratification parameter and thermal slip parameter. Sherwood number is observed to decay with increment in solutal stratification parameter and solutal slip parameter whereas it is enhanced with Schmidt number and chemical reaction parameters. The simulations provide further insight into the transport characteristics of electromagnetic viscoplastic coating material manufacturing