Client Satisfaction Towards Quality of Health Services: an Assessment at Primary Healthcare of District Gujranwala

This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured "Liker scale questionnaire" was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client\u27s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level.Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services

Evaluation of immune response to hepatitis B vaccine in health care workers at a tertiary care hospital in Pakistan: an observational prospective study

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders\u27 rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.Methods: Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination. Results: Initially 666 employees were included in the study. 14 participants were excluded due to incomplete records. 271 (41%) participants were females and 381(59%) were males. Majority of the participants were young (50 years of age. Male non responders were more frequent (18%) than female (8%). Conclusion: Seroconversion rate after HBV vaccination in Pakistani HCWs was similar to that reported in western and neighboring population. HCWs with reduced immune response to HBV vaccine in a high disease prevalent population are at great risk. Therefore, it is crucial to check post vaccination HBsAb in all HCWs. This strategy will ensure safety at work by reducing nosocomial transmission and will have a cost effective impact at an individual as well as at national level, which is very much desired in a resource limited country

Confirmation of root-knot nematode resistant gene Rmi1 using SSR markers

Background: The Root Knot Nematode (RKN) is a serious economic threat to various cultivated crops worldwide. It is a devastating pest of soybean and responsible to cause severe yield loss in Pakistan. The cultivation of resistant soybean varieties against this pest is the sustainable strategy to manage the heavy loss and increase yield. There is an utmost need to identify RKN resistant varieties of soybean against cultivated in Pakistan. The presented study is an attempt to identify and confirm the presence of resistant gene Rmi1 in soybean. Method: Molecular studies have been done using Simple Sequence Repeat (SSR) marker system to identify resistant soybean varieties against Root Knot Nematode (RKN) using fifteen (15) indigenous cultivars and four (4) US cultivars. DNA was isolated, purified, quantified and then used to employ various SSR markers. The amplified product is observed using gel documentation system after electrophoresis.  Results: Diagnostic SSR markers Satt-358 and Satt-492 have shown the presence of Rmi1 gene in all resistance carrying genotypes. Satt-358 amplified the fragment of 200 bp and Satt-492 generated 232 bp bands in all resistant genotypes. This study confirmed the Rmi gene locus (G248A-1) in all internationally confirmed resistant including six (6) native varieties.Conclusion: These investigations have identified six (6) resistant cultivars revealing the effective and informative sources that can be utilized in breeding programs for the selection of RKN resistance soybean genotypes in Pakistan.

Effects of hydrostatic and uniaxial stress on the Schottky barrier heights of Ga-polarity and N-polarity n-GaN

We report measurements of the Schottky barrier heights of Ni/Au contacts on Ga-polarity and N-polarity n-GaN under hydrostatic pressure and applied in-plane uniaxial stress. Under hydrostatic pressure the two different polarities of GaN yield significantly different rates of Schottky barrier height increase with increasing pressure. Uniaxial stress parallel to the surface affects the Schottky barrier height only minimally. The observed changes in barrier height under stress are attributed to a combination of band structure and piezoelectric effects

MgZnO/AlGaN heterostructure light-emitting diodes

We report on p-n junction light-emitting diodes fabricated from MgZnO/ZnO/AlGaN/GaN triple heterostructures. Energy band diagrams of the light-emitting diode structure incorporating piezoelectric and spontaneous polarization fields were simulated, revealing a strong hole confinement near the n-ZnO/p-AlGaN interface with a hole sheet density as large as 1.82x10(13) cm(-2) for strained structures. The measured current-voltage (IV) characteristics of the triple heterostructure p-n junctions have rectifying characteristics with a turn-on voltage of similar to3.2 V. Electron-beam-induced current measurements confirmed the presence of a p-n junction located at the n-ZnO/p-AlGaN interface. Strong optical emission was observed at similar to390 nm as expected for excitonic optical transitions in these structures. Experimental spectral dependence of the photocurrent confirmed the excitonic origin of the optical transition at 390 nm. Light emission was measured up to 650 K, providing additional confirmation of the excitonic nature of the optical transitions in the devices

Effect of hydrostatic pressure on the current-voltage characteristics of GaN∕AlGaN∕GaN heterostructure devices

The current-voltage characteristics of n-GaN∕u-AlGaN∕n-GaN heterostructure devices are investigated for potential pressure sensor applications. Model calculations suggest that the current decreases with pressure as a result of the piezoelectric effect, and this effect becomes more significant with thicker AlGaN layers and increasing AlN composition. The change in current with pressure is shown to be highly sensitive to the change in interfacial polarization charge densities. The concept is verified by measuring the current versus voltage characteristics of an n-GaN∕u-Al0.2Ga0.8N∕n-GaN device under hydrostatic pressure over the range of 0–5 kbars. The measured current is found to decrease approximately linearly with applied pressure in agreement with the model results. A gauge factor, which is defined as the relative change in current divided by the in-plane strain, approaching 500 is extracted from the data, demonstrating the considerable potential of these devices for pressure sensing applications

Estrogen receptor transcription and transactivation: Basic aspects of estrogen action

Estrogen signaling has turned out to be much more complex and exciting than previously thought; the paradigm shift in our understanding of estrogen action came in 1996, when the presence of a new estrogen receptor (ER), ERβ, was reported. An intricate interplay between the classical ERα and the novel ERβ is of paramount importance for the final biological effect of estrogen in different target cells

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group