A New Accelerated Third-Order Two-Step Iterative Method for Solving Nonlinear Equations

In the paper a new two-step iterative method has been suggested for estimating nonlinear problems by using quadrature formula. We have also proved that the proposed two-step iterative method has third-order of convergence. For the duration of study, it has been detected that the third-order iterative Method faster than existing cubic Methods such as variant of Newton Raphson Method and Halley Method. Numerous numerical illustrations are specified to demonstrate the efficiency and the performance of the new two-step method. Henceforth, the third-order iterative Method has been considered as an imperative enhancement and refinement to find the root of nonlinear equations. Keyword: Non-linear equations, cubic methods, order of convergence, error and accuracy

Institutional review boards - a mixed blessing

Institutional Review Boards (IRBs) are an important checkpoint for all types of research in medicine. Although these bodies originated primarily in the developed world, they have special contemporary consideration in the context of developing countries due to the large number of clinical trials being conducted in these regions with the financial support of large pharmaceutical companies. IRBs are vital to ensure that all scientific investigation is conducted in a manner that is transparent, scientifically feasible and ethically sound. However, they have also been variably criticized for introducing unnecessary and often protracted bureaucracy and red tape into the system. There is a need to reorganize and better delineate the exact functions of the IRBs in view of the dynamic changes in the realm of research so that they can function in a more efficient, judicious and effective fashion

Service Quality of Higher Education in Pursuance of Corporate Entrepreneurship: A Pakistan Based Study

This quantitative, investigation was to explore mediating impact of corporate entrepreneurship on the relationship between emotional intelligence, conflict management styles, leadership styles and service quality of Higher Education if rating provided by faculty as an internal customer. In this study, multi-stage cluster sampling technique applied for the selection of sample whereas Smart-PLS was used for testing the hypothesis which measures the direct and indirect effect between the dependent and independent variables. Structured questionnaires were used for data collection which comprised of 5 points Likert scale. The findings proved partial mediation to CE between the relationship of CM, EI and SQHE. On the other hand, full mediation proved to CE between the relationship between LS and the SQHE.  Research suggests that faculty and staff training programs, workshops to improve service quality would change the customer perception. The research also proposes the need to allow room for entrepreneurial activities, develop entrepreneurial principles, opportunities, and encourage entrepreneurial contribution towards improving SQHE

Hughes-Stovin Syndrome

Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown; possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored therapeutic agent in this regard. Antibiotics have no proven role in HSS while anticoagulants and thombolytic agents are generally contraindicated due to an increased risk of fatal hemorrhage. However, their use may be considered with great care under special circumstances, for instance, intracardiac thrombi or massive pulmonary embolism. For cases of massive hemoptysis due to large pulmonary aneurysms or those with lesions confined to one segment or one lung, lobectomy or pneumectomy can be carried out. However, surgical risks merit serious consideration and must be discussed with the patient. Transcatheter arterial embolization has emerged as a less invasive alternative to surgery in selected cases of HSS. Overall, patients with HSS have a poor prognosis and aneurysmal rupture is the leading cause of death. However, early diagnosis and timely intervention is crucial in improving the prognosis. There is a need to clearly elucidate the genetic, etiologic and pathologic basis for HSS in the future. Although most of the evidence put forward to refute the role of an infectious agent in the etiology and pathogenesis of HSS is based on negative blood and other body fluid cultures, more robust objective assessment is needed through the use of electron microscopy or 16 sRNA studies. The development of better therapeutic agents is also needed to address and prevent the serious consequences arising from pulmonary arterial aneurysms seen in BD and HSS. Also, the issue of anticoagulation in these patients is challenging and requires further deliberation

Takotsubo cardiomyopathy vs acute myocardial infarction: diagnostic utility of subtle ECG differences

The clinical findings of Takatsubo Cardiomyopathy and acute myocardial infarction can be very similar. While Takatsubo cardiomyopathy rarely leads to severe complications, acute myocardial infarction can be life threatening. Treatment of both these conditions is different and so it is imperative for clinicians to have a high index of suspicion for either. Several EKG differences between the two entities have been proposed. This article summarizes the EKG changes most likely seen in Takatsubo cardiomyopathy and compares them to those seen in Acute Myocardial infarction

Paradigm shift: 'ABC' to 'CAB' for cardiac arrests

CPR has a proven role in improving survival in cardiac arrest victims, especially those who are outside the hospital. Guidelines published by the AHA have included CPR as a vital intervention for decades. The previous guidelines have focused on the maintenance of airway as the first step, there by delaying the provision of chest compressions. However, the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care corrects this by changing the A-B-C of CPR to C-A-B, acknowledging that chest compressions are the most important aspect of the cardiac arrest management

Geriatric patients\u27 expectations of their physicians: findings from a tertiary care hospital in Pakistan

Background: Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric Patients from their physicians and the factors associated with Patient satisfaction in this particular age bracket. Methods: A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pretested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric Patient\u27s expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important. Results: Three hundred and eighty geriatric Patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 +/- 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric Patients. More than 50% of the Patients were visiting their physicians once every two to three months. Discussing treatment options and letting Patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physician\u27s holistic knowledge about the spectrum of care issues for geriatric Patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by Patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p \u3c 0.001) emerged as independent predictors of the satisfaction of geriatric Patients from care provided by physicians. Conclusion: We have documented the expectations of the geriatric Patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric Patients

Successful surgical embolectomy in acute massive bilateral pulmonary embolism

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. A 52-year-old man presented with progressively increasing dyspnoea for three days. He had a previous history of chronic obstructive pulmonary disease and was currently a heavy smoker. Examination revealed bilateral wheezing. Chest x-ray and electrocardiography showed non-specific changes. The patient was initially treated as a case of chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, despite optimum medical management, his oxygen saturation deteriorated. Emergent computed tomography scan of chest showed bilateral massive pulmonary emboli. As the patient\u27s haemodynamic status rapidly deteriorated, cardiothoracic surgery team was immediately consulted and the patient was taken to the operating room. Under cardiopulmonary bypass, bilateral open embolectomy was performed. Following surgical intervention, the patient made a remarkable recovery

Adenoid cystic carcinoma of the external auditory canal

This is a rare case of a young male with biopsy proven adenoid cystic carcinoma of the external auditory canal who underwent excision of the lesion with superficial parotidectomy sparing the facial nerve. Histopathology showed perineural invasion, which is a diagnostic hallmark of adenoid cystic carcinoma. Clinical examination, chest X-ray and CT scan showed no signs of recurrence or metastasis 2 years postoperatively