Offshore Information Systems Outsourcing: Strategies and Scenarios

This paper presents the findings of an ongoing research study into offshore information technology and systems outsourcing. Fieldwork was conducted in India and the United Kingdom to identify different strategies and scenarios. Based on the premise that offshore outsourcing poses greater risks than using suppliers from the home country, the research develops a risk assessment matrix comprising four scenarios: body shopping; maintenance and support of system hardware and software; IT architecture design; and strategy and product development. As offshore outsourcers develop resources and capabilities to offer high value-added work, this increases their own risk, and those of the customer

Management outcome of residual common bile duct stones at Aga Khan University Hospital

Background: The frequency of residual common bile duct (CBD) stones in patients with previous cholecystectomy ranges from 2-10%, and a minimally invasive approach is generally recommended for these patients. This study reviews the experience in the management of residual CBD stones at the Aga Khan University Hospital.Methods: All adult patients diagnosed to have residual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatment modality utilized and its associated complications. The role of endoscopic sphincterotomy was particularly analyzed in our set-up.Results: The study population consisted of 66 patients. The mean age was 52 (range:18-84 years) years with a female to male ratio of 51:15. The primary mode of management consisted of endoscopic sphincterotomy in 61 patients (92.5%). The initial clearance rate for these patients was 75%, while the remaining 25% required ancillary procedures to achieve a complete clearance. Procedure related complications were observed in 17 (28%) patients, with zero mortality. The other 5 patients (7.5%) underwent an open choledochotomy as a primary procedure with no further complications.CONCLUSIONS: Endoscopic sphincterotomy is the most frequent treatment modality used for the management of residual CBD stones at our hospital. Although initial success rate seems low, the fact that endoscopic sphincterotomy is a less invasive procedure justifies its preferential utilization. The study does not compare the results of endoscopic management with open surgery, as the number of patients managed by open choledochotomy is very small

Episiotomy and its complications: A cross sectional study in secondary care hospital

Episiotomy is a commonly performed procedure at the time of vaginal delivery to prevent perineal lacerations. A study was conducted to evaluate the complications of episiotomy. A sample size of 235 patients was taken. The complications were divided in two groups depending on the time of occurrence after delivery. Out of 235 patients, immediate complications were reported in 10(4.3%) patients. These included perineal tears, postpartum haemorrhage, extended episiotomy, perineal pain, inability to pass urine or stool and vaginal haematoma. Early complications including wound infection, gaping wound and resuturing of wound were reported in 21(8.9%) patients. On multivariate analysis, it was seen that age (19-29 years) was significantly associated with complications. Mediolateral episiotomy is a safe obstetrical surgical procedure in order to prevent third and fourth degree perineal tears and is not associated with increased incidence of complications

Calcaneal ultrasound and its relation to dietary and lifestyle factors, anthropometry, and vitamin D deficiency in young medical students

Background: Bone quality and peak bone mass are greatly affected by lifestyle factors. The objective of the study was to investigate the relationships between anthropometry, dietary and caloric intake, body composition measurements, physical activity, and vitamin D status with quantitative ultrasound-based bone parameters among medical students.Methods: Both male and female medical college students were included in this study. A detailed questionnaire was administered, collecting clinical, dietary, physical activity information, physical examination details, including body mass index (BMI). Body composition (total body fat, total body water, muscle mass, mean visceral fat mass, basal metabolic rate, bone mass using a bioelectrical impedance analyzer) and calcaneal heel ultrasound parameters were measured using an Osteosys Sonost-3000, Ultrasound Bone Densitometer were measured, respectively.Results: In this cross-sectional study, 211 healthy students with a mean age of 20.1 ± 1.1 years, 51.7% (n = 109) were males. Majority (79.4%) of the young adults had vitamin D deficiency. The mean BMI, calcium intake, and vitamin D levels were 22.35 ± 3.43 kg/m2, 788.7 ± 364.8 mg/day, and 15.02 ± 8.63 ng/ml, respectively. Female subjects compared to males had statistically significantly lower daily energy intake, muscle mass, visceral fat mass, calcium intake, and vitamin D levels. In addition the median Z-scores in females [-1.40 (-0.57 to -1.82)] was significantly poorer than the male [-0.50 (0.20 to -1.3)] counterparts, p-value \u3c0.001. Multiple regression analysis showed that overall body fat percent (p-value 0.016) and visceral fat percent (p-value 0.029) were the only significant negative predictors to the calcaneal bone quality index (BQI) values.Conclusion: Adolescent lifestyle patterns can influence young adult bone strength. The young Pakistani females exhibited significantly lower dietary intakes and more inadequate bone parameters compared to males. Our data suggest that total body and visceral fat percent are the predominant negatively associated determinant of bone strength for this cohort. Calcaneal ultrasound can be utilized for mass screening of young adults for identification of low BMD

Effect of Calcium Channel Blockers on Lower Urinary Tract Symptoms: A Systematic Review

Background. Numerous medications are known to be associated with the development of lower urinary tract symptoms (LUTS). One such medication group is calcium channel blockers (CCB). Objective. To critically examine the literature regarding the involvement of CCB in manifestation of LUTS in humans. Methods. A systematic literature search was conducted on PubMed, SciELO, Scopus, and OpenGrey databases to find all potentially relevant research studies before August 2016. Results. Five studies met the inclusion criteria and were included in this review. Three out of five studies stated that CCB were involved in either precipitation or exacerbation of LUTS. As for the remaining two studies, one study found out that only the monotherapy of CCB was associated with increased prevalence of nocturia and voiding symptoms in young females, whereas the other study reported an inverse association of CCB with LUTS. The methodological quality of studies was considered high for four studies and low for one study. Conclusion. Healthcare providers should make efforts for an earlier identification of the individuals at risk of LUTS prior to the commencement of CCB therapy. Moreover, patients should be counselled to notify their healthcare provider if they notice urinary symptoms after the initiation of CCB

Protective effect of Parthenium hysterophorus against carbon tetrachloride- and paracetamol-induced hepatotoxicity in rabbits

Purpose: To investigate the possible hepatoprotective potential of Parthenium hysterophorus crude extract (Ph.Cr) against carbon tetrachloride (CCL4)- and paracetamol-induced hepatotoxicity in rabbits.Methods: Twenty rabbits were divided into five groups of four rabbits each. Group 1 served as normal control and received normal saline (5 mL/kg). Group 2 received normal saline followed by CCL4 (0.75 mL/kg p.o dose) after 1 h. Groups 3 and 4 received Ph.Cr at doses of 15 and 30 mg/kg po, respectively, for 7 days followed by one dose of CCL4, 2 h after the last extract dose (0.75 mL/kg, sc). Group 5 received silymarin as reference standard at a dose of 100 mg/kg orally for 7 days followed by one dose of CCL4 (0.75 mL/kg, sc), 2 h after the last drug dose. The effect of the extract on potassium (K+)- induced contractions in isolated rabbit jejenum was also evaluated. At the end of the study, the animals were sacrificed and their liver architecture examined microscopically.Results: Pre-treatment of rabbits with Ph.Cr reduced ALT, ALP and TB levels (p < 0.05, p < 0.01, p < 0.001) dose dependently. Hepatoprotective data indicate that Ph.Cr markedly reduced CCL4- and paracetamol-induced toxicity by preserving the histological architecture of the liver tissue at near normal. In isolated rabbit jejunum tissue, Ph.Cr relaxed high K+ (80 Mm)-induced contractions in a concentration-dependent (0.03 - 10 mg/mL) manner like that caused by silymarin.Conclusion: In the light of the results obtained, Parthenium hysterophorous  possesses hepatoprotective activity against CCL4- and paracetamol-induced  hepatic damage, possibly mediated via its antioxidant and Ca++ antagonist mechanisms.Keywords: Parthenium hysterophorus, Toxins, Hepatoprotection, Ca++ antagonist, Silymari

Potential application of Conyza canadensis (L) Cronquist in the management of diabetes: In vitro and in vivo evaluation

Purpose: To investigate the antihyperglycemic activity of Conyza canadensis via α-glucosidase inhibition in alloxan-induced diabetic mice.Methods: In vitro antidiabetic activity was investigated using α-glucosidase inhibition assay with acarbose (62.5, 125, 500 and 1000 μg/ml) as the standard drug. Conyza canadensis crude extract (Cc.Cr) in doses of 10, 30, 100 and 300 mg/kg were administered daily as a single dose to alloxaninduced (200 mg/kg) diabetic mice (Balb/c), and its effect on fasting blood glucose levels and body weight were evaluated for 15 consecutive days; oral glucose tolerance test was conducted. Metformin (500 mg/kg) was used as a standard antidiabetic drug for comparison. Acute toxicity of Cc.Cr was also evaluated at doses of 3 and 5 g/kg.Results: Conyza canadensis crude extract (Cc.Cr) exhibited strong enzyme inhibition at concentrations (μg/ml) of 1000 (74.78 ± 0.92), 500 (65.11 ± 0.07), 250 (57.55 ± 0.41), 125 (51.55 ± 0.67) and 62.5 ( 44.00 ± 0.57), with a median inhibitory concentration (IC50) of 107 μg/ml. Cc.Cr at all test doses (10 - 300 mg / kg) reduced fasting blood glucose levels in alloxan (200 mg/kg) - induced diabetic mice on days 5, 10 and 15 compared to the diabetic control group (p < 0. 001). These effects were similar to those caused by the standard antidiabetic drug, metformin. Cc.Cr at all test doses also increased body weight of treated animals. The extract (300 mg/kg) significantly improved tolerance of oral glucose overload in mice, like metformin. The extract did not cause any mortality up to the maximum dose of 5 g/kg.Conclusion: The results reveal that Conyza canadensis possesses potent secondary metabolites which can cause inhibition of α-glucosidase. Moreover, the plant extract has the ability to reduce blood glucose level in diabetic animals and significantly improves oral glucose overload tolerance.Keywords: Conyza canadensis, α-Glucosidase, Blood glucose, Alloxan, Diabetes, Glucose toleranc

Implementing a Humanitarian Needs Assessment Framework for Early Childhood Development: Informing Intervention Design for Displaced Rohingya Communities in Bangladesh

Recent literature focused on education in conflict-affected settings firmly establishes the link between early childhood interventions, poverty reduction, and the effects of adverse childhood experiences, particularly for those exposed to violent conflict. A key factor of effective interventions targeting young children and their families, and thus the long-term sustainability of behavior change, is how those interventions are received by local populations. Despite the importance of understanding local perspectives, needs assessments are often deprioritized when the focus is on meeting the immediate need for safety, food, water, and shelter. In the absence of a needs assessment, programming is developed without understanding the key priorities and motivations of the communities served. Given that the average length of protracted refugee situations is now more than 20 years, early childhood development programming designed without local perspectives brings with it the possibility of long-term repercussions, little community buy-in, and, consequently, limited to no impact. Therefore, the long-term costs of not doing needs assessments in humanitarian contexts are likely to far exceed the initial investments in conducting such research. In acknowledgment of these opportunities and constraints, this article presents a framework for conducting a needs assessment in a humanitarian setting, along with illustrative findings that underscore the value of seeking greater understanding of a community before designing early childhood development programming. Using a needs assessment to inform the design of an early childhood development intervention for displaced Rohingya communities living in Bangladesh, this article uses the design of that assessment to provide a framework for operationalizing needs assessments in humanitarian settings

Effect of similar feeding regime on growth and body composition of Indian major carps (Catla catla, Cirrhinus mrigala and Labeo rohita) under mono and polyculture

Growth performance and body composition of yearling Indian major carps (Catla catla, Cirrhinus mrigala and Labeo rohita) was evaluated in semi-intensive (mono and polyculture) systems for 90 days. Prior to stocking, all ponds were fertilized with organic and inorganic manures. This application was repeated every two weeks throughout the study period. Supplementary feed containing 35% protein was applied daily at 3% of wet body weight. In trial 1, all the three species gained significantly higher weights with experimental feed (F1) versus control group (F0). There was non-significant difference observed among species. In trial 2, non-significant difference was observed for net weight gain among species and between feeds. The feed conversion ratio (FCR), protein efficiency ratio (PER), protein utilization (PU), gross nitrogen retention efficiency (GNRE%) and gross energy retention efficiency (GERE%) were found non-significantly different among species in both trials, except GNRE% in polyculture, where L. rohita showed significantly higher values than its counterparts. No significant difference was observed in body composition and mineral contents among species and between feeds in both trials. In conclusion, all the three fish species performed well under monoculture system with 35% protein diet and showed significantly higher growth than the control, compared to polyculture, without any significant effect on body composition.Keywords: Artificial feed, Indian major carps, growth, proximate composition, nutrient retention efficiency, cost effectivenes