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

Cetacean bycatch in Indian Ocean tuna gillnet fisheries

Pelagic gillnet (driftnet) fisheries account for some 34% of Indian Ocean tuna catches. We combined published results from 10 bycatch sampling programmes (1981−2016) in Australia, Sri Lanka, India and Pakistan to estimate bycatch rates for cetaceans across all Indian Ocean tuna gillnet fisheries. Estimated cetacean bycatch peaked at almost 100 000 ind. yr−1 during 2004−2006, but has declined by over 15% since then, despite an increase in tuna gillnet fishing effort. These fisheries caught an estimated cumulative total of 4.1 million small cetaceans between 1950 and 2018. These bycatch estimates take little or no account of cetaceans caught by gillnet but not landed, of delayed mortality or sub-lethal impacts on cetaceans (especially whales) that escape from gillnets, of mortality associated with ghost nets, of harpoon catches made from gillnetters, or of mortality from other tuna fisheries. Total cetacean mortality from Indian Ocean tuna fisheries may therefore be substantially higher than estimated here. Declining cetacean bycatch rates suggest that such levels of mortality are not sustainable. Indeed, mean small cetacean abundance may currently be 13% of pre-fishery levels. None of these estimates are precise, but they do demonstrate the likely order of magnitude of the issue. Countries with the largest current gillnet catches of tuna, and thus the ones likely to have the largest cetacean bycatch are (in order): Iran, Indonesia, India, Sri Lanka, Pakistan, Oman, Yemen, UAE and Tanzania. These 9 countries together may account for roughly 96% of all cetacean bycatch from tuna gillnet fisheries across the Indian Ocean

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

A Survival Analysis of Islamic and Conventional Banks

Are Islamic banks inherently more stable than conventional banks? We address this question by applying a survival analysis based on the Cox proportional hazard model to a comprehensive sample of 421 banks in 20 Middle and Far Eastern countries from 1995 to 2010. By comparing the failure risk for both bank types, we find that Islamic banks have a significantly lower risk of failure than that of their conventional peers. This lower risk is based both unconditionally and conditionally on bank-specific (microeconomic) variables as well as macroeconomic and market structure variables. Our findings indicate that the design and implementation of early warning systems for bank failure should recognize the distinct risk profiles of the two bank types

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Impact of sample size on principal component analysis ordination of an environmental data set: effects on eigenstructure

In this study, we used bootstrap simulation of a real data set to investigate the impact of sample size (N = 20, 30, 40 and 50) on the eigenvalues and eigenvectors resulting from principal component analysis (PCA). For each sample size, 100 bootstrap samples were drawn from environmental data matrix pertaining to water quality variables (p = 22) of a small data set comprising of 55 samples (stations from where water samples were collected). Because in ecology and environmental sciences the data sets are invariably small owing to high cost of collection and analysis of samples, we restricted our study to relatively small sample sizes. We focused attention on comparison of first 6 eigenvectors and first 10 eigenvalues. Data sets were compared using agglomerative cluster analysis using Ward’s method that does not require any stringent distributional assumptions

Enhancing MPPT Performance in Partially Shaded PV Systems under Sensor Malfunctioning with Fuzzy Control

The shift towards sustainable energy sources is gaining momentum due to their environmental cleanliness, abundant availability, and eco-friendly characteristics. Solar energy, specifically harnessed through photovoltaic (PV) systems, emerges as a clean, abundant, and environmentally friendly alternative. However, the efficacy of PV systems is subjective depending on two critical factors: irradiance and temperature. To optimize power output, maximum power point tracking (MPPT) strategies are essential, allowing operation at the system’s optimal point. In the presence of partial shading, the power–voltage curve exhibits multiple peaks, yet only one global maximum power point (GMPP) can be identified. Existing algorithms for GMPP tracking often encounter challenges, including overshooting during transient periods and chattering during steady states. This study proposes the utilization of fuzzy sliding mode controllers (FSMC) and fuzzy proportional-integral (FPI) control to enhance global MPPT reference tracking under partial shading conditions. Additionally, the system’s performance is evaluated considering potential sensor malfunctions. The proposed techniques ensure precise tracking of the reference voltage and maximum power in partial shading scenarios, facilitating rapid convergence, improved system stability during transitions, and reduced chattering during steady states. The usefulness of the proposed scheme is confirmed through the use of performance indices. FSMC has the lowest integral absolute error (IAE) of 946.94, followed closely by FPI (947.21), in comparison to the sliding mode controller (SMC) (1241.6) and perturb and observe (P&O) (2433.1). Similarly, in integral time absolute error (ITAE), FSMC (56.84) and FPI (57.06) excel over SMC (91.03) and P&O (635.50)

Not Available

Not AvailablePelagic gillnet (driftnet) fisheries account for some 34% of Indian Ocean tuna catches. We combined published results from 10 bycatch sampling programmes (1981−2016) in Australia, Sri Lanka, India and Pakistan to estimate bycatch rates for cetaceans across all Indian Ocean tuna gillnet fisheries. Estimated cetacean bycatch peaked at almost 100 000 ind. yr−1 during 2004−2006, but has declined by over 15% since then, despite an increase in tuna gillnet fishing effort. These fisheries caught an estimated cumulative total of 4.1 million small cetaceans between 1950 and 2018. These bycatch estimates take little or no account of cetaceans caught by gillnet but not landed, of delayed mortality or sub-lethal impacts on cetaceans (especially whales) that escape from gillnets, of mortality associated with ghost nets, of harpoon catches made from gillnetters, or of mortality from other tuna fisheries. Total cetacean mortality from Indian Ocean tuna fisheries may therefore be substantially higher than estimated here. Declining cetacean bycatch rates suggest that such levels of mortality are not sustainable. Indeed, mean small cetacean abundance may currently be 13% of pre-fishery levels. None of these estimates are precise, but they do demonstrate the likely order of magnitude of the issue. Countries with the largest current gillnet catches of tuna, and thus the ones likely to have the largest cetacean bycatch are (in order): Iran, Indonesia, India, Sri Lanka, Pakistan, Oman, Yemen, UAE and Tanzania. These 9 countries together may account for roughly 96% of all cetacean bycatch from tuna gillnet fisheries across the Indian Ocean.Not Availabl