A Review of Impact of Interest Rate Spread on Profitability

The purpose of this study is to explain the relationship between interest rate spread and profitability. Interest rate spread is actually the difference between deposit rate and lending rate of bank. Interest rate spread is an important factor in profitability of banks. It means increase or decrease in interest rate will affect profitability. Many other factors also contribute in the profitability of banks. The growth of any organization depends on its profitability. When the profitability of any organization increases the value of shareholders also increase. Keywords: Interest rate spread, Profitability, Ban

Perceptions and Experiences of Artificial Intelligence (AI) Use in Libraries: A Study of Library Users in Pakistan

This study sought to understand library users\u27 opinions, attitudes, and needs regarding using artificial intelligence (AI) in libraries. A survey questionnaire was administered to 71 respondents from academic and public libraries throughout the region. This survey examined a range of topics related to AI use in libraries, such as its perceived benefits and drawbacks; ethical and privacy considerations; user demographics; and factors influencing user adoption of and satisfaction with AI-powered services. The survey results revealed a generally positive attitude toward AI use in libraries. However, concerns were raised regarding such decisions\u27 privacy and ethical ramifications. Libraries must consider user needs and expectations when implementing and managing AI-powered systems. At the same time, further research is necessary to explore different topics related to this emerging technology field

Phylloides tumors in adolescent girls and young women in Pakistan.

Abstract The objective of this study was to determine the frequency of phylloides tumor (PT) in adolescent girls and youngwomen (less than and equal to 25 years of age) and to define the clinico-pathological features of PT in this unusualclinical setting. This descriptive study was carried out at the Aga Khan University Hospital (AKUH) pathologydepartment. All consecutive cases of PT diagnosed during the last sixteen years in the section of histopathology from1st January 1990 to 31st June 2005 were included. Selection of cases was restricted to patients up to 25 years of age.A total of 42 cases of PT in up to 25 years of age were diagnosed. This comprised 11% of the total PT cases (totaln=363). The number of benign (BPT), borderline (BLPT) and malignant (MPT) was identical i.e. 14 (33.3%) each.Clinically all cases presented with a solid, mobile, palpable mass. The mean age was 19.1 years (95% CI, 16.7-21.6),21.9 years (95% CI, 20.7-21.9) and 19.7 years (95% CI, 17.2-22.3) in BPT, BLPT and MPT respectively. In majorityof cases the surgical procedure performed was lumpectomy (50% of BPT, 78% of BLPT and 64% of MPT). Highgrade PT (BLPT and MPT) is an uncommon mammary tumor in adolescent girls and young women but seems to beoccurring with increased frequency in the study population. This observation may indicate the biological behavior ofPT in a high risk population, though chances of referral bias are also present. In view of the rarity of the disease,larger population studies are suggested to confirm our findings

Population study of 1311 C/T polymorphism of Glucose 6 Phosphate Dehydrogenase gene in Pakistan – an analysis of 715 X-chromosomes

<p>Abstract</p> <p>Background</p> <p>Nucleotide 1311 polymorphism at exon 11 of G6PD gene is widely prevalent in various populations of the world. The aim of the study was to evaluate 1311 polymorphism in subjects carrying G6PD Mediterranean gene and in general population living in Pakistan.</p> <p>Results</p> <p>Patients already known to be G6PD deficient were tested for 563C-T (G6PD Mediterranean) and 1311 C-T mutation through RFLP based PCR and gene sequencing. A control group not known to be G6PD deficient was tested for 1311C/T only.</p> <p>C-T transition at nt 1311 was detected in 60/234 X-chromosomes with 563 C-T mutation (gene frequency of 0.26) while in 130 of normal 402 X-chromosomes (gene frequency of 0.32).</p> <p>Conclusion</p> <p>We conclude that 1311 T is a frequent polymorphism both in general populations and in subjects with G6PD Mediterranean gene in Pakistan. The prevalence is higher compared to most of the populations of the world. The present study will help in understanding genetic basis of G6PD deficiency in Pakistani population and in developing ancestral links of its various ethnic groups.</p

Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise.Objective:The aim of this study was to acquire information about the extent and spread of breast carcinoma in our Patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials AndMethods:One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases.Results:Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c), 53 (44.16%) were T2, 50 (41.66%) were T3, and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0, 29 (27.10%) cases were pN1, 26 (24.30) were pN2, and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis.Conclusion:The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of Patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our Patients

"Caught In Each Other's Traps": Factors Perpetuating Incentive-Linked Prescribing Deals Between Physicians and the Pharmaceutical Industry.

BACKGROUND: Despite known adverse impacts on patients and health systems, 'incentive-linked prescribing', which describes the prescribing of medicines that result in personal benefits for the prescriber, remains a widespread and hidden impediment to quality of healthcare. We investigated factors perpetuating incentive-linked prescribing among primary care physicians in for-profit practices (referred to as private doctors), using Pakistan as a case study. METHODS: Our mixed-methods study synthesised insights from a survey of 419 systematically samples private doctors and 68 semi-structured interviews with private doctors (n=28), pharmaceutical sales representatives (n=12), and provincial and national policy actors (n=28). For the survey, we built a verified database of all registered private doctors within Karachi, Pakistan's most populous city, administered an electronic questionnaire in-person and descriptively analysed the data. Semi-structured interviews incorporated a vignette-based exercise and data was analysed using an interpretive approach. RESULTS: Our survey showed that 90% of private doctors met pharmaceutical sales representatives weekly. Three interlinked factors perpetuating incentive-linked prescribing we identified were: gaps in understanding of conflicts of interest and loss of values among doctors; financial pressures on doctors operating in a (largely) privately financed health-system, exacerbated by competition with unqualified healthcare providers; and aggressive incentivisation by pharmaceutical companies, linked to low political will to regulate and an over-saturated pharmaceutical market. CONCLUSION: Regular interactions between pharmaceutical companies and private doctors are normalised in our study setting, and progress on regulating these is hindered by the substantial role of incentive-linked prescribing in the financial success of physicians and the pharmaceutical industry employees. A first step towards addressing the entrenchment of incentive-linked prescribing may be to reduce opposition to restrictions on incentivisation of physicians from stakeholders within the pharmaceutical industry, physicians themselves, and policymakers concerned about curtailing growth of the pharmaceutical industry

Antibiotic susceptibility surveillance in the Punjab Province of Pakistan : findings and implications

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR

A Delphi Study: Technology Leadership Network's Perceptions of ISTE Essential Conditions for Technology Integration in Professional Learning Communities

Purpose: The purpose of this Delphi study was to identify the essential conditions (ISTE) required for technology integration in Professional Learning Communities for building effective teams, promoting collaboration, and endorsing shared decision making processes as perceived by members of the joint Technology Leadership Network of the Riverside County Office of Education and San Bernardino County Superintendent of Schools, California. Methodology: A structured Delphi Study using mixed methods was conducted to find the expert panel's opinions, the members of the Technology Leadership Network in Riverside County Office of Education. Round 1 and Round 3 comprised scaled questions, producing quantitative data. Round 2 consisted of open ended questions, producing qualitative data. Findings: Delphi expert panelists ranked shared vision, ongoing professional learning, empowered leaders, and student-centered learning as the top four ISTE essential conditions required for technology integration in PLCs. The Delphi expert panelists also identified the preconditions necessary for technology integration. Conclusions: Based on the findings, a transformational plan and a change model were designed to effectively implement technology integration in Professional Learning Communities. The purpose of the plan and model was to provide step-by-step instructions for a transformational change plan for technology integration in Professional Learning Communities. Recommendations: To prepare educators for 21st century PLCs, it is crucial to have technology integrated in professional developments. Technology integration is indispensable for PLCs to build effective teams and to have collaboration and effective decision making; however, it is not possible unless PLCs have a deliberate shared vision, embedded ongoing professional learning, empowered leaders at all levels, and data driven student centered learning. The prerequisites, if addressed properly, can provide the strong foundation required for technology integration in PLCs. Yet, the change needs to come within one's self, and educators as lifelong learners are the right people to integrate this change