Nutrition Policy in the Post-devolution Context in Pakistan: An Analysis of Provincial Opportunities and Barriers

In this article we take a comparative look at strategic opportunities and barriers for action on nutrition in Pakistan's four provinces in the post?devolution context. Provinces have faced historically common constraints of lack of a comprehensive policy and minimal allocations by the state, driven by low visibility of nutrition, siloed working of sectors and weak coalitions. Provinces also face common contextual impediments of poverty, patriarchy, and inadequate health and WASH coverage, with two provinces also constrained by inequitable power structures. Recent focusing events have provided a window of opportunity to the provinces for action on nutrition leading to definite movement towards horizontal coordination for nutrition, upscaled funding and stronger vertical integration. However, there are variations in the extent of coalition building on nutrition, supportive leadership, governance and community outreach. The Pakistan experience shows that strategising for nutrition needs to move beyond a closely tailored national policy to accounting for sub?national potential and constraints

Three-day lansoprazole quadruple therapy for Helicobacter pylori-positive duodenal ulcers: a randomized contolled study

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Bearing capacity charts of soft soil reinforced by deep mixing

A series of preliminary design charts were developed to predict the bearing capacity of fully and partially penetrated deep mixing (DM) of soft soil. The charts were produced by a new numerical analysis tool based on discontinuity layout optimisation (DLO) in which a previously proposed homogenisation method was used to define the improvement area. To measure the applicability of implementation of the homogenisation method in the DLO, a series of validation processes was performed against several previous studies under uniform soil strength. A new empirical solution was developed from the DLO method using the homogenisation method for the bearing capacity of soft ground under uniform soil strength, improved by the fully penetrated DM method. Results produced by the DLO approach were compared with existing analytical solutions and better agreement was found from the present model. The charts consider variation in improvement area ratio, column length and strength, and foundation width for the fully and partially penetrated DM cases. The simulations were related to real field cases in which the strength characteristics of soft soil increase with depth. An example is given to demonstrate use of the charts

Genetic and cytological diversity in cherry tree accessions ( Eugenia involucrata DC) in Rio Grande do Sul

This study aimed to evaluate the genetic and cytological diversity and stability of 35 cherry tree accessions collected in Rio Grande do Sul. We used 15 RAPD (Random Amplified Polymorphic DNA) molecular markers and performed cytological analysis and number count of anthers. Analyses of genetic diversity allowed the separation of accessions into four groups, resulting in an average of 8.93 bands per primer amplified, 7.89 polymorphic bands, 88.08% of polymorphism and 86% of genetic similarity. Cytological analyses of gametic cells allowed for the characterization of accessions as diploids with n=11. In these, the average of meiotic cells considered normal was 82.12%; average pollen viability was 92.44% and in vitro germination was 40.26%; the average number of anthers was 161.85 anthers/flowers. Therefore, the accessions evaluated showed high genetic similarity and cytological stability and can be used in commercial plantations or hybridizations

K-best sphere detector based receiver for mimo non-orthogonal multiple access systems

Non-Orthogonal Multiple Access (NOMA) is a promising radio access technology, which improves the spectrum efficiency and system throughput considerably over conventional Orthogonal Multiple Access (OMA) techniques and also enables massive connectivity. NOMA is currently being considered extensively as a key enabling technology for 5G wireless networks. However, in NOMA, one of the key technical challenges is to develop efficient receivers due to the presence of Multiple-Access Interference (MAI) caused by non-orthogonal resource allocation. Minimum Mean Square Error (MMSE) based Successive Interference Cancellation (SIC) receivers have widely been discussed in the literature for power-domain NOMA systems. However MMSE detector is a linear detector with poor error performance. In this research, a K-Best sphere detector based SIC receiver is discussed for the downlink of power-domain MIMO-NOMA systems. The BER performance of the proposed receiver is investigated for different power allocation ratios and for different K values of the K-Best detector. Link level simulation results demonstrate that our proposed K-Best detector based receiver offers much superior performance over the MMSE-SIC based receiver

Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan

After a lost decade, there is clearly a groundswell of momentum for nutrition in Pakistan, driven by a confluence of policy, evidence and events. This momentum needs to be sustained at the national level, reinforced at the provincial and sub?provincial levels, and converted into action. The articles in this IDS Bulletin highlight some of the key features of undernutrition in Pakistan and its drivers. The correlates of undernutrition in Pakistan are no different than any other country: infection, poor diet quantity and quality, and unequal gender relations. High levels of poverty and fragility make the context for undernutrition reduction more difficult. Yet, the articles here also show that government nutrition interventions can work. But if the logjam of malnutrition in Pakistan is to be broken for good, malnutrition will have to be viewed as a development outcome – one that is a foundation for other outcomes such as economic growth and social cohesion – and this will only be achieved by viewing nutrition through a political?economy lens

Observational study of dexmedetomidine for hysteroscopy, cystoscopy and transrectal ultrasound biopsy

Dexmedetomidine shows promise of being an airway-stable drug. It is approved in Australia for procedural sedation. However, it is important to note that in the study on which this indication is based, all the subjects received a local anaesthetic block before their procedure or surgery. In this regard, as Health Canada has explicitly stated, further evidence still needs to be gained for the use of dexmedetomidine for procedural sedation without accompanying nerve blocks. The purpose of this current proof-of-concept, observational study is to provide further information about dexmedetomidine in three regards. First, can dexmedetomidine be used for procedural sedation per se (i.e. without local anaesthetic blocks)? Second, as opposed to results being averaged out over a wide variety of procedures, the current study examined the feasibility of dexmedetomidine-based procedural sedation for three specific procedures. Third, the current study aims to add to the pool of information regarding the appropriate dose of dexmedetomidine. As described in the dexmedetomidine product information, the Observer's Assessment of Alertness/Sedation Scale grades sedation from 5 (alert) down to 1 (deepest level of sedation). In the study on which dexmedetomidine's indication for procedural sedation is based, patients needed only to achieve a score of 4 and, thus, the approved product information recommends a loading dose of 1.0 g/kg followed by a maintenance infusion of 0.2 to 1.0 g/kg/hour. This current study aims to add to the literature regarding the safety of dexmedetomidine when used at higher than recommended doses

Engaging Development Partners in Efforts to Reverse Malnutrition Trends in Pakistan

After two decades of failed efforts to launch a national nutrition programme and nutrition action largely limited to low coverage interventions, a promising multisectoral nutrition scenario is unfolding in Pakistan led by provincial and regional officials and a well?coordinated group of development partners. The process has emerged from the confluence of three recent events in the country: the floods of 2010 and 2011; the passing of a constitutional amendment in 2010 which had the effect of dissolving the federal government's Ministry of Health and devolving responsibilities for health and nutrition to the provinces and regions; and a National Nutrition Survey in 2011 with results indicating that chronic malnutrition in the country had actually deteriorated over the previous decade. This article discusses the paths leading from these events to the present opportunities to address malnutrition aggressively and systematically, examines the sensitisation, advocacy and strategy development processes employed, and presents both the potential promise and the risks involved in the new provincial and regional nutrition undertakings

Parametric model between pulse transit time and systolic and diastolic blood pressures for non-invasive blood pressure estimation

Early detection of hypertension generally reauires continuous monitoring of blood pressure levels which is not facilitated by traditional methods such as the cuff which cannot be used in the normal environment for continuous monitoring due to the regular pressurization of certain body parts. Thus there is a need for non-invasive continuous pressure monitoring mechanism. In this paper we present a relationship between Pulse Transit Time (PTT) and Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) for continuous pressure monitoring and its experimental validation