Efficacy of early warning systems in assessing country-level risk exposure to COVID-19

COVID-19 has evolved as a pandemic causing unprecedented damages and disruptions to all spheres of life including healthcare, transportation, supply chains, education, and economy, among others. Pandemics are very low-probability events associated with deep uncertainty about the timing of such events and ensuing damages. National policy-makers generally rely on a set of risk indices associated with natural disasters and pandemics to assess the country’s vulnerability and strategy formulation for such rare events. This paper explores the efficacy of early warning systems (disasters and epidemics-based risk ratings) in predicting the country-level exposure to COVID-19. Utilizing three real data-sets reflecting the risk exposure of individual countries to disasters, epidemics, and COVID-19, we explore relations among the associated risk dimensions, namely hazard and exposure, vulnerability, and lack of coping capacity. A comprehensive methodology integrating Pearson’s correlation, ANOVA, and Bayesian Belief Networks-based techniques is adopted to explore and triangulate relations among the three risk indices. Results show that the risk ratings associated with epidemic risk and COVID-19 risk are statistically strongly correlated. However, only the vulnerability dimension of epidemic risk significantly influences the two risks.</p

Recurrence Relations for Marginal and Joint Moment Generating Functions of Topp-Leone Generated Exponential Distribution based on Record Values and its Characterization

The exact expressions and some recurrence relations are derived for marginal and joint moment generating functions of kth lower record values from Topp-Leone Generated (TLG) Exponential distribution. This distribution is characterized by using the recurrence relation of the marginal moment generating function of kth lower record values

Assessment of Knowledge of Cardiopulmonary Resuscitation among Pharmacy Students of Mirpur, Azad Jammu & Kashmir

Introduction: Cardiopulmonary resuscitation (CPR) is the most important lifesaving technique in several emergency situations such as cardiac arrest. In future, being part of health care professionals, pharmacy students are deemed to possess basic skills and expertise which are required to perform CPR. Objective: To access the knowledge of cardiopulmonary among pharmacy students of Mirpur Azad Jammu & Kashmir. Methods: It was a questionnaire-based, descriptive cross-sectional study, conducted among 4th and 5th year students of two Pharmacy institutes of Mirpur AJ&K from November 2018 to January 2019. A pre-tested questionnaire from previous study was used to collect data. It comprised of 13 dichotomous questions with “Yes/No” options, regarding knowledge of CPR. Descriptive statistics was used to unfold the demographic characteristics. Inferential statistics (Kruskal Wallis and Man Whitney) tests were used for evaluating difference between dependent continuous variables and independent variables and Chi-square was applied to determine difference between grouped variables. P-value of less than 0.05 is considered significant. The data was analyzed using SPSS version 20. Result: Overall, 131 out of 150(response rate= 92%) students participated in current study. Gender distribution among the participants was almost equal with 66 males (50.4%) males and 65 (49.6%) females took part in current study. Participants of the age group 21-23 years (n=88, 67.2%) were dominant. Only few students (n=23, 17.6%) reported to have taken training in CPR previously. Eighty-eight (66.7%) had average knowledge of CPR. No significant differences among male and female, 4th and 5th year students of both the institutes were found. Conclusion: The study revealed that knowledge level of CPR is adequate in most of the students of pharmacy. However, further improvements are required to perform CPR in an efficient manner. Thus, training in CPR should be mandatory in the pharmacy curriculum

Phosphorus Fertilizer Response to Onion (Allium cepa L.) Yield in Punjab, Pakistan

Background: Onion (Allium cepa L.) is one of the most essential plants in food with high nutritional value. However, application of right dose of phosphorous (P) is one of the constraints to the profitable onion yields in soils deficient in P.Methods: A systematic study to confirm the best dose of P was conducted for six years in the P deficient soil in farmers’ fields. Based on the findings obtained from 2008-09 to 2010-11, the research was undertaken to determine the effect of different phosphorus levels on the yield of onion in the Randomized Complete Block Design (RCBD) with a total of 114 replicates  in 2011-12 to 2012-13. Four treatments (160, 210, 260 and 310 kg P2O5 ha-1) were tested with N and K at 100 kg ha-1.Results: From the results of this investigation, the variance analysis showed the substantial P impact. The maximum marketable bulb yield (19.03 t ha-1) was obtained from the fertilizer combination NPK @ 100-310-100 kg ha-1 and was shown to be statistically higher than all other treatments.Conclusion: Nonetheless, the nutshell of the overall economic study is that poor farmers (Land holders >12 acres) may have options to select the NPK fertilizer combination @ 100:210:100 kg ha-1 and the average farmer may have options to select the NPK fertilizer combination @ 100:260:100 kg ha-1. But rich farmers (Land holders >25 acres) who can spend more money on fertilizers and are interested in the higher gross margin should follow the combination of NPK fertilizers @ 100:310:100 kg ha-1 to profitably increase their gross margin and maintain soil fertility for onion cultivation in Punjab, Pakistan.   Keywords: Onion; NPK; Plant nutrition; Phosphorus; Pungency

A Review on Pharmaceutical Waste Pollution in Water: Extent, Management and Removal Strategies

Pharmaceutical waste and presence of hazardous pollutants in them is a growing concern due to their fate, origin, higher rate of utilization and varying nature of active ingredients resulting in water contamination. However, there is few research on the graving nature of the problem. Cascading impacts on human and ecosystems can be expected from contaminated groundwater and other aquatic channels. While, various technologies used and studied for the removal/reduction/sedimentation of pharmaceutical pollutants. At the initial stages, level of toxicity should check with respect to flora, fauna, environment, and human health. Furthermore, the production of by-products from pharmaceutical pollutants should also be checked and regulated. These by-products can be much more toxic, than the original contaminants and can exert significant toxic effects. It was concluded that there should be ongoing efforts to reduce the cost associated with pharmaceutical waste and their pollutants removal processes to ensure sustainability in the environment and human being

External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia

From Crossref journal articles via Jisc Publications RouterBackground Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.11pubpub

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good