Evidence Reversal: An exploratory analysis of randomized controlled trials from the New England Journal of Medicine

BACKGROUND: Evidence Reversal (ER) is the phenomenon whereby new and stronger evidence contradicts previously established evidence. OBJECTIVES: To quantify evidence reversals and to determine characteristics associated with reversibility. METHODS: Original articles from the New England Journal of Medicine (2000 to 2016) were screened for three inclusion criteria: tested a clinical practice; Randomized Controlled Trial design; and tested an established clinical practice. The proportion of RCTs that represented ER was determined. Association of trial characteristics with reversal was explored using logistic regression in order to inform a potential framework of reversibility. RESULTS: In total, 611 RCTs met the inclusion criteria, of which 54% were evidence reversals. Based on variables associated with ER, a reversibility framework was proposed, comprised of eight trial characteristics. CONCLUSION: More than 50% of RCTs published in the NEJM that test established practices are evidence reversals. The characteristics of RCTs that are associated with reversal will inform future research to further understand reversibility

Trade Liberalisation Policies, Intra-regional Trade and Opportunities for Sustainable Agricultural Development

Many of the Near East (NE) countries are currently opening their agricultural markets at three distinct but interacting levels: unilateral liberalisation, regional integration schemes and multilateral trade liberalisation. These changes hold important implications for intra- and extra-regional trade, use of agricultural resources and sustainability of agricultural development in the NE countries. Unilaterally, and since the late 1980s, most countries of the region have liberalised their agriculture sectors by eliminating or reducing input subsidies, removing or reducing guaranteed producer prices, reducing the number of subsidised commodities and liberalising the exchange rate and the trade regime. Most of the implicit and explicit subsidies for agricultural inputs and outputs were withdrawn. However, some of the NE countries were able to continue supporting agriculture mainly for food security reasons. Experiences showed that domestic reform is necessary but not sufficient condition for economic growth.

Using saltland in Pakistan : an Australian connection

Pakistan and Australia have a common enemy in salt. In each country millions of hectares of previously productive land have been affected by salt (or have the potential to become saline) because of inappropriate agricultural development. Since 1989 the Western Australian Department of Agriculture has participated in a research project in Pakistan which involves revegetation of salt land using Australian shrubs. Early results are very promising

Perspective and Prospects of Commencing New Education Policy (NEP) of Pakistan: A Review of Conference.

This article focuses on four important factors: Assessment, Curriculum and Text Books’ Policy, Teachers for quality education and Education and management, as formulated by Education and Literacy Department of Sindh Government. Open poll discussions and views given by educationists and experts were taken. All the views have been summarized for consideration by all concerned. Chief Minister Sindh, Arbab Ghulam Rahim, Javed Hussain, Education Minister, Hamida Khoro and Education Secretary to Government of Sindh, Ghulam Ali Pasha also shared their opinions on the new Education Policy and Government’s intention to ensure quality education in Sindh Province. The purpose of this article is to review and summarize the views presented in the Education Conference and reach fruitful conclusions. The implications are also made keeping in mind the targets of New Millennium Development Goals (NMDGs).Assessment, Curriculum and Text Book Policy, Education and Management, Literacy

Is Chaalia/Pan Masala harmful for health? practices and knowledge of children of schools in Mahmoodabad and Chanesar Goth, Karachi

OBJECTIVE: To determine the practices and knowledge of harmful effects regarding use of Chaalia and Pan Masala in three schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi, Pakistan. METHODS: To achieve the objective a cross-sectional design was used in three government schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi. Students of either gender drawn from these schools fulfilling the inclusion and exclusion criteria were interviewed using a pre-coded structured questionnaire. Along with demographic data, questions regarding frequency of Chaalia and Pan Masala use, practices of this habit in friends and family and place of procurement of these substances, were inquired. Knowledge was assessed about harmful effects and its source of information. In addition, practices in relation to that knowledge were assessed. RESULTS: A total of 370 students were interviewed over a period of six weeks, of which 205 (55.4%) were boys. The ages of the students were between 10 and 15 years. Thirty one percent of the fathers and 62% of the mothers were uneducated. The frequency of use of any brand of Chaalia was found to be 94% and that of Pan Masala was 73.8%. Eighty five percent of them were regular users. A large majority (88%) procured the substances themselves from near their homes. Ninety five percent of the children had friends with the same habits. Eighty four percent were using the substances in full knowledge of their families. Chaalia was considered harmful for health by 96% and Pan Masala by 60%. Good taste was cited as a reason for continuing the habit by 88.5% of the children and use by friends by 57%. Knowledge about established harmful effects was variable. Knowledge about harmful effects was high in both daily and less than daily users . CONCLUSION: The frequency of habits of Chaalia and Pan Masala chewing, by school children in lower socio-economic areas is extremely high. The probable reasons for this high frequency are taste, the widespread use of these substances by family members and friends, low cost and easy availability

FACTORS INFLUENCING ACCEPTANCE OF CHATGPT AMONG STUDIOUS STUDENTS FOR ACADEMIC PURPOSES

As we are living in the digital age, also known as the new media age, there is no denying the fact that our lives are shaped by technology to the extent that we have become dependent on it for our day-to-day matters. Although technology, more specifically Artificial Intelligence (AI) has made our lives easier and efficient. One such tool that gained instant popularity and usage after its invention is ChatGPT. Though ChatGPT is benefitting people in various fields but its use in academia still has acquired mixed reviews. While some see its potential for enhanced learning, other view it as a way for students to cheat and plagiarize (Kirk, 2023). Research on the use of ChatGPT in educational setting has been conducted in a few countries but still it needs a lot of research in the Pakistani context. The current paper will find out factors influencing acceptance of ChatGPT among studious students for academic purpose. Moreover, this paper also has a qualitative part which will review the challenges and opportunities of using ChatGPT in higher education in Pakistan by doing a SWOT analysis. Data for the quantitative part will be collected through questionnaire, from engineering students of National Sciences and Technology (NUST) university. In the light of the results gained after data analysis, a comprehensive discussion on the opportunities and challenges of using ChatGPT in Pakistani academic setting will be done. The potential for abuse and exploitation will also be covered in the paper's discussion of the ethical issues. ChatGPT is one of the first of its kind available to general public and more are on its way. Thus, we have to accept its presence in our lives. We need to open dialogue so that AI in education reaches its full potential, which can have more opportunities than challenges

Risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis

Objective: To determine the frequency and distribution of various risk factors and behaviours for coronary artery disease (CAD) among ambulatory Pakistanis.Methods: It is a cross-sectional descriptive study carried out at the Aga Khan University Hospital, a teaching hospital in Karachi. All the subjects were adults (18-60 years) presenting at the general checkup clinic with no history or evidence of CAD by convenient sampling method. Demographic variables included risk factors and behaviors including diabetes, hypertension, dyslipidemia, family history of heart disease, obesity, smoking and sedentary lifestyle.Results: Among 370 ambulatory Pakistanis, the proportions of major risk factors for CAD were: sedentary life style 72%, family history 42%, dyslipidemia 31%, obesity 24%, hypertension 19% and diabetes mellitus 15%. Diabetes, hypertension and dyslipidemia were poorly controlled in the study population. Proportions of the three major risk factors (smoking, hypertension and dyslipidemia) occurring singly, doubly and all three together in the study population were found to be 39%, 11% and 1%, respectively. Data were also analyzed for risk factors by comparing those with and without family history of CAD to eliminate any bias. The results were not statistically significant except for the sedentary life style (P=0.016).Conclusion: There is a high prevalence of CAD risk factors in this study population. Modifiable risk factors like diabetes, hypertension and high cholesterol need better control. Preventive screening programs and healthy lifestyle behaviours need to be emphasized upon in the community