Needs assessment for curricular reform of a post graduate paediatric training programme at a private university hospital in Karachi, Pakistan

In order to make and sustain changes in the curriculum, needs assessment is the key. We conducted a need assessment survey using a questionnaire based on a 7 point Likert Scale by residents and alumni. Over all response rate in the study was 77.5%. Fifty eight percent participants were females. Highest level of agreement (mean score 5.7) was found between the alumni and residents regarding the need to revise the content, teaching and assessment strategies in the programme. Twenty seven alumni (n= 38, 71%) had cleared their FCPS exams. The alumni thought that the existing teaching and assessment strategies do not facilitate in passing professional certificate exams (mean score 3.6). The mean attempts required by the alumni for clearing this exam was 3.3, and 84.2% considered their weak clinical skills as the reason for their recurrent failure

Hybrid Cell Selection-based Heuristic for capacitated multi-facility Weber problem with continuous fixed costs

This is the final version. Available on open access from EDP Sciences via the DOI in this recordLocation-allocation problem (LAP) has attracted much attention in facility location field. The LAP in continuous plane is well-known as Weber problem. This paper assessed this problem by considering capacity constraints and fixed costs as each facility has different setup cost and capacity limit to serve customers. Previous studies considered profitable areas by dividing continuous space into a discrete number of equal cells to identify optimal locations from a smaller set of promising locations. Unfortunately, it may lead to avoid choosing good locations because unprofitable areas are still considered while locating the facilities. Hence, this allows a significant increment in the transportation costs. Thus, this paper intelligently selected profitable area through a hybridization of enhanced Cell Selection-based Heuristic (CSBH) and Furthest Distance Rule (FDR) to minimize total transportation and fixed costs. The CSBH divides customer distribution into smaller set of promising locations and intelligently selected profitable area to increase possibility of finding better locations, while FDR aims to forbid the new locations of the facilities to be close to the previously selected locations. Numerical experiments tested on well-known benchmark datasets showed that the results of hybrid heuristic outperformed single CSBH and FDR, while producing competitive results when compared with previously published results, apart from significantly improving total transportation cost. The new hybrid heuristic is simple yet effective in solving LAP

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January-June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 – 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 – 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 – 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 – 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 – 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 – 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 – 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 – 5.401) were associated with higher medication complexity. Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity

Design Of Class-E Rectifier With DC-DC Boost Converter

This paper presents the design of Class-E rectifier with dc-to-dc boost converter. In this paper, Class E synchronous rectifier that regulates the output voltage at a fixed switching frequency of 1 MHz is presented by a dc-dc power conversion. The experimental prototype has been built and evaluated. The converter achieved 83.33 percent efficiency with less than 5 percent of ripple percentage of the rectifier. This integrated power converter with class E rectifier provides a low loss operation suitable for Very High Frequency (VHF) applications

Low diversity of fruit bats in the East Coast islands of Terengganu, Malaysia

Fruit bats are important pollinators for plants and play important ecological functions and services in the tropical rain forest. Fruit bats are considered more important for the ecological rehabilitation and health of the plant community on islands as other pollinators may not be able to fly across open sea and reach the island. This study was conducted to determine the diversity of fruit bats in three contrasting Terengganu offshore islands, namely, Pulau Perhentian, Pulau Bidong, and Pulau Redang. A total of 40 individuals of four species were captured using 10 mist nets during the 180 mist-net night sampling period from June 27, 2019 until February 29, 2020. Pulau Bidong had the highest number of bats captured (22), followed by Pulau Redang (18) and Pulau Perhentian (0). The most frequently captured species was Cynopterus brachyotis in both islands. No yield in Pulau Perhentian may be caused by tourism activity, seasonal movement following flowering and fruiting trees, or inadequate sampling effort in multiple sites. The data can be further used to determine factors in assessing threats and for future conservation by the management authorities

Efect of maleated anhydride on mechanical properties of rice husk filler reinforced PLA Matrix Polymer Composite

Polylactic acid (PLA) formulated from corn starch has a bright potential to replace the non-renewable petroleum-based plastics. The combination of PLA and natural fbre has gained interest due to its unique performance, as reported in many researches and industries. Meanwhile, rice husk produced as the by-product of rice milling can be utilised, unless it is turned completely into waste. Therefore, in the present study, the rice husk powder (RHP) was used as a fller in the PLA, so to determine the infuence of the fller loading on the mechanical properties of the PLA composite. A coupling agent was selected for treatment from two options, i.e., maleic anhydride polypropylene (MAPP) and maleic anhydride polyethylene (MAPE), by applying the agents with various loading contents, such as 2, 4 and 6 wt%. The composite was fabricated by using the hot compression machine. Both the treated and untreated RHP–PLA composites were characterised via the tensile, fexural and impact strength tests. The increase in the RHP loading content led to the decrease in the tensile and fexural strengths. The applications of the coupling agents (MAPE and MAPP) did not improve the tensile and impact strengths, but the fexural strength was enhanced

Behavioural activation therapy for anxiety disorders in adults

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: 1. To study the effects of BA in comparison with other psychological therapies (e.g. mindfulness therapy, CBT, dialectical behavioural therapy) for anxiety disorders in adults. 2. To study the effects of BA compared with pharmacotherapy for anxiety disorders in adults. 3. To study the effects of BA compared with treatment as usual, waiting list, placebo, and no treatment for anxiety disorders in adults

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London