How early do antibiotics have to be to impact mortality in severe sepsis? A prospective, observational study from an emergency department

BACKGROUND: The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization. METHODS: Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values \u3c 0.05 were considered significant. RESULTS: One hundred and eleven patients were enrolled. Severe sepsis was present in 52% patients; the most frequent organism isolated was Salmonella typhi (18%). Overall mortality was 35.1%. One hundred (90.1%) patients received intravenous antibiotics in the Emergency room; average time from triage to actual administration was 2.48 +/- 1.86 hours. The timing of antibiotic administration was significantly associated with survival (F statistic 2.17, p = 0.003). Using a Cox Regression model, we were able to demonstrate that survival dropped acutely with every hourly delay in antibiotic administration. On multivariate analysis, use of vasopressors (adjusted OR 23.89, 95% CI 2.16,263, p = 0.01) and Escherichia coli sepsis (adjusted OR 6.22, 95% CI 1.21,32, p = 0.03) were adversely related with mortality. CONCLUSIONS: We demonstrated that in the population presenting to our emergency room, each hourly delay in antibiotic administration was associated with an increase in mortality

Multimodal Speech Enhancement Using Burst Propagation

This paper proposes the MBURST, a novel multimodal solution for audio-visual speech enhancements that consider the most recent neurological discoveries regarding pyramidal cells of the prefrontal cortex and other brain regions. The so-called burst propagation implements several criteria to address the credit assignment problem in a more biologically plausible manner: steering the sign and magnitude of plasticity through feedback, multiplexing the feedback and feedforward information across layers through different weight connections, approximating feedback and feedforward connections, and linearizing the feedback signals. MBURST benefits from such capabilities to learn correlations between the noisy signal and the visual stimuli, thus attributing meaning to the speech by amplifying relevant information and suppressing noise. Experiments conducted over a Grid Corpus and CHiME3-based dataset show that MBURST can reproduce similar mask reconstructions to the multimodal backpropagation-based baseline while demonstrating outstanding energy efficiency management, reducing the neuron firing rates to values up to \textbf{$70\%$} lower. Such a feature implies more sustainable implementations, suitable and desirable for hearing aids or any other similar embedded systems

Low Private Investment and Government Failure as the Binding Constraints to Pakistan’s Economy Growth Diagnostics Analysis

This research targets the most binding constraints in the economy of Pakistan during the period from 2007 to 2013 using Husmann-Rodrick-Vilasco (2005) decision tree. The growth diagnostics proves that the economy of Pakistan undergoes and passes from the stages of dilemma and huge economic complexities during this period. The economic growth of Pakistan is continuously being affected by structural problems including domestic energy crisis, low investment, high inflation, and security issues. Growth diagnostics points out to four major constraints to economic growth of Pakistan and these are: energy crisis, inadequate market development, poor performance of institutions, and lack of efficient public sector management. Only two of these constraints are explained in this study including low level of private investment and government failure. For policy implications, several areas like private sector growth, good governance, institutional strength, market development, macroeconomic stability, infrastructure development are important to make considerable reforms

An Empirical Study of Consumer Buying Behaviour Towards Organised Retailing

The main objective of this study is to examine the consumer buying behaviour and to identify the factors involving in purchase decisions in organized retail sector. In order to establish a structure for consumer behaviour research towards organised retail, it is helpful to begin the study by taking into consideration different models and theories of consumer behaviour given by a number of authors.  Under this article the researcher tried to identify a set of dimensions in the literature which can be used to exemplify and differentiate the various viewpoints on consumer behaviour research. During 1960s the consumer behaviour emerges as a different field of research and was characterized by two different aspects, the positivist and the non-positivist. The positivist model covers the economic, behavioural, cognitive, motivational, attitudinal, qualitative and situational perspectives; these aspects are referred to as the traditional models as they occur before the development of non-positivist models.The positivist factor, which is still the dominant factor, accentuates the dominance of human cause and that there is a single, objective fact that can be exposed by science. This paradigm regards the world as a rational and ordered place with a clearly defined past, present, and future. The assumption of rationalism is therefore fundamental to the traditional perspective

Assessing the Determinants of Savings in Pakistan: An Evidence from PSLM 2010-11

The present study aims at investigating the determinants of the savings in Pakistan by using Pakistan Social and Living Standards Measurement (PSLM) survey data collected by Pakistan Bureau of Statistics (PBS) for the year 2010-11. The Multiple Regression Model is estimated for finding out the household saving determinants. The results reveal that savings have positive relationship with income, livestock, number of earner, while these are negatively related with education, gender of the household head and poverty in Pakistan. The regional level analysis reveals that marginal propensity to save is higher in rural areas as compared to urban counterpart. Among the provinces it is the highest in Punjab and lowest in Sindh. To promote savings among households in Pakistan, policies aiming at increasing income of the people should be formulated and implemented. Other policies include creation of job opportunities and provision of loan for livestock especially for the poor and females

Analysis of Energy Crisis, Energy Security and Potential of Renewable Energy: Evidence from Pakistan

Over the last thirty years, Asian countries have become a chief player in the worldwide scene. Pakistan is facing an acute energy disaster since last decade that impacts on social and economic development. Sustainable energy supply is an essential feature for the economic growth of any society. From the last five years, Pakistan is facing a shortfall between 4,000-5,000 megawatt. This study inspects the association between energy security, energy crisis, energy demand, energy supply, and renewable potential in Pakistan. It also evaluates the final energy demand-supply gap, provincial renewable energy distribution, sectorial distribution, and policy recommendation for future energy. For this study, we applied renewable and non-renewable energy scenarios during 2014-2035 and Market-Allocation method to prove the energy situation in Pakistan. The outcomes show that renewable resources are the best option in reducing energy risk, import cost, and enhance environmental and economic sustainability. With the objectives of our key findings, targeted suggestions and policies are given

Estimating the Role of Prices towards Poverty in Pakistan

This study investigates the effects of prices on poverty by applying the methodology of Son and Kakwani (2006) using the two data sets of Pakistan Living Standard Measurement Survey (PSLM) of 2007-08 and 2010-11 in Pakistan. The study calculates three poverty measures such as headcount ratio, poverty gap, and severity of poverty. The study also estimates the price elasticities of poverty for two commodities groups such as food and fuel. The study decomposes the price elasticity of poverty measures into two components; income component and distribution component. The study also estimates pro-poor price index (PPPI) for all the poverty measures. The results show that there in reduction in poverty from 16 % in 2007-08 to 12 % in 2010-11.  The results reveal that food price elasticity of poverty is greater than fuel price elasticity of poverty. The income as well as distribution components contribute to increase poverty, but income component contributes more than the redistribution one towards increase in poverty. The results also disclose that the increases in the prices of both commodities hurt the poor more than the non-poor. The increase in price of food commodities disturbs the poor more than the increase in prices of fuel commodities during 2007-08 and 2010-11. The government should compensate the poor and give some subsidies regarding food

Assessing the Determinants of Savings in Pakistan: An Evidence from PSLM 2010-11

The present study aims at investigating the determinants of the savings in Pakistan by using Pakistan Social and Living Standards Measurement (PSLM) survey data collected by Pakistan Bureau of Statistics (PBS) for the year 2010-11. The Multiple Regression Model is estimated for finding out the household saving determinants. The results reveal that savings have positive relationship with income, livestock, number of earner, while these are negatively related with education, gender of the household head and poverty in Pakistan. The regional level analysis reveals that marginal propensity to save is higher in rural areas as compared to urban counterpart. Among the provinces it is the highest in Punjab and lowest in Sindh. To promote savings among households in Pakistan, policies aiming at increasing income of the people should be formulated and implemented. Other policies include creation of job opportunities and provision of loan for livestock especially for the poor and females

Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosa

Fibrolipomatous hamartoma (FLH) is a rare congenital condition that presents with a benign overgrowth of the bone and fibroadipose tissue termed as macrodystrophia lipomatosa (MDL). Although commonly seen in the median nerve, other peripheral nerves can be involved. Diagnosis can be made on magnetic resonance imaging (MRI) due to the characteristic coaxial cable appearance on axial images and the spaghetti appearance on sagittal images. Histology shows mature adipose and fibrous tissue infiltrating the epineural and perineural compartments. Multiple or debulking surgeries are often needed, with an emphasis on cosmetic aspects. We present one such case in which wide margin excision and sural nerve graft were carried out

Distributed Optical Fiber Sensing in Railway Engineering

There are many technologies associated with optical fiber sensing (OFS) and depending upon the type of application, a specific OFS technology plays a crucial role in the associated application as compared to the use of conventional sensing technologies with these applications. The same is true with the railway industry and the two most suitable OFS technologies in the railway sector are distributed acoustic sensing (DAS) and fiber Bragg grating (FBG). The two mentioned technologies in association with the railway industry are explained briefly in this chapter