Knowledge gain of the non-vascular surgeons after attending a course on traumatic vascular emergencies

Objective: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies.Methodology: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives.Results: Total of 21 participants attended the workshop with mean age of 29 ± 6.06 years. Majority of participants 15 (71%) were surgery residents from different subspecialties. Only 3 (14%) had prior exposure in Vascular Surgery. Mean pretest score was 11.9 ± 4.27 (59.52% ± 21.3) which improved to 16.14 ± 3.69 (81.6% ± 16.6). Gain in knowledge was measured using paired t-test and there was 21% of gain in knowledge of the participants compared between the pretest and posttest score. Overall participants found this workshop to be very useful in refining their skills and learning innovative techniques in managing vascular emergencies.Conclusions: Carefully designed workshop improves the knowledge of non-vascular surgeons in dealing with common vascular emergencies

Implementation of ventilator bundle in pediatric intensive care unit of a developing country

The aim of this study was to assess the frequency of VAP(ventilator associated pneumonia) after strict implementation of ventilator bundle in PICU. Medical records of all children (age 1 month - 16 years) were retrospectively reviewed, who were on mechanical ventilation (MV) for more than 48 hours and received all key components of ventilator bundle from January 2012 to December 2014. Out of 1050, 565 (54%) patients were enrolled. The mean age was 4.02 SD 4.29 years and 62 (69%) were male. The indications of MV were respiratory illness (54%), neurological illness (31%), shock (9%), and postoperative care (6%). The mean duration of MV was 7.05 SD 5.4 days. Only 4 patients (0.7%) developed VAP. The incidence-density of VAP was 1.6 per 1000 ventilator days. The strict implementation of simple, inexpensive interventions (ventilator bundle) in care of mechanically ventilated children can decrease significantly VAP even in resource-limited country

Comparison of Residual based Cointegration Tests: Evidence from Monte Carlo

In this article ten cointegration tests based on residuals of cointegrating equation are compared on basis of stringency criterion: a robust technique for comparison of tests using Monte Carlo simulations. Two tests i.e. Phillips and Ouliaris’ Pu and Choi Durbin-Hausman statistic are the leading performers and are recommended for any sample size. The remaining eight tests are recommended for only large sample sizes of 200 or greater. The use of all these ten tests is not recommended when presence of both intercept and linear time trend is assumed in cointegrating equation unless the sample size is very large i.e. greater than 200

Comparison of Residual based Cointegration Tests: Evidence from Monte Carlo

In this article ten cointegration tests based on residuals of cointegrating equation are compared on basis of stringency criterion: a robust technique for comparison of tests using Monte Carlo simulations. Two tests i.e. Phillips and Ouliaris’ Pu and Choi Durbin-Hausman statistic are the leading performers and are recommended for any sample size. The remaining eight tests are recommended for only large sample sizes of 200 or greater. The use of all these ten tests is not recommended when presence of both intercept and linear time trend is assumed in cointegrating equation unless the sample size is very large i.e. greater than 200

Feasibility of Primary PCI as the Reperfusion Strategy for Acute ST elevation MI at PIMS

Objective: To determine the feasibility of primary PCI in terms of frequency of patients with acute ST elevation MI found to have a first-medical-contact to needle time of 90 minutes.Methodology: The descriptive, cross sectional case series was conducted at department of Cardiology, PIMS, Islamabad from January 2017 to April 2017Results: A total of 350 patients were enrolled into the study, 67% (235) of which were males and 33% (115) females. Mean age of the participating population was 54 ±7.8 years. The mean first medical contact needle time was 2.3±1.1 hours, out of which a vast majority (73%) fell into the 90 minutes range. The patients had a median first medical contact to needle time of 74 minutes.Conclusion: The study concluded that majority of patients presenting to the emergency department with acute STEMI were found to be feasible for primary PCI as the reperfusion strategy with an FMC to needle time of less than 90 minutes. Therefore, accelerated efforts need to be made to develop this center as a primary PCI capable facility providing such standards of care to patients with ST-elevation MI

Effect of Fluxing Additive on Sintering Temperature, Microstructure and Properties of BaTiO\u3csub\u3e3\u3c/sub\u3e

Various fluxing materials are added to technical ceramics in an attempt to lower their sintering temperatures and make their processing economical. The effect of 0·3wt% Li2CO3 addition on the phase, microstructure, phase transition temperatures and dielectric properties of BaTiO3 was investigated in the present study. The addition of 0·3wt% Li2CO3 was observed to lower the optimum sintering temperature by ∼200◦C with no second phase formation and cause a five-fold reduction in grain size. Rhombohedral-to-orthorhombic and tetragonal-to-cubic phase transitions at the expected temperatures were evident from the Raman spectra, but the orthorhombic-totetragonal phase transition was not clearly discernible. The persistence of various phase(s) at higher temperatures in the flux-added materials indicated that the phase transitions occurred relatively slowly. A decrease in dielectric constant of Li2O-added BaTiO3 in comparison to pure BaTiO3 may be due to the diminished dielectric polarizability of Li+ in comparison to Ba2+

Depression as a Risk Factor for Coronary Artery Disease: Myth or Verity

Objectives: To determine the frequency of depression in patients with ischemic heart disease, subgroup analysis of prevalence of depression in patients with heart failure, acute STEMI and non STEMI-ACS and the effect of hospital stay and treatment of primary cardiac illness on depression scores.Methodology: All patients with heart failure, acute STEMI and non STEMI-ACS, presenting to cardiology clinics over a period of March-August, 2016 with a pre-calculated sample size were enrolled into the study by consecutive sampling. HAM-D questionnaire was administered at the time of hospital admission and discharge. SPSS was used for data analysis.Results: A total of 102 patients were included in the study out of which 47 (46%) were females and 55 (54%) were males. The mean age of the study population was 49.5±12 years. At the time of admission, 91/102 (89.2%) patients were found to be depressed, 32 (31.4%) had mild depression, 29 (28.4%) had moderate depression, 10 (9.8%) had severe depression and an alarming number (20 i.e. 19.6%) patients had very severe depression. At the time of discharge, 82/102 (80.3%) patients were found to be depressed, 35 (34.3%) had mild depression, 31 (30.4%) had moderate depression, 12 (11.8%) had severe depression and only 4 (3.9%) had very severe depression. The mean change in HAM-D score during hospital admission was -3.24±4 (Maximum +26, minimum -23). The difference in depression scores during hospital stay tended to inversely correlate with length of hospital stay. A greater proportion of patients with the diagnosis of STEMI had a severe or very severe depression.Conclusion: Depression was found to be alarmingly prevalent in acute coronary syndrome affectees and hospital stay and treatment led to a mean fall in the depression scores

Mechanism of Corrosion and Erosion Resistance of Plasma‐ Sprayed Nanostructured Coatings

There has been a dramatic increase in recent years in a demand for tough, wear‐resistant, abrasion, erosion, and corrosion‐resistant coatings for petroleum, chemical, aerospace industry, and processes encountering harsh environments such as paper and pulp equipment (the ball valve for high‐pressure leaching). Whereas sufficient information on mechanical properties, such as abrasion, wear, and fatigue, has been gathered over the years, work on the resistance of these coatings to erosion and corrosion is seriously lacking. In the work reported, it has been shown that nanostructured TiO2 coatings offer superior physical and mechanical properties compared to conventional TiO2 coatings. Three different types of plasma‐sprayed titanium dioxide coated samples on mild steel substrate were employed for investigation. The feedstocks used were Sulzer Metco nanopowders designated as AE 9340, AE 9342, and AE 9309. Powder 9340 was a precursor. The corrosion resistance of nanostructured TiO2 coating was dictated largely by surface structure and morphology. The distribution and geometry of splat lamellae, contents of unmelted nanoparticles, and magnitude of porosity are the important factors that affect corrosion resistance. TiO2 showed excellent resistance to corrosion in 3% NaCl. The maximum corrosion rate was observed to be 4 mils per year as shown by polarization potential and weight loss studies. The erosion‐corrosion resistance of the plasma‐sprayed nanostructured titanium dioxide coatings depends largely upon the characteristics of feed powder and its reconstitution. Dense, uniform, and evenly dispersed nanostructured constituents provide a high coating integrity, which offers high resistance to erosion‐corrosion. A mechanism of erosion‐corrosion is explained in the chapter with a schematic diagram. The findings show that the nanostructured TiO2 coatings offer superior resistance to corrosion, erosion, and environmental degradation

Hydrophobicity — A Green Technique for Enhancing Corrosion Resistance of Alloys

The corrosion phenomenon is as old as the age of the planet. The cost of corrosion has risen alarmingly with industrial progress and it is estimated to be around 300 billion dollars or 3 to 4.5% of the GNP of developed nations. Thousands of alloys have been developed to control corrosion, which is a major consideration in the development of new ferrous and non-ferrous alloys. Several corrosion control techniques such as inhibitor treatment, coatings, cathodic protection, alloying additions, and designing for corrosion protection have been developed to combat corrosion. Despite their merits, techniques such as inhibition treatment and coatings are limited by their adverse effect on the environment because of their volatile organic components. Due to an increasingly alarming carbon footprint, there is a growing global concern to keep the environment clean. Hence, a great need exists to replace the current control methods by eco-friendly methods. The potential of the green technology of hydrophobicity has therefore been exploited to control corrosion by fabricating hydrophobic surfaces on alloys and these surfaces have shown highly promising results. This technology offers a novel method to control corrosion of metals, alloys, polymers and composites

Use and Quality of Bottled Water in Bahawalpur City, Pakistan: An Overview

As a basic need of human life, the place of safe potable water cannot be ignored elsewhere. Therefore, themain objective of the current study was to take an overview of the main source of water, expenditure on waterpurchasing and use quality of bottled water in Bahawalpur city. Primary data were gathered through a structuredquestionnaire during a field survey in selected five residential areas as sample sites i.e. Model town A, Model town B,Shahdrah, Satellite town, and Islami colony, while the secondary data were collected from PCRWR and a few websources. Data were gathered from 150 respondents (30 from each study site) and analyzed in SPSS 17 software byapplying descriptive statistics (frequencies and percentages) to get a generalized picture regarding the main source ofwater, use and quality of bottled water in the study area. Findings make it clear that majority of the respondents werefetching water from government filtration plants following the electric pumps. Moreover, various local watercompanies (e.g. Pineo, Piyas, Aquafina, Kinley, Al-Shiffa, Life Water) were also supplying water in the study area.Particularly, the use and demand for bottled water are increasing day by day as people have serious concerns on qualityrelated issues of water. Bottled water was available in different quantities from 0.5 liters to 19 liters with respectiveprices that were purchased from various departmental and medical stores or via home delivery service. But the qualityof the bottled water was not satisfactory and up to the standards. The PCRWR laboratory analysis of bottled watersamples show significant variations and alarmingly different brands i.e. Blue water, Kalash pure water and Pan Purawere found chemically and microbiologically unfit for drinking purposes. So, it is suggested that regular monitoringand quality control steps by local government in the private sector would ensure the effective and secure potable waterdeliverance