A Study to Measure the Effectiveness of Education at Alternative Learning Pathway (ALP) Program at Quetta, Sibi and Naseerabad

Abstract Alternative Learning Pathway program is started in seven districts of Baluchistan, UNICEF is funding and providing financial and technical support of under the umbrella of education department this is program designed for those children who have not been to school or have left it due to different causes, projects aim is to mainstream these children in short period of 3 year to pass out primary level for their better future. Researcher has chosen three districts Quetta, Sibi and Naseerabad, five centers from each district. Objectives of the study is to check the effectiveness of ALP centers and sustainability, following are the objective, Head teachers facing the issues in ALP centers, increasing the enrollment and address the drop out of students in ALP centers,. support students’ learning in ALP curriculum in ALP centers, improvement of teaching competency of teachers, observe the text book quality, researcher shared those issues with education department for permanent solution, the curriculum was supportive for ALP students, and was satisfactory but still teachers need trainings. The methodology was used as follow, the samples were selected of 26 teachers, 240 students 16 parents 5 educational administrators and 2 curriculum developer. The instrument was used through questionnaire and interview. Population migration is another issue for teacher as discussed above that his salary depends on the child attendance if they migrate class strength reduces and his salary becomes less. This study conducted to check the effectiveness of ALP, Overall results of ALP centers and student’s performance is satisfactory; teachers are very hardworking and committed with their duties. Keywords: Alternative, Learning Pathway, Education, Effectiveness

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Preparation and properties of complexes of platinum group metals in unusual oxidation states

The present work describes the synthesis and reactivity of Pt(III) complexes\ua0with different carboxylate bridges. Besides the other analytical techniques,\ua0multinuclear NMR in general, and 195Pt NMR spectroscopy in particular was the\ua0major technique used to study these reactions.Reactions of [Pt(NO2)4]2- or [Pt(NO2)2(H2O)2] with RCO2H/CF3SO3H/H2O\ua0(R\ua0= C2H5, n-C3H7, n-C4H9, CF3) resulted in the formation of new dimeric platinum(III)\ua0complexes with longer-chain carboxylates as bridging ligands, [{(H2O)Pt(µ-\ua0O2CR)2}2](CF3SO3)2. The crystal structure of the compound with R = n- C4H9 has\ua0been determined.All these reactions were monitored by 195Pt NMR spectroscopy. The reactions\ua0followed a similar pathway to the formation of the acetate analogue. Various Pt(II)\ua0and Pt(III) complexes with different number of bridging and non-bridging ligands\ua0were obtained in solutions which finally formed the quadruply bridged Pt(III) dimers.\ua0There were some significant differences from the acetate synthesis. The final\ua0reaction solution for all of the longer-chain alkyl carboxylate complexes was blue or\ua0green and the solids isolated were green, whereas the acetate analogue was orange.\ua0UV-Vis spectroscopy of the compounds performed indicated that the blue colour was\ua0lost under some conditions where Pt(III) complexes retained their intigrity, therefore\ua0these blue colours are due to trace impurities which persist in some solvents (i.e.\ua0nitromethane) and not in others (i.e. thf). The formation of the final product was faster\ua0as the length of the alkyl group of the carboxylate ligand increased.These complexes were soluble in many organic solvents but decomposed to\ua0platinum metal rapidly in some solvents (acetone, methanol, ethanol, dmso). In dmf\ua0the tetra-bridged structure was retained but complete or partial displacement of the\ua0aqua ligand by dmf was observed. In thf the carboxylate compounds were soluble and\ua0stable for 10-12 h. The 19F NMR spectrum of the compound with R = CF3 in thf and\ua0thf/H2O indicated that this compound is stable in these solvents.\ua0 \ua0 \ua0 \ua0 \ua0 \ua0 \ua0 \ua0 \ua0 \ua0 ........................

Kinetics of homogeneous hydrogenation of 1-pentene catalysed by bis(diphenylphosphinoethylamine) chlororhodium (I)

Catalytic homogeneous hydrogenation of 1-pentene catalyzed by bis(diphenylphosphinoethylamine) chlororhodium(I) [RhClHN(CH2CH2PPh2)2](1̲) was investigated over the temperature range 10-20°C under 1 atm of hydrogen pressure. The dependence of the rate of hydrogenation on temperature, catalyst and substrate concentration in solution is reported. The thermodynamic and activation parameters for the hydrogenation of 1-pentene catalyzed by 1̲ were computed and compared with those of cyclohexene and 1-heptene

Thermodynamics of homogeneous hydrogenation: Part VI. Thermodynamics of the homogeneous hydrogenation of cyclohexene catalyzed by Rh(I) and Ir(I) complexes of polydentate phosphine ligands

The oxidative addition of H2 to the mixed ligand Rh(I) complex [RhCl(PPh3)(diphos)] 1 and the Rh(I) and Ir(I) complexes of the terdentate ligands NP3, [N(CH2CH2PPl2)3] and triphos, [PhP(CH2CH2PPh2]2 MLC1 2-5 (where M=Rh(I), Ir(I); L=NP3, triphos) proceeds at 30°C and 1 atm of Ha in ethanol-benzene with the formation of the thermodynamically stable cis dihydrides [RhCl(PPh3)(diphos)(H)2] 1a, 1b; [RhCl(NP3)(H)2] 2a, 2b; [RhCl(triphos)(H)2] 3a, 3b; [IrCl(NP3)(H)2] 4a and [IrCl(triphos)-(H)2] 5a, 5b characterized by their hydride NMR in situ. The hydrides of iridium 4a, 4b, 5a, 5b are more stable in solution than their corresponding rhodium analogues. The homogeneous hydrogenation of cyclohexene catalyzed by complexes 1-5 was investigated in the temperature range 10-40°C at 0.6-1 atm of h2 partial pressure. Thermodynamic parameters for the formation of the dihydrido complexes of 1-5 and the monoolefin complexes of Rh(I) and Ir(I) were computed. The activation parameters corresponding to the rate constant k for the homogeneous hydrogenation of cyclohexene were also calculated. The enthalpy of formation δHo for the formation of hydrido and olefin complexes are more exothermic for the Ir(I) complexes compared to the Rh(I) complexes. The catalytic activity of the complexes decreases in the order 2 > 1 > 3 > 4 ≈ 5. The catalytic activity of the chelates 2 and 4 of the potential terdentate ligand NP3 with a large chelate ring is much higher than complexes 3 and 5 of the rigid terdentate ligand triphos. The catalytic activity of the Rh(I) and Ir(I) complexes of triphos is more than those of the NP2 [HN(CH2CH2PPh2)2] complexes. An inverse relationship exists between δHo, the enthalpy of formation of the hydrido complexes and δH‡, the enthalpy of activation of the hydrogenation reaction of cyclohexene by a variety of polydentate complexes of Rh(I) and Ir(I) with P or N, P donors

Thermodynamics of homogeneous hydrogenation: Part II. Thermodynamics of the homogeneous hydrogenation of 1-heptene catalysed by bis(diphenylphosphinoethyl)amine chlororhodium(I)

The homogeneous hydrogenation of 1-heptene catalysed by bis(di- phenylphosphinoethyl)amine chlororhodium(I) (RhClHN(CH2CH2PPh2)2, or RhCl(DPPA)) over the temperature range 10-40°C is reported. The dependence of the rate of hydrogenation on factors such as temperature (10-40°C), catalyst, substrate and H2 concentrations (partial pressure 0.6-1atm) was studied and reported. The order of the reaction with respect to [1-heptene] and [H2] is fractional, and that to [catalyst] is first order. A mechanism for the homogeneous hydrogenation reaction is proposed whereby the coordination of the olefin to the dihydridorhodium(III) catalyst intermediate is rate-determining, before the rapid transfer of the hydrides to the olefin to form the alkane. The thermodynamic parameters corresponding to the equilibrium constants K1 and K2 for the formation of the dihydrido and olefin complexes, respectively, and the activation parameters corresponding to the rate constant k' (rate-determining step) were calculated. The thermodynamic parameters involving the formation of the complex olefin (1-heptene) (S) species [RhCl(DPPA)(S)] were compared with those for the corresponding cyclohexene complex formation. The activation parameters for the hydrogenation of 1-heptene and cyclohexene catalysed by RhCl(DPPA) are compared, and the variation of the rates with the nature of the alkane discussed