The CMS Integration Grid Testbed

The CMS Integration Grid Testbed (IGT) comprises USCMS Tier-1 and Tier-2 hardware at the following sites: the California Institute of Technology, Fermi National Accelerator Laboratory, the University of California at San Diego, and the University of Florida at Gainesville. The IGT runs jobs using the Globus Toolkit with a DAGMan and Condor-G front end. The virtual organization (VO) is managed using VO management scripts from the European Data Grid (EDG). Gridwide monitoring is accomplished using local tools such as Ganglia interfaced into the Globus Metadata Directory Service (MDS) and the agent based Mona Lisa. Domain specific software is packaged and installed using the Distrib ution After Release (DAR) tool of CMS, while middleware under the auspices of the Virtual Data Toolkit (VDT) is distributed using Pacman. During a continuo us two month span in Fall of 2002, over 1 million official CMS GEANT based Monte Carlo events were generated and returned to CERN for analysis while being demonstrated at SC2002. In this paper, we describe the process that led to one of the world's first continuously available, functioning grids.Comment: CHEP 2003 MOCT01

Prevalence of communicable, non-communicable diseases, disabilities and related risk factors in Khyber Pakhtunkhwa Pakistan:Findings from the Khyber Pakhtunkhwa Integrated Population and Health Survey (2016-17)

Introduction Pakistan is facing a triple burden of diseases: communicable diseases (CDs), non-communicable diseases (NCDs) and disabilities. There is limited evidence on the patterns of these diseases in Pakistan, specifically Khyber Pakhtunkhwa. Additionally there remains limited study on the impact of sex-, age and setting-stratified morbidities in Khyber Pakhtunkhwa. Objectives The objective of this study was to present the demographic characteristics and the burden of locally-specific CDs (hepatitis B and C, TB, AIDS), NCDs (diabetes, renal diseases, asthma, epilepsy, coronary heart diseases, cancer, hypertension, cholesterol, thalassemia), and disabilities (congenital, post-disease, post-injury, paralysis) stratified by sex, age and setting in the Khyber Pakhtunkhwa province of Pakistan. Material and methods The Khyber Pakhtunkhwa Integrated Population and Health Survey (KP-IPHS) was conducted in 2016–17 to gather comprehensive information about the demographic characteristics and locale-specific health-related issues of the people of Khyber Pakhtunkhwa, Pakistan. This cross-sectional survey was conducted in 24 districts across all 7 divisions of Khyber Pakhtunkhwa on population ageing ≥18 years. A total of 20704 respondents were taken from primary (n = 1061) and secondary sampling units (n = 15724), designed with considerations for urban/rural and socio-economic status. Each primary unit included 250–300 households. The sample selection utilised a multi-staged stratified systematic cluster sampling technique, involving the inclusion of every 16th household in rural areas and every 12th household in urban areas. Observations were recorded on demographics, quality of life, physical activity, BMI, disabilities, CDs and NCDs. Results Among all NCDs, hypertension has the highest prevalence (29.2%), showing a significant difference between females (32.7%) and males (25.0%). The proportion of males and females with diabetes is 7.4% and 5.2%, respectively, with a more substantial percentage (11.2%) observed in the ≥50 years’ age group compared to 2.5% in the 18–29 years’ age group and 5.0% in the 30–49 years’ age group. Among the included CDs, hepatitis B and C (0.5% and 0.8%, respectively) are most prevalent. Hepatitis B is more common in females (0.8%) and in rural settings (0.6%) compared to males (0.3%) and urban settings (0.2%), respectively. The prevalence of congenital disabilities is the highest of all disabilities, with a significantly high prevalence in females (5.3%) and rural settings (3.5%) compared to males (0.9%) and urban settings (0.6%) respectively. Furthermore, post-injury, post-disease disabilities, and paralysis significantly increase with age (P < 0.001). Conclusions Our findings show that the prevalence of CDs, NCDs and disabilities varies across sex, age and settings, with a notable prevalence in females and the old-age population (≥50 years). The results emphasise the necessity of public health efforts, such as screening, prevention, and treatment, to tackle the triple burden of CDs, NCDs, and disabilities in Khyber Pakhtunkhwa Pakistan

Barriers & facilitators to physical activity in people with depression and type 2 diabetes mellitus in Pakistan: A qualitative study to explore perspectives of patient participants, carers and healthcare staff

Background The health benefits of physical activity in adults with depression and type 2 diabetes mellitus (T2DM) are well established, however people with depression and T2DM do not generally reach recommended levels of physical activity. Evidence on how to support physical activity in this group is limited; this is particularly the case in low- and middle-income countries. To develop interventions to promote physical activity, it is important first to understand the barriers and facilitators in this population. Methods A qualitative study was conducted in Pakistan using semi-structured individual interviews. Adults diagnosed with depression and T2DM, their carers, and healthcare staff were included. Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was used to identify themes. Results Twenty-three participants (12 male; 11 female) were recruited. Five themes were generated from the data: 1) Cultural and religious norms and practices influence physical activity behaviours 2) Availability of resources and the potential for incorporating physical activity into routine life determine physical activity behaviours 3) Available healthcare resources can be used to promote physical activity 4) Patients’ individual-level characteristics affect their physical activity behaviours 5) Technology-based interventions may be used to promote physical activity. Conclusion Individual, cultural, and healthcare system level barriers and facilitators can affect the participation of people with depression and T2DM in physical activity. Religious, social, cultural, domestic, and occupational activities provide opportunities to perform physical activities. Furthermore, harnessing routinely available healthcare resources and the use of technology-based interventions can facilitate the promotion of physical activity

Implementation strategies for providing optimised tuberculosis and diabetes integrated care in LMICs (POTENTIAL):protocol for a multiphase sequential and concurrent mixed-methods study

INTRODUCTION: Almost a quarter of patients with tuberculosis (TB) in Pakistan may also have diabetes, with an additional quarter in a pre-diabetic state. Diabetes is a risk factor for TB. When it co-occurs with TB, it leads to poorer outcomes for both conditions, considerably increasing the burden on individuals, families and the healthcare system. We aim to improve health, quality of life and economic outcomes for people with TB and diabetes by optimising diabetes prevention, screening and management within TB care. The objectives of this study are to: (1) design an integrated optimised tuberculosis-diabetes care package (Opt-TBD) and its implementation strategies; (2) pilot and refine these implementation strategies and (3) implement and evaluate the Opt-TBD care package in 15 TB care facilities in Pakistan. METHODS AND ANALYSIS: We will work with the TB programme across two provinces of Pakistan: Khyber Pakhtunkhwa and Punjab. TB care facilities will be selected from urban and rural settings of these provinces and will include three levels: primary, secondary and tertiary care settings. This multiphase mixed-method study has three sequential phases. Once ready, the care package and its implementation strategies will be piloted to inform further refinement. The package will be implemented in 15 urban and rural TB care facilities and evaluated for its Reach, Effectiveness, Adoption, Implementation and Maintenance, and potential for scale-up. Quantitative data will assess provider adoption and the package's accessibility and effectiveness for patients with TB and with diabetes and pre-diabetes. Qualitative data will explore barriers and facilitators for successful implementation and scale-up. Data will be analysed using statistical methods-including descriptive and inferential statistics-for quantitative data and framework analysis for qualitative data, with triangulation to integrate findings. ETHICS AND DISSEMINATION: Ethics approval was granted by the National Bioethics Committee of Pakistan (NBCR-1010). Findings will be shared through academic publications, conferences and public outreach

Refining the accuracy of validated target identification through coding variant fine-mapping in type 2 diabetes.

We aggregated coding variant data for 81,412 type 2 diabetes cases and 370,832 controls of diverse ancestry, identifying 40 coding variant association signals (P &lt; 2.2 × 10-7); of these, 16 map outside known risk-associated loci. We make two important observations. First, only five of these signals are driven by low-frequency variants: even for these, effect sizes are modest (odds ratio ≤1.29). Second, when we used large-scale genome-wide association data to fine-map the associated variants in their regional context, accounting for the global enrichment of complex trait associations in coding sequence, compelling evidence for coding variant causality was obtained for only 16 signals. At 13 others, the associated coding variants clearly represent 'false leads' with potential to generate erroneous mechanistic inference. Coding variant associations offer a direct route to biological insight for complex diseases and identification of validated therapeutic targets; however, appropriate mechanistic inference requires careful specification of their causal contribution to disease predisposition

Effectiveness, barriers, and facilitators of interventions delivered by traditional healers for the treatment of common mental disorders:A systematic review

We investigated the effectiveness of interventions provided by traditional healers for common mental disorders (CMDs) together with associated barriers and facilitators. Electronic databases including MEDLINE, APA Psych Info, Allied and Complementary Medicine, Embase, CINAHL, Social Science Citation Index, and Scopus were searched from inception until October 2021. Randomised controlled trials (RCTs) assessing interventions by traditional healers for CMDs and qualitative and mixed-methods studies examining traditional healers and their attendees' views about the treatment of CMDs by traditional healers were included. Cochrane Risk of Bias Assessment tool (RoB-1) and Critical Appraisal Skills Programme (CASP) were used for the quality assessment of studies. A meta-analysis and thematic synthesis were conducted. Sixteen RCTs (1,132 participants) and 17 qualitative or mixed-methods studies (380 participants) were included. Improvement in symptoms was greater for interventions by traditional healers compared to control groups for both depression and anxiety. Subgroup analyses indicated that only "spiritual passe" interventions showed improvement in depression and anxiety, and participants with co-morbid anxiety and physical conditions showed improvement in anxiety. Facilitators to engaging with interventions by traditional healers were shared faith-based worldview exhibited by traditional healers and their attendees and perceived effectiveness of traditional healing. Stigma and concealing mental illness were found to be barriers not only to formal healthcare but also to traditional healers' services. Interventions by traditional healers such as "spiritual passe" are effective in improving CMDs. However, evidence is still limited due to the low quality of studies and lack of long-term evidence

Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital:A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan

OBJECTIVE: Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services. METHODS: This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY). RESULTS: Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122. CONCLUSION: Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries : a qualitative evidence synthesis

BACKGROUND: Low- and middle-income countries (LMICs) are experiencing growing demand for healthcare services yet face a persistent shortage in access to specialist health workers (SHWs). Task shifting is an approach used to address this gap in service provision. Specific healthcare tasks are shifted to other, larger cadres of non-specialist health workers (NSHWs), including lay health workers with SHWs potentially taking on supervisory roles. Previous studies demonstrate that task shifting is both clinically and economically effective, however the impact of task shifting on health workers (HWs) is not fully understood. OBJECTIVE: The aim of this synthesis is to generate new knowledge about what influences HWs perspectives of benefits and costs of engaging in task shifting. METHODS: A qualitative evidence synthesis (QES) of peer-reviewed literature using databases CINAHL, the Cochrane Database of Systematic Reviews, Psych INFO, MEDLINE, EMBASE, Epistimonikos, Web of Science (science and social science citation index), Scopus LILACS, the African Index Medicus and Google Scholar. Eligible studies were those that included qualitative data about HWs perspectives of task shifting in LMICs. Information from eligible studies was extracted into a Google Sheet, and the data gathered were analysed thematically. RESULTS: Fifty-four studies were included in the QES. Results were organised under three themes, 'the cultural environment in which task shifting is employed', 'access to resources for task shifting' and 'alignment with personal values and beliefs, self-efficacy and personal emotional resilience'. CONCLUSION: This is the first review bringing together views about task shifting from the perspective of different cadres of HWs drawn from diverse healthcare, geographical and country settings in LMICs. Task shifting is a complex process which relies upon the active engagement of HWs. Taking into consideration factors that influence HWs perspectives, such as their personal characteristics, preparatory training, and ongoing access to resources, is important for informing how task shifted healthcare initiatives are designed and delivered to successfully widen access to healthcare in LMICs