To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule

Introduction: The Ottawa Subarachnoid Hemorrhage rule (OSR) is a clinical decision tool identified for ruling out subarachnoid hemorrhage (SAH) in those patient above 15 years of age who present to the emergency department (ED) with acute onset atraumatic headache. Objective: The primary objective of this study was to externally validate the OSR in a single national health service (NHS) setting in the UK and secondly, to compare it with our current practice without using a decision rule. Method: A retrospective review of computerized medical records was done for all patients registered with headaches from January to December 2016. The data were manually charted on a data sheet from individual patient records. Patients fulfilling the preset inclusion and exclusion criteria as per the OSR were enrolled in the analysis. According to the OSR, if patient had any of the 6 criteria enlisted (age > 40 years, neck stiffness/pain, witnessed loss of consciousness, onset during exertion, thunderclap headache, limited neck flexion on examination), further diagnostic decision was required. All patients were followed up for 6 months on the computer system as it gets highlighted if the patient is represented again to the ED or is deceased. Results: A total of 737 ED visits with acute headache were reviewed for potential eligibility. Out of these, 649 were estimated to be eligible. On excluding 485 patients that could not meet the predetermined inclusion criteria and 19 patients as per the exclusion criteria, 145 (19.7%) patients were included in the analysis. There were 5 cases of SAH, yielding an incidence of 3.4 % (95% CI 1.3 % – 8.3 %). The sensitivity for SAH was 100% (95% CI, 46.3 % - 100 %); specificity of 44.2 % (95% CI, 36 % - 53 %); positive predictive value of 6.02 % (95% CI 2.2 % - 14.1 %); and negative predictive value of 100% (95% CI, 92.7 % - 100%). Conclusion: Although being poorly specific, the OSR is a highly sensitive, simple tool for ruling out SAH in alert patients with a headache in ED settings

To Head CT Scan or Not: The Clinical Quandary in Suspected Subarachnoid Hemorrhage; a Validation Study on Ottawa Subarachnoid Hemorrhage Rule

Introduction: The Ottawa Subarachnoid Hemorrhage rule (OSR) is a clinical decision tool identified for ruling out subarachnoid hemorrhage (SAH) in those patient above 15 years of age who present to the emergency department (ED) with acute onset atraumatic headache. Objective: The primary objective of this study was to externally validate the OSR in a single national health service (NHS) setting in the UK and secondly, to compare it with our current practice without using a decision rule. Method: A retrospective review of computerized medical records was done for all patients registered with headaches from January to December 2016. The data were manually charted on a data sheet from individual patient records. Patients fulfilling the preset inclusion and exclusion criteria as per the OSR were enrolled in the analysis. According to the OSR, if patient had any of the 6 criteria enlisted (age > 40 years, neck stiffness/pain, witnessed loss of consciousness, onset during exertion, thunderclap headache, limited neck flexion on examination), further diagnostic decision was required. All patients were followed up for 6 months on the computer system as it gets highlighted if the patient is represented again to the ED or is deceased. Results: A total of 737 ED visits with acute headache were reviewed for potential eligibility. Out of these, 649 were estimated to be eligible. On excluding 485 patients that could not meet the predetermined inclusion criteria and 19 patients as per the exclusion criteria, 145 (19.7%) patients were included in the analysis. There were 5 cases of SAH, yielding an incidence of 3.4 % (95% CI 1.3 % – 8.3 %). The sensitivity for SAH was 100% (95% CI, 46.3 % - 100 %); specificity of 44.2 % (95% CI, 36 % - 53 %); positive predictive value of 6.02 % (95% CI 2.2 % - 14.1 %); and negative predictive value of 100% (95% CI, 92.7 % - 100%). Conclusion: Although being poorly specific, the OSR is a highly sensitive, simple tool for ruling out SAH in alert patients with a headache in ED settings

¿Puede el Estado de derecho ser una herramienta eficiente de planificación de políticas para el desarrollo sostenible en Asia?

Sustainable Development is currently overriding problem in UN Millennium agenda of 21st century. Recently, is considered purely a matter of rule of law. Rule of law are now considered as bedrock for Sustainable Development in Asia. Keeping in view, this study evaluates the importance of Rule of law for Sustainable Development policy planning in after taking into consideration of 12 Asian countries over the period of 1984 up to 2012. The analysis depicts that rule of law is primarily important for Sustainable Development policy planning in Asia. For empirical analysis, we estimated the results through dynamic panel data model approach.El Desarrollo Sostenible actualmente es el principal problema en la agenda del Milenio de las Naciones Unidas del siglo XXI. Recientemente, se considera puramente una cuestión de estado de derecho. El estado de derecho ahora se considera la piedra angular del desarrollo sostenible en Asia. Teniendo en cuenta, este estudio evalúa la importancia del Estado de derecho para la planificación de políticas de desarrollo sostenible después de tener en cuenta a 12 países asiáticos durante el período de 1984 a 2012. El análisis muestra que el estado de derecho es principalmente importante para la política de desarrollo sostenible planificación en Asia. Para el análisis empírico, estimamos los resultados a través del enfoque del modelo de datos de panel dinámico

Felicidad y globalización: un estudio en perspectiva global sobre el emprendimiento

The study is based on the conjecture that augmented happiness enhances the growth of entrepreneurship and happy nations have tendency to produce greater number of entrepreneurs. Apart from Happiness, this study also measures the effect of globalization on entrepreneurship. For this very purpose, happiness and globalization has been regressed with entrepreneurship. Desire Satisfaction theory has been used to explain the relationship of happiness, globalization and entrepreneurship. To verify stated assumptions, data from 125 countries from the world were tested. Data of Globalization Index (GI), Happiness Index (HI) and Global Entrepreneurship Index (GEI) were extracted from KOF Globalization Index 2017, World Happiness Report 2017 and Global Entrepreneurship index 2017 respectively. It was observed that countries with higher score in happiness and globalization also had higher score in GEI. The relationship is found to be highly significant and positive. It is suggested that countries who wish to promote entrepreneurial ventures should not focus only on conventional measures of growth like GDP but also focus for expansion through globalization and invest for the satisfaction and happiness of its people.El estudio se basa en la conjetura de que la felicidad aumentada mejora el crecimiento del espíritu empresarial y que las naciones felices tienden a producir un mayor número de empresarios. Además de la felicidad, este estudio también mide el efecto de la globalización en el emprendimiento. Para este mismo propósito, la felicidad y la globalización han retrocedido con el espíritu empresarial. La teoría de la satisfacción del deseo se ha utilizado para explicar la relación de felicidad, globalización y emprendimiento. Para verificar los supuestos establecidos, se probaron datos de 125 países del mundo. Los datos del Índice de globalización (IG), el Índice de felicidad (HI) y el Índice de emprendimiento global (GEI) se extrajeron del Índice de globalización KOF 2017, el Informe de felicidad mundial 2017 y el Índice de emprendimiento global 2017, respectivamente. Se observó que los países con puntaje más alto en felicidad y globalización también tenían puntaje más alto en GEI. Se encuentra que la relación es altamente significativa y positiva. Se sugiere que los países que deseen promover emprendimientos empresariales no se centren solo en medidas convencionales de crecimiento como el PIB, sino que también se enfoquen en la expansión a través de la globalización e inviertan para la satisfacción y la felicidad de su gente

Assessment of Students’ Academic Performance in Government Schools of Pakistan

The main purpose of this study was to reduce the gaps in the evaluation of academic performance in Pakistan government schools. This study analyzed the students’ academic performance with respect to social media usage, physical activity, and motivation. A sample of 204 students was selected for studying in different government schools located in Lahore (Pakistan). Both stratified random sampling and simple random sampling techniques were used to draw the sample. This study focused on 9th class and 10th class students who were the respondents of primary data collection. Both correlation and regression analysis were used to analyze the data. The results showed that all the predicted variables were significant and positively correlated with academic performance

Preliminary Investigation of Thermal Behavior of Lightweight Foamed Concrete Incorporating Palm Oil Fuel Ash and Eggshell Powder

This study was performed to investigate the thermal and mechanical properties of foamed concrete when supplementary cementitious materials (SCMs) are utilized. Sustainable foamed concrete of 1800 kg/m3 dry density was prepared by incorporating Palm Oil Fuel Ash (POFA) ranging from 30 % to 35 % and Eggshell Powder (ESP) from 5 % to 15 % as SCMs. It was found that the combined utilization of POFA and ESP in the foamed concrete produced favorable results by reducing the thermal conductivity up to 42.68 % compared to the control sample, thus enhanced thermal insulating property of foamed concrete. This study confirmed that recycling and reusing of POFA and ESP are possible in foamed concrete which could be used for non-structural applications where thermal insulating is required

Spectrum of interstitial lung disease from a tertiary care hospital in Karachi

Objective: To determine the clinical features and patterns of interstitial lung disease.Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised record of patients diagnosed with interstitial lung disease from January 2005 to December 2015. All patients aged 16 years and above diagnosed with interstitial lung disease on the basis of clinical features, radiological features on high-resolution computed tomography of the chest, and lung biopsies were included. SPSS 19 was used for data analysis.Results: Of the 537 patients, 324(60.3%) of the participants were females. The overall mean age was 60.5±14.9 years. The most common co-morbid condition was diabetes mellitus in 72(13.4%) patients, followed by hypertension in 48(8.9%) and ischaemic heart disease in 21(3.9%). The most common interstitial lung disease was idiopathic pulmonary fibrosis in 217(40.4%) patients, followed by non-specific interstitial pneumonia in 106(19.7%), sarcoidosis in 82(15.3%) and connective tissue disease-related interstitial lung disease in 56(10.4%) patients.Conclusions: Idiopathic pulmonary fibrosis was found to be the most common interstitial lung disease subtype followed by non-specific interstitial pneumonia, sarcoidosis and connective tissue disease-related-interstitial lung disease

Dynamic Evaluation of Desiccant Dehumidification Evaporative Cooling Options for Greenhouse Air-Conditioning Application in Multan (Pakistan)

This study provides insights into the feasibility of a desiccant dehumidification-based Maisotsenko cycle evaporative cooling (M-DAC) system for greenhouse air-conditioning application. Conventional cooling techniques include direct evaporative cooling, refrigeration systems, and passive/active ventilation. which are commonly used in Pakistan; however, they are either not feasible due to their energy cost, or they cannot efficiently provide an optimum microclimate depending on the regions, the growing seasons, and the crop being cultivated. The M-DAC system was therefore proposed and evaluated as an alternative solution for air conditioning to achieve optimum levels of vapor pressure deficit (VPD) for greenhouse crop production. The objective of this study was to investigate the thermodynamic performance of the proposed system from the viewpoints of the temperature gradient, relative humidity level, VPD, and dehumidification gradient. Results showed that the standalone desiccant air-conditioning (DAC) system created maximum dehumidification gradient (i.e., 16.8 g/kg) and maximum temperature gradient (i.e., 8.4 °C) at 24.3 g/kg and 38.6 °C ambient air conditions, respectively. The DAC coupled with a heat exchanger (DAC+HX) created a temperature gradient nearly equal to ambient air conditions, which is not in the optimal range for greenhouse growing conditions. Analysis of the M-DAC system showed that a maximum air temperature gradient, i.e., 21.9 °C at 39.2 °C ambient air condition, can be achieved, and is considered optimal for most greenhouse crops. Results were validated with two microclimate models (OptDeg and Cft) by taking into account the optimality of VPD at different growth stages of tomato plants. This study suggests that the M-DAC system is a feasible method to be considered as an efficient solution for greenhouse air-conditioning under the climate conditions of Multan (Pakistan)

Outcome-Based Engineering Education: A Global Report of International OBE Accreditation and Assessment Practices

Outcome-based education (OBE) is a paradigm in which instructional and assessment/ evaluation are explicitly designed for ensuring the attainment and mastery of predefined learning outcomes. OBE is now the underlying paradigm followed by global accreditation efforts such as the Washington Accord (ratified in 1989). The shift to OBE is so pronounced that some education experts identify the shift to outcome-based education and accreditation as one of the top 5 major changes of the last 100 years. OBE is starkly different from the previous content-based educational approaches in shifting the aim from covering the content to a student-centric mastery that is driven by exit-outcomes and educational objectives. And while OBE is often criticized for straitjacketing education, and resisted by hesitant faculty members suspecting additional burden, studies show that the OBE movement, on the whole, has helped in improving the educational standards and outcomes by helping ensure proper planning of curriculum and assessment and their alignment with the program objectives and desired outcomes. OBE is also flexible in the sense that it does not dictate the choice of specific education strategies or teaching methods. New OBE schemes have also diversified in response to early misgiving about OBE (related to excessive paperwork, and bean-counting-like auditing) and now admit diverse types of evidence (including qualitative and quantitative, formative and summative, formal and informal assessments). In this paper, we present—as a geographically dispersed set of academics from Pakistan, United Kingdom, United States of America, Malaysia, Saudi Arabia—a global international perspective on OBE accreditation standards, practices, and attitudes. We will trace the historical development leading to the great shift to OBE in recent times and also synthesize insights from our diverse transnational experience in meeting accreditation requirements in different countries