External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy

Cultivation Effects of Social Media on Cognitive, Social and Moral Skills of Adolescents in Pakistan

This research work aims to find out social, cognitive and moral effects of facebook on adolescents in Pakistan, because about 65% of the country comprises on adolescents. The researcher applied quantitative research methods, while survey was conducted for the collection of data. Structured questionnaires were used for collection of data. Data was collected through purposive sampling method. Data was analyzed by Statistical Package for Social Sciences. The findings revealed that social media, particularly Facebook has cognitive, social and moral effects, which improve their skills to in-touch with relatives, peers and friends to improve social circle, cognitive effects to enhance creativity and mental level during the studies and moral effects where, they bear to respond the slang and abusive language as well as abusive comments on other posts related to their political and religious beliefs. This study also tests the cultivation theory with regard to social media and generated user categories according to their usage of facebook for future researchers. The results of the study justified the objectives and hypotheses of the study, where it has been recommended to parents, teachers and government to regulate the social media in the country to overcome the abuses.  &nbsp

Groundwater-food security nexus under changing climate-historical prospective of Indus basin irrigation system in Pakistan

Irrigated agriculture plays a vital role in the economy of Pakistan by contributing about 90% of food production, 22% of GDP, employing about 45% of the overall labor force, and generating over 60% of foreign exchange. The role of water resources has become significant which underpins the food security in the country. Indus Basin Irrigation System (IBIS) is the lifeline for the economy of Pakistan and is the major pillar of food security. IBIS is one of the largest irrigation networks in the world and is confronted with multidimensional challenges out of which climate changes have attained paramount importance. The irrigation system was designed on a 67% irrigation system during the 19th century while the current cropping intensity has crossed the limits of 150-160% or even more. Continuous increase in population and consequently more food demands have shifted the pressure on the aquifer underlying the Indus Basin. India, USA & China, and Pakistan has become the 4th largest user of groundwater where about 40% of irrigated food production is dependent on groundwater. In Punjab province, about 1.2 million tubewells are extracting about 40-45 MAF of groundwater annually. Consequently, groundwater management has confronted a multitude of tiny users in Pakistan. Climatic changes have made the availability and reliability of surface water a question mark. Resultantly pressure on groundwater is increasing and water levels are dropping abruptly taking this resource beyond the bounds of rural poor farmers. The intrusion of saline water into the fresh aquifer, secondary salinity, and seawater intrusion are the major threats to groundwater quality.  About 3000 piezometers have been installed to monitor groundwater behavior (levels and quality) in the Punjab province. A research study carried out in Lower Bari Doab Canal (LBDC) has indicated that by falling of water table from 40 to 70 ft. the cost of pumping per acre-feet of groundwater has increased by 125%.  Similarly, it has been observed that in many urban areas groundwater is depleting at an annual alarming rate of 2.54 ft., (Lahore city) and the water table in sweet water zones in rural areas (Vehari District) has gone beyond 70-90 ft. Human activities like increasing cropping intensities, unplanned over pumpage, lack of awareness/capacity, use of chemicals in agriculture/food production, industrialization, urbanization, solid waste landfills, domestic effluents, lack of legal and regulatory framework, etc. are the major threats to sustainable use of groundwater for food security. Climatic changes are posing severe adverse impacts on the sustainable use of groundwater which is putting food security under threat. Global warming, rising sea levels, glacier melting, unprecedented rainfall, prolonged droughts, and floods are the consequences of changing climate which are affecting directly or indirectly the groundwater resources in the aquifer underlying the Indus Basin

Role of the Uterine Artery Ligation (UAL) In Control of Postpartum Hemorrhage

Objective: To determine the efficacy and safety of uterine artery ligation (UAL) in control of Postpartum Hemorrhage. Methodology: This case series study was conducted at Department of Gynecology and Obstetrics Peoples University of Medical & Health Sciences for Women Nawabshah. All the women age between 20-45 years, gestation duration at and beyond 34 weeks, antepartum hemorrhage; intraoperative atonic postpartum hemorrhage and discovery of a placenta accreta; or an adherent placental part after piecemeal removal of the placenta, with bleeding from the placental site were included. After failure of treatment from medical measures, the initial surgical approach of uterine artery ligation (UAL) was done. Efficacy was defined as positive when patient improves or clinically doesn’t develop any complication throughout admission after UAL. Safety was assessed by appearance of side effects if any occurred after procedure. Data was recorded via study proforma and analysis was done by using SPSS version 20. Results: Out of 76 patients admitted of postpartum hemorrhage mean age was 58 years. Most of the patients 59.2% were multiparous and 40.8% were primiparous. The most common cause of postpartum hemorrhage was uterine atony 56.5% and adherent Placenta accreta 43.42%. Most of the patients 81.6% had no postoperative complications except for 11 patients, who had developed gaping of the wound from which they recovered and discharged. The patients required hysterectomy due to intractable hemorrhage and 2.3% mortality was observed due to DIC. Conclusion:  Uterine devascularization by bilateral uterine artery ligation is a simple, effective and the safest initial surgical option with less blood loss and less surgical time for controlling postpartum hemorrhage during cesarean section. It should be used as the first surgical step of choice after medical managements fail in controlling postpartum hemorrhage due to minimal rate of complications and mortality

Construction of Quantum Target Space from World-Sheet States using Quantum State Tomography

In this paper, we will construct the quantum states of target space coordinates from world-sheet states, using quantum state tomography. To perform quantum state tomography of an open string, we will construct suitable quadrature operators. We do this by first defining the quadrature operators in world-sheet, and then using them to construct the quantum target space quadrature operators for an open string. We will connect the quantum target space to classical geometry using coherent string states. We will be using a novel construction based on a string displacement operator to construct these coherent states. The coherent states of the world-sheet will also be used to construct the coherent states in target space.Comment: 13 pages, 4 figures, 1 appendi

Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa

Carbon trading system : Model and application for low carbon performance matrix and sustainable development goals alignment

RO1: Establish a carbon trading mechanism based on the existing literature and sustainable reporting of Malaysian public listed firms. RO2: Software development helps firms identify, measure, report, and benchmark their low carbon performance and align with Sustainable Development Goals(SDGs)

Relationship between Personality Types and Job Satisfaction among Employees in Malaysian Manufacturing

Employee job satisfaction is one of the important measurement aspects of an employee work life. Over the years, rich and mass knowledge in terms of academic research and management practice has been collected to understand further employee job satisfaction, especially for a firm, which work design is highly dependent on human workforce. Manufacturing industry is categorized under this group. Employee job satisfaction could be explained in terms of employee personality. As such, this research is design to understand the relationship between personality type and job satisfaction level of employees. For this paper, blue collar employees from manufacturing industry ware chosen. It is hoped that this paper could contribute to the body of knowledge on this field and further help manufacturing firms to explore options in increasing their workers’ job satisfaction level so that in the long term the firm can achieve its mission and vision

A time series analysis of the relationship between total area planted, palm oil price and production of Malaysian palm oil

Malaysia is a very well-known country in the oils and fats sector especially palm oil because it is the world’s biggest producer and exporter of the commodity. This study was conducted to analyze the relationship between total area planted and palm oil price with production of palm oil in terms of magnitude and direction using the time series analysis method. Johansen cointegration technique, error correction model and Granger causality tests were used to estimate those relationships. The findings showed that the total area planted and palm oil price have negative relationship towards production of Malaysian palm oil. On the other hand, there is no causality relationship between total area planted and production of Malaysian palm oil in the short run. However, there is a unidirectional causality relationship between palm oil price and production of palm oil in Malaysia. For future recommendation, it is suggested that other researchers will supplement this research by integrating other factors that might affect the production of palm oil such as climate change and geographical area