Role of Transthoracic Ultrasound in the Detection of Radiographically Undetected Rib Fractures

 To determine the role of high resolution ultrasound in rib fractures after normal radiography.Methods: In this cross-sectional study patients presenting with chest trauma in the hospital and having radiography to rule out rib fracture, but having normal chest X-ray, were included . Demographic details were noted. They were assessed for rib fracture using high-resolution ultrasonography.Results: In this trial, a total of 230 cases were included. The mean age of the patients was calculated as 33.07+10.32 years of age. Rib fracture using high resolution ultrasound in patients with normal radiography after blunt chest trauma was found in 72.17% (n=166) patients while 27.83% (n=64) patients had no finding of the rib fracture. The most commonly fractured rib in this study was found to be 6th rib.Conclusion: Detection of rib fracture using high resolution ultrasound after blunt chest trauma is higher than radiograph

Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

INTRODUCTION: There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. METHODS AND MATERIALS: We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. RESULTS: Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. DISCUSSION: Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

IntroductionThere is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation.Methods and materialsWe collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors.ResultsImplementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits.DiscussionPrograms need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Nonsteroidal anti-inflammatory drugs as potential ecto-nucleotide phosphodiesterase inhibitors

Phosphodiesterases (PDE) are group of enzymes which catalyze the hydrolysis of cAMP and cGMP. Since these cyclic phosphate moieties worked as intracellular second messengers in numerous physiological processes, their inhibition can affect normal physiology of living system. NSAIDs are among the frequently prescribed medications, because of their efficacy as analgesic, antipyretic and anti-inflammatory agents. They are known to block cyclooxygenase pathway. In limited data NSAIDs has been shown anti-tumor potential, and phosphodiesterase inhibition has assumed to be one of the mechanism. To date no further evaluation being done. Further, NSAIDs are classified as cyclooxygenase inhibitors and phosphodiesterase inhibition can imprint its side effects. This study first time investigates the effects of NSAIDs on phosphodiesterase 1 inhibition. The activity against snake venom phosphodiesterase 1 was assayed on a microtitre plate reader spectrophotometer. Selective COX-2 inhibitor, celecoxib, exhibited a potent PDE1 inhibitory activity, at therapeutic doses, with an IC50 value of 29.4 µM. The findings of our study are indicative of new pharmacological actions of cyclooxygenase inhibitors. This article presents the PDE inhibitory properties as a new effects of already existing drugs. These additional effects could be potentially helpful for researchers to assess other physiological and pathological states

Linking Leader\u27s Avoidant Behavior to Counter productive work behavior: A Mediated Moderated Model

Introduction. Extant research has focused on the antecedents of culture, suggesting that a group\u27s culture results from internal and external changes experienced by the group members or successfully transferred by the group leader. The current study aims to understand leaders\u27 role in shaping organisational culture based on their behaviour in temporary work settings. Research to date has mostly focused on leadership styles, not behaviours such as Avoidant behaviour, and yet to examine How leaders\u27 behaviours influence Individual and Organizational Outcomes in project-based firms. Methods. Two hundred ninety-seven leaders and followers (project manager and team members) from Lahore and Islamabad\u27s NGOs participated in the study. Results. A leader\u27s avoidant behaviour positively impacts conflict culture, which affects the individual\u27s performance and organisational well-being. Results identified that CC is a product of behaviour that positively influences counterproductive work behaviour. The present research cannot prove moderation with suggested relations, but direct results unfold the interesting facet. Discussion. The research has found consistent results concerning previous studies. The research has also contributed theoretically and contextually. The research has implications for companies, leaders, and employees. Future researchers might broaden the study\u27s scope by incorporating other constructs, such as employee promotive voice.Introduction. Extant research has focused on the antecedents of culture, suggesting that a group\u27s culture results from internal and external changes experienced by the group members or successfully transferred by the group leader. The current study aims to understand leaders\u27 role in shaping organisational culture based on their behaviour in temporary work settings. Research to date has mostly focused on leadership styles, not behaviours such as Avoidant behaviour, and yet to examine How leaders\u27 behaviours influence Individual and Organizational Outcomes in project-based firms. Methods. Two hundred ninety-seven leaders and followers (project manager and team members) from Lahore and Islamabad\u27s NGOs participated in the study. Results. A leader\u27s avoidant behaviour positively impacts conflict culture, which affects the individual\u27s performance and organisational well-being. Results identified that CC is a product of behaviour that positively influences counterproductive work behaviour. The present research cannot prove moderation with suggested relations, but direct results unfold the interesting facet. Discussion. The research has found consistent results concerning previous studies. The research has also contributed theoretically and contextually. The research has implications for companies, leaders, and employees. Future researchers might broaden the study\u27s scope by incorporating other constructs, such as employee promotive voice

GAP GRADING OF AGGREGATES & ITS EFFECT ON THE INHERENT PROPERTIES OF CONCRETE

Aggregate are one of the most important constituent of concrete. They provide the body to the concrete, help in reducing shrinkage and greatly affect economy. Earlier, they were considered chemically inert but as of now, it has been established that some of these aggregates are chemically active and exhibit chemical bond at the interface of aggregate and cement matrix. The simple fact that they occupy almost 70-80% of the overall volume of concrete, merits the statement that their impact on various characteristics of fresh and hardened concrete is undoubtedly considerable. In this study, emphasis is given on the different types of gradation of aggregates and their influence on the properties of concrete. Standard grading curves as proposed by Gambhir, 2004 are studied in detail to understand the behavior of coarse and fine aggregates. Gap grading is a relatively new term as far as traditional methods of combining aggregates are concerned. Three different batches were cast, using samples of well graded, uniformly graded & gap graded aggregates, for M20 grade of concrete. Various tests were carried out to evaluate the effect of grading of aggregate on the inherent properties of fresh and hardened concrete.

Δημοκρατική κατήχησις / Γ. Λ. Αρβανιτάκη.

Radio refractivity plays a significant role in the development and design of radio systems for attaining the best level of performance. Refractivity in the troposphere is one of the features affecting electromagnetic waves, and hence the communication system interrupts. In this work, a modified artificial neural network (ANN) based model is applied to predict the refractivity. The suggested ANN model comprises three modules: the data preparation module, the feature selection module, and the forecast module. The first module applies pre-processing to make the data compatible for the feature selection module. The second module discards irrelevant and redundant data from the input set. The third module uses ANN for prediction. The ANN model applies a sigmoid activation function and a multi-variate auto regressive model to update the weights during the training process. In this work, the refractivity is predicted and estimated based on ten years (2002-2011) of meteorological data, such as the temperature, pressure, and humidity, obtained from the Pakistan Meteorological Department (PMD), Islamabad. The refractivity is estimated using the method suggested by the International Telecommunication Union (ITU). The refractivity is predicted for the year 2012 using the database of the previous ten years, with the help of ANN. The ANN model is implemented in MATLAB. Next, the estimated and predicted refractivity levels are validated against each other. The predicted and actual values (PMD data) of the atmospheric parameters agree with each other well, and demonstrate the accuracy of the proposed ANN method. It was further found that all parameters have a strong relationship with refractivity, in particular the temperature and humidity. The refractivity values are higher during the rainy season owing to a strong association with the relative humidity. Therefore, it is important to properly cater the signal communication system during hot and humid weather. Based on the results, the proposed ANN method can be used to develop a refractivity database, which is highly important in a radio communication system

First Integral Technique for Finding Exact Solutions of Higher Dimensional Mathematical Physics Models

In this work, we establish the exact solutions of some mathematical physics models. The first integral method (FIM) is extended to find the explicit exact solutions of high-dimensional nonlinear partial differential equations (PDEs). The considered models are: the space-time modified regularized long wave (mRLW) equation, the (1+2) dimensional space-time potential Kadomtsev Petviashvili (pKP) equation and the (1+2) dimensional space-time coupled dispersive long wave (DLW) system. FIM is a powerful mathematical tool that can be used to obtain the exact solutions of many non-linear PDEs

Synthesis of Graphene-MoS2 composite based anode from oxides and their electrochemical behavior

High energy storage capacity and longer life span make rechargeable Li-ion batteries the first choice in portable electronics. Here, a graphene-MoS2 composite material is investigated as a potential electrode material which enhances the electrochemical storage ability of the Li-ion batteries (LIBs). Graphene-MoS2 composite is synthesized from graphene oxide (GO), molybdenum trioxide and thiourea via hydrothermal route. Formation of graphene-MoS2 composite (molar ratio 1:2) is confirmed by X-ray diffraction (XRD). The characteristic phonons modes of graphene (D and G bands) and MoS2 (A1g and E2g) are observed in the Raman spectra of the synthesized graphene-MoS2 composite. Fourier- transform infrared (FTIR) spectroscopy showed reduction from GO to graphene in composite due to absence of C = O bond while the peaks observed at 900 cm−1 and 1095 cm−1 of Mo-O and S = O, respectively, supports the formation composite material. To investigate the diffusion rate of Li+ ions for anode material, the electrochemical impedance spectroscopy (EIS) measurements modeled with equivalent circuit has been performed, which showed the high diffusion rate of Li ions but with less cyclic stability due to drastic change in surface film resistance for increased number of cycles. The value of discharge capacity obtained for the first cycle is ~ 975 mAh/g, which dropped to 250 mAh/g after executing 80 cycles. For different cycles, rate capabilities have also been measured at different current densities. At initial current density of 100 mAh/g, the highest discharge capacity of 975 mAh/g is obtained. The current density dropped to 200 mAh/g from the highest current density of 1000 mAh/g after 40 cycles with a retention capacity of 20%. The present study confirmed that composite synthesized from precursors, namely, molybdenum trioxide and thiourea has the potential as an electrode for LIBs