Patient and Doctor Perceptions of Hypertension and its Treatment: a Qualitative Study in Urban Hospitals of Pakistan

Hypertension (HTN) is a chronic disease that has become a growing public health problem in countries around the world, including Pakistan. Successful HTN control is an essential cornerstone in the prevention of morbidity and mortality associated with uncontrolled HTN. However, patients’ beliefs about their disease, treatment and control are related to the outcome of successful HTN control and management. Likewise, doctors’ understanding of HTN and its treatment is equally important and can affect their practice and HTN management. There is little qualitative research considering patients’ and doctors’ understanding of HTN, its treatment and how it influences HTN management in Pakistan. Therefore, the current study aimed to elicit patients’ and doctors’ perceptions, attitudes and beliefs about HTN and its treatment in urban areas of Pakistan. A qualitative study that drew on grounded theory principles was undertaken in two public hospitals of Pakistan. Thirty in-depth semi-structured interviews with hypertensive patients and thirty interviews with doctors were conducted in two hospitals. Interviews were translated and transcribed from Urdu into English and NVivo was used to organise the data in a systematic way. Data were analysed using a constant comparative approach based on the principles of grounded theory. The study revealed that patients’ (n=30) beliefs were complex, deep-rooted and influenced their attitude towards HTN treatment. Patients’ beliefs were informed by understanding gleaned from the socio-cultural environment (local norms, social relations, religion), individual factors (e.g. income, co-morbidities) and interactions with doctors. In contrast, doctors’ (n=30) own understandings on what constitutes successful HTN management often contradicted patients’ beliefs. Doctors’ reported that time restraints and work burden affected their approach to treatment and the provision of information to patients. Findings also revealed an overlap between patients’ and doctors’ beliefs, however, in relation to adopting lifestyle changes for management of HTN. In general, though doctors paid less consideration to patients’ beliefs in routine clinical practice and evaluated patients through the filter of their own beliefs. The findings suggest that doctors could provide a better service care by aligning with their patients on a common understanding about HTN management and providing culturally appropriate information. Doctors should be aware of the understanding hypertensive patients attach to HTN and avoid providing treatment based on their own beliefs. Doctors must engage with patients’ beliefs and identify their particular healthcare needs in order to achieve control of HTN in Pakistan

CUSTODIAN OF THE JEWISH HISTORY & HERITAGE: AN ACCOUNT OF NATIONAL LIBRARY OF ISRAEL

The National Library of Israel (NLI), located in Jerusalem, has been dedicated to the preservation of Jewish and Israeli culture, history and heritage for over 128 years. The edifice stores valuable ancient Jewish history treasures and continues to add thousands to its collection each year. The NLI has a significant impact on the lives of Jews in Israel and around the world. Millions of documents are undergoing the digital conservation, processing, and scanning process to preserve the cultural DNA of heritage. Books, manuscripts, maps, audio and archival material, and a reference section of rare collections are all means in which cultural heritage is preserved. The NLI has envisioned to bring out rare and out of print items to the public for which digitalized has been taking swiftly. The open access of Jewish heritage is a policy goal of the NLI. The NLI is the protagonist of the notion that all these treasures of mankind\u27s history belong to everyone. This paper is an articulation of the great endeavors of the NLI in collecting and preserving the historical past of the Jewish people and how generously it is making the historical treasure available to all people world-wide

Heuristic Methods for Security Protocols

Model checking is an automatic verification technique to verify hardware and software systems. However it suffers from state-space explosion problem. In this paper we address this problem in the context of cryptographic protocols by proposing a security property-dependent heuristic. The heuristic weights the state space by exploiting the security formulae; the weights may then be used to explore the state space when searching for attacks

Numerical Optical Centroid Measurements

Optical imaging methods are typically restricted to a resolution of order of the probing light wavelength $\lambda_p$ by the Rayleigh diffraction limit. This limit can be circumvented by making use of multiphoton detection of correlated $N$-photon states, having an effective wavelength $\lambda_p/N$. But the required $N$-photon detection usually renders these schemes impractical. To overcome this limitation, recently, so-called optical centroid measurements (OCM) have been proposed which replace the multi-photon detectors by an array of single-photon detectors. Complementary to the existing approximate analytical results, we explore the approach using numerical experiments by sampling and analyzing detection events from the initial state wave function. This allows us to quantitatively study the approach also beyond the constraints set by the approximate analytical treatment, to compare different detection strategies, and to analyze other classes of input states.Comment: 15 pages, 18 figure

The Need for Efficient Record Management System in Pakistan

The United Nations Millennium Declaration, marked in September 2000, calls for world pioneers to battle poverty, hunger, lack of education, environmental degradation, and discrimination against women. Poverty is one of the many dire issues developing countries encounter. Poverty reduction is usually attributed to economic development because it offers economic freedom. Economic freedom can only be realized through financial inclusion. Financial inclusion implies that people and organizations have access to valuable and moderate monetary facilities such as access to bank mortgages insurance and other financial issues that address exchanges, installments, reserve funds, credit and protection – delivered in a responsible and sustainable manner. Accurate record management is the foundation for financial inclusion. Pakistan is a developing country graveling with poverty. A Major cause for the lack of successful poverty elevation initiatives is the improper and incomplete record management. The goal of records management is to help an organization keep the necessary documentation accessible for both business operations and compliance audits. In addition, Records Management provides institutional accountability and timely access to information because in developing country context improper record management of its citizen is a major hindrance in achieving the concept of welfare economy in letter and spirit. An Expository Theoretical Research is used to postulate the problem of record management. The purpose of this study is to highlight the problem of record management in Pakistan. Proper record management systems allow for accurate, and transparent zakat management systems and taxation systems

Information theoretic framework for stochastic sensitivity and specificity analysis in biochemical networks

Biochemical reaction networks involve many chemical species and are inherently stochastic and complex in nature. Reliable and organised functioning of such systems in varied environments requires that their behaviour is robust with respect to certain parameters while sensitive to other variations, and that they exhibit specific responses to various stimuli. There is a continuous need for improved models and methodologies to unravel the complex behaviour of the dynamics of such systems. In this thesis, we apply ideas from information theory to develop novel methods to study properties of biochemical networks. In the first part of the thesis, a framework for the study of parametric sensitivity in stochastic models of biochemical networks using entropies and mutual information is developed. The concept of noise entropy is introduced and its interplay with parametric sensitivity is studied as the system becomes more stochastic. Using the methodology for gene expression models, it is shown that noise can change the sensitivities of the system at var- ious orders of parameter interaction. An approximate and computationally more efficient way of calculating the sensitivities is also developed using unscented transform. Finally, the methodology is applied to a circadian clock model, illustrating the applicability of the approach to more complex systems. In the second part of the thesis, a novel method for specificity quantification in a receptor-ligand binding system is proposed in terms of mutual information estimates be- tween appropriate stimulus and system response. The maximum specificity of 2 × 2 affinity matrices in a parametric setup is theoretically studied. Parameter optimisation methodology and specificity upper bounds are presented for maximum specificity estimates of a given affinity matrix. The quantification framework is then applied to experimental data from T-Cell signalling. Finally, generalisation of the scheme for stochastic systems is discussed.Open Acces