Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

سامی ادیان میں تصورِنزولِ مسیح کا تقابلی جائزہ: A COMPARATIVE ANALYSIS OF THE CONCEPT OF CHRIST'S DESCENT IN SEMITIC RELIGIONS

In the light of the Qur'an, Sunnah, and the consensus of the Ummah, Muslims believe that Messiah (peace be upon him) was raised to heaven alive. He will descend to earth again near the Day of Judgment. He will establish justice, and promote and spread the religion of Muhammad (peace be upon him). The greatest temptation near the Day of Judgment, the temptation of Dajjal, will be ended up at his hands. Even in Christianity, the concept of the descent of Jesus (peace be upon him) exists because it has been mentioned repeatedly in the Bible. However, there are differences between Islam and Christianity regarding the resurrection of Jesus. Christians believe that he has been killed by hands of The Jews on cross. And that he has been resurrected and raised to heaven. While the clear evidence in the Qur'an and the Sunnah is that the Jews had not succeeded in their evil purpose. Therefore, the Jews consider Dajjal to be their Messiah who will end up the troubles and will fight for the exaltation of Judaism. And that with him all the Jews, living or dead, will gather in Jerusalem and join his army and fight against all religions except the Jews

An Applied Study Regarding the Rules, Precautions and Remedies of Corona Pandemic in the Context of sayings of the Prophet (PBUH) about Plague

The Corona virus (Covid-19) pandemic began in December 2019 in Wuhan, China, and    has spread rapidly throughout the world. So far millions of people have died all over the world while millions of people have been suffering from this disease. It is also an infectious disease like plague. In the world many Outbreaks have taken place that have taken many lives. There are many hadiths about the plague, and Covid-19 is also a kind of plague. The cure for Corona virus has not yet been discovered, but some of the protective measures suggested by “WHO”.  These were devised by Islam about fourteen hundred years ago, because all of Islam's teachings guarantee the survival of human beings.  Infectious disease is believed to be effective, but its effect is not definitive. According to the Prophetﷺ , honey and clone are the remedies for every disease.  Each of the world's troubles is the result of certain actions of the past, so it is possible to get rid of this type of trouble by appealing to our Lord through repentance and prayers. The aim of this research paper is to present an applied study   regarding the Rules, Precautions and Remedies of Corona Pandemic in the Context of Hadiths about Plague

Characteristics and Risk Assessment of Environmentally Persistent Free Radicals (EPFRs) of PM2.5 in Lahore, Pakistan

Environmentally persistent free radicals (EPFRs) are an emerging pollutant and source of oxidative stress. Samples of PM2.5 were collected at the urban sites of Lahore in both winter and summertime of 2019. The chemical composition of PM2.5, EPRF concentration, OH radical generation, and risk assessment of EPFRs in PM2.5 were evaluated. The average concentration of PM2.5 in wintertime and summertime in Lahore is 15 and 4.6 times higher than the national environmental quality standards (NEQS) of Pakistan and WHO. The dominant components of PM2.5 are carbonaceous species. The concentration of EPFRs and reactive oxygen species (ROS), such as OH radicals, is higher in the winter than in the summertime. The secondary inorganic ions do not contribute to the generation of OH radicals, although the contribution of SO42+, NO3−, and NH4+ to the mass concentration of PM2.5 is greater in summertime. The atmospheric EPFRs are used to evaluate the exposure risk. The EPFRs in PM2.5 and cigarette smoke have shown similar toxicity to humans. In winter and summer, the residents of Lahore inhaled the amount of EPFRs equivalent to 4.0 and 0.6 cigarettes per person per day, respectively. Compared to Joaquin County, USA, the residents of Lahore are 1.8 to 14.5 times more exposed to EPFRs in summer and wintertime. The correlation analysis of atmospheric EPFRs (spin/m3) and carbonaceous species of PM2.5 indicates that coal combustion, biomass burning, and vehicle emissions are the possible sources of EPFRs in the winter and summertime. In both winter and summertime, metallic and carbonaceous species correlated well with OH radical generation, suggesting that vehicular emissions, coal combustion, and industrial emissions contributed to the OH radical generation. The study’s findings provide valuable information and data for evaluating the potential health effects of EPFRs in South Asia and implementing effective air pollution control strategies

Fine particulate matter from brick kilns site and roadside in Lahore, Pakistan: Insight into chemical composition, oxidative potential, and health risk assessment

Background: Human health is seriously threatened by particulate matter (PM) pollution, which is a major environmental problem. A better indicator of biological responses to PM exposure than its mass alone is the PM ''oxidative potential (OP),'' or ability to oxidize target molecules. When reactive oxygen species (ROS) are generated in the OP in excess of the antioxidant capacity of body due to PM components such metals and organic species, it causes inflammation, deoxyribonucleic acid (DNA), proteins, and lipids damage. Method: The samples of fine particulate matter (PM2.5) are collected from the brick kiln site and the roadside in Lahore, Pakistan. The organic carbon (OC) and elemental carbon (EC) were estimated by carbon analyzer (DRI 2001A) using the thermal/optical transmittance (TOT) protocol. The water-soluble organic carbon (WSOC) concentration was determined using a total organic carbon analyzer (Shimadzu TOC-L CPN). Ion chromatography (Dionex ICS–900) with a conductivity detector was used to analyze the water-soluble anions (Cl−, NO3−, and SO42−) and cations (NH4+, Na+, K+, Mg2+, and Ca2+). Inductively coupled plasma-mass spectrometry (iCAP TQ ICP-MS, Thermo Scientific) was used to determine the concentrations of metals in the solution. The dithiothreitol (DTT) consumption rate was calculated using a spectrophotometer at a wavelength of 412 nm. Results: The mean concentrations of PM2.5 at the brick kiln site and roadside reported are 509.3 ± 32.3 μg/m3 and 467.5 ± 24.9 μg/m3, and the average OC/EC ratio is 1.9 ± 0.4 and 2.1 ± 0.1. primary organic carbon (POC) contributed more to OC than secondary organic carbon (SOC), which indicated the dominance of primary combustion sources. The anion equivalent (AE) to cation equivalent (CE) ratio indicated that PM2.5 is acidic at both sites due to the dominance of NO3− and SO42−. The DTT consumption rate normalized by PM2.5 mass (DTTm) and DTT consumption rate normalized by air volume (DTTv) of PM2.5 at the roadside samples are higher than at the brick kiln site due to the higher contribution of ionic species to the mass of PM2.5. Carbonaceous species of PM2.5 at both sampling sites are significantly correlated with DTTv of PM2.5, while metallic species behaved differently. The incremental lifetime cancer risk (ILCR) values (lung cancer) of As and Cr at both sampling sites, while the ILCR value of Cd at the roadside samples is exceeding the permissible limits for adults and children. The lifetime average daily dose (LADD) value for adults is higher than that for children, indicating that children are less vulnerable to metals. Conclusion: The concentration of PM2.5 at both sampling sites were exceeding the permissible limits of Pakistan’ National Environmental Quality Standard (NEQS) and posing risk to the health of the local population. The POC and SOC contribution to OC at the brick kiln site and roadside in Lahore were 84.6%, 15.4% and 84.4%, 15.6%. POC at both sampling sites were the dominant carbon species indicating the dominance of primary combustion sources. The residence of Lahore poses the lung cancer risk due to Cr, As, and Cd at both sampling sites. The results of this study provide important data and evidence for further evaluation of the potential health risks of PM2.5 from brick kiln site and road side in Pakistan and formulation of efficient air-pollution control measures

Sources, analysis, and health implications of atmospheric microplastics

Microplastics (MPs) are emerging environmental contaminants pervasive in the environment. Studies have revealed that the majority of airborne MPs are in the form of fiber. Inhaled atmospheric MPs adversely impact human health, causing inflammation and oxidative stress. Atmospheric MPs may also carry hazardous chemical pollutants in addition to heavy metals. Many research studies have been conducted about MPs’ presence in the environmental components, however questions about the presence and identification of atmospheric MPs remained unanswered. Based on the mentioned research gaps, this study examined the sources and abundance of MPs in the atmosphere and their generation, accumulation, and fate. The paper further studies and evaluates current methods for identifying and assessing airborne MPs and their impact on human health and the environment. According to the study findings, there are flaws and complexity in MPs assessment and technical procedures, which further challenges data comparability and dependability. In order to ensure data comparability and reliability, the abundance of atmospheric MPs needs to be expressed using a unified and standard methodology. Innovative and well-established identification methods, strategies to minimize the impacts of MPs, and appropriate steps to reduce this global pollution are required for the current state of MPs. It also provides an overview of atmospheric MPs' characteristics, sources, and airborne transmission and deposition mechanisms. Advances in bacterial degradation, sunlight-driven photocatalysts, fuels, and biodegradable plastics could revolutionize future studies on reducing plastic pollution. Future studies should include more research on the various aspects of atmospheric MPs. Despite several research studies conducted on the presence and identification of MPs in various environmental components, many questions regarding MPs in the atmosphere and from the perspectives of COVID-19 and One Health still need to be answered. This study will help the key stakeholders and policymakers in safeguarding public health and environment from the threats posed by airborne MPs