CPEC Investment Opportunities and Challenges in Pakistan

China-Pakistan Economic Corridor (CPEC) is related with energy and infrastructural projects. China has made massive investments in Pakistan so the region will attract reasonable foreign direct investments. Three routes are developed for infrastructural development i.e. Khunjerab to Gwader, establishment of railway, airport and seaport at Gwader so lot of prospering opportunities will be for the areas of Khyber Pakhtunkhwa and Baluchistan. As CPEC is a combination of the myriad projects on infrastructure and energy sector and these projects will be supported by an investment of $46 billion, whereby$ 35 billion will be spent on energy sector and remaining $11 billion will be spent on infrastructural developments. This review considered the available research on the prospects and issues of CPEC and provides implications for research and Pakistani economy. Available research on CPEC and its implications is descriptive in nature. There is a need to conduct sector specific studies to lay out policies and framework of action to capitalize on the opportunities provided by CPEC

Characterization of Hepatitis C Virus genotype 3a Hypervariable region 1 in patients achieved rapid virological response to alpha interferon and Ribavirin Combination therapy

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus roots a chronic liver disease. Currently approved treatment strategy includes administration of alpha interferon and ribavirin combined therapy for 24-48 weeks. One of the predictor of sustained virological response is an early virological response to treatment characterized as rapid response. Hyper variable region 1 (HVR1) of E2 protein is responsible for viral entry and acts as a target for neutralizing antibodies. Any mutation in this region would effect virus interaction with target cell and viral persistence.</p> <p>Methods</p> <p>Thirty one clones of six pre-treatment samples subjected to combination therapy were investigated. Three of the patients were rapid responders (R1, R2 and R3) and two were breakthrough responders (BT1 and BT2). Envelope 2 gene was amplified, cloned and sequenced. Amino acid substitution, frequency, composition and antigenic properties of HVR 1 of E2 protein were studied.</p> <p>Results</p> <p>In both rapid responders (R.R) (14 amino acid sites) and breakthrough responders (BT.R) (13 amino acid sites) half of the amino acid sites were either conserved or resistant to any physiochemical change due to amino acid substitution. It also indicated that average composition of hydrophilic and basic amino acids were comparatively lower in rapid responders than other samples affecting probable interaction of virus with target cells. A central non antigenic region was constant among the breakthrough responders but differed in length significantly among rapid responders reflecting the adaptive nature of HVR1 to the immune response.</p> <p>Conclusions</p> <p>We observed that although HVR1is quite variable region in HCV 3a patients responding differently to treatment it still maintains its physiochemical properties for its proper functioning and viability.</p

Detection of BCR-ABL kinase domain mutations in CD34+ cells from newly diagnosed chronic phase CML patients and their association with imatinib resistance

BCR-ABL kinase domain (KD) mutations, the most common cause of imatinib resistance, are infrequently detected in newly diagnosed chronic-phase chronic myeloid leukemia (CP-CML) patients. Recent studies indicate pre-existing mutations (PEMs) can be detected in a higher percentage of CML patients using CD34+ stem/progenitor cells, and these mutations may correlate with imatinib resistance. We investigated KD mutations in CD34+ stem cells from 100 CP-CML patients by multiplex ASO-PCR and sequencing ASO-PCR products at the time of diagnosis. PEMs were detected in 32/100 patients and included F311L, M351T, and T315I. After a median follow-up of 30 months (range 8-48), all patients with PEMs exhibited imatinib resistance. Of 68 patients without PEMs, 24 developed imatinib resistance. Mutations were detected in 21 of these patients by ASO-PCR and KD sequencing. All 32 patients with PEMs had the same mutations. In imatinib-resistant patients without PEMs, we detected F311L, M351T, Y253F, and T315I mutations. All imatinib-resistant patients without T315I and Y253F mutations responded to imatinib dose escalation. In conclusion, BCR-ABL PEMs can be detected in a substantial number of CP-CML patients when investigated using CD34+ stem/progenitor cells. These mutations are associated with imatinib resistance, and mutation testing using CD34+ cells may facilitate improved, patient-tailored treatment

Readiness for antimicrobial resistance (AMR) surveillance in Pakistan; a model for laboratory strengthening

Background: Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings. Methods: A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that consented were provided additional training and updates sessions over a period of 15 months. Impact of training activities in these laboratories was evaluated using a point scoring (0-11) tool. Results: Results of self-assessment component identified a number of areas that required strengthening (scores of ≤60%). These included; readiness for AMR surveillance; 38 and 46%, quality assurance; 49 and 55%, and detection of specific organisms; 56 and 60% for public and private laboratories respectively. No significant difference was detected in AST capacity between public and private laboratories [ANOVA; p \u3e 0.05]. Scoring tool used to assess impact of training within the longitudinal cohort showed an increase from a baseline of 1-5.5 (August 2015) to improved post training scores of 7-11 (October 2016) for the 5 laboratories included. Moreover, statistical analysis using paired t-Test Analysis, assuming unequal variance, indicated that the increase in scored noted represents a statistically significant improvement in the components evaluated [p \u3c 0.05]. Conclusion: Strengthening of laboratory capacity for AMR surveillance is important. Our data shows that close mentoring and support can help enhance capacity for antimicrobial sensitivity testing in resource limited settings. Our study further presents a model wherein laboratory networks can be successfully established and used towards improving diagnostic capacity in such setting

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A New View on The Socio-Economic Factor In Child Mortality Asymmetric ARDL Provides New Evidence for Developing Country SDG (SDG'S) Achievement

Purpose – The purpose of this study is to explain the link between child mortality and education, environmental health, water sanitation, and climate change. It seeks to manage and reduce child mortality by detailing why and how education, climate change, and environmental factors are crucial in lowering child mortality during a five-year period. The study intends to broaden the realm of child mortality reduction by integrating a water sanitation and health component not commonly identified in the literature. Design/methodology/approach – The paper&nbsp; for an exploratory research between 1996 and 2020 utilising the Asymmetric Auto Regressive Distributed Model (ARDL). Long-run co-integration results suggest that Auto Regressive Distributive Lag (ARDL) is appropriate for examining the short-run connection between the modelled variables. The information comes from the World Development Indicator (WDI), which covers seven developing countries: Pakistan, Iran, Indonesia, Afghanistan, India, Bangladesh, and Nepal. Findings – According to the study, access to improved water and sanitation facilities, environmental health, and climate change all have a substantial and negative impact on child survival. Furthermore, the study looked at the impact of schooling on child mortality. Research limitations/implications – The chosen research technique may limit the generalizability of the study findings. As a result, researchers are encouraged to examine the presented hypotheses further. Practical implications – This report advises policymakers and international organisations that in order to fulfil the needed rate of child mortality, households should have access to clean water and sanitation services. Furthermore, the report suggests that the government adjust environmental and educational policies in order to reduce child mortality. Originality/value – The major objectives of the study are to construct a extrapolative exemplary for under-5&nbsp; mortality and to categorize important hazard variables connected with under-5 deaths using nationwide demonstrative facts on kids under-5

Impact of Small and Medium Scale Enterprises on Poverty Reduction in developing country: A case of Pakistan

This research has been conducted to examine the role of SME`s to eradicate poverty in Pakistan over the period of 2001-2015. The study investigates relationship by using secondary data from World development indicator by estimating simple linear regression model. Results indicate that small medium enterprises have a negative association with poverty and significantly lower poverty rate in Pakistan. SMEs generate employment opportunities which contribute to the poverty alleviation in the economy of Pakistan. Moreover, human capital and government expenditure also significantly reduce poverty in Pakistan. As government expenditure and human capital increase, it causes to lower poverty growth rate. Similarly trade and inflation also have significant association with poverty, however, inflation and poverty have positive association while trade has the negative association with poverty growth rate in Pakistan. The value of R square (0.756) indicates that model is a good fit and F-ratio states the overall significance of the model. Therefore, results suggest that government should adopt the policies that promote SME growth rate, trade openness, human capital, GDP, government development expenditure and lower inflation rate to control poverty in Pakistan.Keywords: SMEs, Poverty reduction, inflation, trade openness, government expenditure

Impact of Globalization on Green Growth: A Case of OECD Countries

Green growth is considered as healthy sign for any country in the world. With growing pollution and other health issues now it is considered as burning issue, either to save our natural resources or the cost should be paid in case of over or unrealistic consumption of resources. This study has been carried with real intension to investigate the role of fdi, R &amp;D and trade openness on green economic growth of OECD countries. Developed economies are open for foreign direct investment, more liberal trade policies and ready to adopt technological innovations, all that causes to bring rapid environmental changes in these nations and continuously increasing level of heat in the atmosphere of these economies. No doubt these countries are attaining high speed of growth at high level of CO2 in the atmosphere. Therefore, this study is conducted to identify the factors that can affect green economic growth. Data is extracted from world development indicator from 1991-2018 where results depict that FDI (Foreign Direct Investment) and trade openness has significant and positive relationship with the emission of CO2 in air and has certain association with green economic growth in short run as well as in the long run. Whereas research and development cost has significant but negative relation with green growth of the OECD countries. Policy makers should work on research and development if they are more focused on green growth of the countries

The mediating role of absorptive capacity in the relationship between intellectual capital and organizational innovation in higher education institutes Punjab, Pakistan

This study aims to investigate the mediating role of absorptive capacity (ACAP) between intellectual capital (IC) and organizational innovation in the context of Higher education institutions (HEI) of Punjab Pakistan. This study used a structured questionnaire to collect the data from employees of HEI Pakistan. This study usesa covariance-based structural equation modeling technique (CB-SEM) for data analysis through AMOSE software. This study performed CB-SEM in two steps; confirmatory factor analysis (CFA) and SEM analysis. Confirmatory factor analysis ensures the reliability and validity of the construct while SEM analysis was used to test the modeled hypothesis. The study found that IC has a significant positive relationship with ACAP and organizationalinnovation. ACAP has a significant and positive relationship with organizational innovation and also plays a mediating role between IC and organizational innovation. The study will help the HEIs of Pakistan to boost innovation activities more effectively in order to improve their innovations performance. This study enriches the theoretical literature of IC by using five dimensions, human, social, structural, relational and spiritual capital, of IC and by suggesting a new path for organizational innovations. Moreover, a few studies investigated a relationship between IC and organizational innovation with the mediating role of absorptive capacity; however, in HEIs Pakistan context, no study exists. This study can be reproduced in another sector like information and communication technology and the banking sector