Factors influencing the perception of medical tourist in selection of their destination : a global perspective

There can be unlimited reasons why patients choose different countries while going for medical treatments or procedures. Moreover, empirical evidence on medical tourism is very limited. Due to the limited literature and empirical evidence on the topic, we believe that, other related studies focusing on the choice and criteria of selecting the destination will provide us with some useful insights and information on the factors influencing the patient’s perception in selecting the medical tourism destination in various countries around the world. The aim of this study is to present the theoretical and empirical literature on medical tourist’s perception on selecting the destination while going for medical treatment. It is organized into three main sections. First section focuses on the concepts, definitions and integrates the foregoing definitions of medical tourism and concepts of tourist’s perception of destination selection criteria and the theoretical framework. In section 2, an attempt is made to illustrate the impact of various reasons for selecting different destinations from the past findings. The final section deals with the conceptual framework of the study

Effects of low water input on rice yield: Fe and Mn bioavailability in soil

Soil fertility and water condition are the main concerns in rice production. In order to determine the effects of low water input on rice production and soil chemical properties, the Fe and Mn contents, and soil pH in soil were measured during rice cultivation. It was found that rice yield and yield parameters obtained were not significantly different under different water levels. Soil pH was moderately acidic to near neutral. Meanwhile, iron (II) in soil extract slowly increased throughout the rice growing period but it increased markedly after the water was drained off. Manganese availability significantly increased after flooding, but it decreased at a similar trend followed after that, followed by a stable level. In addition, weekly data showed no significant differences in Fe(II) and Mn in the soil extract of the different treatments. These results suggest that low water input does not affect rice production as well as soil pH and Fe(II) and Mn bioavailability in soil

Efecto de annealing sobre las propiedades estructurales, térmicas y mecánicas de la composición de aleación binaria Al85 Ni 15

Introduction: The Al 85-Ni15 alloy with 99.99% purity of Al and Ni were prepared by an arc melting technique system. The annealing effect onthe microstructure properties, phase transformation and micro-hardness for the Al-Ni alloy system were investigated. Material and Methods:The alloys were characterized by X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), and Differential Thermal Analysis (DTA) as well as Vickers micro-hardness measurement. Results and Discussion: The quantitative results confirm that the chemical composition of the alloys is very close to compositions and the microstructures are in typical lamellar morphology. Mechanical properties for the as-prepared samples and subsequently heat-treated samples were measured by a Vickers indenter. Values of the micro-hardness (HV) Conclusions: According the XRD pattern analysis a multi phases produced, such as Al, AlNi3in room temperature, Al3Ni2, Al0.42Ni0.58 at 200ºC, Al1.1Ni0.9 at 300ºC and Al 0.802Ni0.198, AlNi3 and AlNi at 400ºC, and Al0.802Ni0.198, AlNi3 and AlNi for 500ºC. Similar approached were obtained from the results of SEM and DTA measurements. Annealing treatments are visibly affecting the alloy phase formation with different phases at different temperature. and the elastic modulus (E) of the as prepared sample are 132.9±0.1 kgfmm-2 (1.329±0.1 GPa) and 80.340±0.1 GPa, respectively. Furthermore, the characteristic of the materials plasticity (δH) value was calculated to be 0.85. The micro-hardness values are decrease with the increase of annealing temperatures

Granulomatosis with polyangiitis: A 17 year experience from a tertiary care hospital in Pakistan

Objective: Granulomatosis with Polyangiitis (GPA) is an autoimmune, multi-system, small and medium vessel vasculitis with granulomatous inflammation. Aim of this study was to assess the clinical and radiological presentations of patients with GPA amongst the Pakistani population. It is a single centre retrospective single observation study. Results: Study was conducted at the Aga Khan University Hospital, Karachi with records were reviewed from January 2000 to December 2017. Definitive diagnosis was made using a combination of serological anti-neutrophil cytoplasmic antibody (ANCA) testing along with the clinical and radiological presentation. A total of 51 patients met the diagnostic criteria in the time frame of the study. There were 23 males and 28 females with mean age of 44.0 ± 17.8 years on presentation. Arthritis was the most common symptom present in 41.2% of the cases followed by cough in 32.0%. Sixteen patients showed pulmonary infiltrates on chest X-ray. C-ANCA was positive in all of the patients compared with 21.6% p-ANCA positivity. A total of 13 biopsies were done. The median Birmingham Vasculitis Activity Score was 12. We report a 17.6% mortality rate with 5 deaths occurring due to respiratory failure. GPA is a diagnostic challenge leading to late diagnosis which can contribute to significant morbidity and mortality specially in the Third World

Knowledge about asthma: A cross-sectional survey in 4 major hospitals of Karachi, Pakistan

Objective: To determine knowledge and misconceptions about asthma among the local population..Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha Institute of Chest Diseases, Karachi, from October to November 2016, and comprised hospital attendants. The questionnaire used in the study comprised 26 questions answered with a true, false or not sure answer.SPSS 20 was used for data analysis.Results: There were 400 participants. The overall mean age was 41.2±14.2 years, and 214(53.5%) of the participants were males. Moreover, 75(19%) participants thought that asthma was a psychological disorder while 181(45%) considered it an infectious disease. Nearly 174(43.5%) believed that inhaled medications had significant side effects. Besides, 264(66%) participants considered steam inhalation to be an effective treatment for asthma, 269(67%) thought that patients with asthma should avoid rice in their diet and 167(42%) considered milk as a common trigger.CONCLUSIONS: Participants\u27 knowledge about asthma was poor and misconceptions were common about the condition

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia.

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines

Effect of Different Potting Mixes on Germination and Vegetative Growth of Sweet Pepper Plant (Capsicum Annum L.) Under Greenhouse Conditions

Sweet pepper is a high nutrient demanding vegetable crop. Fertilizer use and management is therefore of highly important to sustain growth and high yield. However, this study aimed to evaluate the effect of using different types of organic fertilizer on germination and vegetative growth of sweet pepper plant, that have bell-shaped (Capsicum annum L), grown in pots culture under greenhouse condition. The study was conducted at the College of Agriculture, Duhok Governorate, Kurdistan region, Iraq during March 15th, 2015, to June 25th, 2015. The treatments that have been compared in this study were: T1 (Control 100% soil); T2 Municipal Solid Waste compost taken from Kashe factory (1:1 V/V); T3 Sheep manure (1:1 V/V); and T4Peat moss (1:1 V/V).The experiment was randomized complete design with three replicate. The parameters that have been measured were: germination percentage, plant height; number of leave per plant; leaf area and plant fresh and dry weight per pot. In most cases all the studied growth parameters were significantly higher in pot treated by peatmoss and sheep manure compared to control and Municipal Solid Waste compost. Germination percentage was also significantly enhanced in treatment amended by peatmoss and sheep manure. Municipal waste compost was significantly reduced the all the plant growth parameter and germination percentage as well. Depending on these results it can be suggested that organic fertilizers particularly peatmoss and sheep manure can be used to enhance growth and productivity in plant pepper. It was also claimed that the amount of municipal waste compost that was used in this experiment might be too high so further study should be conducted with different ratio on the quality of this type of organic fertilizer

Acceptance of COVID-19 vaccine in Pakistan: A nationwide cross-sectional study

Introduction: The coronavirus disease 2019 (COVID-19) vaccine is available across various countries worldwide, with public-private partnerships ensuring all individuals are vaccinated through a phased approach. Irrespective of the geographical spread, several myths pertaining to the COVID-19 vaccine have stemmed, ultimately limiting the national administration of vaccines and rollouts. This study assessed the acceptance of the COVID-19 vaccine among the general public in Pakistan.Methods: A pre-validated questionnaire was administered from January 2021 to February 2021 to assess the public attitude and acceptance of the COVID-19 vaccine. Logistic regression analyses were run to identify factors associated with the acceptance among the population.Results: A total of 936 responses were elicited, where 15% perceived their risk of being infected at 20-30% with an overall 70% agreeing to be vaccinated if recommended. Multivariate analysis identified higher acceptance in the male gender, healthcare workers, and students. Of all, 66% respondents chose healthcare workers and public officials, whereas 15.6% chose scientific literature, and 12.9% chose social media as the most reliable source of COVID-19 information.Conclusion: Given the relatively greater trust in healthcare providers for information regarding COVID-19, healthcare workers ought to be on the frontline for vaccine campaigns and public outreach efforts, with governmental efforts in addition to the promotion of scientific materials for population-level understanding

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised