Disposable clean delivery kits and prevention of neonatal tetanus in the presence of skilled birth attendants.

OBJECTIVE: To determine whether the use of disposable clean delivery kits (CDKs) is effective in reducing neonatal tetanus (NNT) infection, regardless of the skills of birth attendants in resource-poor settings. METHODS: A secondary analysis was conducted on data from a matched case-control study in Karachi, Pakistan, involving 140 NNT cases and 280 controls between 1998 and 2001. Conditional logistic regression was performed to assess the independent effect on NNT of CDKs and skilled birth attendants (SBAs). RESULTS: After adjustment for socioeconomic factors, both CDKs (adjusted matched odds ratio [mOR] 2.0; 95% confidence interval [CI], 1.3-3.1) and SBAs (adjusted mOR 1.7; 95% CI, 1.1-2.7) were independently associated with NNT. The association with CDKs remained significant when additionally adjusted for SBAs (mOR 2.0; 95% CI, 1.0-3.9; P=0.05). The population attributable risk for lack of CDK use was 24% in the study setting. CONCLUSION: In the context of resource-poor settings in low-income countries with poor coverage of tetanus toxoid immunization, the use of CDKs seems to be an effective strategy for reducing NNT infection, irrespective of the skill levels of birth attendants. Approximately one-quarter of NNT cases could be prevented in low-income populations with the use of CDKs

Systemic problems related to multiple stakeholders in technology adoption and use in organizations : a systems thinking perspective

Understanding and creating the conditions under which information systems will be embraced by human organizations (thinking systems) remain high-priority research issues. Despite numerous benefits associated with information technology (IT), implementing an information system (IS) in organizational environment is challenging. The literature reports numerous IS project failures. During IS implementation, several factors impede technology’s widespread adoption and use in organizations. These organizational problems often result from such barriers or ‘systemic problems’. The proposed work is based on the argument that addressing ‘systemic problems’ can reduce barriers to organizational progress. Most of the IS/IT adoption theories (e.g. TAM, UTAUT, TAM2 and TAM3) highlight factors related to system users, completely ignoring the other stakeholders who are affected by the adoption process. The purpose of this study is to apply an holistic or systems thinking approach to identify systemic problems in information technology adoption and use within an organizational context by considering the complete stakeholder set as a ‘system of stakeholders’. It involves the study of a web portal implementation project in an Australian university referred to as Aus-Uni. Data was collected through face-to-face interviews of different stakeholders across Aus-Uni and were fundamentally classified into the two categories of ‘involved’ and ‘affected’. Their relevant comments and experiences have been analysed using the lens of a systems thinking-based framework of Critical Systems Heuristics (CSH). The interpretive approach, based on structured-case study method, and the technique of practising CSH have been used as a data gathering framework for this case study. The study’s findings contribute towards identifying information needs and systemic problem scenarios, related to multiple stakeholders in the context of the web portal project. However, its insights may allow broader applications. The roles which these stakeholders play have been classified under the categories prescribed by the CSH methodology of boundary critique. This generated ‘system of stakeholders’ was further analysed to explore problem scenarios as subsystems to this ‘system of stakeholders’. Each problem scenario identifies who was involved and affected by it. It is believed that identifying problems holistically will lead to smoother IS adoption, and reduce IS project failures. This research also proposes two theoretical models based on Critical Systems Heuristics (CSH); one for IS adoption, which demonstrates how CSH can be coupled with the existing IS implementation methodologies to create a holistic perspective of IS implementation issues. This model uses Systems Development Life Cycle (SDLC) as an example, and proposes that the stakeholder roles need to be identified using boundary critique throughout the project life cycle. The second model is for managing conflicts in the context of organizational change, and is applicable for implementing innovative practices inside organizations, and identifying conflicting scenarios which surface during that process

Optimal Pricing and order quantity strategies for a firm offering multiple products facing customers cannibalization and random market demand

This paper studies a firm’s profitability problem offering its products into different market segments at differentiated prices. In order to improve the firms’ profitability the firm needs to decide the prices and order quantities allocations for each market segment. In perfect market segmentation, it is assumed that the customers do not cannibalize between market segments. Whereas, in the case of imperfect market segmentation, the customers are assumed to cannibalize from a high price market segment to a lower price segment. Models to determine the optimal strategies for pricing and order quantity for the perfect as well as for the imperfect market segmentations are proposed with both the deterministic and stochastic customers’ demand. The study has shown that the perfect market segmentation always yields higher revenues compared to no segmentation for a firm facing both the deterministic and stochastic demand situations. In addition to this, the study has also shown that when cannibalization exists, a firm is still able to yield higher revenues compared to the case of no market segmentation facing both the deterministic and stochastic demands, however, greater the extent of cannibalization could result substantial losses in the profitability

Vivax malaria and chloroquine resistance: a neglected disease as an emerging threat

In Pakistan, Plasmodium vivax contributes to major malaria burden. In this case, a pregnant woman presented with P. vivax infection and which was not cleared by chloroquine, despite adequate treatment. This is probably the first confirmed case of chloroquine-resistant vivax from Pakistan, where severe malaria due to P. vivax is already an emerging problem

Non-Local Deformation of a Supersymmetric Field Theory

In this paper, we will analyse a supersymmetric field theory deformed by generalized uncertainty principle and Lifshitz scaling. It will be observed that this deformed supersymmetric field theory contains non-local fractional derivative terms. In order to construct such deformed N=1 supersymmetric theory, a harmonic extension of functions will be used. However, the supersymmetry will be only preserved for a free theory and will be broken by the inclusion of interaction terms.Comment: 12 pages, pulished versio

SHORT TERM OUTCOME OF PATIENTS WITH HEPATOPANCREATOBILIARY MALIGNANCIES TREATED IN A MULTIDISCIPLINARY HEPATOBILIARY UNIT IN A TERTIARY REFERRAL CENTER

Purpose: Specialisation in hepatopancreatobiliary (HPB) surgery has evolved over the past few decades based on better understanding of the biology and the behaviour of the diseases. In this review from a specialised HPB service, we aim to provide an overview of the HPB oncological cases managed in a tertiary care cancer hospital. Methods: All cases of HPB malignancies treated in our hospital between October 2014 and September 2015 were included in the study. Clinical findings, operative details and short-term post-operative outcomes were assessed from a prospectively managed database. Results: A total of 65 oncological procedures were performed over 1 year. These included 23 hepatic resections, 27 pancreaticoduodenectomies, 5 radical surgeries for gallbladder cancer, 2 distal pancreatectomy and 8 nephrectomies with exploration of the inferior vena cava. One patient successfully underwent Associated Liver Partition with Portal vein ligation and staged hepatectomy (ALPPS Procedure), which to our knowledge was the rst ALPPS procedure carried out in Pakistan. Conclusion: The short-term experience of patients managed in specialised HPB unit has shown good outcomes.There is a need for establishing HPB units in most tertiary care hospitals in the country. Key words: Associated liver partition with portal vein ligation and staged hepatectomy procedure, hepatic resections, hepatopancreatobiliary surgery, pancreaticoduodenectomy

Structure and Rheological Properties of Bovine Aortic Heart Valve and Pericardium Tissue: Implications in Bioprosthetic and Tissue-Engineered Heart Valves

Heart valve (HV) diseases are among the leading causes of cardiac failure and deaths. Of the various HV diseases, damaged HV leaflets are among the primary culprits. In many cases, impaired HV restoration is not always possible, and the replacement of valves becomes necessary. Bioprosthetic HVs have been used for the replacement of the diseased valves, which is obtained from the sources of bovine and porcine origin, while tissue-engineered heart valves (TEHV) have emerged as a promising future solution. The bioprosthetic valves are prone to become calcified, and thus they last for only ten to fifteen years. The adequate understanding of the correlations between the biomechanics and rheological properties of native HV tissues can enable us to improve the durability of the bioprosthetic HV as well as help in the development of tissue-engineered heart valves (TEHV). In this study, the structural and rheological properties of native bovine aortic HV and pericardium tissues were investigated. The microstructures of the tissues were investigated using scanning electron microscopy, while the rheological properties were studied using oscillatory shear measurement and creep test. The reported results provide significant insights into the correlations between the microstructure and viscoelastic properties of the bovine aortic HV and pericardium tissues.Scopu

Upper-Extremity Injuries are the 2nd Most Common Workplace Injuries from 1992 to 2018

Musculoskeletal injuries occur frequently in the workplace, yet it is unclear whether upper-extremity, lower-extremity, or trunk injuries are the most prevalent. We hypothesize that: (1) trunk injuries are the most common in the overall workplace, and (2) upper-extremity injuries are more common in labor-based industries than non-labor industries. Workplace related injury data from 1992 to 2018 was collected from the Bureau of Labor Statistics “Workplace Injuries & Illnesses” database. Occurrence of trunk, upper-extremity, and lower-extremity injuries in major industries (agriculture, construction, manufacturing, and healthcare) were aggregated during this time period and compared. Overall workplace related injury occurrence in major industries from 1992 to 2018 for the following body regions were tabulated as follows: upper-extremity (4,471,340 cases), lower-extremity (3,296,547 cases), and trunk (5,889,940 cases) (p\u3c.05). Upper-extremity injury incidence was observed to be significantly higher than lower-extremity injury incidence in the manufacturing industry (p\u3c.001) and significantly lower than trunk injury incidence in the healthcare industry (p\u3c.001). However, differences between upper-extremity injury incidence and both lower-extremity and trunk injury incidence were not significant for the other industries. When comparing the occurrence of upper-extremity injuries across industries from 1992 to 2018, significant differences were determined between all industries except for healthcare (p\u3c.001). When identifying changes in injury occurrence in each respective industry across this time span, manufacturing was shown to have the largest decrease (x=-5,432, r=-.91) followed by construction (x=-966, r=-.87) and then agriculture (x=-270, r=-.79). Weak correlation was observed for healthcare (x=118, r=.15)

Hybrid satellite–terrestrial networks toward 6G : key technologies and open issues

Future wireless networks will be required to provide more wireless services at higher data rates and with global coverage. However, existing homogeneous wireless networks, such as cellular and satellite networks, may not be able to meet such requirements individually, especially in remote terrain, including seas and mountains. One possible solution is to use diversified wireless networks that can exploit the inter-connectivity between satellites, aerial base stations (BSs), and terrestrial BSs over inter-connected space, ground, and aerial networks. Hence, enabling wireless communication in one integrated network has attracted both the industry and the research fraternities. In this work, we provide a comprehensive survey of the most recent work on hybrid satellite–terrestrial networks (HSTNs), focusing on system architecture, performance analysis, design optimization, and secure communication schemes for different cooperative and cognitive HSTN network architectures. Different key technologies are compared. Based on this comparison, several open issues for future research are discussed