Association Of Vitamin D Status And Diabetes Mellitus

To evaluate the association of 25-hydroxyvitamin D3 (25OHD)inadequacyand hyperglycaemia in a Pakistani adult population.Study Design:Case control studyPlace & Period of Study:Department of Pathology, PNS SHIFA Hospital, Karachi; Aug 2011 to Nov 2011.Method and Material:Plasma Glucose levels were measured in 86 patients divided on the basis of their 25-hydroxyvitamin D3(25OHD)levels in three groups, normal (>31 ng/ml), insufficient (20-31ng/ml) and deficient (<20ng/ml). Vitamin D insufficiency (VDI)and Vitamin D Deficiency (VDD) are collectively called Vitamin D inadequacy. 25OHD was measured by electrochemiluminescenceusing Roche Elecsys® Systems while glucose was estimated by routine methods on Roche Hitachi® Autoanalyser.Results:.Vitamin D levels were inversely correlated with plasma glucose levels(r=-0.38;p<0.01) with an Odd Ratio of 3.59(95%confidence interval 1.29 to 8.70).Fasting plasma glucose was significantly higher in VDD patientsas compared to patients withnormal vitamin D status (p<0.05).Conclusion:Higher glucose levels were found more frequent in patients with Vitamin D deficiency

Alternative sources of proteins in farm animal feeding

The global demand for protein is on the rise owing to the exponential increase in the world population and to meet the global protein requirements, it is imperative to seek alternative sources of proteins in farm animal feeding. Recognizing the importance of proteins and the fact that a major portion of human protein requirements is derived from livestock in the form of meat, milk, and eggs, the available protein-feeding stuff in the form of soybean meal cannot be regarded as sufficient for feeding to livestock. Oil seeds such as rapeseed meal and canola meal have a crude protein content of 30%-40% and are widely used and hence a potential alternative protein source to soybean meal. Going forward, Grain legumes such as peas, faba beans, and lupins, another alternative source of proteins have the potential to replace traditional protein feeds completely or partially such as bone and fish meals. Duckweed with a protein content of 20%-45% is another plant-based potential protein source that can be employed in livestock feeding particularly pigs owing to its huge potential as a growth promoter as evidenced by studies in pigs and piglets. Because of their nutritional qualities and possible environmental advantages, insects represent another class of alternative protein sources that have enormous potential to function as sustainable protein sources. Several insect species have been assessed for use as animal feeds; the most promising ones include the yellow mealworm (Tenebrio molitor, TM), the common house fly (MD), and the black soldier fly (Hermetia illucens, HI). Byproducts from aquaculture and fisheries are abundant in macro- and micronutrients, and their utilisation can provide fishmeal and fish oil, which can then be further adapted for use as a source of protein in animal nutrition. Employing microalgae as an alternative source of protein in animal feeding is somehow a new concept. Many nutritional and toxicological studies have demonstrated the potential of algae biomass as a valued feed supplement or substitute for conventional protein sources such as soybean meal. While these alternative protein sources in livestock feeding may serve as useful tools, parameters such as feed safety and acceptability should be monitored based on feed safety regulations.O

Social media and SMEs’ performance in developing countries: effects of technological-organizational-environmental factors on the adoption of social media

Increasing globalization and rapid digitization across industries have led to greater international competition. Furthermore, the emergence of new innovation has created both challenges and opportunities for small and medium-sized enterprises (SMEs). SMEs have recently been attracted to social media applications to reach a larger audience, improve their relationship with potential customers, and retain existing customers. However, the scant focus has been devoted to comprehensively understanding the adoption of social media in the SME context in developing countries. This study investigates the effects of technological-organizational-environmental (TOE) factors on social media adoption and its effect on SME performance. Data was collected by generating online survey link. SmartPLS 3.3 was used for the path analysis of 381 SMEs. The findings revealed a significant effect of relative advantage, cost-effectiveness, compatibility, interactivity (technological), entrepreneurial orientation (organizational), and customer pressure (environmental) factors, and an insignificant effect of top management support (organizational) and competitive pressure (environmental) determinants on social media adoption. The study found a significant influence of social media on SME performance. This paper offers several implications for decision-makers, policy-makers, and scholars interested in social media and its use. It builds an empirical, integrated framework for SMEs in developing countries

Social media users’ engagement: Applying network effect theory in participatory platform business in moderating knowledge management decision

Social media user engagement is a network effective in achieving a variety of goals linked to stakeholder networks (SN) and Word-of-Mouth Referral (WOMR). Achieving the results requires network effect theory (NET), which revolves around user engagement (UE) with an active participatory platform (APP) associated with knowledge management connected with stakeholder networks on a digital platform. Methodologically, the empirical quantitative structural equation model examined the interconnected hypotheses. In light of empirical measurements of five essential aspects of NET and stakeholder networks, the knowledge management moderation posits on the stakeholder relationships to better understand the return on social media as an integral part of public administration. The research then puts to test NET connecting various stakeholder networks and KM strategies. The study reveals that User Engagement (UE) is directly significant to SN but not WOMR, with numerous SM-APP signals and intersectional stakeholder networks significant in the study. KM moderation strengthened a positive relationship between UE and SN and partially mediated the relationship between UE and SN

DEVELOPMENT OF OPTIMIZED MAINTENANCE SYSTEM FOR VEHICLE FLEET

Vehicle fleet holds a frm ground in both manufacturing and service industry. Fleet management plays a substantial role in an organization’s growth. Maintenance of vehicle fleet is critical in terms of cost, availability and customer satisfaction. The major cause for delays is inefcient and ineffective maintenance procedures. To avoid major market losses, an efcient maintenance model is required. This research proposed a maintenance system that integrates the flow of information by incorporating different maintenance strategies. The analysis is carried out on the basis of likelihood of the failures. Five Why Analysis is used to identify the root cause. The model incorporates the inspection method by using checklists and maintenance schedules. The system is capable to provide the basis for an advance system development

Impact of supervisory behavior on sustainable employee performance: Mediation of conflict management strategies using PLS-SEM.

This study investigates the relationship between supervisory behavior, conflict management strategies, and sustainable employee performance and inquires the mediating effect of conflict management strategies. Data were collected from the SMEs of the manufacturing industry of Pakistan. The significance of the model was assessed using the PLS-SEM (structural equation modeling). The findings of the study revealed a positive and significant relationship between supervisory behavior and sustainable employee behavior. Similarly, conflict management strategies had a positive effect on the relationship between supervisory behavior and sustainable employee behavior. This study adds in the current literature of supervisory behavior as a critical predictor of sustainable employee performance in two ways. Firstly, this study validates Conflict management strategies as an influential mediator between the relationship of supervisory behavior and sustainable employee performance. Secondly, this study provides substantial practical implications for managers at SMEs to enhance sustainable employee performance through supervisory behavior, stimulated by conflict management strategies. This study is based on cross-sectional data; more longitudinal studies can further strengthen the generalizability of relationships between the constructs. The study adds in the current literature of PLS-SEM as an assessment model for direct and mediation relationships

Modular Product Architecture for Sustainable Flexible Manufacturing in Industry 4.0: The Case of 3D Printer and Electric Toothbrush

Integrating sustainability, a flexible manufacturing system, and Industry 4.0 resolves the issues of fluctuating market demand arising from customization requirements. Modular products allow flexibility to adapt to changing requirements and optimize resource utilization. In this study, a method was proposed and applied to two products, i.e., a 3D printer and an electric toothbrush featuring modular architecture, multiple product versions, and customization, to contribute to the development of sustainable flexible manufacturing systems. From the results of the two case studies nine modules were identified that contain specific functions and related interface information. From these modules, one platform was developed that comprises common entities used in all variants of the products. This platform was further extended to product families. From the modules, product architecture was developed that supports the product and process relationships. These relationships can be developed concurrently, enabling product features to be linked to the manufacturing setup. Thus, when a modular architecture is developed, the factory has to be reorganized accordingly, or reconfiguration is possible. Hence, the main aim of the research was to develop modular product architecture to identify product and process relationships for a sustainable flexible manufacturing system

Correlation between Cholesterol, Triglycerides, Calculated, and Measured Lipoproteins: Whether Calculated Small Density Lipoprotein Fraction Predicts Cardiovascular Risks

Background. Recent literature in lipidology has identified LDL-fractions to be more atherogenic. In this regard, small density LDL-cholesterol (sdLDLc) has been considered to possess more atherogenicity than other LDL-fractions like large buoyant LDL-cholesterol (lbLDLc). Recently, Srisawasdi et al. have developed a method for calculating sdLDLc and lbLDLc based upon a regression equation. Using that in developing world may provide us with a valuable tool for ASCVD risk prediction. Objective. (1) To correlate directly measured and calculated lipid indices with insulin resistance, UACR, glycated hemoglobin, anthropometric indices, and blood pressure. (2) To evaluate these lipid parameters in subjects with or without metabolic syndrome, nephropathy, and hypertension and among various groups based upon glycated hemoglobin results. Design. Cross-sectional study. Place and Duration of Study. From Jan 2016 to 15 April 2017. Subjects and Methods. Finally enrolled subjects (male: 110, female: 122) were evaluated for differences in various lipid parameters, including measured LDL-cholesterol (mLDLc), HDLc and calculated LDL-cholesterol (cLDLc), non-HDLc, sdLDLC, lbLDLC, and their ratio among subjects with or without metabolic syndrome, nephropathy, glycation index, anthropometric indices, and hypertension. Results. Significant but weak correlation was mainly observed between anthropometric indices, insulin resistance, blood pressure, and nephropathy for non-HDLc, sdLDLc, and sdLDLc/lbLDLc. Generally lipid indices were higher among subjects with metabolic syndrome [{sdLDLc: 0.92 + 0.33 versus 0.70 + 0.29 (p 7.0%. Subjects having nephropathy (UACR > 2.4 mg/g) had higher concentration of non-HDLc levels in comparison to sdLDLc [{non-HDLc: 3.68 + 0.59 versus 3.36 + 0.43} (p=0.007), {sdLDLc: 0.83 + 0.27 versus 0.75 + 0.35 (p=NS)}]. Conclusion. Lipid markers including cLDLc and mLDLc are less associated with traditional ASCVD markers than non-HDLc, sdLDLc, and sdLDLc/lbLDLc in predicting metabolic syndrome, nephropathy, glycation status, and hypertension

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research