School teachers and principals’ experiences during COVID-19 in Pakistan

As a result of the COVID-19 pandemic, educational activities were disrupted globally. In Pakistan, schools were also closed, and though some schools had started teaching online, the staff (including principals and teachers) and students\u27 readiness for education during the pandemic remained unexplored. An internet-based survey was conducted to explore the experiences of the teachers and principals during the lockdown. The survey included both open-ended and closed-ended questions. Responses were collected from respondents in different parts of Pakistan, with the majority coming from Sindh and coming from both the private and public sector. While the respondents from private schools reported that they could teach online, the respondents from government schools could not continue the teaching process during the lockdown phase. School principals focused on acquiring technology for online teaching and offering skills development sessions. They used a variety of methods to monitor teaching and learning. Teachers relied on a mix of synchronous and asynchronous teaching. Infrastructure issues posed numerous challenges. Findings highlight an urgent need for teacher education programmes to incorporate digital literacy development and enhance pedagogical understanding of engaging students in online teaching environments and exploring solutions such as blended learning. The findings also draw our attention to questions of equitable access to quality education for all in Pakistan

Nutritional Habits and Weight Status among Jazan University Students: Eating Patterns and Healthy lifestyle Assessment

Objectives The purposes of this study were to assess the prevalence of underweight, overweight, and obesity and to evaluate the nutritional habits, and related factors among the Students of Jazan University. Methods This cross-sectional study was carried out during the academic year 2014/2015 in Jazan University, Gizan, South West Saudi Arabia. A total of 436 students 19–25 y of age were examined. The questionnaires, including items on eating habits, lifestyle, and socio-demographic characteristics, were completed by the students. Data on weight, height were also collected.  The data were analyzed using descriptive statistics and chi-square test. Differences were considered statistically significant at P. value  < 0.05. Results The mean weight for males and females were 67.84 and 54.79 kg respectively, with significant differences between males and females (P. value <0.05). The mean BMI for all study participants was reported as 23.31 (kg/m²), also with significant difference between the males and females groups. About 45% of the students were of normal weight; the rate of obesity and underweight among students was very high (33.6% and 21.1% respectively), and their dietary habits were unhealthy. Regularity of meals was found only among (16.5% and 20.4%) males and females respectively. 83.3% of males and 95.1% of females reported eating snacks during the day. Conclusion The results of this study suggest that the prevalence of overweight and obesity were very high among the studied students. The study showed the need for health education programs on nutritional education in universities in order to increase awareness of students towards healthy eating and lifestyle. &nbsp

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Transfer of STEM research for designing contextually relevant curriculum in Pakistan: A case study

This chapter presents a multiple case study of design, enactment, and redesign of contextually relevant curricular units reflecting how in-service teachers’ varied understanding of Science, Technology, Engineering and Mathematics (STEM) shaped the curricular units differently. This work originated because of researcher practitioner partnership between a private, international higher education institution at Karachi, Sindh, and a school in Sukkur, Sindh, in Pakistan. During this partnership 18 teachers were engaged in integration of STEM through STEM-focused professional development that was coupled with coaching support using the science and mathematics concepts of grade 4–8 that are in line with the National Curriculum of Pakistan. This research used Design Based Research (DBR) as a methodological approach. Detailed analysis showed the evolution of participant teachers’ STEM conceptions. This study found engineering design challenge as a canvas for the varied level of integration and local contextually relevant problems captivated both teachers and students’ attention. The introduction to STEM offered active learning affordances to teachers and a visible inclusion of some STEM pedagogies was noticed in the classrooms. Participating teachers attributed their engagement in the design, enactment, and redesign of STEM curricular units as a unique hands-on learning that was seen as professional growth opportunity. Finally, this chapter concludes with offering implications for developing teachers’ understanding of STEM for the national level implementation of STEM in Pakistani schools

Investigating science teachers’ technology integration in classrooms: A case study of a private higher secondary school in Karachi, Pakistan

The use of technology in all fields of education has expanded, and investigating the level of technology integration in schools becomes increasingly significant because it offers data-driven technology integration for policymakers, school administrators, and educators to make better budgeting decisions, determine educator professional development needs, and ensure effective and efficient use of technology in schools. This study investigated science teachers’ technology integration in classrooms at a private higher secondary school in Karachi. In this study, the SAMR model and TPACK framework were used to evaluate the technology integration. The SAMR model was used to see at what levels teachers are in technology integration, where substitution is the lowest and redefinition is the highest level of technology integration. The TPACK framework was used to explore the technological, pedagogical, and content knowledge of the teachers. This study employed a qualitative single embedded case study design. Multiple data were collected through document review (syllabus breakup), observations, and participant interviews. Purposive sampling was used to select six in-service science teachers. Even though this case was chosen for its well-established use of technology, the findings of the study indicated that teachers’ use of technology and knowledge about technology integration was at the basic level. The result of the study showed that most of the science teacher participants were at the substitution level and demonstrated low TPACK knowledge. The study concludes by suggesting that sustainable teacher professional development focusing on technology integration and teacher-sustained commitment to learning and use of technology can enhance teachers’ TPACK knowledge and enable them to practice transformative technology integration in classrooms

نعت گوئی میں ریاض حسین چودھری کے کلام کا ادبی جائزہ

In Urdu literature Naa't had been a keen source of true relation and love with the Holy Prophet (S.A.W). Many great poets had written and recited Naa't both in Arabic and Persian in the love of the Holy Prophet. One of these most popular and legendary contemporary bets is Riaz Hussain Chaudhry. Almost 13 of his Naa't collections had been published yet. Here, in this article an analysis has been done of different aspects of his art and skill of Naa't writing. Besides, what status contemporary poets award him is also analysized in this article.</p