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Purpose: Based on trait activation theory, the purpose of the present study is to explore the relationship between the antecedents and outcomes of informal learning with the moderating effect of supervisor feedback environment (SFE) in small- and medium-sized enterprises (SMEs). Design/methodology/approach: Data (n = 388) were gathered from middle managers of Pakistan's SME sector by following the purposive sampling technique. The proposed model was examined by means of structural equation modeling analysis with AMOS 24. Findings: The study results delineate that middle managers with high-level self-efficacy and motivation to learn more actively participate in informal learning activities. The study also found that the SFE is a strong contextual moderator between the nexus of personal factors and informal learning. In addition, informal learning also has significant and positive effect on work engagement. Practical implications: Human resource practitioners and organizational leaders of small businesses can use informal learning to improve employees' skills and knowledge with less cost. For instance, management should use different strategies to enhance the effectiveness of informal learning by providing SFE. Originality/value: There are numerous recent calls for research to ascertain the interaction of individual, contextual factors and outcomes of informal learning. The study addresses these voids by empirically examining antecedents and outcomes of informal learning simultaneously through the person-situation interaction perspective. It demonstrates that informal learning at the workplace becomes more effective in SFE.

Purpose: Knowledge acquisition is a pivotal concern for the students and many sources help them to obtain knowledge. In this paper, the authors theoretically examine three engagements such as social media, peer and academic engagement by the theoretical foundation of engagement theory which tells that students interact and collaborate, sharing information for the acquisition of knowledge that enhances their academic performance. But due to the abundance of information, knowledge and resources available to students for the acquisition of knowledge, it becomes difficult for them to comprehend the most relevant information. In this vein, this study examined the impact of information overload on the relationship between social media, peer and academic engagement and knowledge acquisition of students. Design/methodology/approach: The proposed model and structural relationships were validated using the structural equation modeling (SEM) technique through AMOS, version 24.0. To empirically test the hypothesized model, data are collected from the universities of the Sahiwal region (Sahiwal, Okara, Pakpattan) using structured questionnaires. Findings: The findings revealed that social media engagement and academic engagement are positively associated with knowledge acquisition, whereas peer engagement is negatively associated with knowledge acquisition. Moreover, the results of the study further suggested that information overload dampens the positive relationship between social media, peer and academic engagement and knowledge acquisition, which causes negative consequences on students' knowledge acquisition and learning outcomes. Research limitations/implications: Researchers can use this study as the literature as many of the previous studies focused on the positive side of social networking sites and technologies for knowledge purposes, but this study extends the research and focused on the other side of the picture which has been ignored earlier by researchers. The authors theoretically explained the adverse effects of information overload on students' academic progress caused by social media and the abundance of irrelevant information these advanced technologies offer daily. The current research focused on identifying the critical role of social media, peer and academic institutions providing a lot of information to students which caused stress, anxiety and other psychological issues in them. So, this study adds to the literature by highlighting the adverse effects of unnecessary information provided by multiple resources to students. Practical implications: Educationalists can adopt this study as a tool in academic institutions for promoting learning and to actively engage students in collaborative learning activities. As the findings of the study confirm that information overload is caused by the imbalanced use of information technology (IT) and social media sites, so teachers can help students in developing creativity and maintaining the balance between using technology and innovation in their studies pattern. Universities and institutions can play a vital role by exploring further opportunities for students and by making such policies that can help students in their learning progress. For this purpose, the authors developed a model based on the literature and theories that could change the academic system of Pakistan and enhance students' practical knowledge by motivating students in taking part in learning activities by making the higher education system of Pakistan more engaging. Social implications: The authors are presenting simulation games-based learning as an alternate approach to learning and teaching that can positively influence students' engagement with learning activities in Pakistan. By adopting this model, the education system of Pakistan could improve as it can lead to better academic performance of students, which ultimately leads to a better education system. Thus, games if correctly designed and implemented in the education system of Pakistan, it can make a great difference in students' value of learning experience. The enjoyment, interactive and realistic nature of the simulation games appears to produce this value, and students tend to engage more toward these types of games rather than traditional learning methods. Simulation games provide students with an opportunity to engage in both hard (financial management, strategy making, decision-making) and soft skills (negotiation, collaboration) in business by challenging their thinking and decision-making power in a safe learning environment. Originality/value: The phenomena of overload have become increasingly viable due to abundance of resources providing unnecessary information to students as they can get information from peers, teachers, social media platforms, blogs, wikis and many other platforms, which ultimately exhaust their capacity and leading them toward poor academic performance and other negative consequences (Yu, 2019; Bosch, 2016). This study focuses on students of higher education in Pakistan (Sahiwal region) and discusses the major challenges and opportunities that they had to face with the advancement of technology and the current social state of the knowledge in society.

Purpose: Coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented mental health repercussions in the lives of every individual including university students. Therefore, study on students' psychological state and its associated factors during the pandemic are of importance. This study aims to discuss the aforementioned issue. Design/methodology/approach: An online survey was done on a total of 207 university students of Pakistan to collect information on socio-demographic characteristics, concerns or fears amidst COVID-19 and mental distress. Validated tools; Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9)-Depression were used to assess stress, anxiety and depression, respectively. Findings: Around 14% of the university students were experiencing severe stress and anxiety, while 8.2% had severe depression. The authors found that stress among university students was related to psychiatric illness or symptoms (OR = 5.1: 1.1, 22.9) and unpredictability due to the pandemic (OR = 3.7: 1.2, 11.2). The significant determinants of anxiety were psychiatric illness/symptoms (OR = 6.6: 3.4, 12.9), implementation of public health measures (OR = 3.7: 1.1, 11.6), employed mothers (OR = 2.4: 1.1, 5.0) and lack of support from university administration (OR = 2.2: 1.0, 5.0). While the factors associated with depression included psychiatric illness or symptoms (OR = 8.4: 3.3, 21.5), unpredictability due to pandemic (OR = 6.8: 2.2, 20.7), impaired social support system (OR = 3.7: 1.3, 10.4) and studying without a scholarship (OR = 2.1: 1.0, 4.4). Research limitations/implications: These findings call for an urgent need to develop appropriate interventions and educational programs that could address the psychological needs of students. Practical implications: The study directs the role of university and faculty in dealing the mental health needs of the student in COVID-19 pandemic time. Social implications: Educational programs are important that could address the psychological needs of students in COVID-19 pandemic. Originality/value: University students reported mental distress during COVID-19 pandemic which shows that younger people are at risk of COVID-19 repercussions. Moreover, several stressors (i.e. impaired social support system and lack of support from universities) were revealed that could be mitigated by implementing appropriate strategies. [ABSTRACT FROM AUTHOR]

The Need of the LM content in Medical undergraduate curriculum was imperative based on the mortality and morbidity statistics in Pakistan along with lack of LM training and unhealthy lifestyle of physicians themselves. Aims and Objectives for integrating LM content were designed including cognitive, affective and psychomotor domains of learning. while embedding LM content in an integrated modular system, every step was technically monitored and matched with the academic year, teaching methodology and importance of the topic. LM content was integrated in every educational activity from first to final year by adding or modifying LM learning objectives. The alignment of learning domains was in accordance with the teaching and assessment strategies. Teaching methods chosen were according to the designed learning objectives and phase of curriculum. LM content was assessed in formative and summative assessment through, single best and case cluster MCQs, reflections, OSPE. LM curriculum was communicated to teaching faculty and medical students through academic calendar, module guides and timetables. It was shared on Moodle and Teams. Educational environment incorporated both physical and virtual learning and has been supportive of lifestyle practices among medical students. The entire process of embedding LM content in medical education has been multifaceted. Different committees were formed including Steering, Core, implementation, and Evaluation Committees. Students were part of each committee. This write-up describes the evidence-based approach used to embed LM content in Undergraduate Medical Education and offers guidance to other undergraduate medical colleges that may wish to implement lifestyle medicine content. [ABSTRACT FROM AUTHOR]

Background: Oral cancer is one of the major public health issues in Pakistan and is the second most common malignancy in the country. This is mainly attributed to the widespread use of smokeless tobacco products, cigarettes, and paan without tobacco. This review aims to go beyond commonly discussed factors and, consequently, to provide a comprehensive picture of all the multi-faceted contributors to the high prevalence of the carcinoma of the oral cavity, including the role of human papillomavirus and genetic predisposition. The aim is to synthesise all available evidence on the predisposing factors of oral carcinoma in Pakistan. Methods: This is a comprehensive systematic review of all observational studies investigating the contributing factors of malignancy of the oral cavity in Pakistan, and it strictly follows the PRISMA guidelines. Multiple databases, such as PubMed, EBSCO CINAHL Plus, SCOPUS, and Ovid Medline, were used to find studies, and the Cochrane Database of Systematic Reviews was searched for existing/ongoing reviews carried out on the same topic. A meta-synthesis of selected studies was carried out to create robust and statistically valid conclusions. Results: ST and cigarette smoking were found to be the major contributors to the burden of carcinoma of the lip and oral cavity. The included studies indicated that genetic predisposition and human papillomavirus could be major risk factors for the disease in the Pakistani population, but not enough research has been carried out to find their true impact. Conclusions: Smokeless tobacco, cigarette smoking, genetic predisposition, and human papillomavirus can be considered significant risk factors for oral cancer in Pakistan. [ABSTRACT FROM AUTHOR]

This study assessed the usability of the smartphone app, named "Raabta" from the perspective of pregnant women at high risk of preeclampsia to improve the Raabta app for future implementation. Think-aloud and task-completion techniques were used with a purposive sample of 14 pregnant women at high risk of preeclampsia. The sessions were audio-recorded and later professionally transcribed for thematic analysis. The study generated learnings associated with four themes: improving the clarity of instructions, messaging, and terminology; accessibility for non-tech savvy and illiterate Urdu users; enhancing visuals and icons for user engagement; and simplifying navigation and functionality. Overall, user feedback emphasized the importance of enhancing the clarity of instructions, messaging, and terminology within the Raabta app. Voice messages and visuals were valued by users, particularly among the non-tech savvy and illiterate Urdu users, as they enhance accessibility and enable independent monitoring. Suggestions were made to enhance user engagement through visual improvements such as enhanced graphics and culturally aligned color schemes. Lastly, users highlighted the need for improved navigation both between screens and within screens to enhance the overall user experience. The Raabta app prototype will be modified based on the feedback of the users to address the unique needs of diverse groups. [ABSTRACT FROM AUTHOR]

Introduction: Socioeconomically deprived populations are at greater risk for smoking‐induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse‐led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse‐led smoking reduction intervention performed at out‐patient clinics in Karachi, Pakistan. Methods: A single group pre‐and post‐test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021. Intervention: The multi‐modal nurse‐led intervention consisted of two face‐to‐face motivational counseling (30‐min) and free nicotine replacement therapy with telephonic counseling and follow‐ups offered to all eligible patients for 2 months. Results: The nurse‐led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1‐week follow‐up (p <.001), verified by a CO breath test. Conclusion: A nurse‐managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients. [ABSTRACT FROM AUTHOR]

Background: Pakistan has subpar childhood immunization rates and immunization activities have faced several challenges over the past years. We evaluated the social-behavioral and cultural barriers and risk factors for refusal of polio, Routine Immunization (RI), or both in high-risk areas of poliovirus circulation. Methods: A matched case-control study was conducted from April to July 2017 in eight super high-risk Union Councils of five towns in Karachi, Pakistan. A total of 3 groups, each with 250 cases, including refusals for the Oral Polio Vaccine (OPV) in campaigns (national immunization days and supplementary immunization activities), RI, and both, were matched with 500 controls and identified using surveillance records. Sociodemographic characteristics, household information, and immunization history were assessed. Study outcomes included social-behavioral and cultural barriers and reasons for vaccine refusal. Data were analyzed in STATA using conditional logistic regression. Results: RI refusal was associated with illiteracy and fear of the vaccine's adverse effects, while OPV refusals were linked to the mother's decision authority and the assumption that the OPV caused infertility. Conversely, higher socioeconomic status (SES) and knowledge of and willingness to vaccinate with Inactivated Polio Vaccine (IPV) were inversely associated with RI; and lower SES, walking to the vaccination point, knowledge of IPV, and an understanding of contracting polio were inversely associated with OPV refusals, with the latter two also inversely associated with complete vaccine refusal. Conclusion: Education, knowledge and understanding of vaccines, and socioeconomic determinants influenced OPV and RI refusals among children. Effective interventions are needed to address knowledge gaps and misconceptions among parents. [ABSTRACT FROM AUTHOR]

Hypertension has been recognized as a global health concern. In developing countries, it is not addressed and described to the extent that the actual prevalence of the disease makes it necessary. In these countries, control of blood pressure (BP) remains suboptimal. Worldwide BP reduction is a serious issue, and the situation is more alarming situation in our country. Pakistan is one of them, more than 46% of the Pakistani population are hypertensive. In 2010, hypertension was the leading cause of death and disability worldwide, and a greater contributor to events in women. South Asia contributes 24% of world population and is undergoing a rapid epidemiological transition with significant rates of hypertension in different countries. The prevalence of hypertension in low socioeconomic population in Pakistan is 39% in women vs. 37% in men. There is no proper data regarding hypertension in women in Pakistan, except for a few populations based surveys conducted which showed the prevalence of hypertension. The pooled prevalence in Pakistani women is 24.76% vs. 24.9% for men for an age bracket of above 40 years. The occurrence is higher in urban compared to rural areas. General practitioners (GP) in Pakistan underdiagnose and undertreat high BP, especially in the elderly women. Only in 37% of patients, the treatment was initiated by a GP. 23% of this group received only sedatives alone or combination of sedatives and hypertension control medication. We lack published guidelines regarding hypertension. Hypertension still remains the major preventable cause of cardiovascular disease. Hypertension is a leading cause of mortality globally, and especially in our continent. The purpose of these guidelines is to highlight the neglected population (i.e., Women) of Pakistan, who are physically and hormonally different from men. They have more complications as a result of hypertension. Early diagnosis and proper treatment and adherence to the treatment is therefore important. The task of developing guideline on hypertension is by Go Red Chairperson and Scientific Council Pakistan in collaboration with Pakistan cardiac society. This is first clinical practice guidelines for management of hypertension which is a need of our time with the objective to control the epidemic of hypertension in women. This scientific document on hypertension in women with local recommendation which are made local studies and randomized trials and south Asian studies. These educational tool help the health care providers GP and doctors because all see the women in theirs practice and using this guideline facilitate them for treatment because specially in elderly women usually received only sedative alone or in combination with antihypertensive medicines by GPS. Our efforts will encourage GPs and medical practitioners to practice these guidelines in their clinical judgment about risk and complications, as well as in the determination and implementation of preventive, diagnostic or therapeutic medical strategies for control of hypertension. What is new in this guideline is that we focused on treatment of hypertension according to our circumstance as women have limited access to health care and are undertreated. That is the reasons why more women develop complications of hypertension as delay in diagnosis, initiation of recommended treatment and the control is only in 50% in women. These guidelines focused on risk factors and complication throughout the life cycle of women. Lifestyle management should be started in adolescent and more focus should be given to adherence to treatment. This is crucial for control of hypertension. New topics like management of hypertension in chronic kidney diseases is added. Recommendation-based treatment should be started in such cases. The initiation of widespread and intensive continuing medical education for all physicians involved in the management of women patients with hypertension will be the main benefit from this guideline. [ABSTRACT FROM AUTHOR]

Very little is known about the perspectives of the caregivers on the use of telemonitoring (TM) interventions in low-middle-income countries. Understanding caregivers' perspectives on TM interventions is crucial, given that caregiving activities are correlated with the social, emotional, and clinical outcomes among pregnant women. This study aims to explore caregivers' perspectives and perceived acceptability of a mobile phone-based TM program to support pregnant women at high-risk for preeclampsia. A qualitative description design was used to conduct and analyze 28 semi-structured interviews with a diverse group of caregivers. The study was conducted at the Jinnah Post Graduate Medical Center, Karachi, Pakistan. The caregivers were identified through purposive sampling and additional caregivers were interviewed until the point of data saturation. The conventional content analysis technique was used to analyze digital audio recordings of the caregiver interviews. All caregivers embraced the proposed mobile phone-based TM program because they perceived many benefits, including a reduction in caregivers' anxiety and workload, increased convenience, and cost-effectiveness. However, the caregivers cited several caveats to the future implementation of the TM program including the inability of some women and caregivers to use the TM program and the poor acceptance of the TM system among less educated and non-tech savvy families. Our study recommends developing a TM program to reduce the caregiver stress and workload, designing a context-specific TM program using a user-centric approach, training caregivers on the use of the TM program, sensitizing caregivers on the benefits of the TM program, and developing a low-cost TM program to maximize access. [ABSTRACT FROM AUTHOR]

Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization-recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators' understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. [ABSTRACT FROM AUTHOR]

Pakistan has been facing energy crises for more than a decade as a result of its reliance on imported fossil fuels, circular debt, political instability, and absurd energy policies. However, the country has abundant renewable energy resources which, if harnessed, may help to effectively cope with ever-increasing energy demand. This review study investigates the country's economic and energy situations, energy crises, and energy sector performance. A critical analysis of studies conducted on Pakistan's energy planning since its independence in 1947 is, and policies announced to date are assessed. This review reveals that the economic situation of the country has remained severely stressed, and energy sector performance has been compromised over the years for various underlying reasons. The energy policy narrative in the early decades of the post-independence period focused on water resource management, whereas energy concerns were only realized in the late 1960s as demand grew. The first-ever energy and power planning study in Pakistan was conducted in 1967, and since then, various studies have been conducted to support the medium-term development plans of the government. These planning studies inspired further development, and in 1994, the first-ever electricity-focused power policy was announced by the government in response to industrial growth and subsequent electricity demand. However, this and subsequent policies were fossil-fuel-centric until 2006, when the government announced the first-ever renewable energy policy. This 2006 policy focused on increasing renewable energy penetration in the overall energy mix by setting specific targets. However, these targets have rarely been accomplished as a result of a lack of an effective planning paradigm, as most of studies have been conducted without sound demand forecasting and without considering renewable energy's potential to meet growing demand. As such, planning efforts based on proven methodologies/modeling tools and the undertaking of demand forecasts and renewable energy assessments are inevitable for countries such as Pakistan. Therefore, we suggest that sectoral energy demand forecasting, estimation of renewable energy potential with end use, and modeling of optimal penetration of renewable energy using energy modeling tools will be helpful to develop sustainable energy policies in Pakistan to eradicate the energy crisis. [ABSTRACT FROM AUTHOR]

Attitude is very complex and sticky construct. Pakistani sector educational institutions offer three educational streams; Physics, Chemistry, and Biology. Chemistry is a painstaking subject for secondary school students. Students remain curious during the process of learning. Students move away from Chemistry understanding due to complications. The individuals show their poor attitudes towards learning Chemistry as well. The present research was framed to examine the students' attitude towards learning chemistry at the secondary level by gender, academic stream, locale and school type. The nature of this study was descriptive and quantitative with a positivistic paradigm. 700 individuals were selected from 35 boy secondary schools and 35 girl secondary schools. Individuals were selected on the basis of multi-stage random sampling procedure. An adapted attitude scale was used for data collection comprised of seven factors. The questionnaire was piloted tested; the first draft was distributed to 50 male secondary schools and 50 female of 10th grade. The reliability and validity of the instrument were tested by using the statistical operations. The instrument was revised for the final instrumentation; two items were excluded from the final attitude scale and was consisted of 30 items. The researcher himself distributed and collected the data from the 700 subjects. Data were inserted in SPSS-24 for analyzing the data. Standard Deviation (SD), Mean, and independent sample t-test were applied for analyzing and the data. The results show that female students having better attitude than the male students; in the context of academic stream, biology students having better attitude than the computer students; in locale, urban students possessing more positive attitude than the rural students; furthermore, public school students possessing more positive attitude than the private school students towards learning chemistry at secondary level. Further research studies may conduct on the same construct in the future at primary, elementary, higher secondary, college and university level in different subjects. [ABSTRACT FROM AUTHOR]

A new COVID-19 variant, Omicron, has emerged from South Africa, indicating that the pandemic will not be over anytime soon. An unimaginable amount of economic damage has resulted from the pandemic. Omicron and its economic implications are discussed in detail in this review article. It also includes statistics on occurrence, mortality, and recuperation in Pakistan and data on the country's immunization coverage. Developing countries with unstable economies, such as Pakistan, have experienced increased economic difficulties. As a result, all developed and underdeveloped countries should strictly adhere to preventive measures and improvements in diagnostic tests and vaccine development to bring the pandemic under control. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the frequency of first-line antiretroviral therapy (ART) resistance among HIV patients and to identify the factors affecting the drug resistance. Methods: A cross-sectional study was conducted over a sample of 162 HIV-positive patients attending the Medicine Department of Lady Reading Hospital, Peshawar-Pakistan, from July 2020 to January 2021. Blood samples were collected for phylogenic profiles to determine first-line antiretroviral therapy resistance. Results: The frequency of ART resistance was detected in 64.8% of the enrolled HIV patients. Factors such as patient age, gender, comorbidities, and smoking status had no significant impact on drug resistance. While only body mass index (BMI) significantly affected ART resistance among HIV patients. The drug resistance mutations M184V and K103N were detected in the nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), respectively, whereas the mutations G73SC and I47VA were detected in the protease inhibitors (PIs). Conclusion: There is a high frequency of resistance to first-line antiretroviral therapy among HIV patients presenting to the selected healthcare facility in Peshawar. Furthermore, we found no significant factors impacting ART resistance among HIV patients other than BMI. [ABSTRACT FROM AUTHOR]

In Pakistan, around 58% of current electricity is generated from fossil fuels and only 2.4% is generated using renewable energy (RE) resources even though country is blessed with enormous RE potential. Among other RE resources, Pakistan's geographical location offers high solar energy potential, which implies that actual potential assessment should be undertaken. This study, as such, undertakes a comprehensive assessment of solar energy potential and prospects of solar photovoltaic (PV) systems for both off‐grid and grid‐connected systems. This study also estimates the future available capacity of rooftop and rural off‐grid solar PV capacity. Three different types of solar PV modules of the same size, that is, thin‐film, premium, and standard were modeled to compare energy outputs. NREL's System Advisor Model (SAM) is used to estimate the geographical and technical potential of solar PV considering updated data and geographical information. SAM results suggest that an average of 4.5 kWh/kWp/day is obtained from an installed capacity of 1 KWp. The logistic modeling equations are further used to forecast the solar PV penetration over a period until 2090. The research investigation concludes that 2.8 × 106 GWh of electricity can be generated annually in Pakistan. The estimated results prove that solar PV has the potential to meet the present as well as future energy needs of Pakistan. [ABSTRACT FROM AUTHOR]

Food wastage is a global concern with high economic, social and environmental impacts. Pakistan, a developing country, is also significantly affected by the adverse impacts of food wastage. For overcoming this problem, the transition from a Linear to a Circular Economy (CE) for the management of food wastage can serve as a viable strategy. However, there are barriers of political, technical and cultural nature, which are impediments in the path of this transition. This study aims to identify and prioritize these barriers in order of their significance. This research study evaluated and ranked these barriers using a Fuzzy Multi-Criteria Decision Making (MCDM) technique, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). A total of 15 barriers were analyzed, and the 'complicated intrinsic nature of CE', 'misleading information about shelf-life leading to waste rather than distribution', 'the poor economic viability of start-ups with CE model', 'corporate and organizational hesitance to change/innovate' and 'technological backwardness of farmers/growers on the agricultural production side' were ranked as the most significant hurdles. The novelty of this study lies in its application. This study is unique as it has focused on developing countries and proposed policy recommendations for the transition towards a CE. In light of the above-mentioned results, this study provides policy recommendations for public and private sector policymakers that would facilitate the food industry in shifting towards the CE model. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of Dexmedetomidine and Fentanyl on the blunting of the hemodynamic response to intubation. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital Peshawar Pakistan, from Jan to Aug 2021. Methodology: This study was conducted on 908 patients who were ASA grades I and II and underwent general anaesthesia for any surgical procedure. Group-A received Dexmedetomidine, while Group-B received Fentanyl and routine preanaesthetic medications. Hemodynamic responses in both groups were recorded and compared in heart rate and mean arterial pressure at baseline, 2, 5, and 10 minutes after the intubation. Results: Out of 908 patients equally divided into two groups, 579 (63.7%) were males, while 329 (36.3%) were females. The mean age of patients included in our study was 33.445 6.363 years. A significant increase in heart rate was found at 2, 5 and 10 minutes in the group who took Fentanyl compared to the group who took Dexmedetomidine (p-value 0.001). Significant increases in mean arterial pressure were found at 2 and 5 minutes (p-value 0.019 and 0.007, respectively) in the Fentanylgroup, while no significant difference was found at 10 minutes in either group (p-value 0.914). Conclusion: In this study, Dexmedetomidine was found to be a better agent in providing hemodynamic stability during and after the process of intubation compared to Fentanyl. [ABSTRACT FROM AUTHOR]

To achieve higher standards of sustainability, the waste management sector now requires the incorporation of circular economy (CE) principles. However, an easy transition toward the particular goal would require the use of smart waste technologies. To achieve the aforementioned goal, this study aims to provide a facilitating framework for the adoption of smart waste management in the context of CE for Pakistan. To help Pakistan transition toward the new paradigm, a total of 16 critical facilitators are evaluated based on five distinctive criteria using a novel fuzzy hybrid multi-criteria decision-making (MCDM) approach. The hybrid MCDM approach includes fuzzy Stepwise Weight Assessment Ratio Analysis (SWARA) for allocating weights to the determined criteria; whereas, the fuzzy VIšekriterijumsko kompromisno rangiranje (VIKOR) approach is used to rank the critical facilitators adopted from the secondary literature. The fuzzy approach in both cases is to deal with any kind of uncertainty during the data collection process. Based on the achieved results, the study suggests that before the application of smart waste technologies in the country, Pakistan should first focus on devising regulations that effectively address the mismanagement of waste produced in the country. Also, the industries in the country need to become more responsible and should adopt environmental management systems that foster waste minimization. Lastly, the country in the third phase should focus on the wide application of digitalization both in the streams of ICT and IoT, for collecting, sharing, and receiving waste data. The study further provides policy recommendations to the respective stakeholders that will help the country achieve zero-waste CE. [ABSTRACT FROM AUTHOR]

Objective: To assess audiometry investigations in patients having complaint of tinnitus, vertigo or hearing impairment after recovery from COVID-19 disease, having no external or middle ear diseases. Study Design: Cross-sectional study. Place and Duration of Study: United Medical and Dental College, Creek General hospital, Korangi, Karachi Pakistan, from March to May 2021. Methodology: A total of 60 patients were included in this study who had recovered from the primary COVID-19 infection and reported with the complaints of tinnitus, vertigo and hearing loss. Pure tone audiogram was assessed for sensorineural deafness, its severity and frequencies affected. Pearson Chi square test was used to see the relation of symptoms with severity of hearing loss. Results: There were 42 (70%) males and 18 (30%) female patients with age range from 18-50 years with mean age of 28.4 ± 8.1 years. Tinnitus was the most common complaint (83.3%) followed by hearing loss (28.3%) and vertigo (23.3%) patients. None of the patients with complaint of hearing loss had normal pure tone audiogram in either right or left ear (p=0.000). Patients with all the three complaints had more hearing impairment where majority had moderate or severe hearing loss (p=0.000). All patients with isolated complaint of vertigo (9 patients) had normal audiogram in both ears (p=0.000). Conclusion: Auditory and vestibular system involvement in reasonably common in COVID-19 patients. Tinnitus is the most frequent symptom and it should be investigated with full audiological investigations. [ABSTRACT FROM AUTHOR]

The local government system is mainly designed to serve as an instrument for transferring powers at the grass root level. It has three basic elements as envisaged by its founder's that are the decentralization of different types of administrative authority, the transfer of resources to lowest district and Union council level and most importantly the devolution of political authority and power. The concept of decentralization has been adopted by so many developing countries in the recent past. As they want to put an end to their hydra headed issues and problems they face in their home land. The main aim of this paper is to find out the problems and factor that Pakistan has been faced in process of decentralization. This paper can lead us to learn the lesson to avoid ourselves from and most importantly to develop certain amount of understanding in order to support certain factors and the bridge among the democratic governance and the concept of decentralization which are extremely vital and necessary vital for the smooth functioning of decentralization and also to give quick and rapid public services. This research paper will help us to understand that what are the vital factors that can leads us to the success of decentralization in certain particular context? This research have informed us that all the adopted models don't work for the success of decentralization unless that get fit into the local context. [ABSTRACT FROM AUTHOR]

Purpose: Diarrhea and pneumonia greatly contribute to high childhood mortality in Pakistan. Frontline community health workers or the Lady Health Workers (LHWs) provide care at the doorstep of over 60% of Pakistan's rural residents. Difficult terrain, lack of supplies, and inadequate supervision put these LHWs at an added disadvantage in the timely diagnosis and delivery of known treatment options to community caregivers (CCGs). This study aims to assess whether a supportive supervision intervention through Lady Health Supervisors (LHSs) using enhanced mentorship and written feedback cards have the potential to improve case management of childhood diarrhea and pneumonia. Study Setting and Design: This perception-based qualitative inquiry nested within the Nigraan Plus trial included LHSs, LHWs, and CCGs as the participants. Twenty-two in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were conducted before a supportive supervision intervention in 2017, and 10 FGDs were conducted in 2019 once the intervention concluded. Data were analyzed using manual content analysis. Results: The perceived ability of LHWs and LHSs to describe the danger signs of diarrhea and pneumonia, classify dehydration and relate respiratory rate to the severity of pneumonia improved over time. Appropriate prescription of zinc in diarrhea and antibiotics in pneumonia was noted. Furthermore, CCGs' trust in LHWs increased following the intervention, and they reported a growing inclination to contact LHWs as their first point of care. LHWs in the intervention arm were more satisfied with their job due to frequent supervisory visits and continuous feedback by LHSs. Conclusion: Despite geographic, social, and economic inequities, supportive supervision has the potential to improve knowledge, practice, and skills of frontline health workers related to CCM of childhood diarrhea and pneumonia in disadvantaged rural communities. Additionally, the trust of CCGs in the health workers' ability to manage such cases is also enhanced. [ABSTRACT FROM AUTHOR]

E governance always play a very vital role in the development of a nation. There is always a very deep and clear impact of science and technology on the governance. All the developed nations of the world have already adopted this new form of E-Governance. Following the foot step of these developed countries many third world countries have also adopted this new form of governance. Pakistan is also in this pipeline and wants to overcome the governance issues. Pakistan have always faced so many issues and problem in their governance. There is deep governance issues and hurdles in Pakistan. Pakistan want to be like the developed countries and want to overcome these problems. Pakistan need stability very desperately and want to achieve high ranks in governance. This issues and problems in the governance can be sort out only by implementing the E-Governance issues in Pakistan. This paper will help out that what is the status of E-Governance in Pakistan. How can we made improvement in this filed and how can we be parallel to the developed countries in field of E-Governance. [ABSTRACT FROM AUTHOR]

• Tuberculosis (TB) screening is feasible during routine antenatal care visits in high-TB-burden settings. • Out of 113,078 women verbally screened at obstetrics and gynaecology clinics, 2.6% were TB-positive. • The overall yield of active TB cases among pregnant women was low (0.02%; 27/113,078). Active tuberculosis (TB) during pregnancy has an adverse effect on maternal and neonatal outcomes. This study analysed the results of a pilot project integrating TB screening into antenatal care (ANC) visits in a high-TB-burden, low-resource setting. Data were extracted from the TB screening pilot in obstetrician-gynaecologist clinics of six tertiary care facilities in Karachi, Pakistan from April to December 2017. Data from the verbal symptom screening conducted at each ANC visit for all women and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield were analysed by assessing the numbers screened, presumptive patients and active TB diagnoses among pregnant women and neonates. Symptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one TB symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births. TB screening is feasible and should be implemented during routine ANC visits in high-TB-burden settings. There is a need to explore a multi-faceted approach with inclusion of clinical examination and chest X-rays to diagnose TB in pregnant women. [ABSTRACT FROM AUTHOR]

Background: In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. Methods: A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women's health behavior. We analyzed the data through thematic analysis using NVivo 10 software. Results: Most community members were not aware of the term anemia but described anemia as a condition characterized by 'blood deficiency' in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. Conclusion: The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a global health crisis which has brought streams of morbidity and mortality across the world. The unprecedented outbreak has forced people towards self-isolation and social distancing from their loved ones, which has inVlicted detrimental physical, psychological, and economic challenges in people's life. The second spell of COVID-19 has started in Pakistan, so far taking the national tally to 544,813 infected cases and 11,657 lives (Government of Pakistan, 2020; updated 30 Jan 2021). The burden of mental health implication due to COVID-19 also rages across Pakistan, where anxiety, depression, fear, sense of insecurity, and suicide are highly prevalent. The sudden outbreak of COVID-19 has raised key ethical challenges for stakeholders after imposing stringent. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the frequency of cardiogenic shock in patients of younger than 45 years of age presenting with NSTEMI. Methodology: A hospital based Cross sectional study has been conducted in a tertiary hospital of Isra University Hospital, Hyderabad in the Department of Cardiology. This study was started in September 2017 and completed on March 2019 and recruited a total of 321 patients NSTEMI patients having age less than 45 years of either gender to determine the burden of cardiogenic shock during hospitalization. Baseline and clinical data were recorded in a pre-structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Out of total 321 patients the mean age of admitted NSTEMI patients was 37.34 ± 6.19 years and among them male predominance was prevalent (72.8%, N = 234). The overall burden of cardiogenic shock in our study subjects was 19(5.9%). Male gender, cigarette smoking, diabetes mellitus, chronic kidney disease, and increased mean duration of hospital stay were significantly associated with cardiogenic shock in patients admitted with NSTEMI as compared to patients admitted without cardiogenic shock (p<0.05). Conclusion: Our study shows that overall burden of cardiogenic shock is higher in patients with younger age group when they are diabetic, had underlying chronic kidney disease, and increased duration of hospital stay. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to compare the incidence of post STEMI ventricular arrhythmias among patients with versus without LV dysfunction. Methodology: This prospective Cohort study was conducted in the department of cardiology of a tertiary care hospital, Isra University Hospital, Hyderabad over a period of eleven months from 1st September 2019 to 31st July 2020 and recruited a total of 95 patients with STEMI. Baseline data (age, gender, social class, and marital status) and clinical data (basal metabolic rate, systolic and diastolic blood pressure, random blood sugar, and LVSD) were recorded in a pre-structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 21 to see the comparative incidence of ventricular arrhythmias by applying chi-square test where applicable. Results: Out of total 95 STEMI patients, 53 patients had left ventricular systolic dysfunction (55.7%). The overall incidence of ventricular arrhythmias was 23.1% and it was significantly higher in patients with LVSD as compared to those with normal LV function, 36.3% and 72.7% respectively (p = 0.001). Conclusion: Our study shows that overall burden of ventricular tachyarrhythmias is two times higher in patients with left ventricular systolic dysfunction as compared to normal left ventricular systolic function. [ABSTRACT FROM AUTHOR]

Globally, more than 5 million stillbirths and neonatal deaths occur annually. For many, the cause of death (CoD) is unknown. Minimally invasive tissue sampling (MITS) has been increasingly used in postmortem examinations for ascertaining the CoD in stillbirths and neonates. Our study compared the counseling and consent methods used in MITS projects in five countries in Africa and south Asia. Key informant interviews were conducted with researchers to describe the characteristics and backgrounds of counselors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. Counselors at all sites had backgrounds in social science, psychology and counseling or clinical expertise in obstetrics/gynecology or pediatrics. All counsellors received training about techniques for building rapport and offering emotional support to families; training duration and methods differed across sites. Counselling environments varied significantly; some sites allocated a separate room, others counselled families at the bedside or nursing stations. All counsellors had a central role in explaining the MITS procedure to families in their local languages. Most sites did not use visual aids during the process, relying solely on verbal descriptions. In most sites, parents were approached within one hour of death. The time needed for decision making by families varied from a few minutes to 24 h. In most sites, extended family took part in the decision making. Because many parents wanted burial as soon as possible, counsellors ensured that MITS would be conducted promptly after receiving consent. Barriers to consent included decreased comprehension of information due to the emotional and psychological impact of grief. Moreover, having more family members engaged in decision-making increased the complexity of counselling and achieving consensus to consent for the procedure. While each site adapted their approach to fit the context, consistencies and similarities across sites were observed. [ABSTRACT FROM AUTHOR]

Background: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines.Methods: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method.Results: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination.Conclusion: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools.Trial Registration: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017. [ABSTRACT FROM AUTHOR]

Background: Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who were not able to seek the recommended antenatal visits. In Thatta district, the maternal mortality ratio is estimated at 313/100,000 live births. Various studies reported that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services. However, the feasibility and effectiveness of mobile health interventions to increase uptake of preventive maternal healthcare services among pregnant women in different settings may be different due to differing patient demographics, cultural diversity, environmental and behavioral factors, availability and accessibility to mobile phones, and budgetary constraints. Prior to implementing a similar intervention in Thatta District, it is crucially important to assess the mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance. Methods: A cross-sectional quantitative study will be used to assess mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance in district Thatta. The study will be conducted in Thatta district of Sindh province. Married women of reproductive age (MWRA), who are residing in selected villages of Mirpur Sakro and willing to participate will be included in the study. Multistage sampling technique will be used to recruit the 415 study participants. A structured questionnaire has been designed on Epicollect to collect data from 415 women. Data will be analyzed using IBM SPSS Statistics version 23, with a level of significance as < 0.05. Discussion: This research project will provide invaluable information on the current access, usage of mobile phones among women of district Thatta and their willingness to receive voice messages to improve the antenatal care services. The study will also highlight demographic, sociocultural and economic factors associated with women willingness and readiness to receive voice messages regarding antenatal care. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use. Methods: A qualitative study was conducted at ten Sukh stations located in four towns of Karachi. Focus group discussions (FGDs) were conducted with married women of reproductive age (MWRA) and married men who received FP services through the Sukh initiative. Study participants were purposively sampled for focus group discussions (FGDs). Interview data was manually transcribed and analyzed using thematic analysis. Results: A total of 20 FDGs (Men = 10 FGDs; MWRA = 10 FGDs) were conducted. Three overarching themes were identified: (I) Appropriateness and means to promote contraceptive use; (II) Equity and Accessibility to contraceptives; and (III) Perspective on available FP services. Generally, both men and women were informed about FP methods but women were more cognizant of FP information. The door to door services by community health workers in Sukh initiative areas was largely appreciated both by women and men as it has made the accessibility and availability of the information and services easy. Women suggested that the Sukh initiative should bring some strategies that can help men broaden their perspective towards FP. The study informed that the men feel left out from the FP programs. Therefore, male participants expressed keen interest in initiatives for men in their communities that would cater to their FP needs. Conclusions: This qualitative study provided a unique opportunity to understand the perceptions of men and women towards the phenomena of contraceptive use. The study identified the need for trained and qualified female and male healthcare providers and well-established health facilities alongside door-to-door services. [ABSTRACT FROM AUTHOR]

In the scenario of increasing global warming, heat stress attained greater importance. Unfortunately, Pakistan is also in the queue of the most heat-affected country. In this regard, wheat is the most important staple crop in Pakistan which is highly affected by heat stress. In this context, the genotype of wheat was evaluated at 2 sowing dates. Normal planting on 25 November and delay planting on 25 December 2015 were considered as normal and summer stress conditions, respectively. Significant differences between genotypes in normal and high temperatures indicating the suitability of the experiment to improve bread wheat genotype for heat tolerance. A decrease in various traits was noted due to delay planting indicating a visible effect of high temperature on physico-yield traits. At average physical maturity, flag leaf area, specific flag leaf weight, grain spike-1, grain weight spike-1, 1000-grain weight, grain yield plant-1, organic yield plant-1, crop index, relative water content and cell membrane stability showed a decrease of 7.01, 31.38, 20.63, 20.50, 37.93, 30.63, 37.87, 31.62, 9.38, 16.95 and 10.96%, respectively, under heat stress conditions. While the wheat genotypes like Imdad-05, NIA-Sarang and TD-1 showed minimum reductions under heat stress conditions for various traits suggesting their heat tolerance, nonetheless cultivars Khirman and AS-2002 expressed maximum declines under heat stress expressing their susceptibility to heat stress conditions. The remaining genotypes were moderately heated stress-tolerant. [ABSTRACT FROM AUTHOR]

Objective: The unethical drug practices are a common phenomenon worldwide but are severe in the developing countries. Drug practice has two scopes: one is medication and other is drug marketing. Methods: In this paper, the ethical practices of pharmaceutical marketing in Pakistan will be examined; a global perspective will be reviewed bearing in mind the internationally agreed standard and marketing practices. The research design of this study is a systematic review of qualitative studies on the situation of practices of pharmaceutical marketing in Pakistan. Key findings: This study shows the impact of the promotional practices and the influence it plays on the physicians saddled with prescription of drugs, it also shows that the ethical principles highlighted above which include: autonomy, non ‐maleficence, beneficence, justice and fidelity; which are compromised in these interactions. Conclusion: Suggestions to effect on strategy‐making in Pakistan, creating more secure society and guaranteeing best guidelines are maintained in the pharmaceutical business. [ABSTRACT FROM AUTHOR]

Background: Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women's and Children's Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. Methods: We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Results: Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman's body and uterus. Further women are advised to conceive soon so that they get rid of infections. Conclusion: Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities. [ABSTRACT FROM AUTHOR]

Background: Recently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS. Methods: A qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software. Results: A total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants' acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS. Conclusions: This qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation. Study Design: Quasiexperimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020. Methodology: Patients were randomly divided into two Groups by lottery method. Seventythree were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous DexmedetomidineGroup-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation. Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009). Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes. [ABSTRACT FROM AUTHOR]

To achieve higher standards of sustainability, Pakistan has to shift towards the adoption of the Circular Bio-Economy (CBE) approach in its agriculture sector. However, to aid this transition, the determination of a sustainable waste management technology and supporting strategies is very essential. For this purpose, a hybrid methodology based on fuzzy Strength, Weakness, Opportunities, and Threats (SWOT) and fuzzy Technique for Order Preference by Similarity to the Ideal Solution (TOPSIS) is developed. The fuzzy approach used in both the cases is to address any sort of ambiguity during the decision-making process. From the fuzzy SWOT analysis, the decision-makers allocated the most importance to the "ease of adoption" criteria, among the list of internal factors. Whereas, from the list of external factors, the most importance was allocated to the "price competitiveness with respect to fossil feedstock" criteria. Also, composting and anaerobic digestion are considered to be the most sustainable technologies for valorizing the agricultural waste of Pakistan. However, composting showcases more opportunities for its adoption as compared to anaerobic digestion. Whereas, results from fuzzy TOPSIS suggest the provision of financial support to both the local farmers and investors to be the top-ranked strategy for the successful implementation of the CBE approach. [ABSTRACT FROM AUTHOR]

Background: To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan. Methods: Data of this cross sectional study was collected by self administered questionnaire from MBBS students of Ziauddin University from 2010 to 2011. Sample size of 158 (83 First years and 75 Fourth years) were selected by convenient sampling and those students who were present and gave consent were included in the study. The data was analyzed by SPSS version 20. Results: A total of 158 participants from Ziauddin Medical University filled out the questionnaire out of which 83 (52.5%) were first years and 75(47.5%) were fourth year medical students. Mean age of sample was 20 ± 1.7. Majority of students were aware about organ donation with print and electronic media as the main source of information. 81.6% agreed that it was ethically correct to donate an organ. In the students' opinion, most commonly donated organs and tissues were kidney, cornea, blood and platelet. Ideal candidates for donating organ were parents (81%). Regarding list of options for preference to receive an organ, most of the students agreed on young age group patients and persons with family. Willingness to donate was significantly associated with knowledge of allowance of organ donation in religion (P=0.000). Conclusion: Both 1st year and 4th year students are aware of Organ Donation, but there is a significant lack of knowledge regarding the topic. [ABSTRACT FROM AUTHOR]

Background: Pharmacistepatient association is a decisive component in improving health care system. To offer patient centred services, the pharmacists need to fully understand patients' perspectives and views to meet their needs and expectations. Purpose: To evaluate patients' perception of pharmacist and pharmacy practice in Pakistan. Methods: A cross sectional study was conducted between July and September 2012 on patients attended out-patient clinic in a teaching hospital of Pakistan. By using raosoft sample size calculator, questionnaires were distributed to a sample of 376 patients. Questionnaire included different section which evaluated the demographic information, frequency and reason of interaction, perception and choice of pharmacy. Statistical analysis was done by using SPSS (v.17). Results: A total of 301, out of 376, surveys returned giving a response rate of 80%. 51.8% (n = 156) participants interacted with pharmacist on regular basis. The major reasons of interaction were drug alternative and drug availability queries (41.5%, n = 125 and 26.2%, n = 79). The finding also showed that 84.1% (n = 253) of participants agreed that pharmacists are important part of health care system. Interestingly, all the patients (n = 301) either agreed or strongly agreed that discount was the major influencing factor on their choice of pharmacy. Conclusion: The patients' perception of pharmacist in Pakistan was generally positive but their understanding is very primitive as majority of the patients are unaware of pharmaceutical care services. However, they are more devoted to witness such services being practiced in Pakistan. This transition in practice could be brought into certainty by proactive involvement of pharmacists in community setup. [ABSTRACT FROM AUTHOR]

Background: As the focus of medical education shifts from factual learning to a more holistic approach for physician training, we need to concentrate more upon the ethical and moral development of medical students. The purpose of this study was to assess the level of moral development in first-year medical students. Methods: We used the Defining Issues Test (DIT-1) to assess moral development levels among newly entering first- year medical students at a medical school in Rawalpindi, Pakistan. The test was administered to 250 students, out of which 130 responses were included in the final analysis. Results: The mean age of the students was 18.6 ± 0.7 years. We found that only 16% of the students scored a “high” level of moral development based on the DIT. Conclusion: There may be several reasons for the low moral development scores in our cohort, but these findings make a strong case for future research and possible educational interventions in Pakistani medical schools. [ABSTRACT FROM AUTHOR]

The ovigerous female of Synalpheus neptumis, captured from intertidal zone at Buleji (Karachi, Pakistan) on May 26, 1997 was kept under the laboratory conditions. The larvae were hatched out on the same day in an advance stage of development as postlarvae. The postlarvae I of Synalpheus neptunus passed through II and III postlarval stages within twenty seven days at room temperature: 30°C - 33°C, in filtered seawater of salinity of 35-37 ppt and pH 7.9. The postlarvae are described along with their illustrations. The development difference between successive morphological characters of the three postlarvae (I-III) are also given in a tabulated form and the comparison between present study with those of previously studied postlarvae of S. tumidorrianus from Pakistani waters. [ABSTRACT FROM AUTHOR]

For Pakistan, nuclear capability is an instrument of war prevention and insurance against invasion. Its nuclear doctrine is heavily influenced by India's conventional superiority, making it difficult for Pakistan to eschew first use and setting its deterrence policy apart from India's. [ABSTRACT FROM PUBLISHER]

The article examines past arms control agreements and confidence-building measures undertaken between India and Pakistan, and how they could be made more effective in the future. Major agreements and treaties between the two countries since partition in 1947 are reviewed, including the 1949 Karachi Agreement following the Kashmir War, the 1966 Tashkent Agreement following the 1965 Indo-Pakistani conflict, the 1999 Lahore Agreement over nuclear weapons, and others. The strategic concerns and military doctrine of each nation are discussed as well.

The United States failed to prevent Pakistan from building nuclear weapons because U.S. officials never fully grasped Pakistan's perception of its security situation relative to India, especially after the 1971 Bangladesh war. Because Pakistani officials considered nuclear weapons essential to national survival, none of the measures deployed by the United States to dissuade Pakistan could have worked. This and other lessons of the Pakistani experience, including exploiting willing supply networks, providing financial and programmatic autonomy to key officials, and the consequent dangers of losing control of a dangerous program conducted in strict secrecy, are analyzed and their implications for future proliferants assessed. [ABSTRACT FROM AUTHOR]

The present information is based on the study of the first zoeal stages of Uca urvillei and Uca annulipes. The ovigerous females of Uca urvillei and Uca annulipeswere collected from Sandspit on 13 July 2002. Larvae were hatched on 20 July 2002 and 24 July 2002 respectively, at room temperature 30–32 °C, in filtered seawater of a salinity of 35‰–37‰ and pH 7.8. The first zoeae of 2 species from the Pakistan coast are described and illustrated, and a comparison is made between these 2 species of Uca obtained from the Pakistan coast and Uca tangeri studied by Paula from the Portuguese coast. [ABSTRACT FROM AUTHOR]