Search

Copyright of Basrah Journal of Science / Magallat Al-Barat Li-L-ulum is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Basrah Journal of Science / Magallat Al-Barat Li-L-ulum is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Renowned for its agriculture, livestock, and mining, Zhob district, Pakistan, faces the urgent problem of declining groundwater quality due to natural and human-induced factors. This deterioration poses significant challenges for residents who rely on groundwater for drinking, domestic, and irrigation purposes. Therefore, this novel study aimed to carry out a comprehensive assessment of groundwater quality in Zhob district, considering various aspects such as hydrochemical characteristics, human health risks, and suitability for drinking and irrigation purposes. While previous studies may have focused on one or a few of these aspects, this study integrates multiple analyses to provide a holistic understanding of the groundwater quality situation in the region. Additionally, the study applies a range of common hydrochemical analysis methods (acid-base titration, flame atomic absorption spectrometry, and ion chromatography), drinking water quality index (WQI), irrigation indices, and health risk assessment models, using 19 water quality parameters. This multi-method approach enhances the robustness and accuracy of the assessment, providing valuable insights for decision-makers and stakeholders. The results revealed that means of the majority of water quality parameters, such as pH (7.64), electrical conductivity (830.13 μScm -1 ), total dissolved solids (562.83 mgL -1 ), as well as various anions, and cations, were in line with drinking water norms. However, the water quality index (WQI) predominantly indicated poor drinking water quality (range = 51-75) at 50% sites, followed by good quality (range = 26-50) at 37% of the sites, with 10% of the sites exhibiting very poor quality (range = 76-100). For irrigation purposes, indices such as sodium percent (mean = 31.37%), sodium adsorption ratio (mean = 0.98 meqL -1 ), residual sodium carbonate (- 3.15 meqL -1 ), Kelley's index (mean = 0.49), and permeability (mean = 49.11%) indicated suitability without immediate treatment. However, the magnesium hazard (mean = 46.11%) and potential salinity (mean = 3.93) demonstrated that prolonged application of groundwater for irrigation needs soil management to avoid soil compaction and salinity. Water samples exhibit characteristics of medium salinity and low alkalinity (C2S1) as well as high salinity and low alkalinity (C3S1) categories. The Gibbs diagram results revealed that rock weathering, including silicate weathering and cation exchange, is the primary factor governing the hydrochemistry of groundwater. The hydrochemical composition is dominated by mixed Ca-Mg-Cl, followed by Na-Cl and Mg-Cl types. Furthermore, the human health risk assessment highlighted that fluoride (F - ) posed a higher risk compared with nitrate (NO 3 ). Additionally, ingestion was found to pose a higher risk to health compared to dermal contact, with children being particularly vulnerable. The average hazard index (HI) for children was 1.24, surpassing the allowable limit of 1, indicating detrimental health effects on this subpopulation. Conversely, average HI values for adult females (0.59) and adult males (0.44) were within safe levels, suggesting minimal concerns for these demographic groups. Overall, the study's interdisciplinary approach and depth of analysis make a significant contribution to understanding groundwater quality dynamics and associated risks in Zhob district, potentially informing future management and mitigation strategies.- ). Additionally, ingestion was found to pose a higher risk to health compared to dermal contact, with children being particularly vulnerable. The average hazard index (HI) for children was 1.24, surpassing the allowable limit of 1, indicating detrimental health effects on this subpopulation. Conversely, average HI values for adult females (0.59) and adult males (0.44) were within safe levels, suggesting minimal concerns for these demographic groups. Overall, the study's interdisciplinary approach and depth of analysis make a significant contribution to understanding groundwater quality dynamics and associated risks in Zhob district, potentially informing future management and mitigation strategies., (© 2024. The Author(s).)

Purpose: There is a rising number of children with special health care needs (CSHCN) in the pediatric medical home and their care coordination is complicated and challenging. We aimed to integrate nurse care managers to coordinate care for such patients, and then evaluate, if this improved health care utilization., Design and Methods: This quality improvement project evaluated the impact on CSHCN of the integration of nurse care managers in the pediatric medical home. From October 2015 through February 2019, 673 children received longitudinal care coordination support from a care manager. Health care utilization for primary, subspecialty, emergency department (ED) and inpatient care was reviewed using pre and post design., Results: Three medical home-based nurse care managers were integrated into four pediatric hospital affiliated practices in a large, urban center. The number of ED visits and inpatient admissions were statistically significantly decreased post-intervention (p < 0.05).There was also a decrease in the number of subspecialty visits, but it was close to the threshold of significance (p = 0.054). There was no impact noted on primary care visits., Conclusion: This quality improvement project demonstrates that nurse care managers who are integrated into the medical home of CSHCN can potentially decrease the utilization of ED visits and hospital admissions as well as subspecialty visits., Practice Implications: Nurse care managers can play a pivotal role in medical home redesign for the care of CSHCN., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: Lung protective ventilation (LPV), defined as a tidal volume (Vt) ≤8 cc/kg of predicted body weight, reduces ventilator-induced lung injury but is applied inconsistently., Materials and Methods: We conducted a prospective, quasi-experimental, cohort study of adults mechanically ventilated admitted to intensive care units (ICU) in the year before, year after, and second year after implementation of an electronic medical record based LPV order, and a cross-sectional qualitative study of ICU providers regarding their perceptions of the order. We applied the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the implementation., Results: There were 1405, 1424, and 1342 in the control, adoption, and maintenance cohorts, representing 95% of mechanically ventilated adult ICU patients. The overall prevalence of LPV increased from 65% to 73% (p < 0.001, adjusted-OR for LPV adherence: 1.9, 95% CI 1.5-2.3), but LPV adherence in women was approximately 30% worse than in men (women: 44% to 56% [p < 0.001],men: 79% to 86% [p < 0.001]). ICU providers noted difficulty obtaining an accurate height measurement and mistrust of the Vt calculation as barriers to implementation. LPV adherence increased further in the second year post implementation., Conclusion: We designed and implemented an LPV order that sustainably improved LPV adherence across diverse ICUs., Competing Interests: Declaration of Competing Interest There are no conflicts of interest or competing interest regarding this manuscript., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Identifying patients at risk of deterioration in the hospital and intervening more quickly to prevent adverse events is a top patient safety priority. Early warning scores (EWS) identify at risk patients, but there is much opportunity for improvement particularly related to increasing lead time - the time from an alert trigger to adverse event (e.g., cardiac arrest, death). Our team develops healthcare process models of clinical concern (HPM-CC) and in this work has identified documentation signals that are proxies of nurses concern and can be used to predict patient risk earlier than current EWS systems that rely only on physiological data. We compared the performance of a validated EWS - the MEWS - to our novel model (MEWS-CC) comprised of MEWS criteria plus 3 proxy variables of nursing concern. MEWS-CC performed similarly to MEWS, with the added benefit of increased the time from EWS trigger to event by 5-26 hours., (©2019 AMIA - All rights reserved.)

Background: Gout is a common type of inflammatory arthritis in patients seen by primary care physicians., Purpose: To review evidence about treatment of acute gout attacks, management of hyperuricemia to prevent attacks, and discontinuation of medications for chronic gout in adults., Data Sources: Multiple electronic databases from January 2010 to March 2016, reference mining, and pharmaceutical manufacturers., Study Selection: Studies of drugs approved by the U.S. Food and Drug Administration and commonly prescribed by primary care physicians, randomized trials for effectiveness, and trials and observational studies for adverse events., Data Extraction: Data extraction was performed by one reviewer and checked by a second reviewer. Study quality was assessed by 2 independent reviewers. Strength-of-evidence assessment was done by group discussion., Data Synthesis: High-strength evidence from 28 trials (only 3 of which were placebo-controlled) shows that colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids reduce pain in patients with acute gout. Moderate-strength evidence suggests that low-dose colchicine is as effective as high-dose colchicine and causes fewer gastrointestinal adverse events. Moderate-strength evidence suggests that urate-lowering therapy (allopurinol or febuxostat) reduces long-term risk for acute gout attacks after 1 year or more. High-strength evidence shows that prophylaxis with daily colchicine or NSAIDs reduces the risk for acute gout attacks by at least half in patients starting urate-lowering therapy, and moderate-strength evidence indicates that duration of prophylaxis should be longer than 8 weeks. Although lower urate levels reduce risk for recurrent acute attacks, treatment to a specific target level has not been tested., Limitation: Few studies of acute gout treatments, no placebo-controlled trials of management of hyperuricemia lasting longer than 6 months, and few studies in primary care populations., Conclusion: Colchicine, NSAIDs, and corticosteroids relieve pain in adults with acute gout. Urate-lowering therapy decreases serum urate levels and reduces risk for acute gout attacks., Primary Funding Source: Agency for Healthcare Research and Quality. (Protocol registration: http://effectivehealth-care.ahrq.gov/ehc/products/564/1992/Gout-managment-protocol-141103.pdf).

Background: Alternative strategies exist for diagnosing gout that do not rely solely on the documentation of monosodium urate (MSU) crystals., Purpose: To summarize evidence regarding the accuracy of clinical tests and classification algorithms compared with that of a reference standard of MSU crystals in joint aspirate for diagnosing gout., Data Sources: Several electronic databases from inception to 29 February 2016., Study Selection: 21 prospective cohort, cross-sectional, and case-control studies including participants with joint inflammation and no previous definitive gout diagnosis who had MSU analysis of joint aspirate., Data Extraction: Data extraction and risk-of-bias assessment by 2 reviewers independently; overall strength of evidence (SOE) judgment by group., Data Synthesis: Recently developed algorithms including clinical, laboratory, and imaging criteria demonstrated good sensitivity (up to 88%) and fair to good specificity (up to 96%) for diagnosing gout (moderate SOE). Three studies of dual-energy computed tomography (DECT) showed sensitivities of 85% to 100% and specificities of 83% to 92% for diagnosing gout (low SOE). Six studies of ultrasonography showed sensitivities of 37% to 100% and specificities of 68% to 97%, depending on the ultrasonography signs assessed (pooled sensitivity and specificity for the double contour sign: 74% [95% CI, 52% to 88%] and 88% [CI, 68% to 96%], respectively [low SOE])., Limitation: Important study heterogeneity and selection bias; scant evidence in primary and urgent care settings and in patients with conditions that may be confused with or occur with gout., Conclusion: Multidimensional algorithms, which must be validated in primary and urgent care settings, may help clinicians make a provisional diagnosis of gout. Although DECT and ultrasonography also show promise for gout diagnosis, accessibility to these methods may be limited., Primary Funding Source: Agency for Healthcare Research and Quality. (Protocol registration: https://effectivehealthcare.ahrq.gov/ehc/products/564/1937/gout-protocol-140716.pdf).