30th September Research Articles

The Association of Renal Cortical Echogenicity and Length with Serum Creatinine in Patients with Chronic Kidney Disease

Background: The prevalence of chronic kidney disease is 21.2% in Pakistan and rising due to increasing prevalence of diabetes. Ultrasonography is effective tool in early detection and diagnosis of impaired renal function along with renal function tests. Objective: To study the correlation of serum creatinine with renal echogenicity grading and renal length in patients with chronic kidney disease. Methods: This prospective cross sectional study was conducted at Medicine, Nephrology and Radiology departments of Pakistan Railway General Hospital, Rawalpindi from 30th September 2021 to 15th July 2022. A total of 200 patients with chronic kidney disease were enrolled randomly by consecutive non probability sampling from medical and nephrology in and out patients after fulfilling inclusion and exclusion criteria per study design. After history, physical examination of serum creatinine was done and the patient was sent for ultrasound in the radiology department. Demographic data and study data was entered on pre designed proforma and analyzed using SPSS21. Results: Mean age of the patients was 53.45±8.93 years. There were 110 male and 90 female patients in our study. Mean renal length was 9.55 cm. Mean serum creatinine was 1.921 mg/dl with grade 1 cortical echogenicity, 3.561 with grade 2, 4.267 with grade 3 and 6.001 with grade 4 echogenicity respectively on ultrasound. A negative correlation (r= -0.144) was present between renal length and serum creatinine. Conclusion: Renal cortical echogenicity is a valuable sonographic parameter and is found to be significantly related to serum creatinine level in chronic kidney disease. While renal length showed weaker association with serum creatinine levels.

An Analysis of the Principal Purpose Test Rule and the General Anti-Abuse Rules Contained in the Brazil-Poland Double Taxation Convention Signed in September 2022

The paper deals with the analysis of the legal aspects of the principal purpose test rule (PPT-Rule) and the general anti-abuse rules contained in the Brazil-Poland Double Tax Convention concluded on 20th September, 2022, in the light of Brazil’s international tax treaty policy and practice. The Authors discuss issues related to the interaction between the PPT-Rule and other treaty specific anti-tax avoidance provisions as well as the objective and subjective elements of the PPT-Rule itself and the possible consequences of its application, especially challenges related to the legal certainty principle.

The Brazil-Poland Double Tax Convention in the Context of the Countries’ Contemporary Tax Treaty Policy and Practice

This paper deals with the Brazil-Poland double tax convention for the elimination of double taxation with respect to taxes on income and the prevention of tax evasion and avoidance, signed on 20th September, 2022, in the context of contemporary Brazil’s and Poland’s tax treaty policy and practice. The Author analyses its main features in comparison to Brazil’s and Poland’s positions to the MLI and changes introduced to the OECD and UN Models in 2017. Tax treaty provisions relevant to both countries’ tax treaty policies and practices are also examined. The study concentrates around the research question whether the BR-PL DTC fits into the countries’ contemporary tax treaty policy and practice or whether it is a unique bilateral tax treaty with specific features creating a sui generis pattern for tax treaties: for Brazil – with other OECD Member States and for Poland – with other South American states.

Public Attitudes Towards Vaccine Passports in Alberta During the "Pandemic of the Unvaccinated": A Qualitative Analysis of Reddit Posts.

Objective: The goal of this study is to understand the attitudes and beliefs towards mandatory vaccination policies in Alberta, Canada in September 2021, during the fourth wave of COVID-19. Methods: 9400 posts between 1st September and 30th September 2021 were collected from the subreddit r/Alberta with Pushshift.io. Posts and comments were manually screened to determine their relevance to research objectives, and then coded using inductive coding and iterative qualitative analysis methods. Results: Inductive coding methods yielded five key themes: 1) opinions related to autonomy and consent, 2) concerns about COVID-19 vaccine passport enforcement, 3) concerns about government, 4) concerns about the logistics of passports, and 5) opinions relating to the necessity of passports to prevent lockdowns. Conclusion: Overall, the data presented favorable opinions towards an Albertan vaccine passport within r/Alberta. Anti-vaccine and anti-mandate opinions were often less extreme than those present in the literature, although this may be due to r/Alberta subreddit moderators removing those more extreme comments. Most reservations were due to issues of bodily autonomy, though concerns about the government and logistics also played a meaningful role.

The diagnostic accuracy of the ID NOW COVID-19 point of care test in acute hospital admissions

BackgroundPrompt identification of patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on admission to hospital is crucial to ensuring initiation of appropriate treatment, optimising infection control and maintaining patient flow. The Abbott ID NOW™ COVID-19 assay (ID NOW) is a point-of-care, isothermal nucleic acid amplification test, capable of producing a result within minutes, potentially placing it as an invaluable tool in helping to control the coronavirus-disease 2019 (COVID-19) pandemic. ObjectivesTo evaluate the diagnostic accuracy of ID NOW in acute hospital admissions. Study designA prospective approach to data collection was undertaken in consecutive patients with ID NOW and Hologic Aptima™ SARS-CoV-2 transcription-mediated amplification assay (Aptima TMA) results, across three hospitals in the south-west of England between 1st March and 30th September 2021. A nasal swab was taken for ID NOW and a combined nose and throat swab for Aptima TMA. Measures of diagnostic accuracy were calculated for ID NOW against Aptima TMA. This study was conducted during a period of alpha and delta strain predominance. Results19,698 ID NOW assays were performed, of which 12,821 had an Aptima TMA assay performed within 24 hours. ID NOW had sensitivity of 85.2 % (95 % CI, 82.2–87.9) and specificity of 99.6 % (95 % CI, 99.4–99.7) compared with the reference assay. The overall PPV was 91.0 % (95 % CI, 88.5–93.0) and the overall NPV was 99.3 % (95 % CI, 99.1–99.4). ConclusionsID NOW offers a valid diagnostic tool to detect SARS-CoV-2, performing comparably to a reference laboratory-based assay which takes longer to provide results.

Preparing for the implementation of EMIR REFIT

The new obligations under EMIR REFIT (as defined below) require firms to adopt new reporting standards for derivatives transactions and upgrade outstanding derivatives transactions to the new reporting format. The implementation date is 29th April, 2024 in the EU and 30th September, 2024 in the UK. To navigate the complexities of EMIR REFIT, firms should start preparing for the implementation of the new requirements as soon as possible.

Representation Of LGBTQIA+ People in Selected Indian Web Series: A Study

LGBTQIA+ is an acronym for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual. These terms describe the gender identity of those who do not come into the male and female categories. Before 2018 homosexual act between adults was unconstitutional in India under section 377 but on 6th September 2018 Indian supreme court neglected this and their sexual activities or homosexuality became a legal act in India. In the whole world, the media plays a very important and fascinating role to represent any controversy. Now our media like television, OTTs, and cinema also represent the content that discusses the idea of LGBT people. Nowadays the younger generation is moving or shifting towards OTT platforms. On the OTT platform, presenting this kind of content is becoming useful. OTTS is becoming the most trending and easy to represent the difficulties, trauma, depression, raising questions for identities, gender trouble, and the bitterness of life lived by LGBTQIA+. The aim of this article is to drill the concept of representation and acceptance of third-gender people in Indian society through OTT platforms and also it will put light on myths regarding third gender. It has been more than five years since the LGBT+ community and homosexuality are becoming a legal act in India but it has given only legal acceptance. In our society and especially in a small town their acceptance and their sexual acts are still unacceptable and odd. So, media and screens have the power to bring both positive and negative change in the stereotype myths regarding queer people. This research will focus on ‘Mismatched season 2’, ‘Four More Shots Please’ ‘Made in Heaven’, and ‘His Storyy’.

Service evaluation of the implementation of SGLT-2 Inhibitor checklist on information communicated and documented to patients and transfer of care-records

Abstract Introduction Sodium Glucose Co-Transporter 2 (SGLT-2) Inhibitors’ therapeutic role has evolved1 as recent clinical trials showed they have beneficial effects across all stages of the cardio-renal metabolic spectrum2. There are different indications and specialities responsible for the initiation of these medications, so communication from health professionals to patients and documentation of this on transfer of care records is paramount3. It is important all health-care professionals ensure their clinical knowledge is current and updated to be able to communicate accurate and correct information to patients on their medications. A SGLT-2 Inhibitor counselling checklist was developed and approved for implementation in The Trust to promote awareness of new clinical guidelines and support the counselling provided to patients. The checklist included recommendations of the information to communicate and document on patient care records. Aim The aim was to assess the impact of the SGLT-2 Inhibitor counselling checklist on the information provided to patients and to identify if the indication and speciality responsible were recorded on transfer of patient care records for patients newly prescribed SGLT-2 inhibitors. Methods Ethical approval was not required for this quantitative research service evaluation. A data collection tool designed in Excel Microsoft 365 was used to collect data. Data was collected manually by the lead author retrospectively (pre-implementation of the checklist) from 1st January – 30th March 2022, and prospectively (post-implementation) from 1st July – 30th September 2022 from discharge prescriptions detailing newly prescribed SGLT-2 Inhibitors related to patients from four selected wards (A- D). Descriptive statistical analysis was carried out to compare the pre and post implementation data. Results Over the 6 month study period, a total of 110 patients were newly prescribed a SGLT-2 Inhibitor (63 pre- implementation and 47 post implementation). There was increased information communicated to patients in the post implementation group when compared to the pre implementation group. The percentage of patients provided with medicine information books and ‘protect my kidney’ cards increased from 25% to 70% and the proportion that received counselling increased from 27% to 70%. The indication and speciality involved with initiation and prescribing of SGLT-2 Inhibitors was well communicated and documented from 3% unknown in the pre group compared to 0% in the post implementation group. Discussion/Conclusion Despite this study being limited to a short collection period and a small sample size, the data collected demonstrates that the SGLT-2 inhibitor counselling checklist can increase the information communicated to patients and improve information included on transfer of care records, which is paramount between healthcare professionals to ensure a seamless transfer of care3. A key implication is the need to ensure use of counselling checklists as part of the discharge process.

Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland

Abstract Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy & Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement.

South Africa and Covid-19 Pandemic: Unpacking the Strategies of Management and Control

South Africa at 6th September, 2021 recorded 2,824,063 cases of people with corona virus and 83,617 deaths resulting from COVID 19. It made over 1700 arrest to enforce strict compliance to the lockdown imposed on the country when the case started and has increased stimulus packages for companies and individuals to cushion the effect of lockdown on the economy. It has also increased the capacity for testing and has since eased the lockdown initially imposed on the country. Away from few cases of African countries such as Botswana and Tanzania, South Africa has adopted a methodology for managing COVID 19 pandemic that seems to be a direct adaptation from the advanced countries of the United States, France and the United Kingdom. This study using qualitative and participant observation methods investigates the process of managing the pandemic in South Africa, the extent to that has helped to flatten the curve of the spread and the impact it has on the people and the economy of South Africa generally. It probes further to query if there are homegrown alternatives that may be best suited to containing and managing situations of this nature going forward.

Proposals on open design competition to revitalize collage building in Javor street

Abstract University of Obuda Ybl Miklós Faculty of Architecture and Civil Engineering launched an architectural competition to seek for forward-looking solutions for rehabilitation and revitalization of an unused and eroding building. The estate in question is located near the Faculty campus, under 9. Javor Street, 1145, Budapest. When the possibility of a renovation arose, leaders of the Faculty decided to involve the community of the students in order to represent their points of view. The open, secret competition had been launched on 8th September, and by the deadline 30th November fifteen proposals were submitted. Two of the most promising designs were awarded 1st prizes, one got a 2nd prize and two further submissions earned 3rd prize..

Preface

The International Conference on Applications and Design in Mechanical Engineering 2023 (ICADME 2023) was held on 4th and 5th September 2023 in Kuala Lumpur, Malaysia. ICADME 2023 was organized by the Mechanical Engineering Programme, under the purview of Faculty of Mechanical Engineering and Technology, Universiti Malaysia Perlis.The ICADME 2023 aims to provide a platform for participants from diverse field of Mechanical Engineering backgrounds to exchange ideas and findings to promote cooperation, networking as well as knowledge sharing in both engineering practice and research in higher education. The conference includes the fields of i) Material Science & Engineering, ii) Design & Manufacturing, iii) Energy & Thermofluids, iv) Robotics, Automation & Control System as well as v) Biomechanics. The conference received 37 papers from Malaysia and other countries over the world. After a rigorous peer-review process, 28 papers were accepted. The accepted papers that focused on theory, applications, design and experimental studies relevant to mechanical engineering fields were invited to present in this conference.We want to express our gratitude to all reviewers, both local and international, for their time and effort in reviewing the papers. Their feedbacks to the authors have been excellent and useful to ensure the high quality of papers for the conference. Our sincere thanks also go to all sponsors for their generosity. Last but not least, we would like to thank the organizing committee members for their hard work, cooperation and insights in ensuring the success of this conference.List of Editors are available in the pdf.

Pir Hussamuddin Rashidi's Urdu Literary Services

Pir Hussamuddin Rashidi was a famous journalist, historian, scholar and political analyst of his time. He was born on 20th September 1911 in Behman village Near Nusrat Railway Station Taluka Rattodero District Larkana. He was founder member of Sindhi Adabi Board, Urdu College Karachi, Urdu Trust Karachi, Institution of Central and West Asian Studies, Karachi University, Idara-e-Yaadgaar-e-Ghalib etc. He had also been the Chairman of Advisory Council of Sindh University, member of Syndicate of Sindh University. Pir Hussamuddin was basically a historian and it was with reference to history that he viewed other Sciences and Arts.Today Sindhi new generation is treading the path of Scholarship and research in the light of Pir Sahib’s work. Pir Sahib introduced the tradition of modern research in Sindh. The Government of Pakistan, in 1964, conferred on him the literary award Sitaara-e-Imtiaz for his meritorious services in the fields of literature and history. He expired on 1st April 1982. He is buried in the historical graveyard of Makli, Thattaa, Sindh, Pakistan

Early Post-Cesarean Rehabilitation in A Tertiary Hospital in Burkina Faso

Introduction: early post-caesarean rehabilitation could be an ideal alternative in terms of direct health savings for the parturient and indirect for the community. Objective: Studying the effects of early rehabilitation after caesarean section in women at Yalgado Ouedraogo teaching hospital (YOTH) Methodology: This was a cohort study comparing two groups of patients who underwent a scheduled caesarean section from 7th May to 4th September, 2020 in the obstetrics department of YOTH. Group 1 consisted of women benefiting from the early rehabilitation protocol (n=124) and group 2 consisted of non-rehabilitated women (n=124). Results: The times of first getting up (p=0.01), walking (p<0.05), first drink (p=0.0001), removal of the urinary catheter (p<0.05), and urination (p<0.05) were significantly reduced in group 1. There was no statistically significant difference in postoperative pain. The mean time to first urination after removal of the urinary catheter was 18.8 ± 4.3 hours in the rehabilitated operated group versus 28 ± 10.5 hours in the non-rehabilitated group (p < 0.05). The first rise took place on average 7.2 ± 1.5 hours after the cesarean section in the rehabilitated group versus 8.1 ± 3.7 hours in the non-rehabilitated group (p=0.01). There was a significant reduction in length of stay (p < 0.05) and cost of treatment (p=0.) Conclusion: The early rehabilitation protocol after caesarean allows a significant improvement in terms of functional recovery, length of stay and cost of treatment.

A pilot randomised controlled parallel arm trial evaluating treatment satisfaction with the Omnipod DASH® Insulin Management System compared with usual care in adults with type 1 diabetes in Australia: rationale, study design and methodologies

BackgroundInsulin pump therapy (IPT) improves glucose control in people with type 1 diabetes (T1D) compared with multiple daily injections (MDI). However, their size, the tethered insulin infusion set, intrusiveness when operating the device and the need to disconnect during showering limit their acceptance to many who may benefit. The Omnipod DASH® Insulin Management System is a small waterproof tubeless device which is wirelessly controlled by a handheld device which may be an acceptable alternative. However, there are no randomised controlled trials focusing on the impact on user perceptions of tubeless insulin pump therapy. This pilot study aims to assess study feasibility and acceptability of patch pump therapy compared with usual care in adults with T1D in Australia to inform power calculations and progression to a large-scale multi-site randomised controlled study.MethodsA pilot multi-site parallel randomised controlled study will be conducted in sixty-four adults with T1D who are managed on MDI or IPT and self-monitoring with finger-stick blood glucose from four specialist diabetes centres in Victoria, Australia. Following carbohydrate counting education, participants will be randomised to use Omnipod DASH® System (Omnipod group) or continue usual care (usual care group) for 12 weeks, followed by a 12-week extension phase where all participants will use Omnipod DASH® System. The primary outcome measure is feasibility determined by study completion rates with a threshold of 0.80. Acceptability of the intervention (Omnipod DASH® System) will be assessed by the difference in Diabetes Technology Questionnaire ‘current’ (DTQ-current) score at 12 weeks post-randomisation compared to baseline. Secondary outcomes will include other measures of user acceptance, process outcomes, resource outcomes, participant-centred outcomes, healthcare professional perceptions and glycaemic outcomes.DiscussionThis pilot study will provide insights regarding the feasibility of the study design and the first data regarding user acceptance of insulin patch pump technology in Australian T1D adults. We anticipate that this study will provide information informing the design of a larger study evaluating the impact of patch pumps on subjective outcomes that are of significance to the person living with T1D.Trial registrationAustralian New Zealand Clinical Trials Registry (https://anzctr.org.au/) ACTRN12621001195842 (8th September 2021). Please refer to Additional file 1: Appendix 1 for full details.

Monitoring of Critical Undersea Infrastructures: The Nord Stream and Other Recent Case Studies

The explosions on September 26th, 2022, which damaged the gas pipelines of Nord Stream 1 and Nord Stream 2, have highlighted the need and urgency of improving the re- silience of Critical Undersea Infrastructures (CUIs). Comprising gas pipelines and power and communication cables, these con- nect countries worldwide and are critical for the global economy and stability. An attack targeting multiple of such infrastruc- tures simultaneously could potentially cause significant damage and greatly affect various aspects of daily life. Due to the in- creasing number and continuous deployment of CUIs, existing underwater surveillance solutions, such as Autonomous Under- water Vehicles (AUVs) or Remotely Operated Vehicles (ROVs), are not adequate enough to ensure thorough monitoring.We show that the combination of information from both un- derwater and above-water surveillance sensors enables achieving Seabed-to-Space Situational Awareness (S3A), mainly thanks to Artificial Intelligence (AI) and Information Fusion (IF) method- ologies. These are designed to process immense volumes of infor- mation, fused from a variety of sources and generated from mon- itoring a very large number of assets on a daily basis. The learned knowledge can be used to anticipate future behaviors, identify threats, and determine critical situations concerning CUIs.To illustrate the capabilities and importance of S3A, we con- sider three events that occurred in the second half of 2022: the aforementioned Nord Stream explosions, the cutoff of the under- water communication cable SHEFA-2 connecting the Shetland Islands and the UK mainland, and the suspicious activity of a large vessel in the Adriatic Sea. Specifically, we provide analy- ses of the available data, from Automatic Identification System (AIS) and satellite data, integrated with possible contextual in- formation, e.g., bathymetry, Patterns Of Life (POLs), weather conditions, and human intelligence (HUMINT).

Wednesday Wildflower Wanders [6th September, Kalimna Park

Wednesday Wildflower Wanders [6th September, Kalimna Park

Wednesday Wildflower Wanders [20th September, Red White and Blue Track, Muckleford Forest

Wednesday Wildflower Wanders [20th September, Red White and Blue Track, Muckleford Forest

Continental concerted efforts to control the seventh outbreak of Ebola Virus disease in Uganda: The first 90 days of the response.

On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi-country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross-border preparedness and response actions. The outbreak spanned 69 days and recorded 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response, the Government galvanised robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks.

Venous Screening Activities at the Site of Hokkaido East Iburi Earthquake: Report from the Result of Venous Screening in Preventive Awareness Activities.

After previous earthquakes, high prevalence of cardiovascular diseases including venous thromboembolism (VTE) has been reported. We performed venous screening at the site of Hokkaido East Iburi Earthquake which happened at 6th September 2018. VTE screening using ultrasound sonography was performed for total 7 days at Atsuma town, Mukawa town and Abira town (total 9 shelters). Deep vein thrombosis (DVT) was found in 19 of 195 evacuees (9.7%), including 8 fresh thrombus cases (4.1%). On multivariable analysis of evacuees and shelter environment factors, systolic blood pressure, use of cardboard bed and toilet environment were significant predictor of DVT. Introduction and setting-up of cardboard beds were found as an important shelter environment factor. (This is secondary publication from Jpn J Phlebol 2021; 32(1): 5-10.).