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AIMS—To ascertain the type and extent of problems requiring advocacy in paediatrics. To develop an approach for analysing problems according to their root causes and the level of society at which advocacy is needed. METHODS—Nine paediatricians kept detailed clinical diaries for two weeks to identify problems. Classifications were developed to categorise problems by cause and the level of society at which they needed to be addressed. The press was surveyed for one week for childhood issues attracting media attention. RESULTS—60 problems requiring advocacy were identified. Root causes included failures within agencies, between agencies, and inadequate provision. In addition to advocacy required individually, "political" action was needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the press, these did not relate closely to issues identified by clinicians. CONCLUSIONS—Many opportunities for advocacy arise in the course of daily work. A systematic way of analysing them has been developed for use in planning action. To optimise the health and health care of children, there is a need to train and support paediatricians in advocacy work for local as well as national issues. Ten issues were identified that might be prioritised by paediatricians working on an agenda for action.

The international exchange program plays an important role in improving soft skills and helps graduates' to be confident to compete in job market. Student can achieve a vast academic knowledge apart from extra-curricular and co-curricular skills through attending exchange program. Therefore, this paper aims at studying the development of students acquired soft skills and the barriers they face to achieve the goal through the exchange program. The data obtained from 87 students who participated in exchange program in different countries of Asia. Besides descriptive statistics, factor analysis was performed to identify the achieved soft skills through exchange program. This study reveals that, a large number of students were attending in exchange program at their own cost and most of the students were from the year 3. Indubitably, Exchange program helps to improve students' soft skill such as; communication skill, team building ability, adaptability with situation. Moreover, lectures delivered to the students were found interesting. Results of the study are expected to motivate students attending in international exchange program and will offer a right direction to the students to get an expected outcome

Received: 22 June 2021 / Accepted: 13 January 2022 / Published: 5 March 2022

Background: Financing healthcare through out-of-pocket (OOP) payment is a major barrier in accessing healthcare for the poor people. The Health Economics Unit (HEU) of the Ministry of Health and Family Welfare of the government of Bangladesh has developed Shasthyo Suroksha Karmasuchi (SSK), a health protection scheme, with the aim of reducing OOP expenditure and improving access of the below-poverty-line (BPL) population to healthcare. The scheme started piloting in 2016 at Kalihati sub-district of Tangail District. Our objective was to assess healthcare utilization by the enrolled BPL population and to identify the factors those influencing their utilization of the scheme. Method: A cross-sectional household survey was conducted from July to September 2018 in the piloting sub-district. A total of 806 households were surveyed using a semi-structured questionnaire. Information on illness and sources of healthcare service were captured for the last 90 days before the survey. Multiple logistic regression models were applied to determine the factors related to utilization of healthcare from the SSK scheme and other medically trained providers (MTPs) by the SSK members for both inpatient and outpatient care. Result: A total of 781 (24.6%) people reported of suffering from illness of which 639 (81.8%) sought healthcare from any sources. About 8.0% (51 out of 639) of them sought healthcare from SSK scheme and 28.2% from other MTPs within 90 days preceding the survey. Households with knowledge about SSK scheme were more likely to utilize healthcare from the scheme and less likely to utilize healthcare from other MTPs. Non-BPL status and suffering from an accident/injury were significantly positively associated with utilization of healthcare from SSK scheme. Conclusion: Among the BPL population, healthcare utilization from the SSK scheme was very low compared to that of other MTPs. Effective strategies should be in place for improving knowledge of BPL population on SSK scheme and the benefits package of the scheme should ...

Systematic reviews are a valuable tool to inform healthcare decision-making.1 2 While a single randomised controlled trial (RCT) is insufficient to definitively guide healthcare decisions, a systematic review synthesising multiple RCTs can overcome this limitation. The results of rigorous systematic reviews possess wide-ranging applicability to numerous stakeholders within the evidence-based medicine 'ecosystem'. Clinicians consult systematic reviews to inform their clinical decisions.3 Researchers rely on systematic reviews to identify knowledge gaps in existing literature.4 Health policymakers use systematic review evidence to inform practice guidelines and legislation.5 6 Journal editors often prioritise systematic reviews for their impact on readership attention and journal metrics.7 Finally, patients are empowered by systematic reviews that assess the beneficial and harmful patient-important outcomes of available management strategies.8 Evidently, systematic review authors have an important responsibility to ensure their findings provide the most accurate results possible.The biomedical literature expands by 22 systematic reviews daily,9 with no evidence that production is waning. More systematic reviews are desirable if they identify and inform important research questions that improve patient care.10 However, production of this magnitude is problematic when systematic reviews offer 'extensive redundancy, little value, misleading claims and/or vested interests'.11 As we outlined in part 1, bias is a systematic deviation from the truth in the results of a research study due to limitations in study design, conduct, or analysis.2 Deviations may either overestimate or underestimate a study's true findings depending of the type and magnitude of bias. As the results of a systematic review are only as valid as the studies it includes, pooling biased results from different studies can compromise the credibility of systematic review findings when no assessment, or a poor assessment, of risk of bias is performed.3 ...

Abstract. Introduction: Previous deliberate self-harm (DSH) is the strongest predictor of suicide. Although several studies exist in other countries, characteristics of DSH have not been well-studied in Pakistan. Aims: To identify characteristics of deliberate self-harm in a hospital population, building on previous work carried out on this subject at this center. Methods: 284 cases admitted to the Aga Khan University Hospital, Karachi, between January 1997 and August 2003 were studied by analyzing medical records. Information was collected regarding demographics, family history, personal history, suicidal ideation, current stressors, the act of DSH and its management. Results: The most common age group was 21-25 years of age. The majority were females (60.3%). 95.1% of patients used self-poisoning as a method of deliberate self-harm. 47.3% used benzodiazepines for self-poisoning. Precipitating factors included conflict with family, marital problems, chronic illnesses, and unemployment. Comorbid psychiatric disorders were present in 76.4% patients. Discussion: Despite the difference in socio-cultural background of our patients, many of our results were found to be consistent with Western data. Our findings suggest that problem-solving therapy, stress management and improved mental health care may be effective interventions in preventing DSH. Prescription of medications should be regulated. Further studies are suggested at the community level.

Sustainability has long been a topic of substantial interest to the design and human-centered computing communities. With industries increasingly prioritizing climate targets, there is a growing demand for sustainable product design. This article addresses this need through EcoSketch, a digital tool designed to democratize environmental impact assessments for product designers. Shifting typically retrospective evaluations to the early stages of product development, EcoSketch enables proactive consideration and adoption of sustainable alternatives. Unlike software tailored to environmental scientists, it minimizes the need for specialized training or extensive data inputs. We delve into the development and evaluation of EcoSketch, highlighting its unique features and usability strengths. This article concludes by discussing design implications and proposing future research avenues to strengthen the intersection of human-computer interaction and sustainable product design, with the aim of advancing progress on environmental challenges at the systems level.

Faecalibacterium prausnitzii is one of the most abundant commensal bacteria in the healthy human large intestine, but information on genetic diversity and substrate utilization is limited. Here, we examine the phylogeny, phenotypic characteristics, and influence of gut environmental factors on growth of F. prausnitzii strains isolated from healthy subjects. Phylogenetic analysis based on the 16S rRNA sequences indicated that the cultured strains were representative of F. prausnitzii sequences detected by direct analysis of fecal DNA and separated the available isolates into two phylogroups. Most F. prausnitzii strains tested grew well under anaerobic conditions on apple pectin. Furthermore, F. prausnitzii strains competed successfully in coculture with two other abundant pectin-utilizing species, Bacteroides thetaiotaomicron and Eubacterium eligens, with apple pectin as substrate, suggesting that this species makes a contribution to pectin fermentation in the colon. Many F. prausnitzii isolates were able to utilize uronic acids for growth, an ability previously thought to be confined to Bacteroides spp. among human colonic anaerobes. Most strains grew on N-acetylglucosamine, demonstrating an ability to utilize host-derived substrates. All strains tested were bile sensitive, showing at least 80% growth inhibition in the presence of 0.5μg/ml bile salts, while inhibition at mildly acidic pH was strain dependent. These attributes help to explain the abundance of F. prausnitzii in the colonic community but also suggest factors in the gut environment that may limit its distribution ; We acknowledge the Scottish Government Rural Environment Research and Analysis Directorate for support. Mireia Lopez-Siles was awarded a fellowship from the Spanish Ministerio de Educación to support a research stay at the RINH and is also the recipient of an FI grant from the Generalitat de Catalunya (2010FI_B2 00135), which receives support from the European Union Commissionate. This work was partially funded by the Spanish Ministry of Education and Science through project SAF2006-00414

Faecalibacterium prausnitzii is one of the most abundant commensal bacteria in the healthy human large intestine, but information on genetic diversity and substrate utilization is limited. Here, we examine the phylogeny, phenotypic characteristics, and influence of gut environmental factors on growth of F. prausnitzii strains isolated from healthy subjects. Phylogenetic analysis based on the 16S rRNA sequences indicated that the cultured strains were representative of F. prausnitzii sequences detected by direct analysis of fecal DNA and separated the available isolates into two phylogroups. Most F. prausnitzii strains tested grew well under anaerobic conditions on apple pectin. Furthermore, F. prausnitzii strains competed successfully in coculture with two other abundant pectin-utilizing species, Bacteroides thetaiotaomicron and Eubacterium eligens, with apple pectin as substrate, suggesting that this species makes a contribution to pectin fermentation in the colon. Many F. prausnitzii isolates were able to utilize uronic acids for growth, an ability previously thought to be confined to Bacteroides spp. among human colonic anaerobes. Most strains grew on N-acetylglucosamine, demonstrating an ability to utilize host-derived substrates. All strains tested were bile sensitive, showing at least 80% growth inhibition in the presence of 0.5μg/ml bile salts, while inhibition at mildly acidic pH was strain dependent. These attributes help to explain the abundance of F. prausnitzii in the colonic community but also suggest factors in the gut environment that may limit its distribution ; We acknowledge the Scottish Government Rural Environment Research and Analysis Directorate for support. Mireia Lopez-Siles was awarded a fellowship from the Spanish Ministerio de Educación to support a research stay at the RINH and is also the recipient of an FI grant from the Generalitat de Catalunya (2010FI_B2 00135), which receives support from the European Union Commissionate. This work was partially funded by the Spanish Ministry of Education and Science through project SAF2006-00414

Faecalibacterium prausnitzii is one of the most abundant commensal bacteria in the healthy human large intestine, but information on genetic diversity and substrate utilization is limited. Here, we examine the phylogeny, phenotypic characteristics, and influence of gut environmental factors on growth of F. prausnitzii strains isolated from healthy subjects. Phylogenetic analysis based on the 16S rRNA sequences indicated that the cultured strains were representative of F. prausnitzii sequences detected by direct analysis of fecal DNA and separated the available isolates into two phylogroups. Most F. prausnitzii strains tested grew well under anaerobic conditions on apple pectin. Furthermore, F. prausnitzii strains competed successfully in coculture with two other abundant pectin-utilizing species, Bacteroides thetaiotaomicron and Eubacterium eligens, with apple pectin as substrate, suggesting that this species makes a contribution to pectin fermentation in the colon. Many F. prausnitzii isolates were able to utilize uronic acids for growth, an ability previously thought to be confined to Bacteroides spp. among human colonic anaerobes. Most strains grew on N-acetylglucosamine, demonstrating an ability to utilize host-derived substrates. All strains tested were bile sensitive, showing at least 80% growth inhibition in the presence of 0.5μg/ml bile salts, while inhibition at mildly acidic pH was strain dependent. These attributes help to explain the abundance of F. prausnitzii in the colonic community but also suggest factors in the gut environment that may limit its distribution ; We acknowledge the Scottish Government Rural Environment Research and Analysis Directorate for support. Mireia Lopez-Siles was awarded a fellowship from the Spanish Ministerio de Educación to support a research stay at the RINH and is also the recipient of an FI grant from the Generalitat de Catalunya (2010FI_B2 00135), which receives support from the European Union Commissionate. This work was partially funded by the Spanish Ministry of ...

Background Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18years old. Methods and Results We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P<0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P<0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter (P<0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter (P<0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83-10.8; P<0.0001). Conclusions Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.

BACKGROUND: Although the number of hospital visits has exponentially increased for adults with congenital heart disease (CHD) over the past few decades, the relationship between insurance status and hospital encounter type remains unknown. The purpose of this study was to evaluate the association between insurance status and emergent versus nonemergent encounters among adults with CHD ≥18 years old. METHODS AND RESULTS: We used California Office of Statewide Health Planning and Development Database from January 2005 to December 2015 to determine the trends of insurance status and encounters and the association of insurance status on encounter type among adults with CHD. A total 58 359 nonpregnancy encounters were identified in 6077 patients with CHD. From 2005 to 2015, the number of uninsured encounters decreased by 38%, whereas government insured encounters increased by 124% and private by 79%. Overall, there was a significantly higher proportion of emergent than nonemergent encounters associated with uninsured status (13.0% versus 1.8%; P<0.0001), whereas the proportion of nonemergent encounters associated with private insurance was higher than emergent encounters (35.8% versus 62.4%; P<0.0001). When individual patients with CHD became uninsured, they were ≈5 times more likely to experience an emergent encounter (P<0.0001); upon changing from uninsured to insured, they were significantly less likely to have an emergent encounter (P<0.001). After multivariate adjustment, uninsured status exhibited the highest odds of an emergent rather than nonemergent encounter compared with all other covariates (adjusted odds ratio, 9.20; 95% CI, 7.83–10.8; P<0.0001). CONCLUSIONS: Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of patients with CHD might result in meaningful reductions in emergent encounters and a more efficient use of resources.

This report includes discussions on the lithofacies, depositional environments, palynobiostratigraphy, coal quality, and measured sections of Cretaceous and Paleocene strata of northern Pakistan. ; "Prepared in cooperation with the Geological Survey of Pakistan, under the auspices of the Agency for International Development, U.S. Department of State, and the Government of Pakistan." ; Shipping list no.: 1995-0113-P. ; Includes bibliographical references (pages 16-17). ; This report includes discussions on the lithofacies, depositional environments, palynobiostratigraphy, coal quality, and measured sections of Cretaceous and Paleocene strata of northern Pakistan. ; Mode of access: Internet.

This article presents a climatology of total cloud cover (TCC) in the area of the three inland Eurasian seas (Black, Caspian, and Aral Sea). Analyses are performed on the basis of 20 years of data (1991 2010), collected from almost 200 ground stations. Average TCC is 49%, with broad spatial and seasonal variability: minimum TCC values are found in summer and to the southeast, whereas maximum values correspond to winter and to the northwest. For the whole area, linear trend analyses show that TCC did not vary during the study period. We only detected a statistically significant positive trend (+1.2% decade−1) in autumn. We obtained different results for the regions delimited by means of a principal component analysis: a clear decrease, both for the annual, spring, and summer series, was detected for the south of Black Sea, while increasing TCC was found for the annual, autumn, and winter series in the north Caucasus and the west and north of Black Sea. We also analysed the TCC data from global gridded products, including satellite projects [International Satellite Cloud Climatology Project (ISCCP), Pathfinder Atmospheres Extended (PATMOS-x), cLoud, Albedo & Radiation (CLARA)], reanalyses [ERA-interim, National Centers for Environmental Prediction/Department of Energy (NCEP/DOE), Modern-Era Retrospective Analysis for Research and Applications (MERRA)], and surface observations [Climatic Research Unit (CRU)]. Although all these products capture the seasonal evolution over the study area, they differ substantially both among them and in relation to the ground observations: reanalyses produce much lower values of TCC, while ISCCP and CLARA provide a summer minimum that is too high. Trend analyses applied to these data generally showed a decrease in TCC; only CRU and NCEP/DOE tally with the ground data as regards the absence of overall trends. These results are discussed in relation to previous studies presenting trends of other variables such as sunshine duration, diurnal temperature range, or precipitation; we also discuss the connections with changes in synoptic patterns and environmental changes, in particular in the Aral Sea region ; This research was developed under the auspices of, and with funding from, the project 'CLIMSEAS: Climate Change and Inland Seas: Phenomena, Feedbacks, and Uncertainties. The Physical Science Basis', of the Seventh Framework Programme, European Union People-Marie Curie Actions, International Research Staff Exchange Scheme (FP7-PEOPLE-2009-IRSES N. 247512). Several authors are involved within the project NUCLIERSOL (CGL2010-18546), funded by the Spanish Ministry of Economy and Competitiveness. Aarón Enriquez-Alonso was given a grant from the FPI program (BES-2011-049095) of the same ministry. Arturo Sanchez-Lorenzo was supported by the 'Secretaria per a Universitats i Recerca del Departament d'Economia i Coneixement, de la Generalitat de Catalunya i del programa Cofund de les Accions Marie Curie del 7è Programa marc d'R+D de la Unió Europea' (2011 BP-B 00078) and the postdoctoral fellowship JCI-2012-12508. Partial support was provided to the Hydrometeorological Center of Russia by Russian Foundation for Basic Research (№13-05-00562). The ISCCP-D2 data were obtained from the International Satellite Cloud Climatology Project web site (http://isccp.giss.nasa.gov), maintained by the NASA Goddard Institute for Space Studies, New York. Data from EUMETSAT's Satellite Application Facility on Climate Monitoring (CM SAF) were used. PATMOS-x data are available via ftp from the University of Wisconsin, Space Science and Engineering Center (SSEC), and the Cooperative Institute for Meteorological Satellite Studies (CIMSS). ERA-Interim data are supported by the European Center for Medium-range Weather Forecast (ECMWF). NCEP Reanalysis data are provided by the National Oceanic and Atmospheric Administration (NOAA), Oceanic and Atmospheric Research (OAR). Earth System Research Laboratory (ESRL), Physical Sciences Division (PSD) (http://www.esrl.noaa.gov/psd/). MERRA files were obtained from the NASA Goddard Earth Sciences Data and Information Services Center. CRU TS3.20 Time-Series (TS) of High Resolution Gridded Data were provided by the University of East Anglia Climatic Research Unit (CRU)

This article presents a climatology of total cloud cover (TCC) in the area of the three inland Eurasian seas (Black, Caspian, and Aral Sea). Analyses are performed on the basis of 20 years of data (1991 2010), collected from almost 200 ground stations. Average TCC is 49%, with broad spatial and seasonal variability: minimum TCC values are found in summer and to the southeast, whereas maximum values correspond to winter and to the northwest. For the whole area, linear trend analyses show that TCC did not vary during the study period. We only detected a statistically significant positive trend (+1.2% decade−1) in autumn. We obtained different results for the regions delimited by means of a principal component analysis: a clear decrease, both for the annual, spring, and summer series, was detected for the south of Black Sea, while increasing TCC was found for the annual, autumn, and winter series in the north Caucasus and the west and north of Black Sea. We also analysed the TCC data from global gridded products, including satellite projects [International Satellite Cloud Climatology Project (ISCCP), Pathfinder Atmospheres Extended (PATMOS-x), cLoud, Albedo & Radiation (CLARA)], reanalyses [ERA-interim, National Centers for Environmental Prediction/Department of Energy (NCEP/DOE), Modern-Era Retrospective Analysis for Research and Applications (MERRA)], and surface observations [Climatic Research Unit (CRU)]. Although all these products capture the seasonal evolution over the study area, they differ substantially both among them and in relation to the ground observations: reanalyses produce much lower values of TCC, while ISCCP and CLARA provide a summer minimum that is too high. Trend analyses applied to these data generally showed a decrease in TCC; only CRU and NCEP/DOE tally with the ground data as regards the absence of overall trends. These results are discussed in relation to previous studies presenting trends of other variables such as sunshine duration, diurnal temperature range, or precipitation; we also discuss the connections with changes in synoptic patterns and environmental changes, in particular in the Aral Sea region ; This research was developed under the auspices of, and with funding from, the project 'CLIMSEAS: Climate Change and Inland Seas: Phenomena, Feedbacks, and Uncertainties. The Physical Science Basis', of the Seventh Framework Programme, European Union People-Marie Curie Actions, International Research Staff Exchange Scheme (FP7-PEOPLE-2009-IRSES N. 247512). Several authors are involved within the project NUCLIERSOL (CGL2010-18546), funded by the Spanish Ministry of Economy and Competitiveness. Aarón Enriquez-Alonso was given a grant from the FPI program (BES-2011-049095) of the same ministry. Arturo Sanchez-Lorenzo was supported by the 'Secretaria per a Universitats i Recerca del Departament d'Economia i Coneixement, de la Generalitat de Catalunya i del programa Cofund de les Accions Marie Curie del 7è Programa marc d'R+D de la Unió Europea' (2011 BP-B 00078) and the postdoctoral fellowship JCI-2012-12508. Partial support was provided to the Hydrometeorological Center of Russia by Russian Foundation for Basic Research (№13-05-00562). The ISCCP-D2 data were obtained from the International Satellite Cloud Climatology Project web site (http://isccp.giss.nasa.gov), maintained by the NASA Goddard Institute for Space Studies, New York. Data from EUMETSAT's Satellite Application Facility on Climate Monitoring (CM SAF) were used. PATMOS-x data are available via ftp from the University of Wisconsin, Space Science and Engineering Center (SSEC), and the Cooperative Institute for Meteorological Satellite Studies (CIMSS). ERA-Interim data are supported by the European Center for Medium-range Weather Forecast (ECMWF). NCEP Reanalysis data are provided by the National Oceanic and Atmospheric Administration (NOAA), Oceanic and Atmospheric Research (OAR). Earth System Research Laboratory (ESRL), Physical Sciences Division (PSD) (http://www.esrl.noaa.gov/psd/). MERRA files were obtained from the NASA Goddard Earth Sciences Data and Information Services Center. CRU TS3.20 Time-Series (TS) of High Resolution Gridded Data were provided by the University of East Anglia Climatic Research Unit (CRU)