7 research outputs found
ASSESSING THE VIABILITY OF MUZA’RAH AGRO FINANCING AS A SUSTAINABLE SOLUTION FOR SMALL-SCALE FARMERS: A CASE STUDY FROM PAKISTAN
No full textThe interplay between the Muza’rah (Sharecropper) agro-financing structure and its impact on rural income and rural poverty alleviation constitutes a multifaceted phenomenon. In this study, we seek to understand of the relation between Muza’rah agro-financing structure and rural income and the mediating role of national agricultural output for the case of Pakistan, a predominantly Muslim country characterized by a well-established Islamic banking and finance infrastructure. Using data from the Pakistan Social and Living Standard Survey (PSLM), the research reveals that the rural per capita income is significantly and negatively related to the Muza’rah agro-financing structure, which is further strengthened by the level of the national agricultural output. The finding underscores the importance of nuanced understanding for policymakers and practitioners engaged in poverty alleviation efforts, emphasizing the need to consider contextual variables and a nation's developmental status when designing interventions to improve rural livelihoods
Efficacy and safety of microaxial flow pump in infarct-related cardiogenic shock: a meta-analysis
No full textIntroduction
Data regarding mechanical circulatory support with a microaxial flow pump (Impella) in patients with myocardial infarction complicated by cardiogenic shock are limited.
Material and methods
PubMed/Medline, Embase, and the Cochrane Library were used to search for randomized controlled trials (RCTs) from inception to 16 June 2024. Risk ratios (RRs) were pooled with corresponding 95% confidence intervals (CIs) using the random effects model.
Results
Four RCTs were included. The pooled analysis demonstrated a significantly reduced risk of all-cause death in patients with the use of a microaxial flow pump at 6-month follow-up (RR = 0.80; 95% CI: 0.67 to 0.97) and cardiac death (RR = 0.68; 95% CI: 0.49 to 0.94) as compared to the control group. However, the use of a microaxial flow pump was associated with a significantly increased risk of major bleeding (RR = 2.27; 95% CI: 1.21 to 4.24), limb ischemia (RR = 4.46; 95% CI: 1.31 to 15.16), and sepsis (RR = 2.01; 95% CI: 1.11 to 3.67). The risk of stroke and rehospitalizations remained comparable across the two groups.
Conclusions
The use of a microaxial flow pump in infarct-related cardiogenic shock can reduce mortality at the expense of increased risk of bleeding, limb ischemia, and sepsis. Further research is required to validate our findings
FISCAL DECENTRALISATION AND POLITICAL ECONOMY OF POVERTY REDUCTION: THEORY AND EVIDENCE FROM PAKISTAN
No full textThis thesis explores the relationship between fiscal decentralisation and poverty. The thesis consists of four parts. First part reviews the related literature addressing different aspects of fiscal decentralisation and poverty and highlighting the research gap that this thesis intends to address. It also explains the possible channels through which fiscal decentralisation potentially affects poverty. Second part describes the political economy, fiscal decentralisation and poverty in Pakistan. It underlines that fiscal policy decisions in Pakistan are made to reflect many vested interest groups and institutions that may be failed to provide basic social services. Additionally, it discusses the development of federalism and fiscal decentralisation in Pakistan and shows that how the vertical and horizontal resource distribution affect the social and economic development of the provinces. This part also discusses various approaches, measurements and trends of poverty in Pakistan. Third part presents a systematic relationship between fiscal decentralisation and poverty both theoretically and empirically. The theoretical framework implies that if the federal transfer rate is larger, then the decentralisation measure will be greater. Since a larger federal transfer rate reduces poverty, poverty and expenditure decentralisation are expected to be negatively related. In addition to the model, there is an extensive empirical study on Pakistan to look at the impact of fiscal decentralisation on poverty besides investigating the potential channels through pro-poor sectoral outcomes. Ordinary Least Squared, Fixed and Radom Effect Models and Generalised Method of Moment Instrumental Variables methodology is used on simple time series as well as panel datasets covering four provinces of Pakistan over the period from 1975 to 2009. The empirical results suggest a strong relationship between expenditure decentralisation and poverty – proxy alternatively by headcount poverty, poverty gap, severity of poverty and the human development index. Both rural and urban poverty reduction have statistically significant relationship with expenditure decentralisation. The results also reveal that decentralisation improves pro-poor sectoral outcomes of education, health and agriculture that consequently affect poverty.
The last part illustrates the effectiveness of the devolution reforms by transferring fiscal, political and administrative authorities to local governments on certain social and economic sectors that are believed to be pro-poor. The evidence shows that the devolution significantly changes the size and magnitude of investment on many social and economic sectors. In all provinces, the investment increases in sectors such as education, healthcare, agriculture, water management, water supply and sanitation, rural development and the civil work. Since these services are strongly associated with local needs, it is reasonable to conclude that the devolution implicitly enhances the living standard of the local communities, especially the poor
Nadir PSA is a strong predictor of treatment outcome in intermediate and high risk localized prostate cancer patients treated by definitive external beam radiotherapy and androgen deprivation
No full textBackground: The aim of this study is to investigate the effect of tumor characteristics and parameters of treatment response in predicting biochemical disease-free survival (BFS) for patients with intermediate or high risk prostate cancer treated by combined definitive external beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). Methods: Between June 1995 and January 2015, 375 patients with localized prostate cancer and a National Comprehensive Cancer Network (NCCN) intermediate or high risk categories were treated by definitive EBRT and ADT. Median duration of androgen blockade was 10months (range: 3-36months); Median radiation dose was 72Gy (Range: 70-78Gy). Median follow-up time was 5.8years (range: 0.8-16.39years). The main study endpoint was biochemical disease free survival (BFS). Results: Forty seven patients (12.5%) developed biochemical recurrence (BCR) during the observation period. Monovariate analysis identified baseline PSA (bPSA) (p=0.024), T-stage (p=0.001), Gleason's score (GS) (p=0.042), radiation dose (p=0.045), PSA pre-radiation therapy (p=0.048), and nadir PSA (nPSA), (p<0.001) as significant variables affecting BCR. The receiver operating characteristic (ROC) curve identified a nPSA of 0.06ng/ml as optimal cut-off value significantly predicting the patients' risk of BCR (p<0.001). Multivariate cox regression analysis revealed T-stage, GS, and nPSA as independent variable affecting BFS, while bPSA, age, and radiation dose were not. Conclusion: Nadir PSA at 0.06 is a strong independent predictor of BFS in patients with intermediate or high risk prostate cancer treated by definitive EBRT and ADT.</p
Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms
No full textBackground: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders
30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study
No full textObjective: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. Summary background data: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. Methods: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. Results: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. Conclusion: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy
