My patient is short of breath: is the problem in the lung tissue?

Undifferentiated dyspnoea is a common patient presentation in the intensive care unit, medical and surgical floors, and in the emergency department. Physical examination and chest radiography are notoriously insensitive for detection and differentiation of various lung pathologies while computed tomography consumes significant resources and exposes the patient to ionizing radiation. Point-of-care ultrasound (PoCUS) is a highly sensitive and specific diagnostic tool that, with appropriate operator experience, is capable of diagnosing and differentiating between the various causes of dyspnoea. PoCUS machines are readily available, images are rapidly generated and repeatable, and technical skills are easily taught during short training sessions. Furthermore, the development of PoCUS skills in one specific area enables and enhances the development of skills in other non-related areas. This article describes the benefits, technical aspects, and challenges associated with using PoCUS to examine the lung parenchyma in the acutely dyspnoeic patient

My patient is short of breath: is there pleural fluid, and will PoCUS help drain it safely?

Pathological pleural fluid is common in patients presenting to the emergency department, occurring in as many as 17% of patients presenting with shortness of breath, and as many as 20% of patients with blunt thoracic trauma. A typical chest X-ray may fail to identify as much as 175 mL of pleural fluid in the erect position, and as much as 500 mL in the supine position. Point-of-care ultrasound (PoCUS) on the other hand can detect as little as 20 mL of pleural fluid, and has consistently been shown to have sensitivities and specificities for the detection of pleural fluid close to 100% in both the trauma and critically ill populations. In addition, ultrasound identifies pleural fluid more rapidly than chest X-ray. PoCUS can be used to guide thoracentesis, resulting in improved success rates with decreased complications. Here we describe the evidence supporting the use of PoCUS in the management of pleural fluid collections

HR Practices and Employee Retention in the Banking Sector of Pakistan

Purpose: Human Resource is one of the most valuable resources in any organization and its contribution is massive everywhere in the world.  Human Resources (HR) practices can be helpful to retain valued employees. This study examines the role and association between HR practices and employee retention. HR practices include training & development, compensation, job security, working environment, leadership and culture & policies. Major objective of this study is indentfiy the roele and effect of HR practices on employee retention in banking sector of Pakistan.   Design: The population of this study consists of 8 major banks of Pakistan including public, private, Islamic and foreign banks.  The mixed-method was employed to get the data through interviews and questionnaires. Simple random sampling and stratified random were used for interviews and questionnaires respectively. Findings: Findings of the study indicate that compensation; job security, training & development, working environment and leadership practices have a significant association with employee retention. These variables also play a very imperative role in employee retention except job security. The culture & policies have no significant association and role on employee retention. Value: The research findings may help the policymakers to prioritize the areas of instant concerns and invest resources as per the local requirement of staff for their retention in the banking sector of Pakistan

The development and evaluation of single cell suspension from wheat and barley as a model system; a first step towards functional genomics application

<p>Abstract</p> <p>Background</p> <p>The overall research objective was to develop single cell plant cultures as a model system to facilitate functional genomics of monocots, in particular wheat and barley. The essential first step towards achieving the stated objective was the development of a robust, viable single cell suspension culture from both species.</p> <p>Results</p> <p>We established growth conditions to allow routine culturing of somatic cells in 24 well microtiter plate format. Evaluation of the wheat and barley cell suspension as model cell system is a multi step process. As an initial step in the evaluation procedure we chose to study the impact of selected abiotic stress elicitors at the physiological, biochemical and molecular level. We report the results of osmotic stress imposed by NaCl and PEG. As proline is an important osmoprotectant of the cereal cells, colorimetric assay for proline detection was developed for small volumes (200 μl). We performed RT-PCR experiments to study the change in the expression of the genes encoding Δ¹-pyrroline-5-carboxylate synthetase (P5CS) and Δ¹-pyrroline-5-carboxylate reductase (PC5R) in response to abiotic stress.</p> <p>Conclusions</p> <p>We found differences between the wheat and barley suspension cultures, barley being more tolerant to the applied osmotic stresses. We suggested a model to explain the obtained differences in stress tolerance between the two species. The suspension cell cultures have proven useful for determining changes in proline concentration and expression level of genes (P5CS, P5CR) under various treatments and we suggest that the cells can be used as a model host system to study gene expression and regulation in monocots.</p

Will and Skill on Capitol Hill: How the President’s Reputation with Congress Impacts His Legislative Success

American political institutions have been shaped and influenced by the relationship between the president and Congress since the country’s founding. Factors like partisanship, divided government, and oversight have received a multitude of studies exploring how they affect interbranch relations. What we know less about is how Neustadt’s concept of professional reputation affects that relationship. This dissertation builds upon literature exploring the president’s reputation to develop a quantifiable measure of reputation we can apply across presidents and policy areas. Understanding reputation will provide a more complete picture of how the president moves in the legislative arena and will enable us to view interbranch relations through a new lens. To build this measure of professional reputation, I built a dataset consisting of all Statements of Administration Policy (SAPs), White House communications, statements from members of Congress (MCs), and veto-threatened legislation between 2001 – 2021. Each chapter uses these data to analyze how the president builds his reputation in a variety of policy areas related to legislation introduced in Congress. I use the strength of threats contained in SAPs and volume of White House communications effort in that policy area as measures of the president’s reputation-building effort. My results indicate that presidents devote varying levels of reputation-building activities to different policy areas, with each choosing to spend more resources in certain areas over others. Because reputation is ultimately in the eye of the beholder, I use congressional statements regarding the threatened bill or its policy area to measure perceptions of the president’s reputation-building activities. The analysis shows that MCs perceive the president to have a strong reputation in policy areas where he devotes more reputation-building activities. Lastly, I compared the first and final versions of each veto-threatened bill to the president’s preferences as stated in the SAPs to determine whether a strong reputation increased the chances of policy moving in his direction. I found that Congress is more likely to alter legislation according to the president’s preferences, indicating that the president’s efforts to shape congressional behavior are sometimes effective and can influence the outcomes of public policy

Malnutrition; Can the Leeds screening tool identify haemodialysis patients at risk?

There is global recognition of the need for early identification of those at risk of malnutrition. Nutritional screening has been advocated for systematically detecting and managing those at nutritional risk, triggering a dietetic referral where indicated. Dietetic assessment aims to minimise progression to overt malnutrition and ultimately, curtail the associated clinical and financial consequences. Patients receiving haemodialysis treatment are at increased risk of malnutrition. Generic nutritional screening tools are inherently limited in this population due to the observed variances in fluid status. There is currently no validated nutritional screening tool that is effective in this population. The present study aimed to test the effectiveness of the Leeds Nutritional Screening Tool (developed through pilot studies) in 140 representative haemodialysis patients. By means of a clinical audit, the clinical support worker tested the Leeds tool and the dietitian provided the criterion measure. A distinct feature was the inclusion of patients that were unable to fully complete answers, due to dementia, learning difficulties and a language barrier. Risk of malnutrition was evident in 49% of the Leeds sample. The Leeds tool showed good diagnostic accuracy (95%) with sensitivity and specificity comparable with other National Health Service tests. In turn, these results suggest that patients would be appropriately signposted for dietetic assessment, without wasting finite resources. Component analysis showed that the tool was well-balanced with a combination of objective and subjective measures and that it could be simplified by removal of a question on appetite, without affecting performance. Reliability testing was achieved by patient self-completion and by a nurse, both of whom produced consistent results with the clinical support worker. The tool was evaluated to have good practical acceptability amongst users. This research suggests that the Leeds tool can identify patients at risk of malnutrition, fulfilling the requirements needed to consider local implementation, alongside appropriate staff education. This research provide a sound framework for the development and testing of nutritional screening tools, in a field of variable study quality. It is hoped that the results will contribute to the wider audience, with further research needed to assess tool transferability amongst dialysis units.Leeds Teaching Hospital

Indigenous Cultural Safety Training in Health, Education, and Social Service Work

Background: Indigenous Cultural Safety (ICS) training is a growing field of study; however, little consensus exists about how ICS is conceptualized and operationalized. This lack of consistency can lead to misinterpretation and misappropriation of Indigenous knowledges and histories that can further perpetuate colonial harms. Objective: The objective of this scoping review is to explore and characterize the academic literature related to the conceptualization and operationalization of ICS training within the fields of health, social services, and education. Methods: This scoping review protocol employs the Joanna Briggs Institute’s three-step search strategy to identify articles in the following databases: MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA. This protocol follows the PRISMA guidelines for Scoping Reviews (Joanna Briggs Institute, 2015; Tricco et al., 2018). Discussion: This review will add new knowledge by offering insights into the historic and contemporary approaches to defining and operationalizing ICS training in the health, education and social services fields. The results produced will be of interest to scholars and health, social services, and education providers looking to apply the most current and appropriate concepts and practices of ICS

BIOTECHNOLOGY ISSUES FOR DEVELOPING COUNTRIES - Biotechnology in Developing Countries: Harnessing the Potential of High-TECH SMES in the Face of Global Competition

In the global market, the emergence of new technologies are representing opportunities and challenges to both industry and the public sector of the Latin American Countries (LAC). Some of these technologies have far reaching implications for a large number of industrial sectors, creating wealth and employment, resulting in an increased competitiveness of the developed economies around the world. Modern biotechnology is one of these key emerging technologies which LAC must harness successfully to sustain economic growth and competitiveness. The ability to commercially exploit research in this area is also of prime importance. Developed countries have made important progress in recent years, with a strong leadership of USA in this sector. Unless substantial steps are taken now by LAC the gap between developed and developing economies will only continue to widen in the short, medium and long term. In this, the role of Small and Medium size Enterprises (SMES) is of crucial importance, especially because "High-TECH SMES" firms, by their nature, are often start-ups where new products are developed. Therefore, it is up to public authorities and venture-capitalists, at both the national and regional level to help engender a more productive external business. This paper is aimed to provide an overview of the options to harness the potential of "High-TECH SMES" for generating and accessing to new technologies, both at the national and global levels, with particular emphasis on biotechnology sectors in order to improve the LAC competitiveness