COMPARISON OF ISOCONAZOLE NITRATE VERSUS NYSTATIN FOR TREATMENT OF OTOMYCOSIS

Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin.

Measuring Digital Competence: An Exploratory Study Mapping Digital Competence Profiles of Sri Lankan English Language Teachers

The overall vision for 21st century learning has incorporated digitalisation as a key focus in teaching and learning practices. In Sri Lanka, however, despite major initiatives taken to improve digital competency of teachers, only minor improvement was noted. Using the DigCompEdu assessment tool, this study investigates to what extent Sri Lankan English language teachers are digitally competent. The results aim to inform national initiatives to facilitate the shift towards a bottom-up process, informed by actual realities based on skills and competences. The DigCompEdu 22-item quantitative survey was used to sample 40 English language teachers working within the public education system. Overall, the study finds that not even 50% of the sample is at one competency band. It is recommended that for substantial changes to occur, a more varied and individualised teacher-training is recommended, using the DigCompEdu as a diagnostic guide.

Understanding the Effect of Zn Doping on Stability of Cobalt-Free P2-Na0.60Fe0.5Mn0.5O2 Cathode for Sodium Ion Batteries

In this work, we report a sol-gel synthesis-based Zn-doped Na0.6Fe0.5Mn0.5O2 (NFM) cathode and understand the effect of Zn doping on the crystal structure and electrochemical performances such as discharge capacity and rate capability. Detailed X-Ray diffraction (XRD) pattern analysis indicated a decrease in the Na-layer thickness with Zn doping. Small amount of Zn2+ dopant (i.e., 2 at.%) slightly improved cycling stability, reversibility, and rate performances at higher discharge current rates. For example, at 1 C-rate (1 C = 260 mAh/g), the Zn2+-doped cathode retained a stable reversible capacity of 72 mAh/g, which was ~16% greater than that of NFM (62 mAh/g) and showed a minor improvement in the capacity retention of 60% compared to 55% for the pristine NFM after 65 cycles. Slight improvement in the electrochemical performance for the Zn-doped cathode can be attributed to a better structural stability, which prevented the initial phase transition and showed the presence of electrochemical active Fe3+/4+ even after 10 cycles compared to NFM.

Pituitary apoplexy and associated cranial nerve palsies secondary to bleeding caused by immune thrombocytopaenia in a patient with known pituitary macroadenoma

An 84-year-old man presented with a frontal headache and easy bruising. He had a background history of a pituitary macroadenoma, diagnosed incidentally a year earlier. Investigations showed haemorrhage into the pituitary macroadenoma leading to a diagnosis of pituitary apoplexy in the context of low platelet count secondary to immune thrombocytopaenia. He was treated with intravenous hydrocortisone, platelet transfusion, intravenous immunoglobulin and high-dose steroid. Neurosurgical intervention was not indicated initially. Five days into his admission, he developed bilateral ptosis and ophthalmoplegia. MRI confirmed further haemorrhage associated with compression of the optic chiasm. He was transferred to a tertiary neurosurgical centre where he underwent urgent surgical decompression. To date, there has been minor improvement in his neurological symptoms. Management of this patient required considerable multidisciplinary teamwork between the clinics of endocrinology, haematology, neurosurgery, ophthalmology and geriatrics.

Impact of COVID-19 pandemic on training of pharmacy residents and fellows: Results from a national survey of postgraduate pharmacy trainees

Purpose The coronavirus disease 2019 (COVID-19) pandemic has impacted the activities of healthcare workers, including postgraduate pharmacy trainees. Quality training experiences must be maintained to produce competent pharmacy practitioners and maintain program standards. Methods A cross-sectional survey of postgraduate pharmacy trainees in the United States was conducted to evaluate training experience changes and assess perceived impacts on residents and fellows following the COVID-19 pandemic’s onset. Results From June 4 through June 22, 2020, 511 pharmacy trainees in 46 states completed the survey. Participants’ median age was 26 (interquartile range [IQR], 25-28) years, with included responses from postgraduate year 1 residents (54% of sample), postgraduate year 2 residents (40%), and postgraduate fellows (6%). Compared to experiences prior to the onset of the COVID-19 pandemic, fewer trainees conducted direct patient care (38.5% vs 91.4%, P < 0.001), more worked from home (31.7% vs 1.6%, P < 0.001), and less time was spent with preceptors per day (2 [IQR, 2-6] hours vs 4 [IQR, 1-4] hours, P < 0.001). Sixty-five percent of respondents reported experiencing changes in their training program, 39% reported being asked to work in areas outside of their routine training experience, and 89% stated their training shifted to focus on COVID-19 to some degree. Most respondents perceived either major (9.6%) or minor (52.0%) worsening in quality of experience, with major and minor improvement in quality of experience reported by 5.5% and 8.4% of respondents, respectively. Conclusion Pharmacy resident/fellow experiences were perceived to have been extensively impacted by the COVID-19 pandemic in varying ways. Our findings describe shifts in postgraduate training and may aid in the development of best practices for optimizing trainee experiences in future crises.

Latin American economic outlook sees minor improvement

Headline LATIN AMERICA: Economic outlook sees minor improvement

Absorptive Routines and the Economic Impact of Incremental Innovations: Developing Continuous Improvement Strategies

The important influence that incremental innovation has, both on the organization’s results and on the development of disruptive innovations in a synergistic relationship of positive sum, makes it necessary to deepen its study. In the context of absorptive capacity, this paper aims to contribute to the construction of a specific model of routines for more efficient exploitation. The empirical study was carried out in a sample of Spanish manufacturing companies of the PITEC Panel. The results show the superiority of the market as a source of knowledge compared to other sources with more complex knowledge, but not adjusted to the needs of a minor improvement. In addition, the management of external knowledge is a process whose phases are interrelated, so the routines and resources used must contribute to enriching the external knowledge previously acquired and not be redundant. Therefore, that would mean an inefficient allocation of resources for obtaining and exploiting continuous innovation.

Comparative Cost Analysis of Domestic Container Shipping Network: A Case Study of Indonesian Sea-Toll Concept

The Logistics Performance Index (LPI) of Indonesia shows minor improvement compared to neighbouring countries such as Singapore and Malaysia. The economic disparity between Indonesia’s eastern and western regions has reportedly become one of the fundamental problems in the country. Consequently, an ambitious project on shipping connectivity improvement, namely the ‘Sea-Toll’, has been proclaimed by the Indonesian government to overcome this chronic problem. One of the most influential parameters for measuring the success rate of this project is cost efficiency. Therefore, this paper proposes a comparative approach by constructing a generalised cost model. It develops a measurement for transport costs that combines actual freight cost with the value of time attached to delivery activities concerning cargo types. Overall results study depend on the shipping network is described in terms of a current and future condition. This condition is because the factor of economies of scale has a significant influence in the combination of actual empirical data and extractions of regression approach with the function of vessel size. Finally, all scenarios show that there is a positive relationship with a convincing impact on efforts to save costs for domestic shipping routes after the implementation of the sea-Toll program.

Functional and cognitive decline in older delirious adults after an emergency department visit

Background the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient’s functional and cognitive status at 60 days post ED visit. Methods this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. Results a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of −2.9/28 [95%CI: −3.9, −2.0] points on the OARS scale compared to non-delirious patients who lost −1.6 [95%CI: −1.9, −1.3] (P = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by −1.6 [95%CI: −3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: −0.1, 1.1] (P = 0.03). Conclusion seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit.