Impacts of climate change on wheat phenology and yield in Indus Basin, Pakistan.

Aim of this study is to quantify the impacts of climate change on phenology and yield of winter wheat in rainfed and irrigated regions of Pakistan by using integration of two well-known crop models including STICS and APSIM with CORDEX-SA regional climate models (RCMs). A number of different adaptation strategies based on early sowing (i.e. S1:10 and S2:20 days), irrigation (I1:15% and I2:30% additional water) and a combination of sowing and irrigation adaptations were examined to recover the potential losses that would occur due to climate change. The data for the wheat phenology, biomass (t/ha) at different stages and yield (t/ha) was obtained from several experiments at national research institutes in Pakistan under both rainfed and irrigated conditions. After calibration and validation of both crop models (STICS and APSIM), the current climate data were replaced with the CORDEX-SA RCM-projections for climate change impact analysis. A significant rising and declining trends were observed in temperature and precipitation patterns, respectively, for the selected study regions. Consequently, a substantial impact of climate change on wheat phenology (anthesis stage, maturity stage, growing length), biomass (t/ha) and yield (t/ha) was observed under scenario periods for RCP4.5 and RCP8.5. Additionally, the adaptation strategies on wheat for rainfed regions showed a substantial improvement in wheat biomass and yield simulated by STICS model particularly for sowing-2 under RCP4.5. Irrigated regions showed more improvement for irrigation-2 (I2) and combination of sowing-1 + irrigation-2 (S1 + I2) using the STICS model under both RCPs. Overall, it was observed that changes in crop phenology had a stronger impact in terms of crop yield for RCP8.5 as compare to RCP4.5. This study provides a valuable understanding and way forward for the better wheat management under changes in precipitation and temperature patterns. The study also discuss in detail, the adaptation strategies to cope with potential damage, over two different irrigation zones (rainfed and irrigated) in Pakistan.

Health Care-Associated Infections and the Radiology Department.

Health care-associated infections (HCAIs) are a significant concern for both health care workers (HCWs) and patients. They are a major contributing factor of disease in industrialized countries, and are responsible for significant morbidity, mortality, and a direct annual financial loss of $6-7 billion in North America alone. They are an increasingly challenging health issue due to multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci among others, along with an increasing number of susceptible patients. Over the last three decades, the risk of HCAIs has increased in the radiology department (RD) in part because of an increased number of patients visiting the department and an increase in the utilization of imaging modalities. In this review, we will discuss how patients and staff can be exposed to HCAIs in the RD, including contaminated inanimate surfaces, radiology equipment, and associated medical devices. As the role of medical imaging has extended from primarily diagnosis to include more interventions, the implementation and development of standardized infection minimization protocols and infection control procedures are vital in the RD, particularly in interventional radiology. With globalisation and the rapid movement of people regionally, nationally, and globally, there is greater risk of exposure to contagious diseases such as Ebola, especially if infected patients are undiagnosed when they travel. For effective infection control, advanced training and education of HCWs in the RD is essential. The purpose of this article is to provide an overview of HCAIs as related to activities of the RD. We will discuss the following major topics including the variety of HCAIs commonly encountered, the role of the RD in HCAIs, transmission of infections to patients and HCWs in the RD, standard infection prevention measures, and the management of susceptible/infected patients in the RD. We shall also examine the role of, and the preparedness of, HCWs, including RD technologists and interventional radiologists, who may be exposed to undiagnosed, yet infected patients. We shall conclude with a brief discussion of the role of further research related to HCAIs. Learning Objectives After the completion of this review article, the readers will • Understand the exposure and role of radiology department in health care-associated infections, • Know the causes/modes/transmission of infections in radiology department, • Be conscious of standard disinfection protocols, • Be aware of current and future strategies required for the effective control of health care-associated infection in the radiology department. This is a CME article and provides the equivalent of 2 hours of continuing education that may be applied to your professional development credit system. A 10-question multiple-choice quiz follows this reading. Please note that no formalized credit (category A) is available from CAMRT.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations.

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?