Integrated plant nutrient management emphasizes the combined use of inorganic and organic/biological sources of plant nutrients to enhance efficiency of applied nutrients, reduce environmental hazards and improve crop productivity. A field experiment pertaining to wheat based cropping system in rainfed environment was conducted at the Research Farm of Soil Science & SWC of Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan. It was laid out according to randomized complete block design in Split-Plot arrangement with three replications. The experiment was initiated in winter 2004-05 on wheat followed by maize in summer 2005, and was repeated during the year 2005-06 in the same field with same layout of treatments. Main plot treatments of cropping systems (CS) included: wheat–fallow (CS 1 ) and wheat–maize (CS 2 ), while treatments of integrated plant nutrient management allocated to subplots were: control (without NPK fertilizer, FYM or biofertilizer); half dose of recommended N-P 2 O 5 -K 2 O (60-45-30 kg ha -1 ) ; full dose of N-P 2 O 5 -K 2 O (120-90-60 kg ha -1 ); FYM @ 20 t ha -1 , FYM on N requirement basis + make-up dose of P and K fertilizer; 1⁄2 NPK + 1⁄2 FYM (@ 10 t ha -1 ) ; 1⁄2 NPK + Biopower; 1⁄2 FYM + Biopower and 1⁄2 NPK + 1⁄2 FYM + Biopower. Soil analysis for physical and chemical characteristics and plant nutrients (N, P, K, Zn, Fe, Mn, and Cu) at sowing and harvest stage of each crop was performed. Observations on plant growth and yield parameters were recorded at crop maturity. Nutrient concentration in the grain and straw/stalk of the wheat and maize were determined to compute nutrient uptake after the harvest of each crop. Comparison of various treatment means of integrated nutrient management practices for wheat- fallow (CS 1 ) and wheat-maize (CS 2 ) cropping systems indicated that there was2 was significant increase in yield and various yield attributes of both wheat and maize in respective growing seasons. During Rabi seasons of 2004-05 and 2005- 06, application of 1⁄2 NPK + 1⁄2 FYM + Biopower (T 9 ) produced highest grain yield of 3684 kg ha -1 and 3781 kg ha -1 for wheat respectively. During Kharif seasons of 2005 and 2006, application of 1⁄2 NPK + 1⁄2 FYM + Biopower (T 9 ) produced highest grain yield of 3128 kg ha -1 and 3119 kg ha -1 for maize respectively. The analysis of leaf and grain samples showed significant increase in N, P and K concentration due to integrated nutrient management practices for both wheat and maize during both growing seasons over control. The results revealed that as N, P and K concentration in soil was higher; these were taken up and assimilated in proportion to their concentration. Maximum N uptake of 357 kg ha -1 , P uptake of 51 kg ha -1 and K uptake of 215 kg ha -1 was recorded due to application of 1⁄2 NPK + 1⁄2 FYM + Biopower (T 9 ) for wheat during both growing seasons. Micronutrients concentration recorded significant increase in soil, plant and grain of both wheat and maize. Economic analysis of wheat-maize and wheat-fallow cropping systems revealed that wheat-maize cropping system was more profitable with integrated use of mineral and organic and/or biofertilizer under rainfed conditions. The VCR estimated for IPNM in T 9 showed that integrated use of organic and inorganic fertilizer sources had better net profit for wheat yield for the farmer under rainfed condition. Thus, IPNM may prove more viable and sustainable for wheat based cropping system in rainfed Pothowar environment of Punjab province, Pakistan.
مولانا محمد شمیم کیرانوی افسوس ہے کہ شعبان المعظم کے آخری ہفتہ میں مدرسہ صولتیہ مکہ معظمہ کے ناظم مولانا محمد شمیم کیرانوی وفات پاگئے۔ اس مدرسہ کی داغ بیل ترکوں کے دور میں اس وقت پڑی تھی، جب حجاز میں مدرسوں کی تعداد بہت کم تھی، پہلے اس کی زمام کار مولانا رحمت اﷲ کیرانوی نے سنبھالی جن کا خاص مشن ردمسیحیت تھا۔ اظہارالحق کی تصنیف اور مشہور پادری فنڈر کو عبرتناک شکست دینا ان کا بڑا کارنامہ تھا۔ مولانا محمد شمیم کے والد بزرگوار مولانا محمد سلیم کیرانوی کی نظامت کے زمانہ میں مدرسہ صولتیہ نے بڑی ترقی کی۔ ان کی وفات کے بعد مولانا محمد شمیم صاحب نے مدرسہ کے لیے اپنی خدمات وقف کردی تھیں، انھوں نے اپنے والد ماجد کی روایات کو باقی رکھا۔ ہندوستان سے حج و زیارت کے لیے تشریف لے جانے والے علماء مشائخ کے آرام و آسائش کا وہ بڑا خیال رکھتے اور ان کو ہر قسم کی مدد اور سہولت بہم پہنچاتے۔ معارف اور دارالمصنفین کے بھی قدردان تھے اور کبھی کبھی خطوط لکھ کر ان سے اپنے تعلق کا ثبوت دیتے۔ مولانا کی عمر ابھی کچھ زیادہ نہیں تھی لیکن ان کی حیات مستعار کے دن پورے ہوچکے تھے۔ اﷲ تعالیٰ ان کو اپنے جوار رحمت میں جگہ دے اور مدرسہ کو ان کا نعم البدل عطا فرمائے، آمین۔ (ضیاء الدین اصلاحی، اپریل ۱۹۹۲ء)
Innovation at the hospital as a change in the delivery of patient-focused health services by encouraging healthcare professionals to work smarter, faster and better. Service innovation can provide an effective way to create a sustainable competitive advantage for hospitals. This study aims to analyze and examine the factors that influence service innovation in hospitals using the literature review method. The results were obtained from a literature search that discusses the major factors that influence service innovation, namely in the form of a good management system within the scope of the hospital. This big influence is that human resources, starting from the leaders and employees who work in the hospital, must work together for the advancement and empowerment of the hospital.
Introduction: Diabetes mellitus is a metabolic disease characterized by hyperglycaemia secondary to impaired insulin secretion, impaired insulin action or both. In Kenya, an estimated 750,000 people are diabetic with more than 50% estimated to be unaware of their status.
Conventionally, diagnosis has been based on plasma glucose levels. In 2010, Haemoglobin A1c (HbA1c) was approved by the American Diabetes Association (ADA) and World Health Organisation (WHO) for diagnosis of diabetes. However, different studies have shown variations in diagnostic performance of HbA1c.
Research question: What is the diagnostic sensitivity and specificity of HbA1c in diagnosis of diabetes and prediabetes at Aga Khan University Hospital, Nairobi?
Primary objective: To determine the diagnostic sensitivity and specificity of HbA1c based on the ADA cut-off values, in diagnosis of diabetes and prediabetes at Aga Khan University Hospital, Nairobi
Secondary objective: To determine the correlation of HbA1c and fasting plasma glucose levels in diagnosis of diabetes and prediabetes.
To determine the HbA1c cut-off level optimal for diagnosis of diabetes and prediabetes in the study population.
To determine the association between anthropometric characteristics, and HbA1c
Methodology: Cross-sectional study that recruited participants from those directed to undertake fasting plasma glucose at Aga Khan University Hospital, Nairobi in 2016-2017.
Sample size: One hundred and fifty seven non replicate samples were evaluated.
Data collection and statistical analysis: HbA1c and fasting plasma glucose levels were determined for each participant. Receiver operating characteristic curves were constructed and the area under curve calculated for HbA1c to determine its sensitivity and specificity.
Results: Fifteen study participants (9.6%) were diagnosed with diabetes based on criteria combining fasting plasma glucose and HbA1c while fifty five (35.5%) had prediabetes.
ROC curves found the HbA1c cut-off of ≥6.5% to have high sensitivity (93.3%) and specificity (98.6%) in diagnosis of diabetes. HbA1c was also shown to have high sensitivity and specificity (87.3% and 86.9% respectively) in diagnosis of prediabetes using the range of 5.7-6.4% as recommended by ADA
Conclusion: HbA1c showed high diagnostic accuracy in diabetes and prediabetes using the current cut-offs recommended by ADA. Based on these findings, this study recommends adoption of HbA1c in the national guidelines for diagnosis of prediabetes and diabetes.