Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking.
Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH.
Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical charts; and telephone interviews were conducted to determine out of hospital outcomes. Kaplan-Meier method was used for survival analysis and log rank tests were done to assess for differences between subgroups. Cox regression modelling with multivariable adjustment were used to identify factors associated with all-cause mortality.
Results: A total of 659 patients were enrolled in this study, of which 50 (7.6 per cent) were lost to follow-up. The median PASP was 56 mmHg (interquartile range, 49–68 mmHg). After a median follow-up of 626 days, the one and two-year overall survival rates were 73.8 and 65.9 per cent, respectively. Using multivariate cox regression analyses, mortality was significantly associated with age, diabetes mellitus, atrial fibrillation, WHO functional class III and IV, severe pulmonary artery systolic pressures, right ventricular and left v ventricular systolic dysfunction. However, gender, systemic arterial hypertension, rheumatic heart disease and presence of significant valvular abnormalities had no significant association with mortality.
Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients with overall survival rate of 65.9 per cent at two years. Identification of poor prognostic factors can assist in identifying high-risk patients.
اسٹیبلشمنٹ پر آج بھی بھٹو صاحب کا خوف طاری ہے ۔بھٹو اپنے انتخابی نشان تلوار کی طرح مخالفین کے اعصاب پر چھا یا ہوا ہے ۔مخالف بھٹو کی سوچ سے اس لیے بھی ڈرتے ہیں کہ یہ سوچ آج بھی زندہ ہے ۔لاکھوں لوگ بھٹو شہید کے مزار پر آتے ہیں اور ایک نئی طاقت لے کر واپس جاتے یہں ۔
This study aims to determine the effect of compensation, quality of work life on employee performance at the Directorate General of Customs and Excise, East Java Regional Office I. The study population was 1323 employees. Employees, the number of samples is 200 respondents. The technique of collecting data through a questionnaire. Model testing with structural equation modeling (SEM) analysis. The test results show that the model (fit) can be seen from the values of GFI, AGFI, TLI, CFI, RMSEA and CMIN / DF respectively 0.902, 0.907, 0.964, 0.968, 0.026 and 1.127 which indicate the model fit criteria. The results showed that: 1) Compensation has a significant effect on Quality of Work Life, 2) Compensation has a significant effect on Performance, 3) Quality of Work Life has a significant effect on Performance, 4) Compensation has no significant effect on Performance through Quality of Work Life for Office employees Region of the Directorate General of Customs and Excise, East Java I
Project-based learning (PBL) is a teaching and learning strategy, which is gaining popularity rapidly among educators, teachers, parents and students. PBL is not a new concept: it is a well-established teaching strategy in certain parts of the world, but in some it is either alien or newly introduced. This study was conducted in one of the schools in the context of Karachi, Pakistan, which has adopted project-based learning as an initiative towards school improvement. In this context, PBL is practiced in all subject areas and has been in place for the last four years. The purpose of this study was to examine factors which facilitate or hinder the process of conducting project-based learning in a Social Studies classroom. The rationale behind this study was to get insights on how to conduct PBL in other schools as an initiative for school reform and change. To do so, the qualitative case study paradigm was employed for an in-depth investigation of the case as well as to understand the process. Data collection methods such as interviews, observations, and document analysis were used. Findings of the study disclosed that PBL in this particular context was primarily the school management's initiative. And this had consequences for its adoption process. PBL has brought tremendous changes in the school culture by engaging all the stakeholders (Director of the system, principal, vice-principal, teachers, students and parents). Findings suggest that PBL has played an important role in turning the school into a learning community. Nonetheless, factors like a prescribed syllabus and public examinations have greatly shaped the nature of PBL in this context. The findings also indicate that successful implementation of PBL is largely dependent on a thorough understanding of a teacher about the nature and expected outcomes of PBL. Finally, it is realized that students should be included in the planning of PBL activities and given some level of autonomy in the choice of topics, as this would enhance their feelings of ownership and responsibility over their learning. The study recommends that PBL can be successfully conducted and sustained in any school if the stakeholders believe in its importance and benefits. It is also important that the teachers should have a sound understanding of the concept of PBL.