This paper aims to identify the challenges faced by Pakistani students during online learning environment, to determine whether a difference exist between males and females students regarding challenges faced during online learning, and to evaluate the effectiveness of online learning in Pakistan from students' perspectives. The population of the present study was consisted of students who were taking online classes in Lahore Pakistan. The study design was cross sectional and analytic study. A sample of 550 students was drawn. The technique of simple random sampling was used for this purpose. Google form questionnaire was used as a tool for data collection. Frequency table were used to represent the findings. One Sample t-test applied regarding problem faced by students in online learning, Independent Sample t-test regarding difference between male and female students responses about challenges faced during online education and One way ANOVA for significant difference between qualification level of students responses about challenges faced during online education. Results revealed that all the students were facing same issues either they were school level or university level. Male and female students were facing same challenges in online classes. Online learning cannot produce good results in developing countries like Pakistan, where a huge majority of students are not able to access the good internet facility due to technical as well as financial issues. This study addressed the effectiveness of online and challenges faced by students who are taking online classes. As per this study, 88% of students had not proper internet facility and they faced lots of internet issues and 65% students were not satisfied with online learning 85% students complaining about eye sight issue by taking online classes on devices 50% students were unable to manage the university affairs. As a result, we found that all the students were facing same issues either they were school level or university level. We also obtained that male and female students were facing same challenges in online classes.

Accurately diagnosing urinary tract infections (UTIs) in hospitalized patients remains challenging, requiring correlation of frequently nonspecific symptoms and laboratory findings. Urine cultures (UCs) are often ordered indiscriminately, especially in patients with urinary catheters, despite the Infectious Diseases Society of America guidelines recommending against routine screening for asymptomatic bacteriuria (ASB).1,2 Positive UCs can be difficult for providers to ignore, leading to unnecessary antibiotic treatment of ASB.2,3 Using diagnostic stewardship to limit UCs to situations with a positive urinalysis (UA) can reduce inappropriate UCs since the absence of pyuria suggests the absence of infection.4–6 We assessed the impact of the implementation of a UA with reflex to UC algorithm (“reflex intervention”) on UC ordering practices, diagnostic efficiency, and UTIs using a quasi-experimental design.

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None

Composting is regarded as profitable and ecological way to lessen the biodegradable waste dumping in landfills.. In this study, the effects of pit (1 cu yd) composting at Composting Site of CEES, PU on properties of adjoining soil, guava (Psidiumguajava) and Kachnar (Bauhiniavariegata) trees; assessed on the basis of selected soil properties and morphological features of trees. The results showed that the compost prepared by pit composting at the composting site had following properties: bulk density 0.75±0.06g/cm3, water holding capacity 38.67±7.72 %, pH 8.49± 0.31 and electrical conductivity 1.43±0.58, total Kjeldahl nitrogen 3.18±0.99, total organic carbon 0.39±0.12, organic matter 0.67± 0.06, calcium 1.04± 0.31, sodium 0.25±0.15, and potassium 130.11±6.94. All the quality parameters of compost were in the typical range of standard set by U.S Composting Council. The soil in the adjoining areas of composting site showed significant improvement in the quality than soils located far away from the composting time. It was mainly because of flow of runoff from pit composting site, as well as, due to lateral flow of compost tea from the compost pit to the surrounding soils. Both guava and kachnar trees showed highly significant increase in plant growth as compared to similar trees growing at soils far away from the composting site.

Introduction: COVID-19 infection caused by the novel coronavirus SARS-CoV-2 has been associated with new-onset diabetes and diabetic ketoacidosis. There are currently limited reports observing the effect of COVID-19 infection on outcomes in patients hospitalized with diabetic ketoacidosis (DKA). Methods: This retrospective study used electronic medical records, between March 1, 2020 to September 14, 2020, and included patients aged ≥ 18 years with DKA. Clinical characteristics, hospital course, and complications (ICD-10 codes) were compared between patients admitted with DKA and confirmed COVID-19 infection (COVID+) to those with DKA without COVID-19 infection (COVID-). The American Diabetes Association criteria was used to define DKA. Results: Among 757 patients with DKA, 80 COVID+ patients with and 677 COVID- patients were included (mean age 49.1 years, female 52.7%, African-American 70.4%). Baseline characteristics were similar between groups. The COVID+ group had a lower admission glucose (mean glucose 413.1 ± 218.7 mg/dL vs 441.1 ± 222.6 mg/dL, p-value 0.05), and higher serum bicarbonate levels (18.2 mmol/L vs 16.6 mmol/L, p-value &lt;0.05) compared to the COVID- group. Compared to the COVID- group, COVID+ required a longer time to achieve blood glucose &lt; 250 mg/dl from admission (8.8 hours vs 7.1 hours, p-value &lt;0.01), and had higher rates of acute respiratory failure (48.8% vs 9.5%, p-value &lt;0.001), mechanical ventilation (32.5% vs 10.9%, p-value &lt;0.001), sepsis (37.5% vs 15.7%, p-value &lt;0.001), acute thrombotic events (11.3% vs 2.7%, p-value &lt;0.05), and pneumonia (70% vs 10.3%, p-value &lt;0.001). COVID+ had higher mortality (16.3% vs 3.1%, p-value &lt; 0.001), ICU length of stay (median 5.5 days or 2–58 days vs median 2 days or 2–123 days, p-value &lt;0.001), and total LOS (median 7.5 or 1–47 days vs median 5 days or 1–98 days, p-value &lt;0.001). Both groups required similar total insulin doses throughout the entire hospitalization (mean 143 +/- (SD) vs 142 +/- SD units, p-value 0.088). Conclusion: Our data shows that COVID-19 infection is associated with increased mortality, worse clinical outcomes, and longer LOS among patients hospitalized with DKA, while presenting with less severe hyperglycemia and acidemia compared to those without COVID-19 infection.