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This research was conducted to enhance the productivity of the targeted sewing line at the ABC textile company. The existing SAMs, the capacity of the sewing line for various operations, and several required machines were collected. Moreover, the obtained figures were observed and analyzed by using time study and motion study, and certain improvements were made at the sewing line. Results indicated that SAMs for operations A and B were minimized by -13.64% and -14.54% respectively; whereas, SAM for operation C was increased by 16.67%. Machine requirement for operation C was increased by 100%; moreover, the capacity for operations A, B, and C was increased by 12%, 12.69%, and 40% respectively. When it is to production activities, the little improvements play a significant role in boosting the productivity of the production system. Optimal allocation of human resources, machines, and time are the benefits of line balancing. This can be made possible with the application of the line-balancing framework. With every passing day, the nature and type of article vary at the sewing line thus it is highly needed for the company to get the model developed for an automated line balancing application. Moreover, this work can be extended by the development of a line-balancing framework considering the nature of production.

Muhammad Ashir Shafique, Abdul Haseeb, Mohammad Arham Siddiq, Abdullah Mussarat, Hussain Sohail Rangwala, Muhammad Saqlain Mustafa Department of Medicine, Jinnah Sindh Medical University, Karachi, PakistanCorrespondence: Muhammad Ashir Shafique, Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Road, Karachi, Pakistan, Tel +92 334 326954, Email ashirshafique109@gmail.comAbstract: Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.Keywords: urothelial carcinoma, enfortumab vedotin, erdafitinib

The present paper deals with the investigations of a Kenmotsu manifold satisfying certain curvature conditions endowed with 🟉-η-Ricci solitons. First we find some necessary conditions for such a manifold to be φ-Einstein. Then, we study the notion of 🟉-η-Ricci soliton on this manifold and prove some significant results related to this notion. Finally, we construct a nontrivial example of three-dimensional Kenmotsu manifolds to verify some of our results.

EXCLI Journal; 21:Doc1304; ISSN 1611-2156

In the present note, we study ϵ-LP-Sasakian 3-manifolds M3ϵ whose metrics are conformal η-Ricci-Yamabe solitons (in short, CERYS), and it is proven that if an M3ϵ with a constant scalar curvature admits a CERYS, then £Uζ is orthogonal to ζ if and only if Λ−ϵσ=−2ϵl+mr/2+1/2p+2/3. Further, we study gradient CERYS in M3ϵ and proved that an M3ϵ admitting gradient CERYS is a generalized conformal η-Einstein manifold; moreover, the gradient of the potential function is pointwise collinear with the Reeb vector field ζ. Finally, the existence of CERYS in an M3ϵ has been drawn by a concrete example.

In this note, we characterize Sasakian manifolds endowed with ∗-η-Ricci-Yamabe solitons. Also, the existence of ∗-η-Ricci-Yamabe solitons in a 5-dimensional Sasakian manifold has been proved through a concrete example.

High Dynamic Range (HDR) images are the ones that contain a greater range of luminosity as compared to the standard images. HDR images have a higher detail and clarity of structure, objects, and color, which the standard images lack. HDR images are useful in capturing scenes that pose high brightness, darker areas, and shadows, etc. An HDR image comprises multiple narrow-range-exposure images combined into one high-quality image. As these HDR images cannot be displayed on standard display devices, the real challenge comes while converting these HDR images to Low dynamic range (LDR) images. The conversion of HDR image to LDR image is performed using Tone-mapped operators (TMOs). This conversion results in the loss of much valuable information in structure, color, naturalness, and exposures. The loss of information in the LDR image may not directly be visible to the human eye. To calculate how good an LDR image is after conversion, various metrics have been proposed previously. Some are not noise resilient, some work on separate color channels (Red, Green, and Blue one by one), and some lack capacity to identify the structure. To deal with this problem, we propose a metric in this paper called the Tone Mapping Quality Index (TMQI-3), which evaluates the quality of the LDR image based on its objective score. TMQI-3 is noise resilient, takes account of structure and naturalness, and works on all three color channels combined into one luminosity component. This eliminates the need to use multiple metrics at the same time. We compute results for several HDR and LDR images from the literature and show that our quality index metric performs better than the baseline models.

Teaching strategies are the principles and methods that are instrumented by teachers to attain the required optimal learning by students, which depends not only on the subject that is supposed to be taught but also by the nature and psychology of learner. The appropriation and efficiency of a teaching method lies in its relation with the characteristics of learner and the main goal it has supposed to bring about. The study was carried out in Ayub medical college, Abbottabad from December 2016 to August 2017. The methods primarily employed in this research were In-depth interview (IDI) and Focus Group Discussion (FGD). Both FDGs and Interviews were conducted among fourth year MBBS students by team mates. The sampling technique that we used in this study was non-probability purposive sampling. In all about 8 FGDs and 4 in-depth interviews were conducted. Our study revealed that most of the students were not satisfied with one-way teaching. Teacher does not involve students in learning process. Most teachers are unaware of use of technology, which teachers referred to lack of trainings and seminars. In large class strength, every teacher can’t adopt interactive method of teaching. Project writing and field visits were admired. Students were not satisfied with class tests schedule. With the new advancements in education system around the world, teaching methods are also constantly evolving. The conclusion of this study is that teaching is a multidimensional process, which involves key stakeholders that are the teachers, students, and the administration. For an effective teaching, all the stakeholders have to work optimally. These developments can be enhanced with student's feedback, because they are the direct people being affected from the various teaching methods used in a typical classroom of a medical college.

Immunization is a very important process of making a person immune or resistant to an infectious disease. It is of utmost importance for the children under 5 years of age to get immunized against the infectious diseases which are vaccine preventable. The childhood immunization introduced through EPI is the most efficient public health innovation for the prevention of vaccine-preventable common child illnesses provided that the program is uninterrupted and parents are satisfied with the service and adhere to the program. The satisfaction of the accompanying persons depends on different factors which are substantial in making the final decision. The sampling technique that we used in this study was non-probability consecutive sampling. The study was carried out at Immunization center at Ayub Teaching Hospital, Abbottabad from December 2016 to August 2017. The methods primarily employed in this research were based on filling a questionnaire. They were filled by us according to the answers the accompanying persons provided. Our study revealed that most of the accompanying persons were satisfied with the immunization services provided at ATH, Abbottabad. Their education status was at least Primary and secondary and mostly the persons who were graduated were not satisfied with the services. The waiting time was the main concern because the persons who thought waiting time was prolonged were mostly unsatisfied. Greetings affected the behavior of the accompanying persons regarding the services and their satisfaction level was directly affected by the behavior of the health team. Cleanliness of the immunization center didn’t affect the level of satisfaction that much. With the new advancements in health system and education status around the world, everything inconstantly evolves. The conclusion of this study is that satisfaction of the accompanying persons has different factors which affect it directly and indirectly .awaiting time, greetings, distance etc. Satisfying the accompanying persons regarding the immunization services requires teamwork. The government, health professionals and health team workers are all responsible in this regard. The waiting time should be decreased and the accompanying persons should be greeted properly. Cleanliness should be maintained at the immunization center.

Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper–Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using [Formula: see text] and [Formula: see text] statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4–77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25–42%) ( I2 = 100%, τ2 = 0.9170, p 2 = 100%, τ2 = 1.0886, p 2 = 100%, τ2 = 0.7944, p Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071 Plain Language Summary Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors? Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America’s compared with European cohorts of PLWH. Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.

Supplementary File: Mitochondria-Rich Cells: A Novel Type of Concealed Cell in the Small Intestine of Chinese Soft-Shelled Turtles (Pelodiscus Sinensis)

On the basis of the reported air quality index (API) and air pollutant monitoring data obtained at the Peshawar over the last seven years, the characteristics of air quality prominent pollutants and variation of the average annual concentrations of SO2, NO2total suspended particulate (TSP) fine particulates (PM10) CO and dust fall in Peshawar City were analyzed. Results showed that SO2and NO2were the prominent pollutants in the ambient air environment of Peshawar City. Of the prominent pollutants TSP accounted for nearly 63 % SO2, 32.8 ppb NO2, 147 ppb of CH4 , 13.8 ppb of CO, 94.5µg/m3of MC and 0.60 ppb of O3respectively in 2013. NO2to SO2 comparison ratio initially declined to 39.3 in 2009 and then starts to increase to 42.5 in 2010 while in 2013 reached upto 44.8 and O3 to SO2 ratio in the last year of observation, the ratio drop to 0.01830 µg/m3. Concentrations of air pollutants have shown a upward trend in recent years but they are generally worse than ambient air quality standards for EPA-USA, Pak and EU. SO2and NOx pollution were still serious impling that waste gas pollution from all kinds of vehicles had become a significant problem for environmental protection in Peshawar. The possible causes of worsening air quality were also discussed in this paper.

The Risk Of Bias In Non-randomized Studies â of Interventions (ROBINS-I) assessment tool. (DOCX 107 kb)

Transcatheter aortic valve replacement (TAVR) has gained popularity due to its safety and feasibility in severe aortic stenosis (AS). There are limited outcomes data for TAVR performed in low-flow, low-gradient (LFLG) severe AS. Systemic review of literature identified 9 studies (n=24327; mean age

This paper proposes an improved Genetic Algorithms (GA) based sparse multipath channels estimation technique with Superimposed Training (ST) sequences. A nonrandom and periodic training sequence is proposed to be added arithmetically on the information sequence for energy efficient channel estimation within the future generation of wireless receivers. This eliminates the need of separate overhead time/frequency slots for training sequence. The results of the proposed technique are compared with the techniques in the existing literature -the notable first order statistics based channel estimation technique with ST. The normalized channel mean-square error (NCMSE) and bit-error-rate (BER) are chosen as performance measures for the simulation based analysis. It is established that the proposed technique performs better in terms of the accuracy of estimated channel; subsequently the quality of service (QoS), while retrieving information sequence at the receiver. With respect to its comparable counterpart, the proposed GA based scheme delivers an improvement of about 1dB in NCMSE at 12 dB SNR and a gain of about 2 dB in SNR at 10-1 BER, for the population size set at twice the length of channel. It is also demonstrated that, this achievement in performance improvement can further be enhanced at the cost of computational power by increasing the population size.

Single drop microextraction (SDME) combined with electrothermal atomic absorption spectrometry was proposed to extract Silver (Ag) from aqueous samples into a drop of ionic liquid (1-butyl-3- methylimidazolium hexafluorophosphate [C4MIM][PF6]), after complexation with 8-hydroxyquinoline (8HQ). The multivariate strategy was applied to estimate the optimum values of experimental factors for the recovery of Ag. The limit of detection and enhancement factor were 1.12 ng L-1 and 80, respectively. The validity and accuracy of proposed method was checked by analysis of real water sample through standard addition method. The proposed method was successfully applied to determine Ag in different fresh canal water samples.

Background: Radiological determination of gender relies predominantly on the skeletal radiology and assumes importance in mass natural disasters, bomb explosions, exhumations and warfare where skeletal fragmentation is common. Varied literature is present regarding the role of foramen magnum in establishing gender identification. The objective of the study was to establish normative values of cross-sectional area of foramen magnum in both genders using NCCT and try to ascertain any significant difference in cross-sectional area in the two genders which may help in gender identification.Methods: NCCT head images of 378 subjects were analysed in individuals beyond the age of skeletal immaturity. Free ROI technique using electronic calliper tool was used. The cross-sectional area of foramen magnum was automatically obtained after tracing its whole inner circumference.Results: Mean cross-sectional area of foramen magnum in females was 806.79±106.58 mm2 and was 878.33±98.42 mm2 in males. Although the cross-sectional area in males was greater than females no statistically significant difference was found. The correlation coefficient was found to be weaker (R=0.0413).Conclusions: No statistically significant difference was found between the two genders. The correlation coefficient was also weak to draw any inference about the gender of the skull on CT imaging. Further studies are needed to include other parameters like the sagittal and transverse diameters of foramen magnum in a larger sample to show importance of foramen magnum, if any, in helping gender identification of skeletal remains.

Enhanced expression of interleukin-6 (IL-6) plays an important role in the pathogenesis of osteoarthritis (OA). Monocyte chemoattractant protein-induced protein 1 (MCPIP-1) is a novel posttranscriptional regulator of IL-6 expression and is targeted by microRNA-9 (miR-9). We investigated the expression of MCPIP-1 in OA cartilage and explored whether targeting of MCPIP-1 by miR-9 contributes to enhanced IL-6 expression in OA.Gene and protein expression in IL-1β-stimulated human OA chondrocytes/cartilage was determined by TaqMan assay and immunoblotting, respectively. Messenger RNA (mRNA) for MCPIP-1 and IL-6 expression at the single-cell level was analyzed using RNAscope. MCPIP-1 protein interaction with IL-6 mRNA was investigated using RNA immunoprecipitation. Transient transfections were used for the small interfering RNA (siRNA)-mediated knockdown and overexpression of MCPIP-1, its RNase-defective mutant miR-9, or antagomir. The role of signaling pathways was evaluated using small-molecule inhibitors. Binding of miR-9 with the "seed sequence" in the 3'-untranslated region of MCPIP-1 mRNA was investigated using a luciferase reporter assay.MCPIP-1 mRNA expression was low, but expression of miR-9 and IL-6 was high, in damaged OA cartilage. In IL-1β-stimulated OA chondrocytes, the expression of miR-9 and MCPIP-1 was mutually exclusive, and increased expression of miR-9 correlated with reduced MCPIP-1 expression and enhanced IL-6 expression. MCPIP-1 protein directly binds with IL-6 mRNA, and overexpression of wild-type MCPIP-1 destabilized the IL-6 mRNA. MCPIP-1 expression was altered by overexpression or inhibition of miR-9. Transfection with miR-9 mimics inhibited the reporter activity, and mutation of the "seed sequence" abolished the repression of reporter activity.These findings implicate miR-9-mediated suppression of MCPIP-1 in the pathogenesis of OA via up-regulation of IL-6 expression in IL-1β-stimulated human OA chondrocytes.

Background: Adverse Drug Reactions (ADRs) are a major public health problem. Prompt reporting of suspected ADRs is fundamental in the post-marketing surveillance of medicines and helps in ensuring medicine safety. However, fewer ADRs are reported in general and in particular by community pharmacists. There is limited knowledge about the factors which are preventing community pharmacists in the UK from reporting an ADR. Objectives: To identify the barriers to ADR reporting among community pharmacists practicing in the UK. Methods: A cross sectional study using a 25-items questionnaire (both online and paper based) including 10 barriers to ADR reporting was conducted from 1st April 2012 to September 2012. Community pharmacists practicing in the West Midlands, UK, were approached for the participation in this study. Chi-Square and regression were applied to identify covariates for the barriers to ADR reporting. A significant value of 0.05 was assigned for analysis. Results: Of the 230 invited community pharmacists, 138 pharmacists responded (response rate 60%). The median age of respondents was 31 years. All pharmacists reported that they would report both serious and mild ADRs from drugs with black triangle among children as well as adults. About 95% (n=131) of the pharmacists were familiar with the paper based ADR reporting system. Store-based pharmacists were more likely to be more confident about which ADRs to report [0.680, 95% Confidence Interval 0.43-3.59]. Lack of time 46.4% (n=64), and pharmacists perception that ADR is not serious enough to report (65.2%; n=90) were identified as barriers to ADR reporting. Majority 63.0% (n=87) of the pharmacists identified training and information about what to report and access to Information Technology (IT) (For example access to internet connection) 61.6% (n=85) as facilitators to ADR reporting process. Conclusion: Lack of time and ADRs considered not serious enough by pharmacists to report were barriers to ADR reporting. Further training and education about the types of ADRs to be reported can help to improve the reporting of ADRs.

An inverse association between 25-hydroxyvitamin D (25[OH]D) levels and stroke was emphasized in recent studies. Our objective was to determine the rate of Vitamin D deficiency and risk of associated osteoporosis among stroke survivors in a nationally representative population.Participants from the National Health and Nutritional Examination Survey (NHANES) from 2001 to 2006 were included. Stroke survivors were then divided into two groups depending on serum 25(OH)D levels:30 ng/dl as Vitamin D deficiency and ≥30 ng/dl as normal. Comparisons of demographics and risk factors between two groups were performed using SAS software. Multivariate analysis was performed to determine the association between Vitamin D deficiency and osteopororis in stroke survivors after adjusting for potential confounding factors.There were 415 (4.0%) stroke survivors among 10,255 participants in NHANES. The mean age (±SD) of stroke survivors was 67.6 (±17.3) years and 211 (50.8%) were men. Mean 25(OH)D concentrations were not significantly different in patients with stroke (20.3 versus 21.8 ng/ml, p = 0.65) although the rate of osteoporosis was significantly higher among stroke survivors (17.9% versus 6.9%, p0.0001). Out of 415 stroke patients, Vitamin D deficiency was seen in 71.0% of patients. The rates of osteoporosis were similar between patients with or without Vitamin D deficiency. After adjusting for potential confounders, there was no association between Vitamin D deficiency and osteoporosis.Vitamin D deficiency and osteoporosis are highly prevalent among stroke survivors; however, there does not appear to be a relationship between the two entities.

The widespread use of multimedia services on the World Wide Web and the advances in end-user portable devices have recently increased the user demands for better quality. Moreover, providing these services seamlessly and ubiquitously on wireless networks and with user mobility poses hard challenges. To meet these challenges and fulfill the end-user requirements, suitable strategies need to be adopted at both application level and network level. At the application level rate and quality have to be adapted to time-varying bandwidth limitations, whereas on the network side a mechanism for efficient use of the network resources has to be implemented, to provide a better end-user Quality of Experience (QoE) through better Quality of Service (QoS). The work in this thesis addresses these issues by first investigating multi-stream rate adaptation techniques for Scalable Video Coding (SVC) applications aimed at a fair provision of QoE to end-users. Rate Distortion (R-D) models for real-time and non real-time video streaming have been proposed and a rate adaptation technique is also developed to minimize with fairness the distortion of multiple videos with difference complexities. To provide resiliency against errors, the effect of Unequal Error protection (UXP) based on Reed Solomon (RS) encoding with erasure correction has been also included in the proposed R-D modelling. Moreover, to improve the support of QoE at the network level for multimedia applications sensitive to delays, jitters and packet drops, a technique to prioritise different traffic flows using specific QoS classes within an intermediate DiffServ network integrated with a WiMAX access system is investigated. Simulations were performed to test the network under different congestion scenarios.

In a broader sense the main research objective of this thesis (and ongoing research work) is distributed knowledge management for mobile dynamic systems. But the primary focus and presented work focuses on communication/interoperability of heterogeneous entities in an infrastructure less paradigm, a distributed resource manipulation infrastructure and distributed learning in the absence of global knowledge. The research objectives achieved discover the design aspects of heterogeneous distributed knowledge systems towards establishing a seamless integration. This thesis doesn’t cover all aspects in this work; rather focuses on interoperability and distributed learning. Firstly a discussion on the issues in knowledge management for swarm of heterogeneous entities is presented. This is done in a broader and rather abstract fashion to provide an insight of motivation for interoperability and distributed learning towards knowledge management. Moreover this will also serve the reader to understand the ongoing work and research activities in much broader perspective. Primary focus of this thesis is communication/interoperability of heterogeneous entities in an infrastructure less paradigm, a distributed resource manipulation infrastructure and distributed learning in the absence of global knowledge. In dynamic environments for mobile autonomous systems such as robot swarms or mobile software agents there is a need for autonomic publishing and discovery of resources and just-in-time integration for on-the-fly service consumption without any a priori knowledge. SOA (Service-Oriented Architecture) serves the purpose of resource reuse and sharing of services different entities. Web services (a SOA manifestation) achieves these objectives but its exploitation in dynamic environments, where the communication infrastructure is lacking, requires a considerable research. Generally Web services are exploited in stable client-server paradigms, which is a pressing assumption when dynamic distributed systems are considered. UDDI (Universal Description Discovery and Integration) is the main pediment in the exploitation of Web services in distributed control and dynamic natured systems. UDDI can be considered as a directory for publication and discovery of categorized Web services but assumes a centralized registry; even if distributed registries and associated mechanism are employed problems of collaborative communication in infrastructure less paradigms are ignored. Towards interoperability main contribution this thesis is a mediator-based distributed Web services discovery and invocation middleware, which provides a collaborative and decentralized services discovery and management middleware for infrastructure-less mobile dynamic systems with heterogeneous communication capabilities. Heterogeneity of communication capabilities is abstracted in middleware by a conceptual classification of computing entities on the basis of their communication capabilities and communication issues are resolved via conceptual overlay formation for query propagation in system. The proposed and developed middleware has not only been evaluated extensively using Player Stage simulator but also been applied in physical robot swarms. Experimental validations analyze the results in different communication modes i. active and ii. passive mode of communication with and without shared resource conflict resolution. I analyze discoverable Web services with respect to time, services available in complete view of cluster and the impact and resultant improvements in distributed Web services discovery by using caching and semantics. Second part of this thesis focuses on distributed learning in the absence of global information. This thesis takes the argument of defeasibility (common-sense inference) as the basis of intelligence in human-beings, in which conclusions/inferences are drawn and refuted at the same time as more information becomes available. The ability of common-sense reasoning to adapt to dynamic environments and reasoning with uncertainty in the absence of global information seems to be best fit for distributed learning for dynamic systems. This thesis, thus, overviews epistemic cognition in human beings, which motivates the need of a similar epistemic cognitive solution in fabricated systems and considers formal concept analysis as a case for incremental and distributed learning of formal concepts. Thesis also presents a representational schema for underlying logic formalism and formal concepts. An algorithm for incremental learning and its use-case for robotic navigation, in which robots incrementally learn formal concepts and perform common-sense reasoning for their intelligent navigation, is also presented. Moreover elaboration of the logic formalism employed and details of implementation of developed defeasible reasoning engine is given in the latter half of this thesis. In summary, the research results and achievements described in this thesis focus on interoperability and distributed learning for heterogeneous distributed knowledge systems which contributes towards establishing a seamless integration in mobile dynamic systems. QC 20100614 ROBOSWARM EU FP6