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Objectives To compare the changes of palatal volume and area in patients treated with tooth-tissue-borne palatal expanders (conventional Haas) and miniscrew-supported palatal expanders (modified Haas). Materials and Methods The sample included casts of 22 patients treated as part of a clinical study at the Department of Orthodontics, Al-Azhar University, to correct their crossbite malocclusion. Patients were divided equally into two groups upon arrival. The first group, with a mean age of 12 years and 6 months, received the miniscrew-supported palatal expander. The second group, with a mean age of 12 years and 2 months, received the Haas design-palatal expansion appliance. Pre- and post-expansion dental casts were cone beam computed tomography scanned and the slices were constructed into 3D volumes. Fully automated superimposition was done for pre- and post-expansion 3D models. Palatal volume and area were determined, and all measurements were carried out blindly. Paired t-test was used to assess the mean differences within each group and Welch's t-test was applied to assess the mean changes between the two groups. Shapiro-Wilk test was used to test for the normality of the data. Results There were no statistical differences in volume changes either within each group or between the groups. Although area changes were statistically significant within each group, the difference between the groups was not significant. Conclusions Changes that result from the use of either method to expand the upper arch occur primarily in the shape of the palate, but not in its size.

Recently heavy metal pollution is consider among the most essential environmental issues. Due to their impact, the removing of heavy metals from the environment is a high demanding concern. Heavy metals adsorption is a new technology for wastewater treatment that contain different selected heavy metals types. This study aim to adopted adsorbents with low cost application, in this technique a pine cones used as plant wastes adsorbents in Industrial wastewater treatment by implemented batch technique adsorbent dosage and adsorbate initial concentration). The plant waste sample of (pine cone) was used to test its efficiency which that provide the optimum performance in removing heavy metals and other pollutants (Turbidity, TSS and TDS). Activated carbon produced from Pine cones Turkish Pine (ACPC) was adopted as an adsorbent for the Zinc ions removal from wastewater with industrial pollutants. Surface analysis was preform to measure the pore size distribution and specific surface area of the activated carbon produced from pine cone. Optimal parameters, pH, equilibrium time, adsorbent dosage, temperature and mix speed were investigated. Using Langmuir, Freundlech and Elvich isotherm models, equilibrium data were evaluated. Langmuir isotherm model provided the highest fit to the equilibrium data.

Acute upper gastrointestinal bleeding is a well-known complication of peptic ulcers and erosions. The prevalence of Upper Gastrointestinal bleeding ranges from 48-160 patients per 100,000 people, with consistent reports of higher incidence among elderly and men. Objective: To determine the incidence of duodenal ulcer bleeding in patients admitted to the tertiary care hospital with bleeding from the upper gastrointestinal tract. Methods: The study included 270 patients, 20 to 70 years of age, of both sexes with upper gastrointestinal bleeding within 24 hours of symptom onset. A detailed interview and complete physical examination were performed. Endoscopic examination protocols were followed and accomplished within 48-hrs of the start of symptoms as bleeding. All of the above information, including age, sex and duodenal ulcer, was documented in a formerly designed proforma. The data were analyzed and entered in SPSS 22.0. Results: The mean age and SD were 54.5 + 10.54. 110 (40.74%) patients were 20-45 years old and 160 (59.25%) subjects were 46-70 years old. 190 (70.37%) patients were male and 80 (29.62%) females. While in this study duodenal ulcer was seen in 64 (23.70%) patients, 206 (76.29%) patients did not have duodenal ulcer. Conclusions: Upper Gastrointestinal bleeding is secondary to duodenal ulcers due to an increase in early readmissions over time, as observed in this local population, resulting in a higher incidence of duodenal ulcers in our local population.

This paper investigates the health costs and milk productivity losses of farm animals due to pesticide exposure and its impact on farm owners’ profits. This is accomplished using survey data collected from farm owners in Pakistan’s Swat district. For analysis, multiple linear and tobit regressions are utilized. The study finds that the farm owners' experience, the number of lactating buffaloes, pesticide-induced milk losses, disease-induced health costs, and milk losses due to consumption of toxic plants and wastewater significantly affect profits. Specifically, an increase in farm experience by one year leads to a monthly increase in farm profit by Rs. 820.04. Likewise, adding an additional buffalo increases monthly profit by Rs. 535.04. Finally, the monthly loss in milk productivity due to pesticides stands at Rs. 9.71. Farm owners can greatly benefit by improving animal feed along with the know-how of the consequences of grazing animals on pesticide-affected fields.

The \emph{MIDNA} application specific integrated circuit (ASIC) is a skipper-CCD readout chip fabricated in a 65 nm LP-CMOS process that is capable of working at cryogenic temperatures. The chip integrates four front-end channels that process the skipper-CCD signal and performs differential averaging using a dual slope integration (DSI) circuit. Each readout channel contains a pre-amplifier, a DC restorer, and a dual-slope integrator with chopping capability. The integrator chopping is a key system design element in order to mitigate the effect of low-frequency noise produced by the integrator itself, and it is not often required with standard CCDs. Each channel consumes 4.5 mW of power, occupies 0.156 mm${^2}$ area and has an input referred noise of 2.7${\mu\nu}_{rms}$. It is demonstrated experimentally to achieve sub-electron noise when coupled with a skipper-CCD by means of averaging samples of each pixel. Sub-electron noise is shown in three different acquisition approaches. The signal range is 6000 electrons. The readout system achieves 0.2${e^{-}}$ RMS by averaging 1000 samples with MIDNA both at room temperature and at 180 Kelvin.

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Endometrial stromal tumors are extremely rare uterine malignancy, mainly among young females. Herein, we report a case of low-grade endometrial stromal tumor in a 19-year-old women who presented with the non-specific symptoms of lower abdominal pain, swelling and vaginal bleeding similar to the uterine leiomyoma. Ultrasound finding showed bulky uterus with multiple fibroid and degenerative changes. Contrast enhanced computed tomography (CECT) displayed diffusely enlarged uterus with heterogenous enhancement of the solid cystic mass with normal bilateral tubes and ovary. Considering the patient in the reproductive age group and her fertility status, she was operated with surgical subtotal hysterectomy. Histopathological examination and immunohistochemistry confirmed the diagnosis of Low-Grade Endometrial Stromal Sarcoma (LG-ESS). Patient was closely followed up for recurrence. Endometrial Stromal Sarcoma (ESS) should be included in the differential diagnosis of uterine leiomyoma to avoid recurrence of the lesion.

Road transportation does an excellent job of connecting Savar's inner and outer areas, but it might be difficult for commuters to decide which mode of transportation to employ because residents of Savar come from a wide range of socioeconomic backgrounds. It is necessary to do in-depth research on the characteristics of people in the study region who choose different modes of transportation to achieve the goal of selecting a certain mode for their travel. Where a person lives can have a significant impact on their typical patterns of travel behavior. People who live closer to the center of things have access to a wider variety of amenities than those who live further away, and as a consequence, their travel patterns are distinct from one another. The study's findings indicate that several factors, including income, age, gender, and vocational qualities and goals, influence a commuter's preferred method of transportation. When it comes to selecting a mode of transportation, the most predictable factors to take into account are trip time and cost. After conducting research, it was found that most excursions are made from this place to Motijheel, Tejgaon, and Savar Export Processing Zone for their services, businesses, and jobs, respectively.

In this study, we investigated the potential association between the burden of asymptomatic Blastocystis spp. (Blastocystis hominis) infection and nutritional status among children under 2 years of age using the data collected from 1,715 children from eight distinct geographic locations, including Bangladesh, Brazil, India, Peru, Tanzania, Pakistan, Nepal, and South Africa. Childhood stunting, wasting, and underweight were the outcome variables, and B. hominis infection was the exposure variable of this present study. The presence of B. hominis in nondiarrheal stools was evaluated by TaqMan Array Cards. Site-specific incidence rates were estimated using Poisson regression, and multiple generalized estimating equation was used to assess the association between the B. hominis infection and nutritional status. The site-specific incidence rates of asymptomatic B. hominis infections per 100 child-months were higher in Tanzania, Peru, and South Africa when compared with the other study sites. Moreover, in terms of site-specific association, childhood stunting was significantly associated with asymptomatic B. hominis infection in Bangladesh (odds ratio [OR]: 1.62; 95% CI: 1.26–2.08), India (OR: 1.78; 95% CI: 1.46–2.16), Nepal (OR: 2.26; 95% CI: 1.60–3.21), Peru (OR: 1.47; 95% CI: 1.26–1.71), South Africa (OR: 1.57; 95% CI: 1.35–1.83), and Tanzania (OR: 2.46; 95% CI: 2.18–2.79) sites. Wasting was associated with B. hominis in the Brazil site only (OR: 3.19; 95% CI: 1.31–7.77). On the other hand, underweight was associated in the Bangladesh (OR: 1.89; 95% CI: 1.48–2.42), Brazil (OR: 4.41; 95% CI: 1.57–12.4), Nepal (OR: 2.25; 95% CI: 1.52–3.35), and Tanzania (OR: 1.68; 95% CI: 1.42–1.99) sites. Our analysis further reveals that the presence of additional pathogens may play a pathogenic role in children who have B. hominis infection.

Introduction: Extraskeletal Ewing’s sarcoma (EES) is a rare malignant soft tissue tumor. Those aggressive mesenchymal tumors are characterized by genetic alterations of the Ewing sarcoma gene (EWS) on chromosome 22. Signs and symptoms are usually non-specific. The clinical diagnosis of EES is challenging. Case Presentation: A 31-year-old female patient presented to our hospital with rectal bleeding. Physical examination revealed a painful and erythematous bleeding rectal mass. A pelvic MRI revealed a right-sided well-circumscribed perianal mass measuring 6.8 × 6.0 cm. Surgical excision of the rectal mass was subsequently performed. The resected specimen, including the rectal mass with a pedicle from the posterior rectal wall was sent for histopathological examination. The postoperative period was uneventful. Histopathology examination was suggestive of EES of the rectum. Clinical Discussion: EES is an unusual entity of Ewing's Sarcoma Family of Tumors, which are characterized by pathognomonic translocations. The clinical features of EES include localized pain and/or swelling. Diagnosis of EES relies on histopathology and immunohistochemistry analysis. Imaging modalities such as CT, MRI, and PET/CT are crucial to evaluate EES metastasis and assess local tumor resectability. Conclusion: Due to the rare entity of EES of the rectum, we report the case of a 31-year-old female with rectal bleeding, found to be rectal Ewing’s sarcoma.

Emotion recognition is a crucial task in human-computer interaction, psychology, and neuroscience. Electroencephalogram (EEG)-based multi-class emotion recognition is a novel approach that aims to identify and classify human emotions by analysing EEG signals. Traditional methods of emotion recognition often face challenges in accurately identifying and classifying human emotions due to their complexity and subjectivity. EEG-based emotion recognition provides a direct and objective measure of three emotional states (positive, neutral, and negative), making it a promising tool for emotion recognition. The proposed hybrid LSTM approach combines the strengths of different traditional machine learning algorithms: Gaussian Naive Bayes (GNB), Support Vector Machine (SVM), Logistic Regression (LR), and Decision Tree (DT). The approach was tested on the EEG brainwave dataset, and LSTM achieved an accuracy of 95%, while the proposed hybrid LSTM-GNB, LSTM-SVM, LSTM-LR, and LSTM-DT models achieved 65%, 96%, 97%, and 96% accuracy, respectively. The contribution of this study is the development of a hybrid LSTM approach that combines the strengths of two different algorithms, resulting in higher accuracy for multi-class emotion recognition using EEG signals. The results demonstrate the potential of the hybrid LSTM approach for real-world applications such as emotion-based human-computer interaction and mental health diagnosis., {"references":["Paul, R. R., Paul, S. K., & Hamid, Md. E. (2022). A 2D Convolution Neural Network Based Method for Human Emotion Classification from Speech Signal. In 2022 25th International Conference on Computer and Information Technology (ICCIT). 2022 25th International Conference on Computer and Information Technology (ICCIT). 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Propranolol and Carvedilol are the currently used medications for main prophylaxis of variceal bleeding. Objective: To investigate the efficacy of carvedilol vs propranolol for prevention of variceal hemorrhage in liver cirrhosis patients. Methods: This prospective comparative study was carried out on 196 cirrhotic patients in the Gastroenterology Department of Lady Reading Hospital, Peshawar in collaboration with Pharmacology department of Khyber Medical University, Peshawar from July 2018 to June 2020. Patients with no prior history of primary variceal prophylaxis treatment and variceal bleeding were enrolled. All the patients were categorized into two groups: Group-I (Carvedilol) and Group-II (propanol). Frank hematemesis, melena, and endoscopic assessment was used for the evaluation of variceal bleeding. Results: Of the total 196 liver cirrhosis patients, Group-I and Group-II had 102 (52%) and 94 (48%) respectively. Ultrasonography found splenomegaly in 88% of cases and moderate to severe ascites in 42.6% of the patients investigated. The success rate of carvedilol and propanol group was 76% and 64.8% respectively. The side-effects and complication rate were significantly lower in Group-I than Group-II. The prevalence of variceal bleeding was 16.7% (n=17) and 11.7% (n=11) respectively. Conclusions: Carvedilol is an excellent treatment alternative for prevention of variceal bleeding than propranolol in terms of side-effects and complications rate.

Steerable cameras that can be controlled via a network, to retrieve telemetries of interest have become popular. In this paper, we develop a framework called AcTrak , to automate a camera’s motion to appropriately switch between (a) zoom ins on existing targets in a scene to track their activities, and (b) zoom out to search for new targets arriving to the area of interest. Specifically, we seek to achieve a good trade-off between the two tasks, i.e., we want to ensure that new targets are observed by the camera before they leave the scene, while also zooming in on existing targets frequently enough to monitor their activities. There exist prior control algorithms for steering cameras to optimize certain objectives; however, to the best of our knowledge, none have considered this problem, and do not perform well when target activity tracking is required. AcTrak automatically controls the camera’s PTZ configurations using reinforcement learning (RL ), to select the best camera position given the current state. Via simulations using real datasets, we show that AcTrak detects newly arriving targets 30% faster than a non-adaptive baseline and rarely misses targets, unlike the baseline which can miss up to 5% of the targets. We also implement AcTrak to control a real camera and demonstrate that in comparison with the baseline, it acquires about 2× more high resolution images of targets.

Objective: To compare the mean post-treatment bilirubin level with light emitting diode (LED) phototherapy versus compact fluorescent lamp (CFL) phototherapy in neonates presenting with hyperbilirubinemia Study Design: Comparative prospective study Place and Duration of Study: Department of Paediatrics, Pakistan Railway Hospital, Rawalpindi Pakistan, from Jan to Dec 2019. Methodology: Hundred children fulfilling the inclusion criteria were recuited in the study from Emergency Department. Then neonates were divided into two groups. In Group-A, neonates underwent phototherapy with LED; in Group-B, neonates underwent phototherapy with conventional phototherapy. Then neonates were followed up in the neonatal intensive care unit for 24 hours. Pre and post-treatment reports were assessed, and bilirubin level was noted. Results: In Group-A, the mean age of neonates was 49.12±23.42 hours, while in Group-B was 38.70±15.42 hours. In Group-A, the mean Bilirubin level at baseline was 13.64±5.98 gm/dl and in Group-B was 15.88±5.44 gm/dl. In Group-A, the mean Bilirubin level after 24 hours was 8.47±4.96 gm/dl and in Group-B was 9.538±5.35 gm/dl. In both groups, no significant difference in the mean bilirubin level was observed after 24 hours (p-value=0.30). Conclusion: Light-emitting diode phototherapy and compact fluorescent lamp phototherapy are equally effective in a mean reduction in the total serum bilirubin after 24 hours.

The demand of high performance and environmentally sustainable construction materials is ever-increasing in the construction industry worldwide. The rapid growth of nanotechnology and diverse nanomaterials’ accessibility has provided an impulse for the uses of smart construction components like nano-alumina, nano-silica, nano-kaolin, nano-titanium, and so forth Amongst various nanostructures, the core-shell nanoparticles (NPs) have received much interests for wide applications in the field of phase change materials, energy storage, high performance pigments, coating agents, self-cleaning and self-healing systems, etc., due to their distinct properties. Through the fine-tuning of the shells and cores of NPS, various types of functional materials with tailored properties can be achieved, indicating their great potential for the construction applications. In this perception, this paper overviewed the past, present and future of core-shell NPs-based materials that are viable for the construction sectors. In addition, several other applications of the core-shell NPs in the construction industries are emphasized and discussed. Considerable benefits of the core-shell NPs for pigments, phase change components, polymer composites, and self-cleaning glasses with enhanced properties are also underlined. Effect of high performance core-shell NPs type, size and content on the construction materials sustainability are highlighted.

Post-hepatectomy liver failure (PHLF) is a dreaded complication following liver resection for hepatocellular carcinoma (HCC) with a high mortality rate. We sought to develop a score based on preoperative factors to predict PHLF.Patients who underwent resection for HCC between 2000 and 2020 were identified from an international multi-institutional database. Factors associated with PHLF were identified and used to develop a preoperative comorbidity-tumor burden-liver function (CTF) predictive score.Among 1785 patients, 106 (5.9%) experienced PHLF. On multivariate analysis, several factors were associated with PHLF including high Charlson comorbidity index (CCI ≥ 5) (OR 2.80, 95%CI, 1.08-7.26), albumin-bilirubin (ALBI) (OR 1.99, 95%CI, 1.10-3.56), and tumor burden score (TBS) (OR 1.06, 95%CI, 1.02-1.11) (all p 0.05). Using the beta-coefficients of these variables, a weighted predictive score was developed and made available online ( https://alaimolaura.shinyapps.io/PHLFriskCalculator/ ). The CTF score (c-index = 0.67) performed better than Child-Pugh score (CPS) (c-index = 0.53) or Barcelona clinic liver cancer system (BCLC) (c-index = 0.57) to predict PHLF. A high CTF score was also an independent adverse prognostic factor for survival (HR 1.61, 95%CI, 1.12-2.30) and recurrence (HR 1.36, 95%CI, 1.08-1.71) (both p = 0.01).Roughly 1 in 20 patients experienced PHLF following resection of HCC. Patient (i.e., CCI), tumor (i.e., TBS), and liver function (i.e., ALBI) factors were associated with risk of PHLF. These preoperative factors were incorporated into a novel CTF tool that was made available online, which outperformed other previously proposed tools.

Purpose: Sports offer several health benefits but are not free of injury risk. Activity dynamics vary across sports, impacting the injury profile and thereby influencing healthcare resource utilization and health outcomes. The purpose of this study was to investigate sports-related major trauma cases and compare differences across sports and activity groups.Methods: A retrospective case notes review of sports-related major traumas over a 5-year period was conducted. Demographic, hospital episode-related, and health outcome-related data were analyzed, and differences were compared across sports and activity groups. The Glasgow Outcome Scale (GOS) at discharge was used as the primary outcome measure and the length of hospital stay as the secondary outcome measure.Results: In total, 74.6% of cases had good recovery at discharge (GOS, 5), 18.9% had moderate disability (GOS, 4), and 3.7% had severe disability (GOS, 3). The mean length of hospital stay was 11.2 days (range, 1–121 days). The most severely injured body region was the limbs (29.1%) and vertebral/spinal injuries were most common in terms of location (51.8%). A significant difference (P0.05) were found in other health-outcome variables or injury patterns across sports or activity groups, although more competitive sports cases (67.08%) required admission than recreational sports cases (32.9%).Conclusions: Spinal injuries are the most frequent sports injuries, bear the worst health outcomes, and warrant better preventive measures. Head injuries previously dominated the worst outcomes; this change is likely due to better preventive and management modalities. Competitive sports had a higher injury frequency than recreational sports, but no difference in health outcomes or injury patterns.

Much of human emotions are expressed via poetry and other literary genres but when it comes to women in Pashtun society we lose their voices. Afzal Raza believes it is impossible for Pashtun women to speak about their pain and misery or any other feelings (Raza). As women could be persecuted for writing poetry in Pashtun society thus much of the folklore poetry came to existence by female speakers anonymously. Recently, New York Times reported about several young girls set themselves on fire after they were caught reciting poetry to an FM radio from home (Griswold). Reading about women casualties for their poetry, Raza shall be true saying that Tapa or Landay (a two-verse poetry) is the ancient form of poems mostly created by women that still exist as its writer is unknown but has its female speaker for us to understand it. To study Pashtun women and their poetry Tapa or Landay is the primary source to begin (Raza).

Smart home is a habitation that has been outfitted with technological solutions that are intended to provide people with services that are suited to their needs. The purpose of this article is to perform a systematic assessment of the latest smart home literature and to conduct a survey of research and development conducted in this field. In addition to presenting a complete picture of the current smart home system’s (SHS) development and characteristics, this paper provides a deep insight into latest hardware and trends. The research then moves on to a detailed discussion of some of the important services provided by the SHS and its advantages. The paper also statistically discusses the current and future research trends in the SHS, followed by a detailed portrayal of the difficulties and roadblocks in implementing them. The comprehensive overview of the SHS presented in this paper will help designers, researchers, funding agencies, and policymakers have a bird’s-eye view of the overall concept, attributes, technological aspects, and features of modern SHSs.

The Physical Internet (PI) is a paradigm-changing and technology-driven vision, which is expected to significantly impact the development of the freight transport and logistics (FTL) system of today. However, the development of the FTL system towards the PI creates much uncertainty for its current stakeholders. Ports are one of those stakeholders that are expected to be profoundly affected by these developments. However, research that focuses on port policy, under the uncertain developments towards the PI, is still lacking. By providing port authorities with insights and recommendations on robust policy areas, we address this void in literature. We conduct a scenario analysis in combination with multi-criteria decision analysis (MCDA) to determine the importance of port performance indicators and policy areas in different scenarios. The most significant, uncertain, and orthogonal factors for the development of the PI are technological development and institutional development. We find that for a proper alignment with the PI vision, in three out of four scenarios, ports should prioritize the implementation of digital solutions and standards, as opposed to an infrastructure focused policy.

Background: When cirrhosis and ascites are present, a very common bacterial infection known as spontaneous bacterial peritonitis (SBP) often develops. This condition must be early diagnosed and treated to reduce morbidity and mortality. Objective: To assess the frequency of Spontaneous Bacterial Peritonitis in Liver Cirrhosis patients with Ascites. Methodology: This cross sectional study was carried out at the department of gastroenterology, Lady Reading Hospital Peshawar. The duration of study was two years from January 2018 to December 2019. Spontaneous bacterial peritonitis was diagnosed as positive when the ascitic fluid bacterial culture was positive. Ascitic fluid was taken in aseptic condition and send to the hospital diagnostic laboratory for the culture test. All the information’s were recorded in a proforma designed for this research. Data was analyzed by using SPSS version 24. Results: In the current research, totally 150 liver cirrhosis patients with ascites were enrolled. The male patients in our study were 87 (58%) while female patients were 63 (42%). The mean age of the participants (SD) was 48 (4.95) years. The frequency of Spontaneous Bacterial Peritonitis was 60 (40%).

Background: COVID-19 is an infectious disease caused by a newly identified strain of coronavirus (SARS-CoV-2). This strain is responsible for respiratory infections in humans. Objective: The objective of this study was to analyze the clinical efficacy and safety of convalescent plasma (CP) therapy in coronavirus disease 2019 (COVID-19) cases. Methodology: This was an experimental trial of COVID-19 patients treated with convalescent plasma (CP) therapy, these patients were admitted in Lahore General Hospital, Lahore, Pakistan during April 24 to august 24, 2021. Results: Pearson correlation was applied to extract the efficacy of convalescent plasma therapy (CP). A p-value ≤0.05 was considered significant. 16 out of 20 patients (80%) were completely recovered from COVID-19. Conclusion: Convalescent plasma (CP) proved to be an effective and safe therapy for confirmed cases of COVID-19. However, two critically ill patients died.

Recognizing that the political environment that once fostered a global culture of top down, conditionality-driven aid delivery is no longer in place, this theoretically informed study provides insight into the emerging ‘aid and/or development effectiveness’ narrative. By exploring a case study of Bangladesh, it offers a nuanced analytical perspective on the role of donor agencies in managing development partnership at the country level. It interweaves a critical review of the concept of country ownership, the historical role of three major European donors, namely FCDO, DANIDA, and GIZ, and the conversation with select stakeholders to illuminate the ineptness of the ‘development effectiveness’ narrative in guiding our efforts aimed at creating a new aid architecture. In particular, our research findings call into question the assumption that donors are committed to the principles of country ownership. Contrary to the claims of the Global Partnership for Effective Development Cooperation (GPEDC), our study observes that the new language of development effectiveness and/or country ownership did not create a positive space for Bangladesh to manage its own development agenda. Instead of demonstrating their desire to promote self-reliant development, donor agencies and countries appear to have leveraged the development effectiveness rhetoric for advancing their own sociopolitical interests.

Purpose Innovative, efficient treatments are desperately needed for people with glioblastoma (GBM). Methods Sixteen patients (median age 65.8 years) with newly diagnosed, small-sized, not safely resectable supratentorial GBM underwent interstitial photodynamic therapy (iPDT) as upfront eradicating local therapy followed by standard chemoradiation. 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX was used as the photosensitizer. The tumors were irradiated with light at 635 nm wavelength via stereotactically implanted cylindrical diffuser fibers. Outcome after iPDT was retrospectively compared with a positively-selected in-house patient cohort (n = 110) who underwent complete tumor resection followed by chemoradiation. Results Median progression-free survival (PFS) was 16.4 months, and median overall survival (OS) was 28.0 months. Seven patients (43.8%) experienced long-term PFS > 24 months. Median follow-up was 113.9 months for the survivors. Univariate regression revealed MGMT-promoter methylation but not age as a prognostic factor for both OS (p = 0.04 and p = 0.07) and PFS (p = 0.04 and p = 0.67). Permanent iPDT-associated morbidity was seen in one iPDT patient (6.3%). Patients treated with iPDT experienced superior PFS and OS compared to patients who underwent complete tumor removal (p Conclusion iPDT is a feasible treatment concept and might be associated with long-term PFS in a subgroup of GBM patients, potentially via induction of so far unknown immunological tumor-controlling processes.

Service life is often used by state transportation agencies to evaluate alternative flexible pavement designs. The design that keeps the pavement in acceptable condition longest before it needs another maintenance treatment is the preferred design. For a given rehabilitation design, this study evaluates the pavement service life using AASHTO 1972 pavement design guide and mechanistic-empirical (M-E) pavement design guide. The service life here is referred as the duration from last completed rehabilitation to the next maintenance treatment. The goal is not to determine which method is better, but rather, it is to understand how their estimated service lives differ and what factors contribute to their differences. To perform the evaluation, rehabilitation designs developed by the SCDOT for a research project are used. These designs take into account existing pavement distresses obtained through field investigation of 28 actual rehabilitation projects on primary routes. Service life is determined using MAP-21 criteria for good and fair pavements. Analysis results indicated that 1) the predicted service life using the M-E method has lower variation than the AASHTO 1972 method and is affected by the location (rural vs. urban) of the routes, 2) the predicted service life using the AASHTO 1972 method is generally lower than that of the M-E method and is affected by the difference between the design structural number (SN) and required SN, 3) the M-E service life for good pavement is generally longer for routes that include CMRB design and the percentage of trucks lower than 10%, and 4) the AASHTO 1972 service life is higher if the existing SN is already exceeding the required SN from the previous maintenance.

Maha Fathy Elmasry,1 Moemena Maher Fathi Khalil,2 Ashraf Badawi,3,4 Naglaa Sameh Zaki,1 Aya Fahim1 1Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Dermatology, Quesna Central Hospital, Menofia, Egypt; 3Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt; 4Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Szeged, HungaryCorrespondence: Aya Fahim, Dermatology Department, Faculty of Medicine, Cairo University, Post office Box 109, El-Malek El-Saleh, Cairo, 11562, Egypt, Tel +202 01020279628, Email ayafahim2011@cu.edu.egBackground: Acanthosis nigricans (AN) is a common chronic skin disorder clinically presents by velvety hyperpigmented lesions mainly at the flexural areas. Fractional photothermolysis has been reported to improve both pigmentary and textural changes by removing thin layers of skin with minimal thermal damage. Other options are the Q-switched (Qs) Nd:YAG (1064 nm) and Qs KTP (532 nm) lasers. Both can induce collagen remodeling by dermal photo-mechanical microdamage.Aim of the Work: The aim of this study was to assess the clinical efficacy and the safety of fractional CO2 laser versus Qs Nd:YAG and KTP lasers in the treatment of acanthosis nigricans.Methods: This randomized-controlled split neck study was conducted on 23 patients suffering from AN. For each patient, one side of the neck was randomly assigned to fractional CO2 laser and the other side to Qs Nd:YAG and KTP lasers every four weeks for four months followed by 4 monthly follow-up assessment. Acanthosis Nigricans Area and Severity Index (ANASI) score, melanin and erythema indices as well as Patient Satisfaction Scale (PSS) were used to assess improvement on each side separately.Results: There was no statistically significant difference regarding the clinical improvement between the side treated with Fractional CO2 laser and the side treated with Qs Nd:YAG and KTP lasers (P value > 0.05). In most patients, both sides showed improvement during different sessions of therapy, as regards ANASI scores, melanin indices, patient satisfaction scores, and side effects.Conclusion: In this study, we concluded that both fractional CO2 and Q-switched lasers proved to be a safe and effective line of treatment of acanthosis nigricans.Keywords: acanthosis nigricans, fractional CO2 laser, Q-switched Nd:YAG laser, ANASI score, Q-switched KTP laser

Aim: To assess the aesthetic satisfaction with the metal-ceramic dental prosthesis in relation to patient education, age and gender. Methods: This prospective longitudinal study was undertaken by selecting 360 adult patients from both genders indicated for single maxillary porcelain fused to metal crowns. These patients were categorized into three groups based on gender, age, and education. Patients were assessed for aesthetic satisfaction for tooth shape; color, angulation, visibility, and shade at the time of insertion and at a follow-up of 12 weeks. At the time of the prosthesis insertion, a self-evaluation questionnaire was provided to each patient to record their satisfaction levels with the prosthesis. Satisfaction levels among the participants were evaluated based on participants' age, gender, and education level (Chi-square). A p-value of 0.05 was considered statistically significant. Results: The study enrolled 150(41.67%) males and 210(58.33%) females with the participant age ranging from 19 to 60 years and a mean age of 30.53 (± 10.88 years). 84(23.3%) were uneducated participants, 210(58.3%) were high school graduates, and 66(18.3%) were university graduates. A decrease in the level of satisfaction was observed with increasing years of patient education at insertion. The overall aesthetic satisfaction among patients at PFM crown insertion (65%) and at 12 weeks follow-up (69.2%) was statistically comparable (p>0.05). Practical implication: Aesthetic is the most important consideration for the replacement of anterior teeth. Numerous studies evaluated the aesthetic satisfaction of the patients after providing full ceramic prosthesis, however, data regarding patient satisfaction after the metal ceramic dental prosthesisis scarce in the scientific literature. Conclusion: Satisfaction with the esthetic restoration depends on patient education and awareness. Age and education add to a person's experience and increase awareness with respect to better aesthetics. Keywords: Aesthetics; patient satisfaction; assessment; patient care, metal ceramic prosthesis