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Objectives: Atrial high-rate episodes (AHRE) are associated with an increased risk of subclinical atrial fibrillation (SCAF) and can be identified in patients with cardiac implantable electronic devices (CIEDs). This first study from Pakistan aims to determine the incidence of AHREs and the characteristics of a Pakistani cohort with AHREs. Methodology: In this bicentric Cross-sectional study, there were 162 patients of more than 18 years with CIEDs presenting to the device clinics were enrolled. The AHREs cutoff was predefined and AHREs were documented if they last for >30 seconds. Patients with known atrial fibrillation were excluded. Results: Mean age of the patients was 64.69±11.64 years and men were of 62.3%. AHREs were found in 22 (13.6%) patients out of which 13(8%) lasted more than 5 minutes. Mean AHREs cutoff 182.27±20.93. Mean CHA₂DS₂-VASc score; 3.10±1.47. 54.9% on beta-blockers, and 37% on angiotensin receptor blockers (ARB). Dual-chamber pacemaker (75.3%) and AV block (60.5%) mostly complete AV block , were the most common CIED and indication for an implant respectively. 43.8% had mildly dilated LA, only 1.2 % had severe mitral stenosis, and 3.1% had severe mitral regurgitation. Multivariable binary logistic regression analysis showed that patients on ARB had fewer episodes of AHREs (OR=0.2, 95% CI= 0.05 -0.8, P-value =0.023) while positive family history for coronary artery disease (CAD) was associated with more episodes (OR=5.62, 95% CI=1.58 -20, P-value =0.008). Conclusion: The incidence of AHREs was considerably lower in our population on CIEDs interrogation as compared to prior studies, although the CHA₂DS₂-VASc score is higher. ARB use and positive family history of CAD had a statistically significant association with AHRE occurrence.

Objective: To compare frequency of anastomotic leak with ligation versus preservation of azygos vein in the primary repair of esophageal atresia (EA) with trachea-esophageal fistula (TEF) in neonates. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Surgery, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2019 to September 2020. Material & Methods: This study involved 180 neonates (1-28 days of life) of both genders undergoing primary repair of EA with TEF and dividied in azygous vein ligation surgery and azygous vein preservation surgery. Outcome variable was frequency of post-operative anastomotic leak. Results: In a total of 180 neonates, mean age was 6.75±6.39 days. Majority (n=130, 72.2%) of the patients were aged ≤7 days. There were 107 (59.4%) male and 73 (40.6%) female neonates. The frequency of anastomotic leak was significantly lower in Azygous vein preservation group (6.7% vs. 20.0%; p=0.009) as compared to azygous vein ligation group. Conclusion: Preservation of azygous vein was associated with significantly lower frequency of post-operative anastomotic leak among neonates undergoing primary repair of EA with TEF.

Cardiac Electrophysiology Study (EPS) and Ablation procedures are definitive treatment for multiple common arrhythmias the major component of the cost of the procedure is the expense of the catheters. Many centres around the world used to reuse these catheters but few years ago started noticing Single Use Device (SUD) labelling appearing on them without any change in the catheters (1). This SUD labelling certifies that this can be safely used once but does not mean that it cannot be used again. Based on this the Federal Drug Authority of the United States shifted the liability of the reused device on the entity reprocessing it. Despite this, due to their high cost these catheters are reused not just in low income countries but also in many European and North American centres (1) (2). This reuse is supported by extensive literature showing safety in reusing these catheters. Currently there are no specific regulatory guidelines either at the federal or provincial levels for reuse of electrophysiology catheters in Pakistan. The Pakistan Heart Rhythm Society created this task force to review the literature and give recommendations to guide both the Heart Rhythm physician community as well as provide basis for discussion with regulatory authorities. This task force includes members from major public and private institutions performing cardiac electrophysiology procedures. The members included specialists in cardiac electrophysiology, infectious diseases and certified infection control staff. This literature review has been done to give recommendations for use of reprocessed electrophysiology catheters specifically for the patients in Pakistan. Since more than 90 percent of EP procedures in Pakistan are for supraventricular tachycardia (SVT) ablations, costs and other measures in this document are calculated using SVT ablation for modelling. Moreover, connecting cables and other equipment that are located outside the body but in the sterile field are not addressed in this document as they do not have significant safety impact. Similarly, catheters with lumens or balloons are not addressed in this document due to paucity of studies to demonstrate safety. The following aspects of using SUD or reprocessed catheters were compared and reviewed before final recommendations of this committee at the end of this paper. Cost Safety Unused expired catheters International practices Ethics Hospital Policies and personnel Cleaning and sterilization procedures

In this research, we investigate a resistor capacitor electric circuit that exhibits an exponentially decaying transient response. Due to uncertainty in the precise capacitance value, we treat the capacitance as a continuous uniformly distributed random variable. Using this approach, we derive the desired transient current response of the circuit as a function of the capacitance. Subsequently, we develop a probability model for the response current, expressed in terms of probability density function and cumulative distribution function. The model’s validity and correctness are verified, and it is further utilized for probabilistic analysis of the transient current. We demonstrate the application of the model for determining the probability of the transient current response reaching a specific value. By following the same procedure used to derive the probability model of the transient current, probability distributions for other circuit parameters, such as voltages and currents, can also be obtained. Furthermore, for parameters that are functions of the transient current, the probability model can also be obtained from the already derived probability model. To illustrate this, we derive the probability models of three other parameters in the circuit from the already obtained models. We also present examples to demonstrate the usage of the developed probability models.

An earthquake occurs in the form of seismic waves due to sudden release of energy and results inground shaking. During earthquake, seismic waves propagate through the soil which results in structural damage due to movements within the earth’s crust. It impacts the behavior of interactionof components like building, foundation, underlying soils and also overall system behavior. Whenearthquake occurs, the behavior of a building depends on distribution of mass, strength and stiffness. Generally, the buildings are subjected to various types of forces throughout theirexistence. The forces can be static forces due to dead and live loads and dynamic forces due to earthquake. In this study, the analysis is carried out for seismic response of 20 Storey Commercialoffice building for Zone-I and Zone-III regions through response spectrum method in ETABS. Thedesign details such as reinforcement area for beams, columns and shear walls and resultant parameterslike storey displacement, storey drift, storey shear, base shear, PMM Interaction curves,D/C ratios are observed for specified zones

Maker culture and DIY practices are central to democratizing the design of technology; enabling non-designers (future end-users) to actively participate in the design process. However, little is known about how individuals from under-resourced communities and low socioeconomic status (SES) backgrounds, can practically leverage maker practices to design technology, creating value for themselves or their communities. To investigate this, we collaborated with an e-waste recycling centre, involving 24 participants (staff and low-SES volunteers) in two participatory maker workshop activities. Participants were provided with a generative e-waste toolkit, through which they repurposed e-waste materials and developed novel technology prototypes that created value from their perspectives and agendas. Our findings unpack three factors that influenced their making: balancing personal and community needs; incorporating convenience and productivity; and re-thinking sustainability and connection; and discuss strategies for scaffolding participation and engagement of under-resourced communities in making using an e-waste generative toolkit to democratize technology design., CHI-2023

William Walter Busse,1 Ian Douglas Pavord,2 Shahid Siddiqui,3 Asif Hameed Khan,4 Amy Praestgaard,5 Scott Nash,3 Juby Anne Jacob-Nara,6 Paul Jonathan Rowe,6 Yamo Deniz3 1Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA; 2Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK; 3Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA; 4Global Medical Affairs, Sanofi, Chilly-Mazarin, France; 5Department of Biostatistics, Sanofi, Cambridge, MA, USA; 6Global Medical Affairs, Sanofi, Bridgewater, NJ, USACorrespondence: William Walter Busse, Department of Medicine, Division of Allergy, Pulmonary and Critical Care, University of Wisconsin, Madison, WI, USA, Tel +1 608 263-6183, Email wwb@medicine.wisc.eduPurpose: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammatory disease frequently coexisting with other type 2 conditions including asthma and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD). Coexisting asthma leads to increased CRSwNP symptom burden. Dupilumab, a monoclonal antibody that blocks the shared receptor component for interleukin-4 and -13, demonstrated efficacy in adults with severe CRSwNP in the Phase 3 SINUS-24 (NCT02912468) and SINUS-52 (NCT02898454) studies, including in patients with coexisting asthma/NSAID-ERD. However, the impact of different asthma characteristics on dupilumab treatment in this population is unknown. We report CRSwNP and asthma outcomes with dupilumab in patients with CRSwNP and coexisting asthma according to baseline asthma characteristics.Methods: Change from baseline at Week 24 (pooled studies) and Week 52 (SINUS-52) in CRSwNP outcomes (nasal polyp score, nasal congestion, 22-item Sino-Nasal Outcome Test [SNOT-22], loss of smell score, University of Pennsylvania Smell Identification Test) and asthma outcomes (5-item Asthma Control Questionnaire [ACQ-5], pre-bronchodilator forced expiratory volume in 1 second [FEV1]) were analyzed post hoc for placebo and dupilumab 300 mg every 2 weeks according to baseline blood eosinophils ≥ 150/≥ 300 cells/μL, ACQ-5 scores < 1.5/≥ 1.5, and FEV1 < 80%.Results: In the pooled studies, 428/724 patients (59.1%) had coexisting asthma, of which 181/428 (42.3%) had coexisting NSAID-ERD. Dupilumab significantly improved all CRSwNP and asthma outcomes vs placebo at Week 24 (P < 0.001) regardless of baseline eosinophil or ACQ-5 category, or FEV1 < 80%. Similar magnitude of improvement was seen at Week 52 (SINUS-52) and in patients with NSAID-ERD (pooled studies, Week 24). By Week 24, improvements with dupilumab exceeded the minimum clinically important differences for ACQ-5 and SNOT-22 in 35.2% to 74.2% and 72.0% to 78.7% of patients, respectively.Conclusion: Dupilumab improved CRSwNP outcomes in patients with CRSwNP and coexisting asthma, and improved asthma outcomes, regardless of differences in baseline asthma characteristics.Keywords: chronic rhinosinusitis with nasal polyps, dupilumab, asthma

Introduction: High blood pressure has a more burden on public health in the middle aged to a older population. The incidence of newly developed hypertension is not well known than its prevalence. Objective: To assess high blood pressure among general population and to determine the risk factors associated with it. Materials and Methods: It was cross sectional study conducted over a period of 06 months from April 2021-September 2021 at South East Hospital and Research Center, Islamabad, Pakistan. We enrolled a total of three hundred (n=300) participant in our study of both gender who visited South East Hospital by using Non-Probability convenient Sampling method technique. Individual having blood pressure exceeding to the normal limit or within normal limit at the time of visit to the hospital were included in our study and those individuals who had already diagnosed with hypertension were excluded. Results: The mean age of the respondent was (37.44±12.669), mean systolic BP (164.50±21.176) and mean diastolic BP was (100.09±14.045). Blood pressure systole was significantly correlated with risk factors (Diabetic mellitus, family history and obesity) (r=.293***, p

With nearly 11 billion doses of the COVID-19 vaccine being administered, stark differences in the vaccination rates persist. Vaccine distribution initiatives such as COVAX and African Vaccine Acquisition Trust (AVAT) were formed to ensure equitable vaccine delivery. This review evaluates the initial COVID-19 vaccination efforts and the impact of different vaccine distribution initiatives on equitable vaccination coverage in the early phase. We conducted a descriptive and trend analysis with sub-groups by various context parameters of data on COVID-19 vaccination from December 2020 till February 2022, from four public databases including UNICEF, WHO, COVID-19 Task Force and Our World in Data to examine COVID-19 vaccine distribution progress and the contributions of vaccine procurement initiatives. We found that High Income Countries (HICs) had much higher vaccination rate (78.4%) than Lower-Middle-Income Countries (LMICs) (55.5%) and Low-Income Countries (LICs) (10.9%). Large differentials (>80% to

We apply probability theory for the analysis of the exponentially decaying transient response of a resistor inductor electric circuit with partially known value of the inductance due to its failure. The inductance is known to be within a continuous interval, and the exact value is unknown, which may happen as a result of inductor faults due to a variety of factors—for example, when the circuit is deployed in an unusually harsh environment. We consider the inductance as a continuous uniform random variable for our analysis, and the transient voltage is treated as a derived random variable which is a function of the inductance random variable. Using this approach, a probability model of the transient voltage at the output terminals of the circuit is derived in terms of its cumulative distribution function and the probability density function. In our work, we further elaborate that the probability model of any other circuit parameter can also be obtained in a similar manner, or it can be derived from the transient voltage probability model. This is demonstrated by getting the model of a branch current from the probability distribution of the transient voltage. Usage of the probability model is demonstrated with the help of examples. The probability of the transient voltage falling in a certain interval at a given instant of time is evaluated. Similarly, the probability values of the branch current in different intervals are determined and analyzed. The derived probability model is checked for its validity and correctness as well. The model is found to be useful for probabilistic analysis of the circuit.

Objective: To assess the effect of Remedisvir, its safety Profile, and efficacy among COVID-19 patients. Study Design: Retrospective Observational study. Setting: South East Hospital and Research Center, Islamabad, Pakistan. Period: December 2020 to July 2021. Material & Methods: 100 patients were included in this study who received Remedisvir infusion, day 5, 7, and 10 after admitting the hospital with COVID-19 symptoms. We infuse 200mg I/V Remedisvir in 100cc N/S followed by 100mg I/V daily into 100cc N/S. After infusion, all patients were monitored strictly. Results: The mean age of the patients was (51. 89±15.441). The outcome of Remedisvir showed that 14% improved their condition, 42% discharged with oxygen, 27% discharged without oxygen, and only 17% expired). Remedisvir showed a positive effect at (p≤0.001) among laboratory values and oxygen support category. Conclusion: When patient suffering from COVID-19 symptoms and low oxygen saturation show good clinical outcome treated with Remedisvir. According to the results of our study, it is concluded that, at present Remedisvir remains a good drug, it shows a positive effect on oxygen saturation and length of hospital stay.

Objectives: This study aimed to determine the indications, success rate of elective cardioversion and its manifest complications. Methodology: It is a retrospective study involving 53 patients. We reviewed the hospital records files for the demographic data including age, gender, as well as indication of cardioversion, duration of arrhythmia and date of cardioversion along with complications. Results: Out of 53 patients, 58.5% (31) were males with a mean age of 48.17 ± 18.43 years. Arrhythmia related symptoms (palpitations and fatigue) were the indication for cardioversion in 44% (23) of the subjects. Our data showed that 98.1%( 52) were cardioverted to sinus rhythm successfully with a median energy of 100 joules. Out of those who underwent successful cardioversion, 92.5% (49) were followed up till 1 year after the cardioversion. At six week follow up, all the patients were found in sinus rhythm. At 6 months follow up, 94.2% (49) remained in sinus rhythm, while at 1 year follow up, 73% (38) of the patients remained in sinus rhythm. All patients were anticoagulated for at least four weeks after cardioversion. None of the patients required pacemaker and none of them developed stroke after cardioversion. Conclusion: Electrical cardioversion for atrial fibrillation and flutter is a low risk procedure in our population and it has a high success rate and relatively low complications.

International audience; In this paper, for the first time, we investigate the relationship between infrastructure and sectoral distribution of FDI inflow in China. We use the Estimating Autoregressive Distributed Lag (ARDL) bound testing and Vector Error Correction Model (VECM) procedures of estimation. To unmask the shortcomings in the previous literature, we use a composite index of infrastructure with more than 30 indicators. The results show that there is a long-run relationship between sectoral FDI and infrastructure. A bidirectional causal relationship is confirmed by using VECM. However, we find unidirectional causality between the primary sector's FDI and infrastructure, and it is running from infrastructure to primary sector FDI. The inclusion of control variables, e.g., institutional quality, trade openness, and domestic investment, is robust in our analysis. The positive role of infrastructure in the sectoral distribution of FDI inflows is of utmost importance for policymakers and Chinese-government. Several policy implications are given in our study.

Conventional object detection models require large amounts of training data. In comparison, humans can recognize previously unseen objects by merely knowing their semantic description. To mimic similar behavior, zero-shot object detection (ZSD) aims to recognize and localize "unseen" object instances by using only their semantic information. The model is first trained to learn the relationships between visual and semantic domains for seen objects, later transferring the acquired knowledge to totally unseen objects. This setting gives rise to the need for correct alignment between visual and semantic concepts so that the unseen objects can be identified using only their semantic attributes. In this article, we propose a novel loss function called "polarity loss" that promotes correct visual-semantic alignment for an improved ZSD. On the one hand, it refines the noisy semantic embeddings via metric learning on a "semantic vocabulary" of related concepts to establish a better synergy between visual and semantic domains. On the other hand, it explicitly maximizes the gap between positive and negative predictions to achieve better discrimination between seen, unseen, and background objects. Our approach is inspired by embodiment theories in cognitive science that claim human semantic understanding to be grounded in past experiences (seen objects), related linguistic concepts (word vocabulary), and visual perception (seen/unseen object images). We conduct extensive evaluations on the Microsoft Common Objects in Context (MS-COCO) and Pascal Visual Object Classes (VOC) datasets, showing significant improvements over state of the art. Our code and evaluation protocols available at: https://github.com/salman-h-khan/PL-ZSD_Release.

Background Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. Methods A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants’ self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants. Results At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin–angiotensin–aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05); P = 0.031), and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19); P = 0.016) was observed. Conclusions In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension. Clinical trials registration Trial Number NCT02657746.

The rapidly expanding gig economy has been criticized for creating precarious and indecent working conditions. These critiques draw on decent work debates centred on employment classification, regulation and platform fairness, with less focus on the interactions between workers, platforms and clients, which are central to the experience of platform-mediated work. This article adopts a worker-centric relational perspective to explore decent work in the gig economy. Drawing on the experiences of workers in platform-mediated domestic care work, the insights from this study highlight the importance of social interactions and relationships, using an ethics of care lens, to elucidate how relational aspects shape workers’ experiences. The findings reveal platform workers centre mutuality of interests, responsiveness and reciprocity, attentiveness and solidarity to maintain a balance of care (care-for-self and care-for-others) when negotiating platform-mediated care work. This article contributes relationality as a key dimension of decent work currently overlooked in studies exploring gig work arrangements.

Diarrhea and pneumonia are the leading causes of morbidity and mortality in children under five, and Pakistan is amongst the countries with the highest burden and low rates of related treatment coverage. We conducted a qualitative study as part of the formative phase to inform the design of the Community Mobilization and Community Incentivization (CoMIC) cluster randomized control trial (NCT03594279) in a rural district of Pakistan. We conducted in-dept interviews and focused group discussions with key stakeholders using a semi-structured study guide. Data underwent rigorous thematic analysis and major themes identified included socio-cultural dynamics, community mobilization and incentives, behavioral patterns and care seeking practices for childhood diarrhea and pneumonia, infant and young child feeding practices (IYCF), immunization, water sanitation and hygiene (WASH) and access to healthcare. This study highlights shortcomings in knowledge, health practices and health systems. There was to a certain extent awareness of the importance of hygiene, immunization, nutrition, and care-seeking, but the practices were poor due to various reasons. Poverty and lifestyle were considered prime factors for poor health behaviors, while health system inefficiencies added to these as rural facilities lack equipment and supplies, resources, and funding. The community identified that intensive inclusive community engagement and demand creation strategies tied to conditioned short term tangible incentives could help foster behavior change.

This paper presents a trainable hybrid approach involving a shallow autoencoder (AE) and a conventional classifier for epileptic seizure detection. The signal segments of a channel of electroencephalogram (EEG) (EEG epochs) are classified as epileptic and non-epileptic by employing its encoded AE representation as a feature vector. Analysis on a single channel-basis and the low computational complexity of the algorithm allow its use in body sensor networks and wearable devices using one or few EEG channels for wearing comfort. This enables the extended diagnosis and monitoring of epileptic patients at home. The encoded representation of EEG signal segments is obtained based on training the shallow AE to minimize the signal reconstruction error. Extensive experimentation with classifiers has led us to propose two versions of our hybrid method: (a) one yielding the best classification performance compared to the reported methods using the k-nearest neighbor (kNN) classifier and (b) the second with a hardware-friendly architecture and yet with the best classification performance compared to other reported methods in this category using a support-vector machine (SVM) classifier. The algorithm is evaluated on the Children’s Hospital Boston, Massachusetts Institute of Technology (CHB-MIT), and University of Bonn EEG datasets. The proposed method achieves 98.85% accuracy, 99.29% sensitivity, and 98.86% specificity on the CHB-MIT dataset using the kNN classifier. The best figures using the SVM classifier for accuracy, sensitivity, and specificity are 99.19%, 96.10%, and 99.19%, respectively. Our experiments establish the superiority of using an AE approach with a shallow architecture to generate a low-dimensionality yet effective EEG signal representation capable of high-performance abnormal seizure activity detection at a single-channel EEG level and with a fine granularity of 1 s EEG epochs.

IntroductionPeople with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be ‘living books’, sharing their experiences in dialogue with ‘readers’ who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts.Methods and analysisWe will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries’ impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream 1.Ethics and disseminationEthical approval was granted by Coventry and Warwick National Health Service Research Ethics Committee on 29 December 2021 (reference number 305975). The programme theory and implementation guide will be published as open access and shared widely through a knowledge exchange event, a study website, mental health provider and peer support networks, peer reviewed journals and a funders report.PROSPERO registration detailsCRD42022312789.

In-hospital mortality rates have approved in the recent past1 6 to 12-month death persists at approximately 50%2. The goal of treatment is to reestablish tissue perfusion while closely monitoring hemodynamics. Provisional automatic cardiovascular support is a mainstay of the management of patients who cannot be stabilized with medical therapy. Apart from the acute setting, automatic cardiovascular support is also used in the mid- and long-term treatment of heart failure patients. This can either be until heart transplant or life-long in patents who are not candidates for heart transplant. Further it is an essential tool of open-heart surgery. In the present review we will give an overview and update of the different devices for mechanical cardiac support. Non-mechanical Cardio-Circulatory Support includes intravenous fluids and pharmacological treatment with vasopressors and inotropic agents. Norepinephrine is mainly a vasopressor, but also has other activities such as inotropy. It serves as first line agent, particularly in the acute setting of a cardiogenic shock. A recent randomized trial comparing Norepinephrine versus Epinephrine in cardiogenic shock after myocardial infarction found that Norepinephrine appeared to be a safer choice than Epinephrine3. Vasopressin causes less pulmonary vasoconstriction than norepinephrine and is therefore might better as a first line vasopressor compared to Norepinephrine4. Dobutamine, a beta agonist is frequently being used for cardiogenic shock, acting as inotropic agent. Levosimendan is a Calcium sensitizer and often used in patients with acute decompensation of chronic heart failure.

This paper describes the path planning of an autonomous mobile robot using an advanced version of the swarm bat algorithm in a time‐varying situation. The foremost objective of this present contribution is to acquire the shortest path between the initial and end‐point avoiding dynamic obstacles. In this work, an adaptation of the frequency parameter of the standard bat algorithm to develop an improved version known as the modified frequency bat (MFB) algorithm is proposed. The modified frequency bat algorithm works in two steps, in the first step, the robot path is generated when there are no obstacles in the environment using the proposed method. As soon as an obstacle is detected near the robot, the second mode is initiated to avoid any obstacle. Extensive simulations are performed to validate the effectiveness of the proposed modified frequency bat algorithm by implementing it on standard benchmark functions and path planning problems and simultaneously matching its performance with the original bat algorithm. It has been concluded that the modified frequency bat algorithm shows superior performance as compared to the standard bat algorithm by drawing a shorter and collision‐free path for the mobile robot path‐planning problem.

A Kashmiri scholar, Yousuf Teng, has recently discovered a manuscript of the Qur’ān along with its Persian translation by Fathullah Kashmiri which dates back to 1237 A.D., indicating that the study of the Qur’ān had begun in Kashmir even before the advent of Islam there. A number of Kashmiri scholars, thereafter, have contributed to the field of Qur’ānic studies in languages such as Arabic, Persian, English, Urdu, Punjabi, Kashmiri, Pahari, and Gojri. However, despite the abundance of material on the subject, there have been very little academic works dedicated to its growth in Kashmir. This articles attempts to outline the evolution of Qur’ānic studies in Kashmir by tracing the written material on the subject from the past seven centuries.

Background: Glucose-insulin-potassium (GIK) infusion is most commonly used in diabetic patients during cardiopulmonary bypass. Many studies suggest that the use of GIK infusion has beneficial outcomes mainly in myocardial protection, as myocardial protection is the main goal of Perfusionist during bypass surgery. In Pakistan, GIK is used normally in the diabetic patient as it has a good effect on insulin maintenance. Most surgeons use GIK in diabetic patients but many of the studies suggest that it has good post-op outcomes especially in myocardial protection. Method: This was an observational cross-sectional study conducted for 6 months, from November 2019 to April 2020 at the Pakistan Institute of medical sciences department of Cardiac surgery. Ethical approval was taken from the hospital ethical committee. It was consisting of 80 patients, 40 from group A (GIK infused) and 40 from group B (GIK non-infused) by using the Non-probability convenient sampling technique. Data was collected through pre-structured Performa. Results: In the early postoperative period, peak CKMB levels were high in the Non-GIK group (62.7375± 19.75393IU/L) versus (54.0005±11.41493IU/L) in the GIK group (p-value 0.000). Mean ventilation time in the GIK group was (10.85 ±6.302) hours versus (12.15 ±7.814) hours in the non-GIK group (p< 0.001). Similarly, ICU stay period was also shorter in the GIK group is (3.50 ±1.013) and in the non-GIK group is (3.50 ±0.906) (p>0.001). Conclusion: Glucose-insulin-potassium (GIK) infusion has a beneficial role in myocardial protection and is associated with better post-operative outcomes without increasing the risk of non-cardiac complications.

The present study was conducted to get more information about the genome and locate the taxonomic position of Schizothorax niger in Schizothoracinae through mitochondrial 13 protein-coding genes (PCGs). These PCGs for S. niger were found to be 11409 bps in length ranging from 165 (ATPase 8) to 1824 bps (NADH dehydrogenase subunit 5) and encode 3801 amino acids. In these PCGs, 4 genes overlap on the similar strands, while one shown on the opposite one: ATPase 6+8 and NADH dehydrogenase subunit 4+4L overlap by 7 nucleotides. Similarly, ND5-ND6 overlap by 4 nucleotides, while ATP6 and COIII overlap by 1 nucleotide. Similarly, four commonly used amino acids in S. niger were Leu (15.6 %), Ile (10.12 %), Thr (8.12 %), and Ala (8.7 %). The results presented that COII, COIII, NDI, ND4L, and Cytb had substantial amino acid conservation as compared to the COI gene. Through phylogenetic analysis, it was observed that S. niger is closely linked with S. progastus, S. labiatus, S. plagiostomus, and S. nepalensis with high bootstrap values. The present study provided more genomic data to know the diversity of the mitochondrial genome and its molecular evolution in Schizothoracinae.

The mystical interpretation of the Holy Qur'an refers to the collection of meanings that descend on the pure hearts of the guided servants of Allah, which are in harmony with the text of the Qur'an. Such interpretive endeavors of Sufi commentators have been accepted by the ummah in every age. The Mystical interpretations of Allama Alusi and Maulana Thanwi in the subcontinent are considered as prominent examples of mystical exegesis. Apart from Tafsir literature, among the Sufi scholars who have penned allusions to mystical interpretation while deducing from the Qur'an and Hadith, Mawlawi Rome is at the forefront. In the article under review, we have tried to present the commentary on Maulana’s theory of Wahdat-ul-Wujud from the Masnavi of Mawlawi Rome, which was bestowed on his pure heart.

Software-defined networking (SDN) is an emerging technology of efficiently controlling and managing computer networks, such as in data centres, wide-area networks, as well as in ubiquitous communication. In this study, the authors explore the idea of embedding the SDN components, represented by SDN controller and virtual switch, in end-hosts to improve network performance. In particular, the authors consider load balancing across multiple network interfaces on end-hosts with different link capacity scenarios. The authors have explored and implemented different SDN-based load-balancing approaches based on OpenFlow software switches, and have demonstrated the feasibility and the potential of this approach. The proposed system has been evaluated with MultiPath transmission control protocol (MPTCP). The proposed results demonstrated the potential of applying the SDN concepts on multi-homed devices resulting in an increase in achieved throughput of 55% compared to the legacy single network approach and 10% compared to the MPTCP.

The study examines the differences in the attitude of Indian and Omani Undergraduate Business Studies students towards business ethics about gender, parents’ occupation, and nationality. The pre-validated scale of Attitudes towards Business Ethics Questionnaire (ATBEQ) has been used as a measurement instrument. The primary data has been collected from 237 respondents using the convenience sampling technique. Factor analysis revealed seven factors consisting of 21 variables. The study found significant differences in attitudes towards business ethics about gender, nationality, and parents’ occupation.

Background The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas. Methods We conducted a...

Traffic congestion is becoming a serious problem with the large number of vehicle on the roads. In the traditional traffic control system, the timing of the green light is adjusted regardless of the average traffic rate at the junction. Many strategies have been introduced to solve and improve vehicle management. However, in order to handle road traffic issues, an intelligent traffic management solution is required. This article represents a self adaptive real-time traffic light control algorithm based on the traffic flow. We present a machine learning approach coupled with image processing to manage the traffic clearance at the signal junction. The proposed system utilizes single image processing via neural network and You Only Look Once (YOLOv3) framework to establish traffic clearance at the signal. We employed YOLO architectures because it is accurate in terms of mean average precision (mAP), interaction over union (IOU) values and fast in object detection tasks as well. It runs significantly faster than other detection methods with comparable performance. The average processing time of single image was estimated to be 1.3 s. Further based on the input from YOLO we estimated the ‘on’ time period green light for effective traffic clearance. Several real time parameters like number of vehicles (two wheelers, four wheelers), road width and junction crossing time are considered to estimate the ‘on’time of green light. Moreover, we used the real traffic images to test the performance and trained the system with different dataset. Our experiments investigation reveals that the predicted vehicle counts were well matched with the actual vehicle count and proposed method apprehended an average accuracy of 81.1%. The reported strategy is self adaptive, highly accurate, fast and has the potential to be implemented in the traffic clearance at the junctions.