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We all are needed the personal vehicle that could help us to travel from home to office and travel to vocations means we need the personal vehicle for traveling for this we purchase the new vehicle or used vehicle this is some time take so much to take decision for purchasing the new one and most difficult decision is to take how to sale the old one that is already we have keep using if we sale and what is best price we can get or gives us more benefits. More over the purchasing power of the customers is low due to the prices of the new cars. There are different methods to predict the price of the car according to market value. Our proposed method helps the both the purchase and seller for to purchase and sale their vehicle and they can predict the best for their vehicle and make their decision good for personal and business. Our proposed model performance shows that the proposed study is productive and efficient. In the proposed study the machine learning algorithm Regression helps in the outperform. Here we use the Statistical test to get the design value of P and get the optimal features and using the linear regression. First, we find the RFE and then apply the statistical test for VIF for the OLS Regression. Prediction results shows the study is efficient and effective.

Peripheral nerve injuries of the upper extremity can result from a wide array of etiologies, with the two most common being compression neuropathy and traumatic injuries. These types of injuries are common and can be psychologically, functionally, and financially devastating to the patient. A detailed preoperative evaluation is imperative for appropriate management. Traumatic injuries can typically be treated with local burial techniques, targeted muscle reinnervation, and regenerative peripheral nerve interfaces. Median nerve compression is frequently managed with complete release of the antebrachial fascia/transverse carpal ligament and/or use of flap coverage such as the hypothenar fat pad flap and local muscle flaps. Ulnar nerve compression is commonly managed via submuscular transposition, subcutaneous transposition, neurolysis, and nerve wrapping. In this review, we discuss the preoperative evaluation, surgical techniques, and advantages and disadvantages of each treatment modality for patients with compressive and traumatic upper extremity nerve injuries.

Objective: Stress during residency training in surgical disciplines not only hampers professional development but can also compromise patient care and personal health. The purpose of this study was to measure the stress level among the surgical residents, identify factors within the learning and work environment that cause stress, and identify different strategies that the residents use habitually to cope with these stresses. Methods: This mix method study was conducted in the department of Surgery at Aga Khan University, Pakistan. Residents’ stress level was measured using Perceived Stress Scale (PSS); focus group discussions (FGDs) with faculty and residents explored stressors during residency training, while Brief COPE Inventory identified the residents’ preferred coping strategy. Results: A total of 68 (83%) surgery residents completed the survey of which 19% had high stress scores while only one resident had perception of low stress. Females had significantly higher stress scores (25.7±3.0; p=0.008) as compared to male counterparts. Planning (87.8%) and Self-distraction (65%) were the most commonly used adaptive and maladaptive strategies respectively. The reliability of the PSS and BCI measured by Cronbach’s alpha was 0.73 and 0.82 respectively. Work-life imbalance, workload and contradicting programme and hospital policies were identified in FGDs as major stressors during residency. Conclusion: Although surgical residency programmes are very stressful, coping strategies are not formally taught during surgical training. Academia and hospital should join hands in developing interventions to enable residents cope with the situation. Keywords: Stress level, Surgical Residency Training, Coping Strategies, Working hours

The hands are one of the most visible parts of the body, and prominent dorsal veins and extensor tendons are the most readily recognized signs of the aging process. Fat grafting has been demonstrated to be a safe and effective method of hand rejuvenation by restoration of subcutaneous fat. Despite some variability in the technical approach, fat grafting techniques are consistent in their use of low-pressure injection with standard cannula sizes, small aliquots of graft, and a total volume of graft greater than or equal to 15 mL per hand. While distribution of the fat is an area of debate and a topic of active research, published studies have shown high patient satisfaction rates, suggesting that perhaps the restoration of volume alone is paramount. In this article, we will review the applications of fat grafting to the hand, focusing primarily on its role in hand rejuvenation.

The banking industry is shifting from old traditional banking systems to virtual banking around the world. As it is moving towards online, the issues related to it are also increasing. Most common issues faced by e-banking around the globe are security, fraud, customer awareness, trust, risk, privacy, phishing attacks and government laws. The objective of this study is to highlight the issues faced by e-banking in developing countries like Pakistan. For this purpose, five national banks were selected. Interviews and discussions with the senior managers were conducted and transcribed. The critical issues identified were mostly related to security, regulatory and reversal of wrong transaction. Lack of awareness and knowledge about technical systems are also found as the major concerns of the senior management of these banks. The findings of this research will help the senior management to successfully develop proactive strategies for e-banking in Pakistan.

Mutual funds have a significant role as an institutional investor to allocate funds in an efficient way. Therefore, this study examines efficiency of mutual funds due to their substantial role in the growth of economy. Technical Efficiency (TE), Pure Technical Efficiency (PTE), and Scale Efficiency (SE) of mutual funds are examined over the period of 2011 to 2016 by following Data Envelopment Analysis (DEA). The results showed a TE of 70.6%, PTE of 73%, and SE of 96.3% in mutual funds of Pakistan. A significant boost has been noticed in the efficiency of the initial year but it decreased afterward. Decreasing return to scale is found 52.40% whereas, increasing return to scale are found 17.41%. There were only 30.19% mutual funds which are working on right scale. It suggests that regulators need to closely monitor mutual funds since unplanned growth in size of mutual funds will damage the overall efficiency since the decreasing return to scale are

Leasing firms consider the conventional interest-based method whereas, the mud. ¯arabah firms consider the Shar¯ı‘ah-based non-interest-based method to operate in the financial market. The role of both these Financial Institutions (FIs) is of much importance for the sustainable development of Small and Medium Enterprises (SMEs). While comparing mud. ¯arabah firms and conventional leasing firms, in the first stage, the current paper has computed Technical Efficiency (TE), Pure Technical Efficiency (PTE), and Scale Efficiency (SE) of mud. ¯arabah and leasing firms. Data Envelopment Analysis (DEA) is applied by following a value-added approach. Equity, liabilities, fixed assets, Operating expenses and are selected as input variables whereas, income and investments are selected as output variables. The results suggest that Shar¯ı‘ah-compliant mud. ¯arabah firms are competing well with conventional leasing firms. It indicates that there is no major difference in the efficiency of both FIs. In the second stage, the study also analyzes the association of firm-specific factors with efficiency with the help of the Tobit regression model which suggests that leverage, tangibility, operating expenses, and profitability of the firm are significantly related to the efficiency of both Financial Institutions.

The temple is an intriguing region of the face with unique anatomic features, such as the temporal hairline, concave contour, and close proximity to vital structures like the frontal branch of the facial nerve. However, cancerous skin lesions can plague this sun-exposed region and, when excised, it can result in large and significant defects. Reconstruction in this area is a formidable challenge for surgeons, as it requires comprehensive knowledge of temple morphology and the use of creative techniques in order to minimize disruption of surrounding functional and aesthetic structures. In this study, we describe our experience with temple reconstruction in patients of varying defect size and depth. Based on these defect characteristics, anatomic and aesthetic principles of the temple, we propose a surgical algorithm for temple reconstruction to aid surgeons in achieving optimal results.

Summary:. Plastic surgery is a rapidly evolving field that requires novel approaches in providing continuous and dynamic educational resources to address the increasing time and skill demands from residents. Online resources in their various forms, such as books, journals, simulators, and applications, are increasingly used by residents, notably over traditional print and in-person counterparts. In this digital era, it is imperative to understand the scope and utility of online resources that have the potential to revolutionize plastic surgery education. In this review article, we first discuss the current model of plastic surgery education and the challenges of meeting its goals and then suggest reasons by which online resources close this gap. We also offer an exposition on the benefits of distinct types of resources and current trends regarding their use. Our goal is to create a framework within which learners and educators are able to organize online resources in plastic surgery.

This study is conducted in two steps. Firstly, Stochastic Frontier Approach (SFA) is applied to estimate efficiency of the Takaful and conventional insurance firms in Pakistan from 2005 to 2010. It is found that life insurers are performing poor in comparison to general insurers. In addition, Takaful firms are found less cost efficient in comparison to conventional insurance firms. Secondly, the Tobit results imply that the size, investment and claim are found negatively related with the efficiency of insurance companies which suggests that larger size raise the cost of doing business whereas, due to financial crises the investment of large firms are also dropped. Moreover, improvement in minimum capital requirement is found fruit full both for cost and profit efficiencies. Therefore, it is suggested that the regulators should keep continue this policy to further improve financial health of the insurance industry.

Objective: To investigate the predictive validity of Uniform Entrance Test for academic performance in the first two years in various health science degree programs. Methods: A retrospective analysis of admissions data and academic performance of students admitted in under-graduate programs of medicine, dentistry and pharmacy of three cohorts was taken. The independent and dependent variables were entry test scores and semester scores respectively. Spearman’s Correlation co-efficient was computed to determine the association between entrance test scores and semester scores for three groups. Results: Majority of the students were from the MBBS degree program (61%) with majority of female students (65%) in all three programs. In MBBS the highest correlation coefficient between entry test and semester scores was observed for semester one rs = 0.334 and lowest in semester four rs= 0.208. In BDS degree program both highest and lowest correlations were in semester one. In the Pharm-D degree program, a significant correlation was only seen in cohort 1 but not in the subsequent cohorts. Conclusion: The uniform entrance test has an incremental predictive validity for the MBBS and BDS programs as compared to Pharm-D. Better performance in the entrance test predicts higher semester scores and more likelihood of achieving higher scores in the first year as compared to the second year. How to cite this:Ali R, Ali SK, Afzal A. Predictive validity of a Uniform Entrance Test for the health professionals. Pak J Med Sci. 2019;35(2):330-336. doi: https://doi.org/10.12669/pjms.35.2.334 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The nose is the most central and anterior projecting facial feature. Therefore, the presence of a defect is easily noticeable to the untrained eye. Return of the defect to the original form is an achievable end goal of reconstruction, necessitating appropriate reformation of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures. Regarding its physiological importance, disruption of the normal function may cause respiratory obstruction and contribute to patient distress. To achieve successful repair, preoperative preparation must consider the location, the layers involved, and the size of the defect. Prompt and well-organized repair minimizes the occurrence of progressive necrosis and severe late-stage deformity. Here the authors provide a framework to approach various nasal defects and provide a review of the novel ideologies and techniques. The workhorse of nasal repair, the forehead flap, is discussed independently due to the breadth of innovation.

Enophthalmos, or recession of the eye posteriorly and inferiorly, is a potential sequela of orbital trauma and a source of significant cosmetic and functional concern. Late enophthalmos occurs when early reconstruction of the bony orbit fails to completely restore normal orbital shape and volume, resulting in aesthetic deformity and persistent diplopia. In this article, we provide a framework for evaluation of posttraumatic enophthalmos and outline the surgical principles of secondary repair necessary to optimize globe position. With implementation of proper craniofacial exposure, osteotomy, and orbital reconstruction, surgeons may achieve significant improvement in both the aesthetic and functional sequelae of enophthalmos.

STUDY OBJECTIVE To compare postoperative pain in patients using an abdominal binder with a control group after laparoendoscopic single-site (LESS) surgery. DESIGN A randomized controlled trial (Canadian Task Force classification level 1). SETTING An academic gynecologic surgeon's practice. PATIENTS Private patients undergoing surgery performed by a fellowship-trained minimally invasive gynecologic surgeon between April 2016 and April 2017. INTERVENTIONS Ninety total patients were selected for this study, with 60 randomized to receive an abdominal binder after surgery and 30 patients randomized to the control group without a binder. MEASUREMENTS AND MAIN RESULTS Using a 10-point verbal analog scale, patients recorded pain levels for 3 weeks postoperatively on a variety of measures, including overall and incisional pain. They recorded results on postoperative days 0, 1, 2, 3, 4, 7, 14, and 21. On average, the association between time and the overall pain score did not differ with binder use (p = .37). The overall pain decreases significantly over time (p

Ear prominence is a relatively common cosmetic deformity with no associated functional deficits, but with profound psychosocial impact, especially in young patients. Protruding ears in children have propagated surgical advances that incorporate reconstructive techniques. Here we outline a systematic framework to evaluate the protruding ear and present various reconstructive surgical options for correction. Both cosmetic and reconstructive perspectives should be entertained when addressing this anatomical deformity.

Microtia is a congenital auricular deformity that commonly presents with associated congenital aural atresia. The most acute concern in these patients is concomitant hearing loss at birth. A team-based approach by plastic surgeons and otologists is necessary to address both the otologic and audiologic concerns of microtia and atresia. Hearing rehabilitation is imperative; yet it should not compromise the aesthetic components of reconstruction and vice versa. Here, the authors propose a framework to evaluate and manage patients with microtia and atresia with the goal of optimizing functional and cosmetic outcomes.

Total ear reconstruction has been approached by several techniques involving autologous graft, prosthetic implant, and alloplastic implant options. Recent studies have shown the superiority of porous polyethylene (Medpor, Porex Surgical) reconstruction over autologous reconstruction based on improved aesthetic results, earlier age of intervention, shorter surgery times, fewer number of required procedures, and a simpler postoperative recovery process. A durable and permanent option for total ear reconstruction, like Medpor, can help alleviate the cosmetic concerns that patients with auricular deformities may be burdened with on a daily basis. In this article, the authors discuss the advantages of Medpor-based ear reconstruction and discuss recent advances in the surgical techniques involved, such as harvesting a temporoparietal fascia flap and full-thickness skin graft to adequately cover the Medpor framework and decrease extrusion rates.

Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.

Background Violence against health care providers (HCPs) remains a significant public health problem in developing countries, affecting their performance and motivation. Objectives To report the quantity and perceived causes of violence committed upon HCPs and identify strategies intended to prevent and de-escalate it. Methods This was a mixed-methods concurrent study design (QUAN-QUAL). A structured questionnaire was filled in on-site by trained data collectors for quantitative study. Sites were tertiary care hospitals, local nongovernmental organizations (NGOs) providing health services, and ambulance services. Qualitative data were collected through in-depth interviews and focus group discussions at these same sites, as well as with other stakeholders including media and law enforcement agencies. Results One-third of the participants had experienced some form of violence in the last 12 months. Verbal violence was experienced more frequently (30.5%) than physical violence (14.6%). Persons who accompanied patients (58.1%) were found to be the chief perpetrators. Security staff and ambulance staff were significantly more likely to report physical violence (p = 0.001). Private hospitals and local NGOs providing health services were significantly less likely to report physical violence (p = 0.002). HCPs complained about poor facilities, heavy workload, and lack of preparedness to deal with violence. The deficiencies highlighted predominantly included inadequate security and lack of training to respond effectively to violence. Most stakeholders thought that poor quality of services and low capacity of HCPs contributed significantly to violent incidents. Conclusion There is a great need to design interventions that can help in addressing the behavioral, institutional, and sociopolitical factors promoting violence against HCPs. Future projects should focus on designing interventions to prevent and mitigate violence at multiple levels.

The Discrete Fourier Transform (DFT) is an important technique in the field of Digital Signal Processing (DSP) and Telecommunications, especially for applications in Orthogonal Frequency Division Multiplexing (OFDM) systems. The Fast Fourier Transform (FFT) is an efficient algorithm to compute the DFT and its inverse. The FFT processor plays a key role in the field of communication systems such as Digital Video or Audio Broadcasting, Wireless LAN with Standards of IEEE 802.11, High Speed Digital Subscriber Lines etc. In this paper involves the implementation of a area efficient 8-point, 16-point, 32-point, 64-point and 128-point single path delay feedback (SDF) and folding technique using radix-2 DIT FFT algorithm. The proposed algorithms are used in radix-2 butterfly in all stage. The proposed algorithm is area efficient and consumed delay in previous algorithm. The all design are implementation vertex-2p device family Xilinx software.

Being cost effective and environmental friendly, stone columns are used worldwide for supporting flexible structures such as embankments, oil storage tanks etc. which can tolerate some settlements. However, when the stone columns in very soft soils are loaded; stone columns undergo excessive settlement due to low lateral confinement provided by the soft soil, leading to the failure of the structure. The excessive settlements may be avoided or at least reduced to a great extent, when the columns are reinforced with geosynthetic. The technique of wrapping the individual stone column with a suitable geosynthetic (encasement) is one of the reinforcement modes which improve the performance of stone columns. In this study, model tests were performed on single floating as well as end-bearing stone columns with and without encasement. The column was reinforced by providing geosynthetic encasement over varying column length. The tests indicate that the encasement over the full column length gives higher failure stress as compared to the encasement over partial length of column for both floating and end bearing columns. Further, the performance of end-bearing columns was found to be better than the floating columns.

ABSTRACT: Stone columns have proved to be a useful technique for supporting flexible structures resting on soft soils. However, in the case of very soft soils, stone columns have encountered excessive settlements due to insufficient lateral resistance offered by the soft soil against bulging of the columns upon loading. The bulging may be reduced to a great extent by reinforcing the columns either by encasing them with geosynthetics or by placing horizontal circular discs of geosynthetics within the columns at a regular interval. In the present study, model tests have been carried out on long floating and end-bearing single and groups of columns with and without reinforcement to evaluate the relative improvement in the failure stress of the composite ground due to different types of reinforcement. The exhumed deformed column shapes were used to understand the failure mechanism for different types and configurations of reinforcement. The geogrid was the best geosynthetic type for encasement for end-bearing columns; for floating columns, geotextile and geogrid were equally good for horizontal circular discs and encasement configurations.

Background : Written Feedback (WFB) plays a significant role in student’s learning in terms of improvement of their academic writing skills. However, the quality of WFB may be affected by various personal and contextual factors. This study aimed to identify nurse teachers’ conceptions and practices of WFB on written assignments in nursing degree offering institutions in Karachi, Pakistan. Methods : A cross-sectional descriptive study design was used to answer the study questions. The study was conducted at 11 nursing schools in Karachi by recruiting those teachers who were teaching in nursing degree programs. The sample size of the study consists of 80 teachers. Universal sampling technique was used to select the subjects of the study. Results : The study result consists of demographic information of the participants, teachers’ conceptions and their practices of WFB. Although majority (92%) of the teachers believed that WFB is important for students’ learning, they acknowledged that they were not able to provide WFB at optimum level to their students. This gap in practice is attributed to various personal, contextual, and organizational factors; among them, the highest reported factors were teachers’ lack of training for provision of WFB (84%), distraction in the environment (78%), and constraints of time due to teacher’s workload (74%). Conclusions : The importance of WFB for students’ learning is well established in the literature. However, the preparation of teachers and an enabling environment to facilitate teachers for optimum practices of WFB needs considerable attention by educational institutions.

ABSTRACT: The use of stone columns is popular as a ground-reinforcing technique for supporting flexible structures on soft to very soft soils. When a very soft soil improved by stone columns is loaded, the stone columns undergo excessive bulging, because the very low lateral confinement provided by such a soil gives rise to a very low failure stress of the composite ground. The performance of stone columns in such conditions can be improved either by encasing them with geosynthetics or by placing horizontal strips of geosynthetics within the columns at regular intervals. In the present study, model tests have been carried out on short, floating and fully penetrating single columns with and without reinforcement to evaluate the relative improvement in the failure stress of the composite ground due to different types of reinforcement. A comparative evaluation of the column shape on exhumation reveals subtle differences in failure mode due to the different configurations and types of reinforcement. Whereas for the end-bearing stone columns encasement is clearly the best method, for the floating columns there is no significant difference between the performance of the horizontal strip reinforcement and that of the encasement. For end-bearing columns a geogrid is the best type of geosynthetic to use for both types of reinforcement, but for floating columns the best types of geosynthetic are geogrid as the horizontal strip and geotextile as the encasement.

Context The subject of economic migration among health care professionals has received intense attention. However, the aetiology of this migration has not been rigorously evaluated in Pakistan. Such knowledge can potentially influence health care and academic policies. Our current study proposes to quantify the relative contributions of various personal, professional and economic variables among final-year medical students in Karachi. Methods A self-administered structured questionnaire using a 10-point scale was developed and piloted among Karachi medical students. Additional open-ended questions were included to allow us to capture information not otherwise covered in the questionnaire. spss software was used for data entry and analysis. Results Over 95% of Aga Khan University (AKU) and over 65% of Baqai University (BU) final-year medical students intend to proceed abroad for their postgraduate training. The 2 most important factors behind this intent as pointed out by the students are poor salary structure (AKU mean score 8.94 ± 1.73, BU mean score 7.14 ± 2.6) and poor quality of training in the home country (AKU mean score 9.20 ± 1.20, BU mean score 8.68 ± 2.03). Other interesting factors captured through the open-ended questions were the poor work environment and lack of rigor in teaching of residents in domestic university hospitals. Over 50% of final-year medical students cited these issues as major reasons behind their decision to migrate.

Background and objectives With advances in laparoscopic surgery, the goal of surgeons and patients is to minimize pain to allow for faster recovery and return to normal daily activities. One of these advances is single-site surgery. In this study, we compared postoperative pain in laparoendoscopic single-site surgery (LESS) to that in traditional multiple-incision hysterectomy. Methods Seventy patients were selected for this prospective cohort study, with 35 undergoing multiple-incision and 35 undergoing LESS hysterectomy. All patients were included who were undergoing hysterectomy with the primary surgeon. All multiport hysterectomies were performed laparoscopically. Six patients underwent LESS hysterectomy and 29 underwent robotic single-site surgery (rLESS). Patients recorded pain levels for 3 weeks after surgery on a variety of measures, including overall and incisional pain. Linear mixed effects models for repeated measures were used for all multivariate analyses, with an unstructured covariance matrix accounting for correlation between time points. Results Overall, across all time points, there was an average reduction in pain by 1.26 (SD 0.69) points in the single-site group (P = .06). Days 3 and 14 had a marginally significant reduction in pain (P = .06 and 0.058, respectively). On days 4 and 7 there was a significant reduction in overall pain (P = .04 and .04, respectively). Conclusion Based on the results, it is likely that single-site hysterectomy leads to less postoperative pain and achieves a lower pain score faster than multiport surgery. A randomized control trial is necessary to confirm these results before accepting them in clinical practice.

Financial economists believe that the arbitrage forces in the market are the main reason of market efficiency and these forces are the fundamental concept of efficient market hypothesis (EMH). During last few years, various theoretical and empirical evidences have been presented to support the work of financial modeling for the markets with less than rational investors whose trading strategies are based on psychological factors like mood and emotions. Weather condition is among the substantial factors affecting investors’ mood and emotions. Present study investigates the impact of temperature on stock market returns in emerging economy of Pakistan. Using the daily temperature records and stock market indices of Karachi and Islamabad, the study has employed auto regressive (AR) – generalized autoregressive conditional heteroscedasticity (GARCH) model from 2006 to 2010. Based on AR (1)-GARCH (1, 1) estimation the study has found that weather temperatures of both Karachi and Islamabad are negatively related with Karachi Stock Exchange (KSE) and Islamabad Stock Exchange (ISE) index returns, respectively.

The study has investigated the determinants of performance in the general insurers of Pakistan over the period 2004 to 2009. Performance of the general insurers is measured as Return on Assets (ROA) and Return on Equity (ROE) whereas; size, investments, leverage, claims, past year performance and age are chosen as explanatory variables. The results suggest that size, investment, past performance and age are positively related whereas; leverage and claims are negatively related with the performance of the general insurers. Moreover, it was also found that the recent economic uncertainty has adversely affected the performance of the general insurers in Pakistan.

2 Abstract: The study has estimated the profit efficiency, technical efficiency and cost efficiency of modaraba and leasing companies in Pakistan over the period of 2005 to 2010 with the help of parametric Stochastic Frontier Approach (SFA). The input and output variables were selected by following the value added approach. The results revealed that leasing companies are 86.4% profit efficient, 86.5% technical efficient and 89% cost efficient whereas, modaraba companies are 87.2% profit efficient, 51.2% technical efficient and 96.1% cost efficient. Moreover, the study also found that the financial crisis in 2009 has negatively affected the profit efficiency of leasing firm whereas, the study do not find any drop in the efficiency trend of modaraba companies.