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Artificial intelligence (AI) has been widely used throughout medical imaging, including PET, for data correction, image reconstruction, and image processing tasks. However, there are number of opportunities for the application of AI in photon detector performance or the data collection process, such as to improve detector spatial resolution, time-of-flight information, or other PET system performance characteristics. This review outlines current topics, research highlights, and future directions of AI in PET instrumentation.

The present study investigates the effect of financial development on sustainable competitiveness and its components (natural capital, resource intensity, and social cohesion) in the Arctic region. We employ bank-based, stock-market based, and composite index to measure financial development. To deal with endogeneity bias, system GMM is utilized. The results show a positive and significant effect of financial development on sustainable competitiveness. The estimates also assert that financial development encourages resource efficiency and social cohesion in the region. In contrast, we find the negative effect of financial development on natural capital. This suggests that overexploitation of natural resources may provide short-term benefits to the local and regional communities but it may threaten the long-term sustainability of the Arctic. Thus, the financial sector should be guided to support financing and investing activities in alternative eco-friendly technologies and ventures for reducing excessive natural resource utilization.

Sustainability has become an integral part of today's business environment and decision-making processes. At all levels of the organizational structure, awareness of sustainable supply chain management (SSCM) practices is now a priority. This paper investigates the potential relationships among environmental sustainability, innovation capacity, and stakeholder relationships of business organizations in the context of SSCM. A mixed methods approach is proposed and designed to understand and assess these complex relationships. Data were collected from 57 firms in Pakistan. The results show that organizational innovation and supplier relations are significant enablers of sustainable practices. Moreover, cluster analysis depicts that service industry lags the production industry in adopting sustainable practices. The analysis of the proposed model also reveals that the role of supply chains in Pakistan towards achieving credible environmental sustainability is still at its infancy and that supplier relationships and organizational innovation are the predecessors of environmental sustainability.

Objectives: To retrospectively review the short term outcomes of rotational atherectomy in a high CathPCI Risk and high Syntax Population. Methodology: A total of 51 patients who underwent RA between 1st June 2017 and 31st April 2019 were retrospectively reviewed after approval from ethical review committee. Clinical follow up was obtained for procedural success and major adverse cardiovascular events (MACE) at 3 months. Results: Patients who underwent RA were high risk with a mean Syntax score 32.7±5.9 and mean NCDR CathPCI risk score of 51.1±13. The mean age of the patients were 70 years, majority were males (81%), type 2 diabetics (78%) with chronic kidney disease (52.7%), Non-ST elevated myocardial infarction (NSTEMI) (35%) and Syntax Score>32 (64.8%). Out of 37 individuals, procedural success was reported in all subjects except one in the high risk syntax group. At three months, MACE was reported in 4 patients. Out of these four, one was intra-procedural death, three had repeat myocardial infarction. Out of these three, two declined repeat revascularization and were managed medically. One patient died during admission despite repeat revascularization. Almost all MACE reported, occurred in patients with Syntax>32. Conclusion: Despite high risk Syntax and CathPCI scores, RA led to high immediate procedural success for PCI in calcified lesions at our hospital with infrequent MACE.

In the present approach, a Cr2O3-TiO2-modified, portable, and biomimetic nanosensor was designed to meet the requirement of a robust and colorimetric sensing of hydrogen peroxide. Cr2O3-TiO2 nanocomposites prepared via the hydrothermal method were fabricated as a transducer surface on the filter paper using the sol-gel matrix. The color on the filter paper sensor changed from green to blue upon the addition of hydrogen peroxide in the presence of TMB. This change in the color intensity was linear with the concentration of H2O2. RGB software was used as a color analyzing model to evaluate the optical signals. This paper-based colorimetric platform provided us with an improved analytical figure of merit with a linear range of 0.005-100 μM with 0.003 μM limit of detection. The real sample analysis and excellent anti-interference potential results proved the good analytical performance of the proposed design, providing a more promising tool for colorimetric H2O2 detection. Introducing Cr2O3-TiO2 nanocomposite-based paper sensors, being a novel method for optical and colorimetric detection, can pave the way for the development of other sensing devices for the detection of different analytes.

The potential of agricultural land in Indonesia is still very wide so that the agricultural sector is still one of the incomes for most Indonesian people. The agricultural land sector is widely distributed in various regions in Indonesia, one of which is in the East Oku Regency, South Sumatra. As an agricultural area, the majority of the population in East Oku Regency choose their livelihood as farmers. However, the distribution of agricultural land has not been mapped, which can provide information about the location of agricultural land, especially in East Oku Regency. In this study, the development of a web-based Agricultural Land Geographic Information System in East OKU Regency was carried out. The geographic information system built can display information in the form of spatial and non-spatial data that describes an object based on the state of the earth. The method used in making this system is object-oriented method. With the development of this Geographic Information System, it is hoped that it will be able to provide information for the community about the distribution of the location and area of ​​agricultural land, especially in the East OKU Regency area.

This article explores the anatomical characteristics of the Islamic Education Curriculum based on personal and community development in General Higher Education in Indonesia. This research is a qualitative study, words or actions of people observed and interviewed are the main data sources. The primary data sources of this study were elements of faculty leaders, heads of study programs, students, and lecturers of Islamic Religious Education. This study illustrates how the anatomical characteristics of Islamic Higher Education of General Islamic Education curriculum support strengthening personal and community development. The research findings show that the learning achievements of graduates, the content and teaching materials, the learning process or learning experience, and the assessment model illustrated in the curriculum structure, strongly support the development of responsibilities as individuals of Allah's servants and as Khalifah fi al-ardh. The aspect of personal development is the aspect of tathwir al-nafsi in the form of individual monotheism which includes the teaching of Islamic belief, strengthening of mahdhah and others. The aspect of tathwir al-ijetimaiy, illustrated in the strengthening of student social monotheism in the form of al-amr bi al-makruf wa al-nahy an al-mungkar, the human concept as caliph, democracy, science, technology, art, harmony, civil society, welfare, religious people, Islamic culture, Islamic political system, and democracy. The learning process is still dominated by increasing the understanding of the propositions, concepts, and theories with the teaching model of information processing. The internalization process through practice with social and humanistic teaching models still needs to be improved.

In automobile and household appliances, the manufacturer’s decision to offer retailer rebates to retailers or delayed incentives directly to end customers is very important. Under game theoretic environment, we show that delayed incentive is an important tool not only for price discrimination but it also provides more flexibility to the manufacturer. We differentiate the impact of delayed incentives and retailer rebates. We draw implications for optimal rebate strategies for both retailer rebates and delayed incentives. We also discuss delayed incentives in the form coupons that give more control to the manufacturer, whereas retailer rebates require retailer’s participation. Analysis and numerical insights show that the manufacturer prefers better observance of retail price. We provide a decision rule to the manufacturer on how to select the rebate type based on customer heterogeneity.

Nasal septal defects may present with no clinical symptoms to dryness, nasal obstruction, pain, mucosal injury, crusting, epistaxis, rhinorrhea, nasal twang in speech, hyposmia, and breathing difficulties. Prosthetic rehabilitation of these defects may lead to improvement in these conditions. This case report describes the construction of a custom-made two-piece, magnet-retained nasal prosthesis fabricated in heat-cured acrylic resin. Intra-nasal and extra-nasal alginate impressions were splinted with soft plaster. Sequential model pouring was done for convenient access to the complicated intra-nasal anatomy. Two individual nasal stent waxups, containing two magnets with opposing poles facing each other, were well adapted to their respective medial nasal walls and anterior retentive rounded tips. Waxups were processed in heat-cured acrylic resin and delivered after finishing and polishing. Patient's symptoms were relieved, while maintaining the nasal patency. Such inexpensive method with a tissue-friendly material may prove beneficial for rehabilitation of larger nasal septal defects. Key Words: Nasal septal defects, Rehabilitation, Acrylic resin, Prosthesis.

Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization. Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management. Resumo Introdução: A traqueostomia é um procedimento cirúrgico comumente feito na prática otorrinolaringológica. O cuidado pós-operatório é o aspecto mais importante para alcançar bons resultados para o paciente. A indisponibilidade de diretrizes padrão para o manejo da traqueostomia e o treinamento inadequado podem tornar complexa essa prática básica. A equipe de enfermagem e os médicos desempenham um papel muito importante no manejo à beira do leito, tanto na enfermaria quanto na unidade de terapia intensiva (UTI). Portanto, é crucial que todos os profissionais de saúde diretamente envolvidos na prestação de cuidados pós-operatórios a esses pacientes possam fazer isso de forma eficiente. Objetivo: Avaliar o conhecimento sobre a identificação e manejo de emergências relacionadas à traqueostomia e complicações precoces entre os profissionais de saúde, a fim de melhorar a prática e sua padronização. Método: Estudo observacional transversal que incluiu 254 médicos e enfermeiras de quatro grandes hospitais terciários. As perguntas foram simples e diretas em relação à aspiração da traqueostomia, cuidados com o cuff, manejo do cuff, obstrução da cânula e manejo da alimentação em pacientes traqueostomizados. Resultado: Com base nas evidências de nosso estudo, o nível de conhecimento sobre os cuidados com a traqueostomia varia de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios. Existem lacunas significativas no conhecimento em vários aspectos dos cuidados e manejo da traqueostomia entre os profissionais de saúde. Conclusão: Nossos achados demonstraram um nível de conhecimento adequado entre os profissionais de saúde, variação de 48% a 52%, com escores de conhecimento acima de 50% considerados satisfatórios e revelaram que ainda existem lacunas no conhecimento em vários aspectos do tratamento e manejo do paciente traqueostomizado.

The competitiveness of Small and Medium Enterprises (SMEs) in Indonesia is still very low and vulnerable compared to increasingly uncertain business environment dynamics. Changing conditions require SMEs carry out continuous and systematic analysis of the external environment, so that owners who carry out strategic planning get information through various sources in the external environment. This is done to maintain a competitive advantage and as an effort to realize unexpected opportunities and progress. This study aims to: (1) measure the impact of external environment on differentiation strategy in SMEs in Central Java; (2) measure the impact of external environment on competitive advantage in SMEs in Central Java; (3) measure the impact of differentiation strategy on competitive advantage in SMEs in Central Java. The type of research used in this study is causal research. The method used in this research is quantitative. The population that will be used and examined in this study is all SMEs in Central Java, while the samples in this study were 180 SMEs in Central Java with a multivariate type sample size. Data collection technique was conducted using a questionnaire. This study uses Partial Least Square (PLS) for its analysis technique. The results in this study indicate that: (1) External Environmental has a significant effect on Differentiation Strategy; (2) External Environmental has a significant impact on Competitive Advantage. And (3) Differentiation Strategy has a significant effect on Competitive Advantage.

OBJECTIVE: This study was conducted to observe the relationship of mesio-angular impacted third molars to the development of distal caries in adjacent second molars. METHODOLOGY: This cross-sectional study was conducted at Nishtar Institute of Dentistry, Multan. Nine hundred and eighty nine periapical, bitewing and Panoramic radiographs were recorded and examined for distally carious second molars and impacted mandibular third molars. SPSS version 23.0 was used for data entry and analysis. RESULTS: Almost 40.8% of the target population reported with distal caries due to third molar impactions. A total of 53.30% of these impactions were of the mesio-angular variety. No distal caries was detected in transverse type of impactions. CONCLUSION: The current study concluded that the prevalence of distal caries in mandibular second molars and the positioning of adjacent impacted mandibular third molars in the dental arch were interlinked. Consequently, extraction of mandibular third molars should be considered to prevent caries and premature loss of second molar teeth. KEYWORDS: Distal caries, Impacted third molar, Infections, Risk Factor HOW TO CITE: Ashar T, Shakoor A, Ghazal S, Parveen N, Saleem MN, Raja HZ. Prevalence of distal carious lesions in mandibular second molars due to mesio-angular impacted third molars. J Pak Dent Assoc 2021;30(1):50-55.

Objective: To identify whether the timing of initiation of continuous renal replacement therapy affects outcome in septic patients with acute kidney injury in term of 28 days mortality. Study Design: Cross sectional analytical study. Place and Duration of Study: This research was conducted at department of Anaesthesiology and critical care unit of the Aga Khan University Hospital, Karachi, from Oct 2018 to Jun 2019. Methodology: The study reviewed all adult patients aged >18 years who developed acute kidney injury after septic shock and required continuous renal replacement therapy in surgical intensive care unit. Considering the value of blood urea nitrogen, patients were classified into two groups. One was in early group that‟s was defined as blood urea nitrogen value of

Problem based learning (PBL) approach has attained prominence due to its novelty in higher education. Problem based learning is pedagogical shift from traditional educational approaches to innovative educational approaches. Problem based learning alerts and challenges to classical and traditional assessment approaches because PBL is concerned with unique assessment approaches. Alternative pedagogies and assessment approaches enhance and give new insights to the effectiveness of PBL at higher education level. Students of higher education institutions learn through cognitions, socialization and experimental connections. Different students make different cognitive, social and experiential connections. This new phenomena has given new insights to the idea of shift of pedagogical paradigm in higher education with focus of teaching to learning. This approach has got prominence in scientific research and has equal importance in various fields of knowledge. It is equally important in other fields of knowledge. The major objective of this study was to explore the impact of higher education problem based learning in comparative perspectives of Malaysia and Pakistan. The participants of the study were included from Malaysia and Pakistan. Cross sectional research design has been used to analyze the collected data to achieve the objectives of the study. The study is significant for researchers in higher education institutions in comprehending the impact of higher education problem based learning in 21st century. Keywords: Problem-Based Learning, Higher Education, Impact, Teaching & Learning

Size-segregated of particulate matter (PM) including PM0.1 at two different sites, i.e., educational (EA) and residential (RA) areas in Padang city, Indonesia were sampled by using a cascade type air sampler for 24 hours with the average flowrate 40 l/m throughout three weeks (March, 08th-25th 2018). Carbonaceous components were analyses by a carbon analyzer following the IMPROVE_TOR protocol. Average PM2.5 and PM10 concentrations in RA were higher than those in EA while being below the NAAQS of Indonesia. However, it was much higher compared to the WHO limit for 24 hours in RA. OC was the dominant fraction in TC. OC/EC ratio ranging from 2.4 to 33.0 was similar at both sites, suggesting the OC was emitted from various sources. Char-EC and soot-EC ratio were founded to be minimized for PM0.1 (0.40 ± 0.27 and 0.39 ± 0.39, respectively at each site), indicating a more influence of burning of fossil fuel as vehicles exhaust and coal combustion. The transboundary influence of open biomass burning was not so significant although it cannot be ignored.

Food supply chain process comprises crops collection, processing of food, shipping & delivery to the whole seller in the market. Harvested foods decompose from the moment they are harvested due to attacks from enzymes, oxidation, and microorganisms. These include bacteria, mold, yeast, moisture, temperature, and chemical reaction. The spoilage of fresh food has increased over time due to the multistage slow food supply chain process. The identification, traceability, and real-time tracking of goods in supply chains have always been a challenge. The advent of the Internet of Things and cloud computing has brought a new approach to the food supply chain process for better cooperation among supply chain partners. The supply chain management (SCM) benefit greatly through automation based on key technologies of IoT, Radio Frequency Identification (RFID), and Wireless Sensor Networks (WSN). These technologies collect the data relevant to the food supply chain system, such as identifying tag-possessed objects or individuals and sensing capabilities of the surrounding environment. However, the collected data can be tempered or modified by attackers to provide false information about environmental conditions. They can destroy or damage the product due to false identification of dynamic environmental conditions. Furthermore, the current automation systems in industry-based retail logistics and SCM do not provide efficient solutions for monitoring the quality of perishable products with integrated solutions. This research aims to develop a secure monitoring and reporting system based on IoT to update the quality of the perishables along with the SCM with a focus on transportation without any human intervention.

This research departs from the background of the problem of the low work discipline of the members of the PKK Motivating Team in Bungo Regency so that they have not been able to achieve good performance. The purpose of this study was to determine the application, barriers, and efforts to overcome obstacles in the application of work discipline members of the Bungo District PKK Driving Team. This research uses descriptive research with a qualitative approach. The population in this study were the chairman and all members of the PKK Movement Team for Bungo Regency, with a total sample of fifteen people. The results showed that the application of work discipline in the Office of the PKK Movement Team in Bungo Regency has not been going well, it can be seen from the dimensions of timeliness and dimensions of work responsibility that have not been implemented properly. The inhibiting factor is the absence of sanctions for members who are not disciplined at work, and there are still members who are not responsible for completing the workload given. Efforts are being made, namely by applying sanctions in the form of fines, conducting member coaching once a month.

The focus of this communication is to study about the optimal radiation pattern of the feed of Luneburg lens for high-gain application. Based on geometric optics and equivalent aperture theory, the effect of the radiation pattern of the feed on the gain of Luneburg lens is analyzed first. Then the optimal radiation pattern of the feed is predicted by theoretical calculation to guarantee the maximum radiation gain of Luneburg lens, and the half-power beamwidth (HPBW) of the optimal radiation pattern of the feed is near 68° for the Luneburg lens with a radius greater than three wavelengths. To verify the theory, the Luneburg lens antennas fed by the feeds with different radiation patterns working at 10 GHz are analyzed. Finally, a prototype of Luneburg lens with a radius of 100 mm and several different feed antennas are manufactured to verify the theory and the simulation. The final simulated and measured results are consistent with the theory.

OBJECTIVES: To determine the trends in endodontic protocols amongst practicing dentists in teaching institutions and private clinics in Lahore. METHODOLOGY: A cross sectional survey was conducted amongst dentists working in the teaching institutions and in the private clinics of Lahore. A pre-piloted questionnaire survey adopted from Kohli et al with slight modifications was used. In this descriptive study 270 practicing dentists were selected using consecutive sampling with a 5% level of significance and margin of error. RESULTS: The 270 respondents had a mean age of 28.16 ± 6.18 participated in this study among which 111 (41.1%) were males and 159(58.9%) were females with the mean age of 30.28 ± 7.416 and 26.68 ± 4.62 respectively (12.2%) were consultants, 175(64.8%) were general dentists whereas 62(23%) were postgraduate residents. In our study population, 76(28.1%) dentists were using magnification among which 67(88.2%) were using loupes and 9(11.8%) were using microscope. The prevalence of the rubber dam usage for isolation among our respondents was 110(40.7%) only, 201(74.4%) dentists reported for routine removal of smear layer. Manual canal preparation technique was the most commonly used method practiced by 149(55.2%) dentists. 136(50.4%) dentists were using beveled needles for irrigation, whereas only 71(26.3%) were using side venting irrigation needles. Majority of the dentists (45.2%) were not using any method to increase the efficacy of the irrigants. CONCLUSION: There are deficiencies in the endodontic protocols followed by majority of the dentists in Lahore and these short comings should be addressed by governing bodies. KEYWORDS: Root canal therapy, Endodontic, Practice Patterns, Dentists HOW TO CITE: Lodhi Sk, Ehsan S, Rafique A, Saleem MN. Trends in endodontic protocols amongst dentists in Lahore. J Pak Dent Assoc 2020;29(4):239-245. DOI: https://doi.org/10.25301/JPDA.294.239 Received: 30 July 2020, Accepted: 08 September 2020

Ambiguities in current fire design codes have triggered conflicting responses from researchers and professionals about steel buildings in fire. This is because fire codes do not consider the integrated structure of the building, but are based on the tests and models of the individual structural members of a construction subjected to a standard fire (ISO 834 or ASTM E 119). This study designed a four-story steel frame structure containing five bays with a bay span of 12 m and a height of 3.5 m according to Eurocode 3, considering all joints as being simply supported. Four different fire scenarios were modeled with reference to members of the assembled structure utilizing the Vulcan software package considering standard and parametric fire curves on exposed and protected sections. The results were compared with those obtained by exposing to the same fire curves an isolated beam member equal to those belonging to the frame under investigation. The comparison shows that the assembled members in the modeled structure had a better fire performance than did the isolated members. Because connections are important components of structures, we believe that the effects of connections on the fire performance of structures should be studied in the future.

Malignant melanoma is considered as one of the most deadly cancers, which has broadly increased worldwide since the last decade. In 2018, around 91,270 cases of melanoma were reported and 9,320 people died in the US. However, diagnosis at the initial stage indicates a high survival rate. The conventional diagnostic methods are expensive, inconvenient and subject to the dermatologist’s expertise as well as a highly equipped environment. Recent achievements in computerized based systems are highly promising with improved accuracy and efficiency. Several measures such as irregularity, contrast stretching, change in origin, feature extraction and feature selection are considered for accurate melanoma detection and classification. Typically, digital dermoscopy comprises four fundamental image processing steps including preprocessing, segmentation, feature extraction and reduction, and lesion classification. Our survey is compared with the existing surveys in terms of preprocessing techniques (hair removal, contrast stretching) and their challenges, lesion segmentation methods, feature extraction methods with their challenges, features selection techniques, datasets for the validation of the digital system, classification methods and performance measure. Also, a brief summary of each step is presented in the tables. The challenges for each step are also described in detail, which clearly indicate why the digital systems are not performing well. Future directions are also given in this survey.

The heavy metals were studied in water, sediments, algae, and various tissues of Glyptosternon reticulatum and Cyprinus carpio from River Swat, Pakistan, using flame atomic absorption spectrophotometer. The Zn, Cu, Pb and Ni were higher in water at sewage site compared to upstream and downstream sites. In sediments, the Ni and Cd were not detected whereas Cu, Pb and Zn were higher at downstream followed by sewage and upstream sites. The Ni and Zn in algae were higher at upstream and sewage sites compared to downstream site whereas Pb and Cd were higher at upstream site compared to sewage and downstream sites and Cu was found same at all the three sites. The heavy metals (Zn > Cu > Pb and Ni) in tissues (liver > gills > skin > muscles) of G. reticulatum was higher than in C. carpio. This study recommends the proper monitoring of River Swat in order to save its water and inhabitant aquatic life.

Strengthening of structural members is a common practice around the world that may arise due to deterioration of concrete with age or upgradation of design code. This paper aims to elucidate a technique used for strengthening of the reinforced concrete beam for flexural capacity by using externally welded steel angles and steel bars. For this motive, three beams were strengthened with external steel angles and three with external steel bars. The external strengthening steel elements were attached at the bottom of the beam with shear reinforcement. Control samples without external steel angles and steel bars for comparison purposes were also prepared. All reinforced concrete beams were first constructed using a concrete ratio of 1:2:4, and then external steel elements were added to existing flexural reinforcement by using a fillet weld with tee joints having thickness and length of 5/16" (7.9 mm) and 6" (152.4 mm), respectively. Fourth point loading criteria were used to investigate the flexural capacity of beams in positive bending. All beams were designed strong enough in shear, to resist the ultimate loads without shear failure. Test results indicated that beams strengthened with this technique have an average increase of 238% with steel angles and 106% with steel bars, in load-carrying capacity than control samples. Strengthened beams showed a uniform crack pattern. Moreover, the concrete cover made a good bond with existing concrete and was strong enough to withstand ultimate loads. Conclusively, the steel angles and steel bars can be used as an external strengthening material, to enhance the flexural capacity of reinforced concrete beams.

Diabetes mellitus is a major public health issue globally, and type-2 diabetes mellitus is the most prevalent form of this disease. Due to multiple factors, most diabetic patients develop functional disabilities including musculoskeletal complications. To determine the frequency of musculoskeletal complications, the relationship between these complications and different potential variables, and the status of pharmacotherapy management to treat these complications among patients with type-2 diabetes mellitus. It was a cross-sectional study and data was collected through self-administered, face-validated pro forma in the English language in outpatient clinics of two tertiary care hospitals of Multan, Pakistan. Total n = 270 type-2 diabetic patients of both genders were assessed for musculoskeletal complications; n = 126 (46.7%) patients had at least one musculoskeletal complication. The most common manifestations were shoulder capsulitis or frozen shoulder (20.7%), flexor tenosynovitis (10.4%), hand stiffness syndrome (10%), and limited joint mobility (9.6%). A statistically significant association was found between frozen shoulder, limited joint mobility, and hand stiffness syndrome with the duration of diabetes (p value = 0.003, 0.0001), and overall glycemic control (p value = 0.004, 0.001) respectively. Out of 254 complaints, only 42.9% of complaints were receiving pharmacotherapy management. Main outcome measure: overall prevalence of musculoskeletal complications among patients of type-2 diabetes and level of pharmacotherapy management for them. Periarticular region of the joints in the hands and shoulders should be examined whenever diabetic patients present with uncontrolled diabetes, and pharmacotherapy management should be planned for these patients who will improve their quality of life.

This article evaluates the thermal and energy performance of mortar blocks containing local agricultural waste. The mortar blocks were cast by the replacement of ordinary Portland cement (OPC) with varying amounts of date palm ash (DPA) in the range of 10–30%. Experiments and simulations were carried out to assess the thermal characteristics and energy performance of the specimens. A prototype office building was modeled and simulated in DesignBuilder (Version 6.1.06) with modified blocks prepared with DPA under the Arabian Gulf environment characterized by hot and humid climatic conditions of Dhahran, Saudi Arabia. The developed blocks are characterized as lightweight blocks based on density data which satisfy the requirement of ASTM C55-11. The analysis and simulation indicate that the incorporation of DPA improves the thermal resistance of up to 47%, enhances the indoor environment and yields annual energy consumption of up to 7.6%, consequently reduces the cost of masonry block production by ~ 11% without compromising the physical, chemical, and mechanical properties. The masonry blocks prepared with DPA found to be economical than conventional masonry blocks. It is postulated that the novel DPA-based developed blocks are significantly sustainable products which will contribute to the valorization of DPA waste along with the reduction in the cost of construction and operational cost of the building.

In this work, a 2D/2D heterojunction composed of CoAl layered double hydroxide (LDH) and graphitic carbon nitride nanosheets (CNNS) was designed and fabricated for boosting photocatalytic hydrogen generation. The as-prepared 20 mol% CoAl-LDH/CNNS exhibited a remarkable photocatalytic hydrogen evolution rate of 680.13 μmol h−1 g−1, which was 21 times higher than that of pure CoAl-LDH (32.91 μmol h−1 g−1). The enhanced activity could be mainly attributed to its unique structure and high surface area. Distinct from ordinary heterojunction photocatalysts, two-dimensional (2D) heterojunctions with abundant 2D coupling interfaces and strong interfacial interaction could efficiently suppress the recombination of photo-induced charge carriers and shorten charge transmission distance. Particularly, compared with other concentrations, the increased surface area (138.70 m2 g−1) of 20 mol% CoAl-LDH/CNNS, which is 3.94 times of pure CNNS (35.48 m2 g−1), is more favorable for enhanced photocatalytic activity. Increasing the surface area of sheet-on-sheet heterostructure is an effective and novel strategy to facilitate the photocatalytic hydrogen evolution from water splitting.

An ellipsoidal Luneburg lens (LBL) binary array is proposed and implemented for wide-angle scanning. In order to solve the occlusion problem between the lens elements in the array, the spherical LBL is transformed into the ellipsoidal LBL based on the transformation optics. The permittivity distribution of the LBL is revised to increase the lens’ aperture efficiency when the lens is not particularly large compared with the feed. Further, by introducing the local-beam shifting method, the number of feeds under each lens and the mutual coupling between the feeds can be reduced with the scanning characteristics remained. To validate the proposed design, a ${1 \times 2}$ ellipsoidal LBL array has been designed, fabricated, and tested. Each ellipsoidal LBL with 110 mm long-axis radius and 88 mm short-axis radius is fabricated by means of 3-D printing technology. Patch antennas operating at 2.25 GHz are employed as feeds. The measured results show that the proposed ellipsoidal LBL binary array can realize the maximum gain of 15.5 dB at zenith direction and 13.3 dB at 62°. The maximum scanning angle of ±68° can be achieved with a 3 dB gain reduction and −8 dB sidelobe.

Therapeutic role of antioxidant against lipid profile and lipoprotein (choline) was observed by the different researchers, but clinical evidences required about the use of antioxidant vitamins against the lipoproteins. Patients with clinical evidence of cardiovascular disease (CVD) confirmed by standard diagnostic techniques were followed. Newly or recently, diagnosed case subjects were recruited wherever possible. At least 120 cases, subjects both male and female with CVD were selected from a local hospital. Four groups developed on the base of antioxidant therapy and blood samples were collected at zero day, 20 days, 40 days and 60 days. vitamins C and E are the major dietary cellular and lipid antioxidants, respectively; we found no evidence to support the use of vitamin or antioxidant supplements in the reduction of mortality. However, they are helpful in the management of prevention of cardiovascular disease.

Whole-blood choline, plasma choline and serum choline are emerging biomarkers in cardiovascular diseases (CVD). To examine the association of Whole-blood choline is an early predictor for cardiac events. In case control study, we enrolled 240 individuals including 120 normal (39 females and 82 males) and 120 cases (49 females and 71 males) where age limit was >40 years) Information through interviews, family disease history, 24 recall diet assessment and blood sampling. Odds ratios express the associated risks with CVD and without CVD patients. In healthy populations, good dietary habits and active lifestyle were observed. The number of participants with CVD were smokers than normal. In men, and women the risk was observed highly significant. (p=0.0049) Different blood parameters like Triglycerides, Uric Acid, Urea, Creatinine, CRP and ESR were non-significant observed. In females the low carbohydrates and high protein and frequent salad vegetable consumption observed. On the other hand, men consume more carbohydrates. Body mass index was significantly with p= 0.036 (OD 1.12 95% 1.00-1.26). The total fats (p=0.017) (OD 1.3301 95% 1.05-1.69) total carbohydrate (p=0.076) (OD 1.1536 95% 0.98-1.35) and total proteins (p=0.287) (OD 1.1456 95% 0.89-1.47) effecting respectively. The Blood choline level was significant observed between cases (p=0.026) OD (0.944 95%0.89- 0.99).

Objectives: Breast cancer is the most common cause of death in women. 20% of breast cancer cases are due to the variations in the BRCA1/BRCA2 genes. Various variants of BRCA1/2 genes have been reported worldwide, which cause breast cancer by forming truncated proteins. In the current study, we aimed to find out the prevalence of mutations 1294DEL40, E1250X and 5382insC (BRCA1) and 2157DELG (BRCA2) in a case control cohort of Pakistani origin. Study Design: Case Control Study. Setting: Microbiology and Molecular Genetics University of Punjab, Lahore. Period: December 2017 to June 2018. Material & Methods: Blood samples from 80 female breast cancer patients and 80 healthy females were taken. DNA was isolated from blood by manual method and genotyping was done by PCR-RFLP. Results: We found that for the 2157DELG mutation of the BRCA2 gene, homozygous mutant phenotype is present only in the cases at a frequency of 25% while the BRCA1 gene mutations were less common i.e., the E1250X mutation showed 6.6% prevalence in patients, and the 1294del40 and 5382insC mutations were absent in the current cohort. Conclusion: Despite of sample size limitation, this study provides information about the prevalence of some common mutations. In addition, clinical risk factors were also noted which are essential in risk assessment. We foresee that targeting of specific genetic variants restricted to a particular ethnic group would be more effective in the future therapeutic approaches for the prevention and cure of breast cancer.

It is argued that masses in Pakistan are excluded from the mainstream progress of education resulting in social unrest and adverse state of human development. This paper examines prevailing inequality in and exclusion from education in the Khyber Pakhtunkhwa province of Pakistan, and provides an empirical base for designing an appropriate policy framework to mitigate the underline issues. Towards this end the household-based education and Inequality-adjusted education indices are derived using Foster-López-Calva-Székely (FLS) methodology at the provincial, and district levels from the most recent Pakistan Social and Living Standard Measurement (PSLM) survey 2014-15. The provincial analysis is elaborated at the urban and rural regions as well. The distribution of these indices across households are utilized to measure inequality and inclusiveness coefficients by employing “Atkinson’s inequality measure” and “sixty percent of median as threshold of exclusion,” respectively. At the district level the impact of economic, social, demographic, and locational factors on inclusiveness of education are also investigated using linear regression. The results demonstrate that KPK households reside on average in low category of actual education level experiencing high inter-regional and intra-regional disparities and exclusions. At the district levels, the inequalities in educational achievement and exclusions are even more pronounced, indicating that aggregated analyses suppress the intra-regional disparities and segregations. Based on these findings, it is asserted that investment in social infrastructure specifically educational, health, and law and order facilities, development of agriculture sector, and eradication of gender discrimination, are important factors to promote inclusive education in the province.

Concreting in hot weather poses special problems, and the properties of concrete are significantly influenced by mix parameters, construction practices and environmental conditions. In this study, mix design parameters, casting temperature and curing conditions were varied to study the mechanical properties and durability characteristics with the ultimate aim of developing models relating the concrete properties and the experimental parameters. The effect of w/c ratio (0.3 to 0.45), in situ concrete temperature (25 to 45 °C) and curing method (ponding, covering with wet burlap or applying curing compound followed by curing under laboratory or field conditions) was assessed by measuring compressive strength (f′c), split tensile strength (ft), pulse velocity (PV) and depth of water penetration (WP) up to 180 days. Prediction models were developed utilizing quadratic regression models and artificial neural networks (ANNs). The regression models indicated that moist curing, in situ concrete temperature and curing period have a positive impact on the strength parameters and PV, while the former two variables had a negative effect on the WP. The w/c ratio had a significant positive impact on the WP. The concrete properties predicted by ANN models were more accurate than those predicted by regression models. A combined ANN model, developed for predicting strength and PV simultaneously, had a better correlation coefficient compared to ANN models developed for each variable separately. The developed models are expected to assist concrete technologists in the selection of appropriate concrete mixture parameters to obtain concrete with desired properties under hot weather conditions.

Background: Most postsurgical infections can be prevented through the effective use of antimicrobial. This study was conducted to investigate the antimicrobial prophylaxis practices and adherence to guidelines in gynecological surgeries. Methods: An audit based prospective study was carried out between February and April 2019 in the gynecological ward in a teaching hospital, Peshawar, Pakistan. This study included women who had two common surgical procedures (caesarean surgery and hysterectomy), did not undergo any previous surgery and having no infection at the time of surgery. The indication, choice/selection, timing and pattern of antimicrobials were the main evaluated parameters. The required information was collected from medical records through standardized data collection proforma. Observed prescribing practices were compared with antimicrobial prophylaxis guideline. Results: A total of 264 patients (caesarean surgery n = 173 and hysterectomy n = 91) with mean age: 32.6 ± 6.3 years were recruited in the analysis. Antimicrobial was prescribed to 241 patients (91.3%). The selection and timing of antimicrobial were adhered to guidelines in 40.7% and 56.4% cases, respectively (optimal value 100%). There was a statistically significant difference between guideline recommendations and antimicrobial practice in surgical procedures (P = 0.000).The commonly prescribed antimicrobials were ceftriaxone (22.4%) and cefazolin (22%).The combination usage of antimicrobial was also observed. Conclusion: Inappropriate use of antimicrobial prophylaxis and low adherence to standard guidelines was observed. Periodic audit and awareness about standard guidelines are required for the judicial use of antimicrobials in surgery.

The image resolution of computed tomography (CT) scan system can be affected by numbers of factors such as collimator material, collimator design, stopping power of detector and scatter photons rejection and/or correction technique. The scatter photons are one of the major sources of background noise that can immensely degrade the image quality of the CT system. The image quality, in turn, affects the discrimination and identification performance of the system especially in the case of dual-energy CT systems for material decomposition. Therefore, for material identification, acquisition of raw data with minimal noise is of immense importance. In this simulation study, the performance of two types of collimators was evaluated to come up with a better collimator design for background noise compression. Both collimators were made of tungsten with similar length of 30 mm but with different hole shapes (fan and parallel). In both cases, results suggest that there is a clear improvement in terms of spatial resolution. In a comparison of grids structure, fan grid performed slightly better than parallel for most of the cases. The peak-to-valley (PV) ratio for 122 keV gamma radiation source improved on average ∼0.16 (16%) and ∼0.23 (23%) for fan collimator and parallel collimator respectively. For 60 keV gamma source, the improvements were ∼0.14 (14%) and ∼0.17 (17%) respectively. Thus, from the results, it can be concluded that fan grid collimator can provide superior performance compared to parallel grid collimator.

From the last few decades' radio frequency (RF) spectrum remained attractive for wireless/wire-line applications. RF spectrum becomes dense and occupied, which makes its availability difficult to other broadband channels. Free space optical (FSO) communication, which was used for messaging/indication in the ancient days, now becomes more popular and attractive in the new era. The popularity of FSO is due to its freely available large spectrum, inherited secure links and ease of deployment. However, FSO link has to face certain challenges, e.g., line-of-sight (LOS) requirement, link attenuation due to atmospheric turbulence and severe weather conditions. To overcome the issues of FSO communication, hybrid optical-radio transmission system is proposed by which we can get maximum benefits of both spectrum. Considering the proposed transmission system link quality, link budget analysis is done in the presented work. Link budget design of transmission system is important to analyze and give recommendations.

Introduction: Gallstones are common in western countries. Usually in minimally invasive cholecystectomy, cystic artery and duct both are separately ligated using metallic clips and then divided. Harmonic scalpel is effectual, useful, and secure instrument regarding control of blood loss and dissection especially in laparoscopic procedure for cholecystectomy. Objective: To delineate outcome of totally clipless laparoscopic cholecystectomy with harmonic scalpels in gall stones disease.Materials and Method: This research (a retrospective case study) was done at surgical department, Lahore General Hospital, Lahore for 12 months. Total 195 patients fulfilling the above mentioned inclusion criteria were enrolled. Then patients underwent surgery under general anaesthesia. During surgery, operative time, gall bladder perforation and blood loss were noted. Patients were evaluated if conversion to open surgery was required. After surgery, patients were followed-up in OPD for 7 days for assessment of infection.Results: Mean age of patients was 45.75±14.98 years. Among patients 93(47.7%) were male and 102(52.3%) were female. Mean duration of gall bladder stone was 5.02±0.80 months. Mean time for operation was 50.27±12 minutes. Mean loss of blood was 73.11±20.46 ml respectively. There were 24(12.3%) cases who had perforation. Total 35(17.9%) patients suffered from infection post operatively. Conclusion: Total laparoscopic clipless cholecystectomy by harmonic scalpels is fully safe and useful technique in surgery for gall bladder stones.Key words: Total laparoscopic clipless cholecystectomy, harmonic scalpels (HS), gall bladder stones

Installation of distributed generations (DGs) can cause performance degradation of distribution lines protection. Therefore, the objective of this paper is to propose a protection scheme that can be a solution for this protection line degradation.. The proposed scheme consist of quadrilateral distance relays at upper stream of the lines and directional overcurrent relays at downstream of the lines. The performance of the scheme was tested using Digsilent Powerfactory simulation. The simulation was carried out for four fault types, 0 - 50 Ohms fault resistance and four network conditions/scenarios. The test system consist of three current source i.e. Grid, DG1 and DG2. Variation on-off state of the three current sources is applied in order to check the ability of the scheme to perform correctly for multiple network condition and possibility installation of new DG in the future. The results show that the scheme perform correctly for all bolted fault regardless of fault types, fault location and network scenarios. For three phase and two phase to ground faults the scheme perform correctly for all simulated fault resistance. However, for single line to ground faults and phase to phase faults, the scheme has limitation on maximum fault resistance that can result in correct operation. In general, the proposed scheme able to protect the distribution lines better than the scheme of previous research, but it has a slightly higher chance to perform unwanted operation. Keywords : Distribution line protection, distributed generation, quadrilateral distance relay, directional overcurrent relay

This study aims to determine flood victims’ satisfaction towards housing relocation at Kuala Krai, Kelantan, during the post-occupancy period. The evaluation of satisfaction criteria of housing relocation is derived from the literature review conducted. Throughout this study, a questionnaire survey was used to obtain the required data. This quantitative research method employed a questionnaire survey to identify flood victims' satisfaction towards housing relocation established from the selected 13 criteria. The data were collected from 80 out of 100 targeted respondents among the flood victims in Kuala Krai residing in this area. The data obtained were analysed using the Statistical Package for Social Sciences (SPSS) version 23.0 software. The data were also interpreted in a table and ranked according to the mean score range. Hence, this study's overall findings indicate that the respondents were not satisfied with the relocation building's performance, particularly on housing design, indoor air quality, waste management, public amenities, public transportation, safety and were most dissatisfied with public areas. Therefore, it is hoped that this study's findings will be benefited mainly to improve the post-disaster housing construction for the flood victims in the future since the satisfaction level for every element is highlighted in this study.

Efforts are being devoted to reducing the harmful effect of the construction industry around the globe, including the use of rice husk ash as a partial replacement of cement. However, no method is available to date to predict the compressive strength (CS) of rice husk ash blended concrete (RHAC). In this study, advanced machine learning techniques (artificial neural network, artificial neuro-fuzzy inference system) were used to predict the CS of RHAC. Based on the published literature, six inputs, i.e., age of specimen, percentage of rice husk ash, percentage of superplasticizer, aggregates, water, and amount of cement, were selected. Results obtained from machine learning methods were compared with traditional methods such as linear and non-linear regressions. It was observed that the performance of machine learning methods was superior to traditional methods for determining the CS of RHAC. This study will prove beneficial in minimizing the cost and time of executing laboratory experiments for designing the optimum content portions of RHAC.

In Mobile Ad-hoc Network based Internet of things (MANET-IoT), nodes are mobile, infrastructure less, managed and organized by themselves that have important role in many areas such as Mobile Computing, Military Sector, Sensor Networks Commercial Sector, medical etc. One major problem in MANET based IoT is security because nodes are mobile, having not any central administrator and are also not reliable. So, MANET-IoT is more defenseless to denial-of-service attacks for-example Blackhole, Wormhole, Gray-hole etc. To compare the performance of network under different attacks for checking which attack is more affecting the performance of network, we implemented Blackhole and Wormhole attack by modifying AODV routing protocol in NS-3. After preprocessing of data that is obtained by using Flow-monitor module, we calculated performance parameters such as Average Throughput, Average Packet Delivery Ratio, Average End to End Delay, Average Jitter-Sum and compared it with no. of nodes in MANET-IoT network. Throughput and goodput performance of each node in the network is also calculated by using Trace metric module and compared with each node in the network. This approach is also very helpful for further research in MANET-IoT Security.

Air quality is a social, economical, and health issue for fast-developing countries such as China. Due to the overuse of nonrenewable energy, industrialization, and the population put pressure on air quality, which seriously threatens public health and economic growth. This study focuses on air quality and also aims to investigate the short-and long-run correlation between foreign direct investment, energy consumption, domestic credit, and financial development. The Autoregressive distributed lag model and the Granger non-causality test were carried out over the period from 1985 to 2018. The main findings of this study show a positive and significant long-run impact of energy consumption on air quality. In addition, domestic credit and financial development similarly show a significant positive short-run association with air quality. Moreover, the unidirectional causality correlation running from foreign direct investment and domestic credit to air quality was concluded by the Granger non-causality test. Considering the empirical analysis, this study suggests that domestic financial institutions should offer credit to industries at a low-interest rate in order to help them to switch from non-renewable to renewable energy consumption towards the promotion of sustainable and healthy air quality.

In this work, a no-reference framework is proposed for the video quality estimation streamed through the wireless network. The work presents a comprehensive survey of the existing full reference (FR), reduced reference (RR), and no-reference (NR) algorithms. A comparison has been made among existing algorithms, i.e. in terms of subjective correlation and feasibility to use these algorithms in wireless architecture, to describe the necessity of the proposed framework to overcome the limitations of the existing algorithms. A brief summary of our previously published algorithms, i.e. NR blockiness, NR blur, NR network, NR just noticeable distortion, and RR, has also been presented. These algorithms have also been used as function modules in the proposed framework. The proposed framework is able to measure the video quality by taking into account major spatial, temporal, network impairments, and human visual system effects for a comprehensive quality evaluation. The proposed framework is able to measure the video quality compressed by different codecs, i.e. MPEG x / H.264x, Motion JPEG/Motion, and JPEG2000, etc. The framework is able to work with two different kinds of received data, i.e. bit streams and decoded pixels. The framework is an integration of the RR and NR method, and can work in three different modes depending on the availability of the RR data, i.e. 1) only RR measurement, 2) hybrid of RR and NR measurement, and 3) only NR estimation. In addition, any individual function block, i.e. blurring, can also be used independently for particular specific distortion. A new subjective video quality database containing compressed and distorted videos (due to channel induced distortions) is also developed to test the proposed framework. The framework has also been tested on publicly available LIVE Video Quality Database. Overall test results show that our framework demonstrates a strong correlation with subjective evaluation of the two separate video databases as compared with other existing algorithms. The proposed framework also shows good results while working only in NR mode as compared with existing RR and FR algorithms. The proposed framework is more scalable and feasible to use in any kind of available network bandwidth as compared with other algorithms, as it can be used in different modes by using different function modules.

A 72-year-old man with prior history of coronary artery bypass grafting and sternal wire infection presented with non-ST-segment elevation myocardial infarction. His coronary angiogram revealed stenosis of the distal left main coronary artery (LMCA) and a pseudoaneurysm of saphenous venous graft (SVG) to right posterior descending artery. Patient developed ventricular fibrillation during admission, and postcardiopulmonary resuscitation, a pulsatile chest mass was observed which was diagnosed with computed tomography as a chest wall collection resulting from rupture of the pseudo-aneurysm. He underwent percutaneous coronary intervention of the LMCA with drug-eluting stents followed by successful coil embolization of the SVG pseudoaneurysm. Patient had an uneventful recovery postprocedure.

This study aims to determine the effect of motor vehicle tax and the tariff of transfer motor vehicle name to thelocally-generated revenue, the contribution of the locally-generated revenue to the total revenue of districts in Aceh province. The data used in this research is time series during the period 2007-2013. The data analysis method used in this research is multiple linear regression with ordinary least square (OLS). The results showed that motor vehicle tax and the tariff of transfer motor vehicle name significantly had a positive effect on the locally-generated revenue of districts in Aceh province. The contribution of the locally-generated revenue to total regional revenue is relatively low, the contribution of motor vehicle tax to the locally-generated revenue is higher than the contribution of the tariff of transfer motor vehicle name to the locally-generated revenue, therefore the Aceh government should be able to improve its own regional revenue by digging up new sources of the revenue besides of motor vehicle tax and the tariff of transfer motor vehicle name. In addition and a must that is the increase of locally-generated revenue also needs to be done by improving coordination among fellow related agencies in increasing motor vehicle tax the tariff of transfer motor vehicle name.