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Objectives:To compare the outcomes of early tracheostomy vs. late tracheostomy in post-operative patients after acute subdural hematoma at receiving GCS (Glasgow comma scale) of six or below. Method: A quasi observational study was conducted on 30 patients with acute subdural hematoma after RTA (road traffic accident) and were operated in The Department of Neurosurgery Unit 2, Punjab Institute of Neurosciences, LGH, Lahore. The age range was 20 – 65 years. All patients were operated upon within 12 hours of RTA. Results: In Group A, 12 (40%) patients, decompressive craniectomy with the evacuation of acute subdural hematoma and early tracheostomy were performed. In Group B, 8 (26%) patients’ craniotomy and evacuation of acute subdural hematoma were done along with early tracheostomy. In 6(20%) patients, decompressive craniectomy and evacuation were done and their tracheostomies were done at the 10th post-operative day. In 4 (13.33%) patients’ craniotomy and evacuation of hematoma done and their tracheostomies were also done at 10th post-operative day. In Group A, on 5th postoperative day GCS of 16 (53.33%) patients with early tracheostomies and fewer comorbidities improved, they were extubated, while 2 (6.67%) patients did not improve and 2 (6.67%) patients died. In Group B, in 30 patients with late tracheostomies, only 4 (13.33%) patients were improved. On 10th post-op day, GCS of 4 (13.33%) patients improved, GCS of 3 (10%) patients not improved and 3 (10%) patients died. Conclusion: Early tracheostomy in patients with acute subdural hematoma yields good results as compared to late tracheostomy.

Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an uncommon site for cardiac Myxoma. We present a case of an 18 years old girl who presented to us with history of shortness of breath, abdominal distension, leg swelling, palpitations and dizziness for two months. On Echocardiography there was a large pedunculated mass attached to tricuspid valve. She underwent surgical excision of the mass. Biopsy confirmed the Myxoma. In conclusion, Myxoma originating from tricuspid valve are rare tumours which can cause tricuspid valve obstruction and right heart failure symptoms due to their location. In these cases shortness of breath, embolisation and symptoms of venous congestion are commonly observed. Key Words: Case report, Myxoma, right heart, cardiac CT, tricuspid valve. Continuous...

Background: Imaging techniques are providing physicians an opportunity to ensure more accurate diagnostics. While MRI and CT are the gold standard diagnostic tools, they are not utilized as primary diagnostic tools due to their size, immobility, and exposure to radiation. It is not always feasible or practical to wait for a technician in an emergency department to conduct these examinations. As technology continues to advance, diagnostic tools are becoming more portable. X-ray and ultrasound are utilized to diagnose, as well as exclude potential causes of illness. Our objective is to determine which diagnostic tool is more efficient in diagnosing patella/knee injuries. Methods: This systematic review aims to determine which diagnostic tool is more efficient at diagnosing injuries. By collecting and reviewing existing research to compare the limitations of injury detection, the accessibility and portability of both diagnostic machines, the safety in regards to radiation exposure to patient and physician, the reliability of the diagnoses, and the costs of each machine Results: Of the reviewed articles, 58% of the articles focusing on knee injuries indicated that ultrasound imaging is a superior diagnostic instrument due to its efficacy and accessibility. When comparing ultrasound to x-ray directly, it was shown that ultrasound is a more precise diagnostic tool. Conclusion: Ultrasound imaging is a more effective diagnostic tool than x-ray. It is better able to diagnose bone, soft tissue, and vessel injuries. It is a safer tool for both the patient and the physician because it uses sound rather than radiation to produce an image. It is also more accessible as advances in technology have made portable ultrasounds a protocol for quick assessments of injuries.

Background Perinatal loss is a traumatic and complex experience that contributes to negative maternal psychological states and adverse outcomes impacting fetal development, maternal-fetal/infant bonding, marital/partner relationships, and child cognitive, emotional, and behavioral development. These outcomes present preventable disease burden and financial liability to individuals, families, and the healthcare system. Psychological interventions have the potential to improve outcomes for women and their families after perinatal loss. A few studies have explored the effectiveness of individual psychotherapeutic interventions in reducing maternal psychological distress after perinatal loss; however, a systematic review to compare these interventions has not been conducted. The primary objective of this systematic review is to determine the effectiveness of psychotherapeutic intervention on psychological distress and perception, coping, and adjustment in women who have experienced perinatal loss. The secondary objective of this review is to examine the content and delivery methods of effective psychotherapeutic interventions. Methods We endeavor to search electronic databases (PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, Social Work Abstracts, Family and Society Studies Worldwide, Family Studies Abstracts, Academic Search Premier), gray literature databases (Proquest Dissertation and Theses Global, Web of Science Conference Proceedings Citation Index, OAIster, Open-Grey, Canadian Electronic Library, Canadian Research Index), and relevant organizational websites and conduct forward and backward citation searches of included studies. Inclusion criteria will consider studies that (1) are randomized controlled trials (RCTs), quasi-experimental (e.g., before-after design), and observational (prospective cohort); (2) include women affected by perinatal loss accessing psychotherapeutic intervention or support; and (3) evaluate a mental health or related outcome. Two authors will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. The primary outcome(s) will be measurements on the severity of depressive, anxiety, grief, and post-traumatic stress symptoms. Secondary outcomes will include measurements on difficulties in perception, coping, social, or dyadic adjustment. Conducting a narrative synthesis will identify relationships within study findings, and if appropriate, a random effects meta-analysis will be performed. Discussion This systematic review will summarize the effectiveness of psychological interventions, including their content and delivery method, in reducing psychological distress and improving outcomes for women affected by perinatal loss. The evidence generated from this review can inform researchers and policymakers in expanding on related research and developing customized interventions or programs. Systematic review registration PROSPERO CRD42019126456.

Arthritis is a chronic inflammatory disease that causes severe joint pain. Interleukin 17F (IL17F) is considered as a candidate gene functionally; it mediates pro-inflammatory responses, depending on the type and site of inflammation. The present study examined the polymorphism of IL17F (rs763780 and rs2397084) among the families affected by arthritis. Demographic data and blood samples were collected from the families with at least one affected offspring with arthritis. Analysis of the IL17F gene polymorphism was performed by the digestion of DNA with NlaIII and AvaII. The results showed that IL17F rs763780 (AA, AG and GG genotypes) and rs2397084 (AA, AG and GG genotypes) were associated with arthritis (OA & RA). It was evaluated that about 65 and 21 percent of the individuals mutated with homozygous mutation for wild type allele A, heterozygous mutation A/G against selected SNPs respectively. But homozygous polymorphic allele for allele G was only found against rs2397084. Mutation in rs2397084 resulted to change Lysine into Arginine, whereas mutation in rs763780 changed Histidine into Arginine. Maternal history was found as a stronger factor in transferring arthritis. The results of this study revealed an association of arthritis with IL17F among Pakistani population.

Aim: The aim of this study was to evaluate the effects of surgical repair on craniofacial growth in patients with complete unilateral cleft lip and palate. Materials and Methods: Forty patients were taken and were divided into two groups: Group 1 consisted of 20 patients presenting with a nonsyndromic complete unilateral cleft lip and palate and Group 2 (control) consisted of 20 patients without any clefts. The lip closure was done by Millard's cleft lip repair technique. Palatal closure was performed by Bardach two-flap palatoplasty. Lateral cephalograms were traced and studied by the same operator. Composite cephalometric analysis was done to measure the various parameters of craniofacial growth. Results: Values of only lower facial height angle and nasion perpendicular to point A were found to be higher in patients with cleft lip and palate as compared to noncleft participants. The values of the rest of the variables were found to be higher in noncleft participants as compared to patients with cleft lip and palate. Differences were found to be statistically significant only for maxillary length (condylion–point A) (P = 0.027), mandibular length (condylion–gnathion) (P = 0.045), upper 1–point A (P = 0.001), lower 1–point A/pogonion (P = 0.039), and upper lip thickness (P = 0.001). Conclusions: Surgical repair of cleft lip and palate affects the growth of maxilla and mandible. There is a restraining effect on the basal part of the premaxilla, and it is influenced by cleft palate and lip repair.

The Public Relations is becoming more demanding with the diverse practices during recent years. An organization is considered stronger because of effective PR. PR experts are working to enhance the effectiveness of an organization while eliminating the deficiencies of PR which directly affects the organizational strength. This paper aims to explore how effectively public relations build image of its organization, how it gratify its public, refining its policies on the basis of active feedback. Specifically, the purpose was to measure the relationship among organization, employees and its publics. The data was collected through survey method from Coca Cola Pakistan via closed ended questionnaire and taking into account the influence of public opinion. This study concludes with the importance of the prime position of public relations in an organization and its publics in constructing a quality relation and a good image.

Adverse childhood experiences (ACEs) have been found to be associated with various health conditions; however, there is dearth of evidence on the relationship between ACEs and prenatal depression. This study was conducted to determine the association between overall ACE score and prenatal depression symptoms, assess the moderating effect of social support and partner support on this relationship, and determine the association between individual ACE scores and prenatal depression. A secondary analysis was conducted of data from an RCT that assessed the feasibility of e-screening for maternal mental health among 636 pregnant women recruited from antenatal clinics. Two logistic regression models were built to reach our objectives. Over 80% of the participants were older than 25 years and had education beyond high school. Eighteen percent of the women had an ACE score of four or more. Univariable analysis found a 2.5-fold increase in the odds of prenatal depression for women with an ACEs score of ≥ 4. When examining the overall ACE score, lack of social support during pregnancy [AOR = 4.16; 95%CI (2.10-10.35)] and partner's relationship [AOR = 2.23; 95%CI (1.12-4.44)] were associated with prenatal depression while among the individual ACE scores, living with a person who went to prison was found to be associated with prenatal depression even when controlled for all variables. No moderating effect was found. These findings suggest for the improvement of partner's relationship and provision of social support before women conceive, in order to mitigate the effect of these adversities.

BACKGROUND: Hepatitis B is an important public health problem for Pakistan. Being asymptomatic in many of the carriers, it needs screening to assess disease burden. Screening blood donors will not only help point out the subliminally diseased individuals but will also offer a boost to treatment rates and preclude the dreaded complications in the affected population. AIM: The aim of this study is to estimate disease burden and depict current trend of Hepatitis B in healthy blood donors by assessing its prevalence at one of the largest hospitals of Pakistan over a 2-year interval. This will serve to offer a direction to health policymakers to channel their resources in an attempt to accelerate diagnostic, preventive, and therapeutic measures against the disease. METHODOLOGY: It is a retrospective single-center cross-sectional study. We screened 76,530 healthy blood donors for hepatitis B virus (HBV) visiting Mayo Hospital, Lahore, Pakistan during 2016 and 2017 with rapid test kits which used lateral flow immunoassay based on the principle of double antibody sandwich technique. RESULTS: Out of 76,530 donors in 2016 and 2017, we detected 1262 donors (1.65%) positive for hepatitis B viral serology. CONCLUSION: We found a positivity rate of 1.65% of hepatitis B in healthy blood donors during 2 years. Although in comparison to 2016, the positivity rate has somewhat declined in 2017, but it remains worrisome. Our findings endorse the need for policy making to sustain and amplify the current HBV screening and treatment strategies and enhance public awareness.

Circulation of the dominant sub-genotype VII.2 of Avian Orthoavulavirus-1 (AOAV-1) is affecting multiple poultry and non-poultry avian species and causing significant economic losses to the poultry industry worldwide. In countries where ND is endemic, continuous monitoring and characterization of field strains are necessary. In this study, genetic characteristics of eleven AOAV-1 strains were analyzed isolated from wild birds including parakeets (n = 3), lovebird parrot (n = 1), pheasant (n = 1), peacock (n = 1), and backyard chickens (n = 5) during 2015–2016. Genetic characterization (genome size [15,192 nucleotides], the presence of typical cleavage site [112−RRQKRF−117]) and biological assessment (HA log 27 to 29 and intracerebral pathogenicity index [ICPI] value ranging from 1.50 to 1.86) showed virulent AOAV-1. Phylogenetic analysis showed that the studied isolates belonged to sub-genotype VII.2 and genetically very closely related (> 98.9%) to viruses repeatedly isolated (2011–2018) from commercial poultry. These findings provide evidence for the existence of epidemiological links between poultry and wild bird species in the region where the disease is prevalent. The deduced amino acid analysis revealed several substitutions in critical domains of fusion and hemagglutinin-neuraminidase genes. The pathogenesis and transmission potential of wild bird-origin AOAV-1 strain (AW-Pht/2015) was evaluated in 21-day-old chickens that showed the strain was highly virulent causing clinical signs and killed all chickens. High viral loads were detected in different organs of the infected chickens correlating with the severity of lesions developed. The continuous monitoring of AOAV-1 isolates in different species of birds will improve our knowledge of the evolution of these viruses, thereby preventing possible panzootic.

Agriculture, worldwide, has seen remarkable transformation in farming practices, institutional frameworks and policies during the last three decades. Dynamic international markets and the diffusion of bioinformatics technology are shifting farming towards a new organizational model. Production systems are seeking new forms of coordination and control, increasing demand for traceability of origin, and greater integration into international markets. Public research programs are looking beyond mono-cropping systems toward integration of farming, cattle-raising and forestry and whole agriculture innovation system. Global positioning systems (GPS) and computerized agricultural machinery linked via satellites is promoting precision agriculture where inputs are calibrated exactly to the differences in soil and farm activities while farmers are looking for their linkages with output markets for their produce. Commitments to international agreements and conventions regarding biodiversity, climate change, food security, and land use are creating a new bottom line for agricultural practices. This necessitates a new institutional and regulatory framework.

The food systems approach can contribute to food security and reduced malnutrition levels by identifying key investments and policies throughout the food system, including production, processing, marketing, and consumption of food. However, in countries facing fragility and conflict, it has proven difficult to implement such an approach and achieve the desired results. This has been the case in Afghanistan, where high levels of malnutrition stem in part from an undersupply of nutritious food. Multi-sectoral approaches to promote nutrition sensitivity and achieve diet-based solutions have also had only limited impact. This paper reports on an analysis of the nutrition sensitivity of food systems in Afghanistan using multi-sector consultations and gap analyses to examine two key food and nutrition policies, the National Comprehensive Agriculture Development Priority Program and the Afghanistan Food Security and Nutrition Agenda. It highlights gaps in the policies and identifies investment priorities to make food systems more nutrition sensitive. The results show that instilling nutrition sensitivity into the operation of Afghanistan’s food systems can only be accomplished if certain key measures are incorporated into the food system. These include addressing the absence of knowledge in the population regarding healthy diets, the lack of sufficient food for vulnerable populations, weak irrigation systems, capacity constraints at individual and institutional levels, data challenges, and weak natural resource management. In addition, the above weaknesses are compounded by the continued violence and conflict-induced insecurity, weak government, and inadequate investments. Given the role of different sectors in contributing to improved nutrition, appropriate and effective multi-stakeholder coordination and collaboration is paramount to such efforts.

In this paper, a half-circular disc PMA (Printed Monopole Antenna) for SWB (Super Wide Band) applications is presented. The dimensions of the substrate is 40x40x1.7mm. The antenna is printed on Rogers RT5880 dielectric material. The antenna VSWR (Voltage Standing Wave Ratio) has less than 2 between 2.7 and 50 GHz. The antenna S11 has less than -10 between 2.7 and 50GHz. The antenna has a maximum gain of 12.4dBi. The BW (Bandwidth) of the proposed antenna is about 47.3 GHz. The antenna covered the WiMAX ((Worldwide Interoperability for Microwave Access), WLAN (Wireless Local Area Network), X band, Ka band, Ku band, 4G band, and the band of 5G (Fifth Generation) at the same time with nice gain and radiation efficiency. The radiator of the proposed antenna designs from a half-circular disc, rectangle, and triangle. The antenna has a partial ground plane. Three slots are etched in the ground plane for better impedance matching, two are circular slots and one is the rectangular slot. The antenna design is simulated in CST microwave studio 2016. The antenna has good radiation efficiency, other parameters such as VSWR S11, gain, and radiation pattern are discussed in detail.

Background Erdheim Chester disease (ECD) is very rare in pediatrics with no standard treatment guidelines. Here we present the case of a pediatric ECD patient who was cured with a Langerhan cell histiocytosis (LCH) directed chemotherapy protocol. Aim The aim of the report was to publish this rare presentation of ECD in pediatrics and highlight the complete response obtained to treatment. Methods The details of the patient were extracted by a retrospective review of her clinical records. Results (Case) An 11 years old girl presented with fever and bone pain. On investigating she had multiple lytic bony lesions scattered throughout her skeleton. A biopsy from one of the bone lesions confirmed the diagnosis to be ECD. ECD is very rare in pediatrics and this case adds to the existing list of 11 previously reported ones. Also, worth mention is the fact that the child presented with isolated skeletal involvement in form of multiple osteolytic lesions. The child was started on the LCH‐III protocol on which she achieved a cure. Conclusion Lytic bone lesions in a child may be present in ECD. A subset of ECD may have good response to LCH like chemotherapy.

Afghanistan has long history of ongoing conflicts, resulting in massive destruction of the country’s infrastructure. Illegal trade of livestock between Afghanistan and Pakistan boosted the spread of Foot & Mouth Disease (FMD). Current study was conducted to investigate outbreaks of FMD occurred between April-August 2014 in Nangarhar, Afghanistan. Descriptive data about suspected FMD cases were collected from the Civil Veterinary Hospital, Nangarhar to analyze spatio-temporal pattern of FMD. Case farms (n = 137) were selected from list of clinically confirmed FMD outbreaks available in the hospital. Control farms (n = 137) were enrolled from neighboring premises of case farms. The epidemic curve showed that the virus is continuously circulating among susceptible population. The mean age of the oldest lesion was 2.8 days. Foot & Mouth Disease was more likely to occur in female animals compared to male animals (p

Background: Hepatitis is a serious public health issue in the present era. More than 2 billion population is suffering from Hepatitis infection. Similarly, there are about 36 million healthcare professionals globally, out of which approximately 3 million per year get an injury from some sharps, thus resulting in 2 million subjects being infected with HBV and 1 million with HCV (WHO). A systematic study of 2015 showed HCV seroprevalence in the adult population of Pakistan was 6.8 whereas individuals infected with HCV were 6%. Methods: A qualitative study, with Phenomenological approach, was conducted among wardboys of Islamabad. Two Tertiary care hospitals of Islamabad, one in the public sector and the other in the private healthcare sector were selected as a study site. In-depth interviews with purposely and conveniently with selected ward-boys working in both the hospitals. A total of 25 in-depth interviews were conducted by the principal researcher from wardboys, 12 and 13 from the public and private sector hospital till the saturation was achieved. Results: 25 participants were interviewed on the basis of the interview guide and asked in detail about hepatitis B and C disease, their risk factors and causes. It was found that wardboys lacked comprehensive knowledge about the disease process. They did not adopt preventive strategies and precautionary measures and they lack refresher training and possess knowledge about the spread of infection which was close to none. Little efforts were made in these hospitals to ensure the safety of this group which would render them at high risk of attaining infection as well as transmitting it. Apart from health care workers, especially the wardboys that are subjects of this study were not compelled and penalize to follow infection control standards which led to the downfall of the system and provided a way for infection to proliferate and prosper. Conclusion & Recommendations: From this study, it is concluded that ward boys in private and public tertiary care hospitals are at high risk of acquiring Hepatitis B and C infection. They lacked knowledge about the infective disease and its preventions. Certifications should be made mandatory for ward boys to allow for work in this environment. Hospitals do not have an efficient system for infection control measure and lack of infection control training. It is important to make infection control processes strong and conduct regular refresher training for all health care workers.

Juvenile myelomonocytic leukemia(JMML) is a pediatric myeloproliferative disorder. Allogeneic hematopoietic stem cell transplant (HSCT) is the only curative treatment for JMML. Pre-transplant therapy is a matter of controversy, and there are no firm recommendations. Whether chemotherapy is effective in achieving durable remission is questionable. Patients diagnosed as JMML at our center from January-2014 to December-2019 were retrospectively analyzed. All patients treated with at least one cycle of sequential therapy with subcutaneous cytarabine and oral 6-mercaptopurine were further assessed. The total number of patients diagnosed during the study period was 33. Patients were divided into two groups: patients who did not get any chemotherapy (

Cotton is the most important cash crop in Pakistan and cotton products export account for 55 percent of all foreign exchange earnings of the country. Nearly 26 percent of farmers grow cot-ton, and over 15 percent of total cultivated area is devoted to this crop, with production pri-marily in two provinces. Approximately 65 percent of Pakistan’s cotton is grown in Punjab, which has dry conditions, and the rest is grown in Sindh, which has a more humid climate, with negligible area under cotton in Khyber Pakhtunkhwa and Balochistan. Cotton production ac-counts for 4.5 percent of the value added in AgGDP and 0.8 per cent of GDP. It serves as the raw material for the textile industry, the country’s largest agro-industrial sector , employs 17 per-cent, earns 60 percent of foreign exchange and contributes 8.5 percent to GDP.

Balochistan’s agriculture and related economic development during the last four decades has been driven by an enhancement in canal command areas and widespread use of tubewells. While it enabled yield increases and the growth of high value horticulture, it led to excessive mining of ground water. It is not only threatening sustainable agriculture and livelihoods but also creating severe environmental repercussions. It is generally believed that this unchecked groundwater extraction has been a result of policy regime, such as promoting installation of tubewells through various incentive schemes and tubewells subsidy which allows farmers to pay only 5-10% of the actual cost, and as a result the Federal and provincial governments have been paying PKR 23 billion per year.

In this paper three dimensional nonlinear finite element analysis is performed for the optimization of an overhead crane box girder for capacity (50~120ton) and span (10 ~ 32 m) for safe bending stress and deflection with minimum mass and volume. A customized optimization code is developed using interpolative relations and correction factors to achieve optimized results with and without considering industrial constraints. A cutting and welding plan is developed to provide a standard operating procedure for the manufacturing of the box girder. Bill of materials, box girder design dimensions, and cutting and welding lengths are recorded with considerable time saving. ABSTRAK: Kertas ini mengkaji tentang analisis tidak linear tiga dimensi unsur terhingga bagi mengoptimumkan kotak kren galang atas kepala bagi kapasiti (50 ~ 120 tan) dan pada kadar (10 ~ 32 m) bagi takat lentur selamat dan pesongan dengan jisim minimum dan isipadu. Kod optimum penyesuaian telah direka mengguna pakai kaitan interpolatif dan faktor-faktor pembetulan bagi mencapai keputusan yang optimum, dengan dan tanpa mengambil kira kekangan industri. Pelan pemotongan dan kimpalan telah dicipta bagi menyediakan prosedur operasi biasa bagi pembuatan kotak galang. Rang undang-undang bahan, dimensi reka bentuk kotak galang, pemotongan dan panjang kimpalan telah direkodkan dengan penjimatan masa yang besar.

The Water-Energy Nexus is gaining considerable interest with growing environmental concerns, especially in developing countries such as Pakistan that are now under a state of water stress. Thermal power plants consume large amounts of freshwater, thereby making their water usage optimization immensely important. For potential repowering featuring reduced cooling water consumption, a clear understanding of the influence of key condenser parameters on the power plant is required. This study investigates a degraded combined cycle gas turbine power plant for reduced cooling water usage from a repowering perspective. The degraded power plant under consideration draws 13% more freshwater for recirculation-based cooling from a canal linked with the River Indus in Pakistan. The power plant has been modeled using 120 h of real-time probabilistic data at baseload by generating three study cases stemming from 24-hour parametric variations. The commercial tool Cycle-Tempo has been deployed for modeling and simulating the power plant performance with the incorporation of physical uncertainties and errors originating from the measurement sensors. The model is validated and compared with the 23 years old design case data to highlight the degradations via an exergy analysis. A tri-parametric optimization is later performed to reduce the cooling water consumption through specialized performance maps that relate exergy, low-pressure section steam turbine performance, and condenser performance to highlight potential repowering opportunities while retaining the baseload performance. The optimized cases result in approximately 9.5–11.0% lesser water consumption in terms of mass flow rate while retaining the baseload performance and key heat recovery steam generator operating points.

Sustainable management of canal water through optimum water allocation is the need of the modern world due to the rapid rise in water demand and climatic variations. The present research was conducted at the Chaj Doab, Indus Basin Irrigation System (IBIS) of Pakistan, using the WEAP (Water Evaluation and Planning) model. Six different scenarios were developed, and the results showed that the current available surface water is not sufficient to meet crop water demands. The Lower Jhelum Canal (LJC) command area is more sensitive to water scarcity than the Upper Jhelum Canal (UJC). The future (up to 2070) climate change scenarios for RCP 4.5 and 8.5 showed a decrease in catchment reliability up to 26.80 and 26.28% for UJC as well as 27.56 and 27.31% for LJC catchment, respectively. We concluded that scenario 3 (irrigation efficiency improvement through implementation of a high efficiency irrigation system, canal lining, reduction and replacement of high delta crops with low delta crops) was sufficient to reduce the canal water deficit in order to optimize canal water allocation. Improvement in the irrigation system and cropping area should be optimized for efficient canal water management.

This paper presents design of aerodynamic downforce generating devices (front wing, rear wing and diffuser) to enhance the performance of the Formula Student Race Car using numerical and experimental studies. Numerical results using computational fluid dynamics (CFD) studies were primarily validated with the experimental results performed in the wind tunnel. It was concluded that the use of a downforce package can enhance the performance of the vehicle in the competition.

Objective: The main aim of the project is to control the home and the industrial equipment from a distant place by using the raspberry pi through android application and also through a web server. Methodology: Controlling of the equipment from a remote place is done through both android application and web server. Based on the type of equipment, different types of sensors are interfaced to raspberry pi. Each sensor senses the surroundings and gives the data to raspberry pi. Then processor displays the sensor data in web server and android application, based on which user will control the equipment. Findings/Improvements: In this system, the data is updated for every pulse and if the sensor exceeds the threshold value, automatically user receives the SMS using Global System for Mobile Communication GSM module. Then the user can login to either the application or web server and control the equipment. Application/Improvements: The main advantage of this project from the already existing work is that the application is logged out automatically and the user need not logged into the application continuously. Whenever the sensor exceeds the threshold value, user gets the alert message then only he need to login to the android application or web server and control the required equipment.

Background Psychological distress, defined as depression, anxiety and perceived stress, during pregnancy is common, with 15–25% of women experiencing clinically significant levels of such distress. Despite the far-reaching impact of prenatal psychological distress on mothers and their children, and that women are receptive to screening, few providers routinely screen for prenatal psychological distress and less than one in five women will receive the mental health care that they require. There is a lack of certainty regarding the most effective treatments for prenatal psychological distress. No online interpersonal psychotherapy (IPT) trials have been conducted that focus on improving psychological distress in prenatal women. The purpose of this pilot randomized controlled trial is to evaluate the perspectives of pregnant women on the feasibility and acceptability of online IPT (e-IPT) delivered during pregnancy. Methods A pilot randomized controlled trial design with repeated measures will evaluate the feasibility and acceptability of e-IPT for pregnant women compared to routine prenatal care. Qualitative interviews with 15–30 individuals in the intervention group will provide further data on the feasibility and acceptability of the intervention. Assessment of feasibility will include the ease of accessing and completing the intervention. Women will also be asked about what barriers there were to starting and completing the e-IPT. Assessment of acceptability will inquire about the perception of women regarding the intervention and its various features. A sample size of 160 consenting pregnant women aged 18 years and older will be enrolled and randomized into the experimental (e-IPT) or control (routine care) condition. The secondary outcome measures include: depression, anxiety and stress symptoms; self-efficacy; self-mastery; self-esteem; relationship quality (spouse, immediate family members); coping; and resilience. All participants will complete the aforementioned measures at baseline during pregnancy (T1), 3 months postrandomization (T2), at 8 months of pregnancy (T3), and 3 months postpartum (T4). Discussion The results of this pilot randomized controlled trial will provide data on the feasibility and acceptability of the intervention and identify necessary adaptations. This study will allow for optimization of full trial processes and inform the evaluation strategy, including sample size calculations for the full randomized controlled trial. Trial registration ClinicalTrials.gov, NCT01901796. Registered on 18 December 2014.

Background Maternal mental health problems contributes significantly to perinatal morbidities and extend beyond the perinatal period for some women. Drawing data from a population-based study this paper aimed to: 1) identify patterns of maternal psychological distress spanning ten years following the birth of a baby, and 2) identify psychosocial risk factors in the first postnatal year for trajectories of elevated psychological distress. Methodology A secondary analysis was conducted using data from 4875 mothers participating in the Longitudinal Study of Australian Children. The Kessler-6 assessed maternal psychological distress symptoms when the child was 0–12 months, 2–3 years, 4–5 years, 6–7 years, 8–9 years and 10–11 years. Longitudinal latent class analyses (LCA) was conducted to identify patterns of psychological distress. Latent class membership was assigned and used in subsequent regression analyses to identify predictors of each trajectory. Results LCA identified five distinct trajectories of maternal psychological distress symptoms over time. Predictors of trajectories with elevated symptoms reflected a pattern of social and economic disadvantage and psychosocial stress. The strongest predictors of elevated mental health symptoms were a history of depression [OR: 7.57(4.73–12.11)] and 3 or more stressful life events in the past year [OR: 3.38(2.02–5.65)]. Limitations The assessment of maternal mental health and child health was based on brief self-report measures and mothers from lower socioeconomic and diverse cultural backgrounds were underrepresented. Conclusions These findings underscore the importance of early diagnosis and treatment of women at risk of mental health problems in the postnatal period and early years of parenting.

Background Interpersonal psychotherapy (IPT) is an intervention that has established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of well-being. There is limited data regarding factors that moderate and mediate the effectiveness of IPT including the timing of the intervention or the mode of delivery of IPT intervention. The objective of this systematic review and meta-analysis is to evaluate the effectiveness, feasibility, and acceptability of IPT interventions to treat perinatal psychological distress and to summarize the evidence on predictors, mediators, and moderators of IPT. Methods We will include peer-reviewed studies that recruited perinatal women. The search strategy will involve the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO), and Scopus. Study inclusion criteria include (1) randomized controlled trials, quasi-experimental studies, and pre-post studies that evaluated the effectiveness of IPT; (2) qualitative studies that evaluated feasibility and acceptability of IPT; (3) study sample included and analyzed perinatal women; and (4) publication language was English. Using pilot-tested screening and data extraction forms, two reviewers will independently review studies in three steps: (1) abstract/title screening, (2) full-text screening of potentially accepted studies, and (3) data extraction of accepted studies. Disagreements will be resolved by a third reviewer. Studies will be aggregated for meta-synthesis and meta-analysis should the data allow for this. Two independent reviewers will grade methodological quality. Discussion Findings from this review will inform future development and implementation of IPT intervention research for perinatal women. Identifying key factors of successful IPT interventions will inform intervention design and adaptation of IPT interventions to increase the likelihood that perinatal women will engage in and benefit from IPT interventions. This review will also identify key considerations for increasing the effectiveness of IPT interventions during the perinatal period. Systematic review registration PROSPERO CRD42019114292

Background As mental healthcare expands to web-apps, smartphones, and other technologies, it is important to understand the psychological profiles of women who self-select to participate in perinatal mental health digital platform randomized control trials. There are concerns that those seeking internet-based mental health treatments may not be representative of the general perinatal populations seeking face-to-face treatments resulting in a lack of generalizability. The aim of this study is to describe the demographic and psychological profiles of prenatal women seeking treatment over the internet for mental health concerns as compared to the general perinatal population seeking mental health treatments. Methods This was a descriptive study involving pregnant women across Alberta, Canada, aged 18–47 years old. Profiles were collected through self-report baseline demographics and mental health information using the Edinburgh Postnatal Depression Scale (EPDS), Antenatal Risk Questionnaire (ANRQ), Depression Anxiety Stress Scale (DASS-21)- Anxiety and Stress Subscales, and Maclean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Results A total of 887 women completed self-reported baseline demographic data and 590 women completed baseline mental health data. Mean age of women was 31.3 years with a mean pregnancy gestational age of 15.3 weeks). A history of depression was reported by 36.3%, a history of anxiety was reported by 20.8% of women, and a history of abuse and emotional abuse was reported in 27.7% and 23.5% of women. At baseline, 57.6% of women had clinically significant mental health risk scores, 24.3% of women had probable minor depression, and mild to moderate levels of anxiety were reported in 23.2% of women. Borderline personality disorder was reported by 12.5% of women. Conclusions Overall, this sample of pregnant women has prevalence rates of depression, anxiety, and stress that are comparable to those rates found in pregnant women in the general population. This suggests that there is broad utility for and consumer interest in internet-based mental health treatments.

This paper presents results of detailed nonlinear finite element analysis of gasketed bolted flange pipe joints of different sizes (1, 4, 5, 6, 8, 10, 20 in.) of 900# pressure class for achieving proper preload close to the target stress values with and without considering yielding at bolt and flange and gasket crushing recommended by ASME and industrial guidelines for optimized performance using customized optimization algorithm. In addition, two strategies torque control method and stretch control method are used which is a normal practice in the industry.

Democracy is government of people. In democratic states people choose their leaders to make government to lead the country and political parties connect with the people with the help of mass media. The present study conducted in southern Punjab Pakistan to know about the relationship of media and political parties in the term of strengthening democracy. The study conducted under the light of "Agenda Setting Theory". Survey methodology was used to collect the data from the target public. The results showed that media and political parties have strong relation to promote democracy. Moreover, media and political parties monitor each other so that no one could cross its limit according to responsibilities.

Background: Interpersonal psychotherapy (IPT) is a psychological intervention with established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of wellbeing. There is limited information regarding moderating and mediating factors that impact the effectiveness of IPT such as the timing of the intervention or the mode of delivery of IPT intervention. The overall objective of this systematic review was to evaluate the effectiveness of IPT interventions to treat perinatal (from pregnancy up to 12 months postpartum) psychological distress. Methods: MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), CINAHL with Full Text (Ebsco), Social Work Abstracts (Ebsco), SocINDEX with Full Text (Ebsco), Academic Search Complete (Ebsco), Family & Society Studies Worldwide (Ebsco), Family Studies Abstracts (Ebsco), and Scopus databases were searched from inception until 31 January 2019. Two researchers independently screened articles for eligibility. Of the 685 screened articles, 43 met the inclusion criteria. The search was re-run on 11 May 2020. An additional 204 articles were screened and two met the inclusion criteria, resulting in a total of 45 studies included in this review. There were 25 Randomized Controlled Trials, 10 Quasi-experimental studies, eight Open Trials, and two Single Case Studies. All included studies were critically appraised for quality. Results: In most studies (n = 24, 53%), the IPT intervention was delivered individually; in 17 (38%) studies IPT was delivered in a group setting and two (4%) studies delivered the intervention as a combination of group and individual IPT. Most interventions were initiated during pregnancy (n = 27, 60%), with the remaining 18 (40%) studies initiating interventions during the postpartum period. Limitations: This review included only English-language articles and peer-reviewed literature. It excluded government reports, dissertations, conference papers, and reviews. This limited the access to grassroots or community-based recruitment and retention strategies that may have been used to target smaller or marginalized groups of perinatal women. Conclusions: IPT is an effective intervention for the prevention and treatment of psychological distress in women during their pregnancy and postpartum period. As a treatment intervention, IPT is effective in significantly reducing symptoms of depression and anxiety as well as improving social support, relationship quality/satisfaction, and adjustment. Systematic Review Registration: PROSPERO CRD42019114292.

In this paper the strength and sealing performance of a gasketed bolted flanged pipe joint is studied under bolt up and combined operating conditions using 3D nonlinear finite element analysis. The key combinations of internal pressure, axial and thermal loading are considered. The strength of the joint is seen to be affected by the axial and thermal loading combination whereas the joint sealing is seen to be dependent on the bolt up strategy during assembly and is slightly affected under pressure but only partially affected under axial loading in certain locations. Thermal loading was also considered and was found to have a significant effect on the sealing performance up to 100 °C, but beyond that no sealing was observed, resulting in the possibility of leakage and hence increasing the risk of overall joint failure. Finally, the joint load capacities are determined under various combined loadings showing its safe and unsafe operational limits.

Background Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors. Methods We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors. Results 1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant. Conclusion These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development.

Background Existing literature on the impact of the course of maternal distress symptoms in the perinatal period and beyond has mainly focused on one source of distress (e.g., anxiety or depression) and only selected aspects of child development. This study examined the relative impact of trajectories of maternal depression, anxiety, and stress symptoms from mid-pregnancy to early childhood on child communication, gross motor, fine motor, problem solving, and personal social development at three years of age. Methods Data were analyzed from 1983 mother-child dyads who participated in the three-year follow-up of the All Our Families (AOF) study. Maternal distress and child development across five domains were measured using validated tools. Latent class analysis (LCA) was conducted to identify trajectories of maternal distress over time. Multivariable logistic regression was used to explore the relationship between the trajectories and child development while adjusting for the covariates. Results At age three years, 5.2% of children were at risk communication delay; 12.7% for gross motor delay; 15.4% for fine motor delay; 11.2 for problem solving delay; and 5.6% for personal-social delay on ASQ-3 domains. Multivariable analysis showed children born to mothers with persistent high anxiety symptoms from pregnancy to 3-years postpartum had an increased risk of delays in communication and personal-social domains. Limitations The use of self-reported maternal mental health symptoms and maternal reported child development are the study limitations. Conclusions The impact of high levels of maternal anxiety symptoms on the increased risk of child developmental delay in communication and personal-social domains highlights the importance of early intervention and addressing maternal anxiety from pregnancy through early childhood.

In 21st century fast convenient and reliable access to the internet, the commodity management and online shopping have attracted various industries. Gravestone-which is relatively uncommon as compared to other commodities is used by various Christian and Muslim societies as a headstone in cemeteries for their deceased ones as memorials. In this paper, a gravestone design and ordering application based on PHP, jQuery and MVC framework have been designed and developed with MySQL database. This system not only efficiently helps managers to manage various stone types, their colors, sizes availability information and various frames for selected sizes but also allows customers to design the headstone for their beloved ones. The system allows them to input the details for the deceased person and to choose the design, style, font, and place for the text elements over selected stone. This paper also explains how MVC framework is implemented in the system and jQuery is employed to meet customer design needs. System data modeling and access techniques are also discussed. Developed system has been utilized in a granite company and actual operation has exhibited that the presented designer and shopping application is stable, efficient and safe.

Orange, which is most cultivated fruit in the world, is commonly used in food processing industries to prepare juice, marmalades, and orange pulp. With modern computer vision techniques, manual sorting of fruits is being replaced with automated low cost and consistent approach. This paper presents a mean for distinguishing orange condition (ripe, unripe and scaled or rotten) rapidly. Fruit image features including RGB color space and gray values based on BIC (Border/Interior pixel Classification) are extracted. An investigation for the applicability and performance of various classification algorithms including Naive Bayes, Artificial Neural Network, and Decision Tree has been performed. Comparisons among results of these algorithms have been drawn and it has been observed that Decision Tree classification technique for orange conditions is efficient than other techniques. The results recorded for the accuracy, precision, and sensitivity using this technique are 93.13%, 93.45%, and 93.24% respectively.

This paper presents a prototype of projectile launcher based on GPS which is controlled by android. Projectile launcher involves the launching of an object at a specified point in the area of range of system. North identification can be accomplished using a sensor known as reed switch. The coordinates of targets and that of the system are obtained from the GPS of the system or through android application installed in cellular phone. The azimuth angle is controlled by the stepper motor while the elevation angle is set by the linear actuator attached with the system. Object is thrown at the target with the help of compressed air. To insure the security of system, a login activity is added so that access of any unauthorized person can be denied.

Background Childhood obesity has become a global epidemic irrespective of the socioeconomic status of a country or nation. Obesity increases the risk of various diseases in children, for example asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems. The existing literature informs us of the many factors associated with childhood obesity. Among these factors, maternal mental health has been found to be a strong predictor. Maternal mental health programs were implemented to address the issue of childhood obesity but with little or no improvement. It suggests systematically reviewing the literature to assess the contents of these programs and carrying out meta-analysis for the overall effect of these interventions. Methods The studies included in this review will be experimental designs such as randomized controlled trials (RCTs) which provide information on interventions to improve maternal mental health and its effects on childhood obesity. We plan to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Scopus, and Web of Science with no restrictions as to language. Reference lists of the selected articles will also be searched for additional articles. The Cochrane EPOC Risk of Bias Tool will be used to assess the quality of studies. If the studies lend themselves to a statistical analysis, we will also carry out a meta-analysis. Discussion This review will help determine the effect of maternal health improvement programs on childhood obesity. These findings, in turn, will guide the research community on the development of related programs in the future. Systematic review registration PROSPERO: CRD42017072737. Electronic supplementary material The online version of this article (10.1186/s13643-018-0798-2) contains supplementary material, which is available to authorized users.

This research paper attempts to evaluate the consumer rights and their violation by electronic media through advertisement. This is misguiding the consumer to buy harmful and unnecessary products. This research also aims at interpolating and ascertaining the onus of responsibility of a responsible media with regards to advertising. In the recent past the principle of "Caveat Emptor" which meant "Buyers beware" governed the relationship between a seller and buyer. In the era of open markets the buyer and seller came face to face, seller exhibited his goods, and buyer thoroughly examined them and then purchased them. The assumption would be consumer would use all his care and skill while entering into a transaction. The buyer to examine the goods beforehand and most of the transactions are now concluded by correspondence. Discussion on consumer's rights and their violation by media through advertisements is suggestive that consumers today enjoy a good amount of legal protection. But, even today, a large number of us remain exploited.