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Purpose To define the burden of morbidity and mortality arising from COVID-19 in individuals with primary (PID) and secondary immunodeficiency (SID) in the United Kingdom. Methods In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. Anonymised demographic data, pre-SARS-CoV-2 infection lymphocyte counts, co-morbidities, targeted treatments and outcomes were collected. Three groups were analysed in further detail: individuals with common variable immunodeficiency (CVID), individuals with any PID, including CVID, receiving immunoglobulin replacement therapy (IgRT) and individuals with secondary immunodeficiency. Results A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID, had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Conclusion Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count and the presence of co-morbidities are additional risk factors for poor outcome in this cohort.

PurposeThe effect of empowering leadership on knowledge sharing is well defined, but factors that stimulate employees for knowledge sharing are still limited. Therefore, this study aims to address to what extent empowering leadership is desirable to create a trustful and fair environment that is conducive for an employee’s knowledge sharing.Design/methodology/approachThrough integration of social exchange, equity and uncertainty management theories develop a moderating mediating model that links empowering leadership to knowledge sharing. Three-wave data collection from the sample of 375 managers–subordinates’ dyads was done in Pakistan textile industries.FindingsHierarchal regression analysis and bootstrapping method were applied to test the hypotheses. The results indicate that affective trust partially mediates the relationship between empowering leadership and knowledge sharing. More especially, the findings demonstrate that the relationship between empowering leadership and knowledge sharing becomes strong with high level of distributive and procedural justices.Practical implicationsThis research study uses empowering leadership as a proposed motivational pathway for stimulating employee’s knowledge sharing through development of affective trust and buffering effect of distributive and procedural justices.Originality/valueMost of previous research in knowledge sharing just cynosure organizational-level elements like leadership and organizational justices but deteriorate individual factors like trust. Therefore, this study will combine both organizational- and individual-level factors for urging employees for knowledge sharing.

We report radiatively coupled arrayed gold nanodisks on invisible substrate (AGNIS) as a cost-effective, high-performance platform for nanoplasmonic biosensing. By substrate undercut, the electric field distribution around the nanodisks has been restored to as if the nanodisks were surrounded by a single medium, thereby provides analyte accessibility to otherwise buried enhanced electric field. The AGNIS substrate has been fabricated by wafer-scale nanosphere lithography without the need for costly lithography. The LSPR blue-shifting behavior synergistically contributed by radiative coupling and substrate undercut have been investigated for the first time, which culminates in a remarkable refractive index sensitivity increase from 207 nm/RIU to 578 nm/RIU. The synergy also improves surface sensitivity to monolayer neutravidin-biotin binding from 7.4 nm to 20.3 nm with the limit of detection (LOD) of neutravidin at 50 fM, which is among the best label-free results reported to date on this specific surface binding reaction. As a potential cancer diagnostic application, extracellular vesicles such as exosomes excreted by cancer and normal cells were measured with a LOD within 112–600 (exosomes/ $\mu \text{L}$ ), which would be sufficient in many clinical applications. Using CD9, CD63, and CD81 antibodies, label-free profiling has shown increased expression of all three surface antigens in cancer-derived exosomes. This work demonstrates, for the first time, strong synergy of arrayed radiative coupling and substrate undercut can enable economical, ultrasensitive biosensing in the visible light spectrum where high-quality, low-cost silicon detectors are readily available for point-of-care applications.

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e.

Background: Stroke is a generic term in use to describe the sudden interruption of blood flow to the part of brain, resulting loss of brain function. A stroke may be also known as cerebrovascular accident. Cerebrovascular accident which defines as pathology in which brain disease occurs secondary to disorders of blood supply of brain. It is essential to know about the magnitude of impact of stroke globally. Aim: To determine effectiveness of constraint induced movement therapy and comparing its efficacy to traditional rehabilitation in acute and sub-acute stroke survivors exhibiting upper limb hemiplegia Methodology: This was a randomized clinical trial study, conducted in Lahore in which eighteen stroke patients had participated. Current study includes MAL and WMFT questionnaire in it and sample size was 18. Patients were treated 4 times a week and unaffected limb was constrained for two hours in therapy session and onwards to 10 hours to motivate the use of effected limb. Readings were taken weekly and patients were reassessed by using MAL and WMFT. CIMT treatment protocol consists of 3 or 4 month of daily intensive training of the affected extremity for 2 hours in association with restriction of the non-affected extremity for 10 hours a day. Group B: Traditional rehabilitation therapy used Sling (shoulder immobilizer) made of poly urethane material. Hair brush, cup, marbles, cards, blocks, tissue paper, cones, Swiss ball, dexterity board. Results: Statistical analysis was set at p ≤ 0.05. huge and direct to vast impacts existed on WMFT (P=0.010) noteworthy and direct to extensive impacts existed When p-value is not as much as the foreordained importance level which is frequently 0.05 or 0.01, showing that the watched results would be profoundly impossible under the alternate theory. In this way, the alternate hypothesis was supported. Subsequently null hypothesis is rejected and alternate hypothesis is accepted. Conclusion: This study concluded that the patients who were treated with CIMT showed remarkable change in upper extremity functions. While patients who were treated with traditional rehabilitation therapy they exhibited less change in their functional activities than Constraint-Induced Movement Therapy. Keywords: Comparison, traditional rehabilitation therapy, Constraint-Induced Movement Therapy (CIMT) Approaches

Objectives: To compare the perinatal outcome (low birth weight, preterm delivery) in women with 28 weeks assessed on LMP were selected for this study. Patients were divided into two groups (A & B) according to their inter-pregnancy interval i.e.

In recent times, Wireless Sensor Network (WSN) technology has received significant attention owing to its numerous applications in various mission critical services, such as healthcare, military monitoring, public safety systems, and forest monitoring. However, sensor node’s low computational power and inadequate advancements in battery design hinder resource-rigorous applications from fully exploiting WSN capabilities. The trend of shifting computations and storage to remote clouds offers the opportunity to integrate WSNs into the cloud to mitigate their limitations. The Sensor Cloud augments WSN capabilities of remote sensing and monitoring while exploiting resource-rich cloud infrastructure. To date, numerous solutions have been proposed to handle the integration concerns of WSNs with the cloud. However, a comprehensive study that covers various Sensor Cloud aspects in terms of architecture, network dynamics, heterogeneity, communication patterns, data management, and security, is still lacking. To fill this gap, state-of-the-art sensor cloud integration frameworks are analyzed in this article. Moreover, a detailed thematic taxonomy is presented to classify existing sensor cloud frameworks while focusing in service oriented and client server architectures. Related features and critical aspects of existing frameworks are inspected through a qualitative analysis based on the parameters selected from the literature and extracted from the taxonomy. Several research opportunities in this research domain are suggested to assist researchers in identifying and designing optimal resource sensor cloud integration frameworks to host emerging applications.

Chronic obstructive lung disease (COPD), predominantly emphysema, causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters. A 12-lead electrocardiogram (ECG), which is often a part of routine evaluation in most clinical settings, may serve as a useful screening modality for diagnosis of COPD or emphysema. Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database. Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool. Verticalization of P-vector, changes in QRS duration, pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes. In conclusion, 12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema. An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.

Background: Stroke is a universal health care disease, the important cause of long time disability in world. Stroke leads to an inactive living, physical restrictions, and not good physical levels, which are related with common post-stroke participation limits. Aerobic capability and walking ability are decreased in old chronic patients of stroke. Aim: To determine the effects of treadmill training and stationary cycling training to improve ambulatory function and cardiovascular fitness in hemiparetic stroke patients Methods: 54 chronic stroke patients were allocated to treadmill training group(n=27) or stationary cycle exercise group (n=27). All participants received conventional physical therapy along with treadmill or stationary cycle training. The 10MWT was conducted to measure gait function and 6 min walk test was used to measure cardiovascular health. Results: The mean of treadmill group for 10 meter walk test is 10.01 + 15.48. The mean of stationary cycle group for 10 meter walk test is 9.80 + 6.77. The mean of treadmill group for 6 min walk test is 22.04+ 17.45. The mean of stationary cycle group for 6 min walk test is 23.20+ 22.92. The p value of 0.000 shows significant difference. This significant difference reflects that both interventions show equal improvement in participants. There is significant difference between pre and post treatment values of both interventions. Both intervention groups displayed significant effect in ambulatory functions and cardiovascular fitness. The results between groups were non significant, it means both interventions showed equal effect but results with in groups were significant. Conclusion: The study showed that treadmill training and stationary cycling training equally enhanced the gait ability and cardiovascular health of chronic stroke patients. Therefore, these exercises could be used to enhance walking and cardiovascular health in management of stroke. Keywords: treadmill training, stationary cycle training, ambulatory function, cardiovascular fitness, stroke

Stem cell technology is demonstrating promising advancements in cure of diseases due its differentiation ability. Type 1 diabetes is mainly caused by autoimmune ? cells destruction. In this review, we focus on treatment procedures of Type 1 Diabetes (T1D) with numerous stem cells (SCs) i.e hPSCs, MSCs, hESCs, BMSCs, AFSCs, HSCs and islet cells (that are not stem cells but they are approved worldwide and are being successfully used to permanently reverse T1D). A brief overview of this disease along with the advancements in treatment of T1D with stem cells is discussed. Biomaterial encapsulation to avoid immune rejection and improved immunomodulation and immune tolerance via drugs /bioengineering techniques makes the outcomes of SC therapies more efficient and productive, hence, proving to be another future milestone of completely reversing type 1 diabetes especially in those patients who got clinically diagnosed at an early stage and then received prompt treatment of either restoration of already available ? cells functionality or transplantation of purified and functional SCs differentiated insulin producing cells to normalize the glycemic control and homeostasis. Keywords: Type 1 Diabetes, ?-cells, Stem cells, Biomaterial

Real-time object detection and segmentation are considered as one of the fundamental but challenging problems in remote sensing and surveillance applications (including satellite and aerial). Consequently, it performs a crucial role in various management and monitoring applications and has received notable attention in recent years. This paper aims to present a real-time, efficient system in which a deep learning-based model U-Net is explored for multiple object segmentation in aerial drone images. We perform data augmentation and apply transfer learning to enhance the model efficiency. We experimented U-Net segmentation model with different base architectures, including VGG 16, ResNet-50, and MobileNet, and compare their performance. We also compare the results U-Net segmentation model with different base architectures and concludes that the U-Net (MobileNet) achieves good results. The experimental results demonstrate that data augmentation improves the model’s performance by achieving a segmentation accuracy of 92%, 93%, and 95% with base architectures VGG-16, ResNet-50, and MobileNet, respectively.

This study aims to describe the effectiveness of static fluid module based on local wisdom in the wetlands environment. This study is a research and development study and uses the 4D model modified. The effectiveness of the module is measured using a learning outcome test. The subjects of this study were sixty grade XI students from two public high schools in Banjarmasin city. The result of the analysis showed that the effectiveness of teaching materials have a medium category. The result indicates that the static fluid module based on local wisdom in the wetland environment is effective so that they can be used in the learning process in the classroom, at the high school level.

Background: Maturing is followed by slow physiological changes in body structures, such as decreases in muscle strength, movement speed, response time, and changes in equilibrium and integumentary systems. Deftness is constantly compromised by maturing procedure. Aim: To determine effects of circuit training on vestibular dysfunction in geriatric population Methods: This research included 34 participants with age ranges from 50 to 85. All the participants were divided into two groups. Participants were assessed pre and post treatment by using modified CTSIB, DHI and Fukuda test. Group A received Cawthorne & Cooksey protocol. The standardized protocol consists of 4 steps that include specific exercises carried out during lying, sitting position, position of standing and walking state. These exercises were undertaken during the following 12 weeks until the end of the intervention. Results: Modified CTSIB pretreatment mean±SD for conventional group was 93.64± 20.709 and post treatment was 80.35± 30.211. On the other hand, pretreatment mean±SD for treatment group was 96.07± 15.349 and post treatment was 79.47± 25.169. Pretreatment P.value for CTSIB is .166 and of post treatment is .466 (P= > .05). DHI pretreatment mean±SD of conventional group was 41.41± 22.25 and post treatment was 20.0± 12.74. Pretreatment mean±SD of treatment group was 38.7± 22.404 and post treatment was 19.8± 16.501. Conclusion: Conventional treatment and circuit training both are equally effective for the rehabilitation of vestibular dysfunctions. However, according to the P.value (P=

Pleural and pericardial involvements are well recognized in eosinophilic granulomatosis with polyangiitis (EGPA) but considered rare manifestations of the other forms of antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV).What are the frequency and clinical characteristics of pleuritis and pericarditis in AAV?and Methods: Using an institutional database of 1,830 patients with AAV, we analyzed clinical notes and diagnosis codes for key words related to pleuritis and pericarditis. Chart review to confirm these findings was performed.Eighty-eight of 1,058 patients (8.3%) with granulomatosis with polyangiitis (GPA), 27 of 267 (10.1%) with microscopic polyangiitis (MPA), and 35 of 201 (17.4%) with EGPA had a manifestation of pleuritis and/or pericarditis attributable to vasculitis. There was a higher frequency of pericarditis in EGPA compared with that in the other AAVs (P .01). There was no difference in the frequency of pleuritis in GPA, MPA, or EGPA. In the 156 patients with AAV with pleuritis and/or pericarditis, this was a presenting feature in 127 (81.4%). Overall, it was a presenting feature in 6.9% of all patients with AAV, including 6.5% with GPA, 8.6% with MPA, and 15.9% with EGPA.Pleuritis and pericarditis occur across all the AAVs and, when present, are commonly presenting features of these diseases. Patients with EGPA have a higher proportion of pericardial involvement compared with pleural involvement, whereas this distribution is more equal in patients with GPA and MPA. Pleuritis and pericarditis are underrecognized features of AAV. All forms of AAV should be considered in the differential diagnosis when evaluating a patient with pleuritis or pericarditis.

Continuous increase in the population of the world along with multiple nutrient deficiencies and poor water use efficiency offers a challenging scenario for agriculture sector to meet the increasing demand of food. Use of organic amendments like biochar and compost has been suggested as a novel approach for restoration of degraded soil further improving crop productivity and water productivity. Thus here, we have reviewed the publications on individual and combined application of biochar and compost to find out the potential role of these amendments in agriculture sector. We have concluded that (1) data on well-designed field studies and long-term effect of biochar and compost is limited; (2) traditional methods have been adopted for production of biochar and compost; and (3) biochar and compost have the potential to enhance soil fertility, crop production and water productivity with reduced environmental impacts. Furthermore, combined application of biochar and compost found to be more effective as compared to sole application of these amendments. This review article will play a dynamic role for scientists to conduct research to evaluate these ecological fertilizers best suited for soils, which will be helpful to reduce the chances of soil degradation caused by application of unsuitable amendments. Application of amendments not suitable for a soil may increase the demand of synthetic fertilizers thus making it uneconomical for farmers. Thus, it is suggested for the scientists and policy makers to make a great collaboration to implement this promising technology worldwide.

Power consumption of wellbore drilling in oil and gas exploitations count for 40% of total costs, hence power saving of WBM (water-based mud) by adding different concentrations of Al2O3, TiO2 and SiO2 nanoparticles is investigated here. A high-speed Taylor–Couette system (TCS) was devised to operate at speeds 0–1600 RPM to simulate power consumption of wellbore drilling using nanofluids in laminar to turbulent flow conditions. The TCS control unit uses several sensors to record current, voltage and rotational speed and Arduino microprocessors to process outputs including rheological properties and power consumption. Total power consumption of the TCS was correlated with a second-order polynomial function of rotational speed for different nanofluids, and the correlated parameters were found using an optimization technique. For the first time, energy saving of three nanofluids at four low volume concentrations 0.05, 0.1, 0.5 and 1% is investigated in the TCS simulating wellbore drilling operation. It is interesting to observe that the lower concentration nanofluids (0.05%) have better power savings. In average, for the lower concentration nanofluids (0.05%), power was saved by 39%, 30% and 26% for TiO2, Al2O3 and SiO2 WBM nanofluids, respectively. TiO2 nanofluids have better power saving at lower concentrations of 0.05 and 0.1%, while Al2O3 nanofluids have saved more power at higher concentrations of 0.5 and 1.0% compared with their counterpart nanofluids.

This paper compares the contemporary myth of Eurydice by Sarah Ruhl with the Greek mythology of Orpheus, drawing on Julia Kristeva’s theory of intertextuality and Carl G. Jung’s concepts about myth. According to Julia Kristeva, the term “intertextuality” refers to interpreting the meanings of literary texts in the light of other texts. This paper reveals the comparabilities between Eurydice and the Greek mythology “Orpheus.” Both stories share some features like aspects of character and ways of narrating while it differs with regard to the plot and images. The main focus of this study is to shed light on parallels, additions and their functions. The playwright uses the Greek myth to represent modern hero myth in a male dominated culture. It deals with love, loss, death and reminiscence. The play deals with incompatible notions such as forgetfulness, memory, happiness, grief, the real world, the underworld, despair, hope, uncertainty and faith. The study shows that the playwright uses a classical myth about two lovers to put into focus father/daughter relationship. This asserts that some old myths are timeless, and each generation is capable of reinventing and reproducing them. Moreover, modern generation can create its modern hero myth to ennoble its heroes and idealize their experiences.

Objectives To review the data of infants and children with suspected monogenic diabetes who underwent genetic testing. Methods Monogenic diabetes is a rare form of diabetes resulting from mutations in a single gene. It can be caused by dominant as well as recessive modes of inheritance. In a country like Pakistan where interfamily marriages are common the incidence of genetic disorders is increased. As Pakistan a resource-poor country, the diagnosis of insulin-dependent diabetes is often delayed and a genetic diagnosis of monogenic diabetes is extremely difficult. Children with clinical diagnosis of monogenic and syndromic diabates were recruited and blood samples were sent for genetic analysis. Results One thousand sixty four new cases diagnosed with type 1 diabetes were registered at the National Institute of Child Health, Karachi, in the last 10 years. Of these 39 patients were selected for genetic testing who were diagnosed with diabetes/had a sibling diagnosed with diabetes before the age of nine months (n = 27) or had extra pancreatic features ( n= 12). We identified mutations in 18/27 cases diagnosed with diabetes before nine months of age. The most common genetic subtype was WolcottRallison syndrome caused by EIF2AK3 mutations (seven cases). KCNJ11 mutations were identified in two cases, ABCC8mutations were identified in four cases from three families, GCK and INS mutations were each identified in two cases, and one SLC2A2 mutation was identified in one case. A genetic diagnosis was made in 12/12 children from six families with diabetes diagnosed after the age of nine months who had extrapancreatic features. Six patients had genetically confirmed Wolfram syndrome (WFS1), three had thiamine-responsive megaloblastic anemia (SLC19A2) and three were diagnosed with histocytosis lymphadenopathy plus syndrome (SLC29A3). Conclusions Genetic testing is essential to confirm a diagnosis of monogenic diabetes which guides clinical management and future counselling. Our study highlights the importance of diagnosing monogenic diabetes in the largely consanguineously-married population of Pakistan.

The accumulation of toxic substances involving the inorganic and organic contaminants in the soil is a global problem. Status of the World's Soil Resources Report (SWSR) recognized soil pollution as one of the main reasons affecting global soils and the ecosystem services provided by them. However, transgenic approaches utilizing the biodegradation capabilities of microbes and mammals into plants pledge an efficient and eco-friendly approach to renewing the environment. An effective method of phytoremediation involves an enhanced rate of pollutant uptake by the plant, followed by the detoxification of the chemicals absorbed or translocated. It also involves the production of genetically modified herbicide-resistant plants for herbicide remediation and exploits the principles of biotechnology and molecular biology for the introduction and improvement of potentially superior genes into plants. This review discusses the various transgenic approaches involved in the phytoremediation of persistent organic pollutants, metals, metalloids, and explosives. Besides, it also focuses on the limitations of transgenics and provides an insight into the future potential of emerging biotechnological tools and techniques in this field.

This paper aims to find out the extent to which organizational culture and intellectual capital influence the textile industry’s business performance in Pakistan. The study uses causal and explanatory research design. Several 200 textile industry employees participated in this survey, selected as the study sample using the purposive sampling technique. The study detects that both organizational and intellectual capital directly impact the textile firms’ business performance. However, the impact of intellectual capital on business performance is more substantial than that of organizational culture. The mediating effect of technological innovation in the relationship between organizational culture and business performance is also supported. The study can be used by the textile industry managers to set up policies on how to improve business performance in the textile firms. The study also fills the literature gap as prior studies do not have worked on the mediating aspect of technological innovation.

This study was aimed to investigate the relationship between the psychological status of oral health care workers (OHCWs) and the willingness to treat a patient during the COVID-19 pandemic. This cross-sectional study was carried out on oral health care workers at ten different dental hospitals in Pakistan from March to July 2020. Information on the socio-demographic status, and willingness to report for duty and treat patients during the COVID-19 pandemic were assessed using a self-administered questionnaire. The psychological impact of the COVID-19 pandemic was assessed using the Urdu version of the Generalized Anxiety Disorder Scale and Impact of Events Scale. Simple and multiple linear regression tests were used for analysis. A total of 392 OHCWs participated in this study and 25% of them had moderate to severe anxiety levels and only 14% had post-traumatic stress disorder. About 26% of the OHCWs were willing to work and treat patients during the COVID-19 pandemic and they had lower anxiety and stress scores. Greater anxiety and stress were associated with participants who were older, female, single, married, living with family and friends. The adjusted coefficients of GAD and IES scores were greater in participants who were not willing and unsure to work compared to their colleagues who were willing. The OHCWs are anxious and stressed because of the COVID-19 outbreak and that affects the perception of whether they should work and treat patients during the pandemic. © 2021 KBCSM, Zagreb.

PurposeThis study divulges the new concept of employees' withdrawal behavior during the global pandemic (COVID-19). The study's purpose is to draw new insights into workplace stressors and employee withdrawal behavior. The study also considers the mediating role of aggression and the moderating role of COVID-19 worry and cyberloafing.Design/methodology/approachThe study's statistical population consists of 384 frontline hotel employees from Pakistan's hospitality industry. Statistical analysis SPSS and AMOS were utilized to conduct Pearson's correlation and multilevel regression analysis. A Hayes process technique has been used for moderation and mediation analysis.FindingsThe results demonstrated that COVID-19 has a psychological effect on the employee's mental health and higher turnover intention during the current pandemic. Workplace stressor is significantly related to aggression and employee withdrawal behavior. Aggression mediates the relationship between workplace stressors and withdrawal behavior. The study results show that COVID-19 worry moderates between workplace stressors and aggression – notably, cyberloafing moderate aggression and withdrawal behavior.Practical implicationsThe government and hospitality organizations need to implement crisis management strategies in response to COVID-19. This research can help management in coping with employees' mental and psychological challenges. Employees' mental health has been affected during the current global health crises. Firms should encourage their employees psychologically while going for downsizing.Originality/valueThis study enhances the existing literature on the COVID-19 crisis in Pakistan's hospitality industry. This study contributes to new understandings of employees' withdrawal behavior in the hospitality industry. The research shows how COVID-19 affects employees' turnover, mental health and job performance in the hospitality industry. Employees are facing mental and physiological challenges during COVID-19. The study fills a considerable gap in the hospitality industry by exploring the role organization's crisis management during a global pandemic.

Purpose: To determine knowledge regarding hypertension, adherence to medication and HealthRelated Quality of Life (HRQoL), and their associations in hypertensive patients in Pakistan. Methods: A cross-sectional study was conducted among 384 hypertensive patients attending a tertiary health care public sector hospital in Islamabad, Pakistan. Data were collected using knowledge questionnaire regarding hypertension, Morisky Medication Adherence Scale, and EuroQol (EQ-5D) scale. Results: The mean systolic and diastolic blood pressures of the 384 patients were 140.39 ± 15.485 and 88.74 ± 10.683 mmHg, respectively. The coefficient of correlation between knowledge regarding hypertension and adherence was 0.638 (p < 0.001), showing a positive association. The correlation coefficient between knowledge and HRQoL was 0.709 (p < 0.001), suggesting a good association. The correlation coefficient between adherence to medication and HRQoL was 0.545 (p < 0.001), which indicated a positive correlation. Conclusion: These results indicate that there are statistically significant associations between hypertension knowledge and HRQoL, hypertension knowledge and medication adherence, and between adherence and HRQoL in the hypertensive patients studied.

Many businesses worldwide are badly affected due to the COVID-19 outbreak. As the Covid-19 pandemic spreads around the world, business person should create new business methods during this socio-economic, cultural, and health crisis. How to address the future is another critical question for businesses. Although the pandemic has affected businesses in different profound ways due to the various social, cultural, economic, and environmental factors, experience sharing and learning from successful businesses can help policymakers and business leaders to come up with innovative and effective strategies to minimize the adverse impact of the pandemic on the business operation. The study aims to determine how Covid-19 affected the fast food industry in Malaysia. Due to the Movement Control Order (MCO), all Malaysians are required to stay at home. The data of this study was collected through primary data and secondary data. The surveys using online Google form was conducted as primary data to gain more information regarding the topic. There are as many as 100 customers were surveyed. The results showed the fast food industry sustained operations and they adopted digitalization technologies. Digital technologies have influenced fast food restaurant strategies during the global pandemic, while technology may enable digital transformation, fast food restaurants are rapid to match the changes. Digitization opens new possibilities for fast food restaurants to sustain their business. With digital infrastructures in place like mobile devices, Wi-Fi networks, and online payment systems, it brings convenience to both business and customers. Deepening digitization has helped fast food restaurants to become more customer centric.

Microscopic examination of peripheral blood smears and bone marrow is the preliminary step for the diagnosis of several life-threatening diseases. Acute lymphocytic leukemia (ALL) is the most common disease in children that also needs an early diagnosis for on-time treatment as it spreads rapidly in the blood and forms immature lymphocytes. This might cause death in some weeks if left untreated. Manual methods in clinical laboratory being applied for the diagnosis of these diseases are inefficient and expensive, and the results are less accurate. A computer-aided system is the need of the day in which the most important step is segmenting the region of interest in blood or bone marrow for the detection and cure of the diseases which is the most challenging task. This study aims to propose a simple threshold-based segmentation technique by processing the S component of the HSV color space to segment the lymphoblasts in the bone marrow images of ALL patients. The technique was applied to 230 RGB bone marrow images having all the three types of ALL, i.e., L1, L2, and L3 resulted in the overall accuracy of 96.8%.

Objective: The study was conducted to assess the maternal health related quality of life and its affecting factors in postpartum period. Study Design: Analytical cross-sectional study. Place and Duration of Study: The study was done in a tertiary care hospital, Rawalpindi, from Mar to Jun 2019.Methodology: By using non-probability purposive sampling technique, sample of 268 women in post-partum period were interviewed. A validated short form-36 (SF-36) Questionnaire was administered to women aged 15-49 years, who had spontaneous vaginal delivery or cesarean section, and were within six weeks up to six months of postpartum period. Data was analyzed by using SPSS-22. A p-value of ≤0.05 was taken as significant. Results: Highest median scores were reported in physical functioning 75 (55, 90) and social functioning 75 (75, 62). Lowest median scores were reported in energy fatigue 37 (31, 50) body pain 45 (22, 62) and general health 45 (30, 60). Health-related quality of life scores showed significant difference (p-value

Internet of things (IoT) is transforming technological evolution in several practical applications. These applications range from smart cities, smart healthcare to intelligent video surveillance, where the primary interest is person monitoring and detection. The amalgamation of Artificial Intelligence (AI) and IoT-based techniques maintain a balance between computational cost and efficiency that is essential for next-generation IoT networks. In this context, a real-time IoT-enabled people detection system is introduced. The developed system performs image processing task over the cloud using an internet connection, thus reduces the computational cost by processing high-resolution images over the cloud. For person detection, a pre-trained Cascade RCNN, a deep learning approach is used. It is an object detection architecture, seeks to address discrediting performance with increased Intersection over Union (IoU) thresholds. As the architecture is pre-trained with COCO data set and the person body’s appearance in overhead perspective is significantly different; thus, additional training is performed to enhance the detection results. Taking advantage of transfer learning architecture is trained for overhead person images, and the newly trained feature layer is added to the existing architecture. Experimental outcomes reveal that additional training increases the detection architecture’s performance with an accuracy rate of 0.96.

Objective: To determine the Efficacy of probiotic (saccharomyces boulardii) in children (2 months to 5 years) with acute watery diarrhea. Study Design: Comparative cross sectional study. Place and Duration of Study: This study was carried out in the department of pediatrics, Combined Military Hospital, Quetta, from Jan 2017 to Jun 2018. Methodology: All children (2 months to 5 years) with acute watery diarrhea presenting within 24 hour of illness with no dehydration and some dehydration were enrolled and divided into two groups, study group and control group. Efficacy was assessed by reduced frequency of stools(less than 3 per day) and duration during the study period. Results: Mean age of the children in probiotic saccharomyces boulardii group was 3.42 ± 1.36 years, while mean age in control group was 3.91 ± 1.16 years (p-value 0.002). Significant difference was also observed in duration of stool and frequency of stool at day 1-5 (p-value

Background: Double coronary culprit lesions in ST-segment elevation myocardial infarction (STEMI) is uncommon. Despite successful primary percutaneous coronary intervention (PPCI) in all culprit lesions, the clinical outcome remains unfavorable and the possible factors for the outcome are not fully understood.Cases Presentation: We reported four cases of double culprit lesions STEMI underwent PPCI. Patient A, a 62 y.o. male with extensive anterior-inferior STEMI, had total occlusion (TO) at both proximal left anterior descending (LAD) and mid right coronary artery (RCA). Patient B, a 42 y.o. male with extensive anterior-inferior STEMI, had subtotal occlusion (STO) at proximal RCA and TO at proximal LAD. Both of them had RBBB ECG pattern. Patient C, a 67 y.o. male with inferior STEMI had 90% thrombus occlusion at proximal–mid LAD and TO at proximal RCA. Patient D, a 65 y.o. male with anteroseptal STEMI, had STO at proximal LAD and 80% thrombus occlusion at mid left circumflex. The cardiomyocyte infarction biomarkers increased in all patients. Although all of them underwent successful PPCI in all of culprit lesions, they suffered from acute heart failure and two of them experienced recurrent ventricular arrhythmia episodes. One of them (patient A) died two days post PPCI. He was only patient who suffering from total occlusion in LAD and RCA with TIMI thrombus 5 and experienced a total atrioventricular block post-PPCI.Conclusion: STEMI with coronary double culprits have severe clinical outcome, regardless of the successful PCI. The degree of coronary occlusions might be linked to the patient clinical outcome.

The paper aimed to examine part of mentors in the primary schools under the eyes of key stakeholders, the teachers of primary schools (TPSs). This study was carried out in one major district of the Punjab Province. The mixed-methods approach was used to meet the objectives of the study. The population of the research work was all TPSs in the district under study. The study sample was comprised of 1127 TPSs selected through random sampling in layers. Quantitative data was collected on a self-developed structured questionnaire while qualitative data was taken through semi-structured interview protocols from the 32 participants by convenient sampling. Descriptive statistics was employed for analyzing the data through qualitative analytical techniques for the explanation of qualitative data. The results of this research work explored most of the mentoring services of the District teacher educators’ were unsatisfactory. The authoritative behavior, less attention towards instructing, and lack of confidence were the key issues of coaching and mentoring. The results of this research work can be supportive in improving the current practices of the mentors for better results of the CPD framework.

Current work reports the fabrication of cadmium, cobalt and cobalt doped cadmium semiconductor chalcogenide [Cd-(dtc)2 [dtc = dithiocarbmate], Co-(dtc)2, and Co:Cd-(dtc)2] complexes using iso-propylammonium dithiocarbamate precursor grown into thin films via physical vapor deposition (PVD) for the first time. Cubic crystals having 18 nm of average size were revealed via X-ray diffraction. Varied molecular arrangements and bonding types were disclosed by Fourier transform infrared spectroscopy. Bandgap tailoring was done by doping leading to a broadening in bandgap i.e., 3.72, and 3.5 eV direct and indirect bandgaps, respectively through ultra-violet visible spectrophotometry. PVD grown thin films indicated formation of clusters and irregular structures between the gaps and voids of micro-grains shown by field emission scanning electron microscopy. Rutherford back scattering spectroscopy expressed the remarkable thickness i.e., 615 nm with stronger signals for Cd, Co and S elements. Furthermore, the electrochemical analysis of the pristine and doped chalcogenide thin films done via cyclic, linear sweep voltammetry and chronoamperometry elucidated the excellent photo-response and functional stability and confirmed the potential of these films as future candidates for multitudinous photovoltaic and optoelectronic devices especially the utilization of [Co:Cd-(dtc)2]/SnO2 thin films in solar cell devices is expected to yield higher through put potentials and photo-currents if sandwiched between the active absorber layer and photo-electrodes.

Background: Patient centered approach is the cornerstone in health care facility. Therefore, patient satisfaction is of utmost importance. Factors related to satisfaction of patient in connection with physiotherapy practice are not evaluated. The purpose of this retrospective survey was to evaluate satisfaction of patient receiving physiotherapy for their musculoskeletal disorders at Helping Hand institute of Rehabilitation sciences Khyber Pakhtoon Khawa Mansehra, Pakistan Methods: A retrospective survey of 200 male and female patients in the range of 18 to 80 years old was conducted in 2019 for the patient who had availed the services between 2017 and 2018. These patients were recruited through simple random sampling only to refrain from biasness. Keeping in mind the requirement of this survey the Med Risk Instrument Patient Satisfaction questionnaire was modified and was translated in Urdu. Results: The retrospective survey of 200 patients of a median age 46 with musculoskeletal conditions 46. According to the survey among the abovementioned recipients 67% were with the opinion of highly satisfied with the way they have been facilitated and 32% of recipient fall under the term moderate satisfaction. With P-value

Environmental degradation has put significant consequences at both the national and global levels. Economic development and ecological sustainability can be achieved by an increase in economic growth but on the cost of environmental quality. The basic aim of this analysis is to find the existence of the aviation Kuznets curve (AKC) and the environmental Kuznets curve (EKC) for the selected 21 OECD nations from 1980 to 2018. The aviation cargo and aviation passengers’ patterns are separately analyzed in relation to CO2 emissions to quantify whether Kuznets phenomenon exists in the aviation industry of OECD nations? The econometric results of panel GMM confirm the validation of the aviation Kuznets curve in case of aviation passengers such that the “inverted U shaped” pattern. While the environmental Kuznets curve and aviation cargo Kuznets curve do not exist in the OECD nation. It means that an increase in aviation cargo and economic growth increases the CO2 emissions showing the “U shaped” association. Moreover, the Pairwise Dumitrescu Hurlin panel causality test exhibits uni–directional association moving from economic growth to carbon emissions, while there is bidirectional granger causality among trade openness, aviation sector, and energy consumption to carbon emissions. The overall results suggest that OECD nations must consider the pollution reduction techniques, investment in renewable sources, continuous research, implementation of efficient energy sources, and the imposition of aviation emissions taxes to limit the pollution.

Fasciolosis is a cosmopolitan parasitic disorder cause great economic decline in cattle and buffaloes in terms of poor carcasses quality decrease in meat and milk production, malfunctioning of livers and weight loss. This research work was carried out in district Bagh, Azad Jammu and Kashmir, Pakistan, extending from December 2016 to May 2017. During this study 200 fecal sample from Buffaloes (Bablus bubalis) of the study area were collected, it was found that 40 percent fecal samples contain eggs of Fasciola hepatica and 60 percent fecal samples were negative. Liver samples of slaughtered buffaloes were also examined during study period and it was found that 74 samples have faciola, out of 200 samples, so 37 per cent samples contain F. hepatica and 63 per cent buffaloes liver samples were negative. It was observed that 19.25% animals of the area have parasites in their body, which are causing economic losses to the owners, in the form of less production of milk and meat and more mortality among the livestock and damages to farmers.

Objective To assess the impact of emollient therapy on gain in weight and length among preterm and low birth weight babies. Study design Randomised controlled trial. Place and duration of study Department of Pediatric Medicine, KEMU / Mayo Hospital Lahore, from January till June 2018. Methodology Infants with birth weight between 1.5 and 2.5 Kgs or preterm neonates born between 28 and 37 completed weeks of gestation were included in the study. Neonates with genetic syndrome, infection or with a history of admission in NICU due to any reason, were excluded. They were randomly divided into two groups-A and B, by lottery method. Mothers of the neonates in group A were advised massage with sunflower oil; while mothers of the neonates in group B were advised massage without any emollient. Babies were closely followed up and their weight and length were measured at two months of age and were analysed using SPSS version 23.0. Results For 140 neonates, the mean increase in weight was 489.84 ± 297.48 grams among group-A neonates (emollient therapy group) and it was 373.43 ± 276.31 grams among group-B neonates (p = 0.018). The mean increase in length was 6.5 ± 1.1 cm, among group-A neonates and 4.8 ± 1.3 cm in group-B neonates (p ˂0.001). Conclusion: Massage with emollient therapy leads to significantly more increase in weight and length compared to massage alone, among preterm and low birth weight neonates. Emollient therapy is an effective non-pharmacological intervention for increasing weight and length in low birth weight and preterm neonates. Key Words: Emollient, Massage, Low birth weight, Preterm neonates, Weight, Length.

During this short term study a total of 110 samples were collected from the selected individuals of study area. This study was aimed to count the White blood cells in the blood samples of individuals, who were mostly exposed to exhaust fumes (air pollution), like traffic constables, cooks and shopkeepers. For this purpose blood samples were taken into an evacuee container having anticoagulant Ethylene diamine tetra-acetic acid (EDTA) so to prevent coagulation of blood, for the count of WBCs, heamocyto-meter was used. During the study the body mass index and blood pressure was also measured by digital blood pressure measuring apparatus. Samples were observed under the microscope. It was found that 15% (13,133±2544.081) sampled individuals had increased WBCs and 85% (7821±1482.76) normal WBCs. In female samples 50% (11900±2151.27) were observed with above range of WBCs and other 50% (8540±844.39) with normal range of WBCs count, non-had WBCs count lower than the normal WBCs. Mostly had normal and few had above the range. One way ANOVA has been used to analyze connection of exposure to air pollution with counts of circulating white blood cells.

Aim: To compare the effect of isometrics, isotonic concentric and isotonic eccentric strengthening techniques on patients diagnosed with subacromial impingement syndrome. Methods: The study design used is randomized clinical trial. 36 patients are allocated in 3 groups with 12 patients in each group with age limit from 30-50 years treated for 6 weeks on alternate days with isometrics, isotonic concentric and isotonic eccentric with baseline exercise plan respectively. Each patient received 18 sessions of exercise plan. Intervention plan is divided into 2 phases, with each phase of 3 weeks. Outcome measuring tools used are Numeric Pain Rating Scale(NPRS) to measure pain, Manual Muscle Testing (MMT) to measure muscle strength was assessed at Day 0, Week3, and Week 6. Result: Results are generated by using SPSS 21. Post treatment ONE WAY ANOVA showed no significant difference in reduction of pain assessed by NPRS in GROUP1 treated with isometric exercise plan and GROUP2 & GROUP3 treated with isotonic eccentric and isotonic concentric exercise plan respectively. Post treatment One way anova showed p value .117 which is greater than 0.05. Post treatment ONE WAY ANOVA showed significant difference for strength of all the rotator cuff muscles. Conclusion: Isometric exercise plan conclusively proved to be better as compared to isotonic eccentric and isotonic concentric program in strengthening of patients with subacromial impingement syndrome. Keywords: Subacromial Impingement Syndrome, Isometric, Isotonic Eccentric, Isotonic Concentric.

Background: Over the last few years, there are two major problems identified during organ transplantation such as surgical restrictions and transplant rejections. Few of these obstacles have been partially removed such as the use of immunosuppressant improved it consistently while decreasing graft rejection up to 12.2%. Methods: This study was conducted from 2019-2021. In all patients renal function was examined through glomerular filtration rate. Induction therapy was given to all the transplant recipients. Induction therapy with basiliximab 20mg intravenously on 0 and 4 days. After transplantation tacrolimus and MMF was given with varied concentration dose. Acute rejections were found in patients who had no biopsy or biopsy-proven rejection. In the end, clinical pathologists had analyzed all biopsies again and recipients who were experienced the vascular Banff grade 2 and tubule interstitial rejection. Results: Immunosuppressant tacrolimus treated patients were 71(67.61%) and mycophenolate mofetil used in 34(32.38%). Total 39(37.14%) rejections were received and 66(62.85%) acceptance was recorded. Two types of rejection were highlighted namely cell-mediated rejection 25(23.80%) and 14(13.33%) chronic antibody-mediated rejection. The effect of tacrolimus on follicular helper T cells and follicular regulatory T cells shows the clear difference between the kidney transplant and healthy control cells. Reduction in numbers of follicular regulatory T cells was measured in patients. Conclusion: eventually we find tacrolimus significantly affects the number of follicular regulatory T-cells and follicular helper T cells. Alemtuzumab substantially lowers the follicular regulatory T-cells. Mycophenolate mofetil showed non-significant on T-cells. Keywords: kidney transplant, follicular regulatory T-cells, follicular helper T-cells.

Background: Heavy amounts of menstrual blood loss regularly in three or more consecutive cycles are characterized as menorrhagia which has been shown to be present among in many peri-menopausal and premenopausal women. Aim: To determine the frequency of patients’ satisfaction with TBA for the treatment of intractable menorrhagia. Methods: This descriptive study was undertaken in Department of Obstetrics and Gynecology, Lady Wallington Hospital Lahore from January to July 2017. A sample size of 200 patients was calculated and informed consent was taken to fill predesigned Performa. Prophylactic dose of 1g Ceftriaxon antibiotic was administered and Foly’s catheters were placed simultaneously in uterine cavity of patients after curettage and dilations. The uterine balloon catheter was then entered into the uterus and balloon was filled with sterile fluid. Results: A high number of 157(78.5%) women were found to be satisfied with thermal balloon ablation while different age groups presented an insignificant difference on level of satisfaction. Level of education and BMI had insignificant difference (p >0.05) while a significant difference (p6 months as compared to short duration of 3-6 months. Conclusion: Thermal balloon ablation is the method of choice for treatment of women suffering from menorrhagia and high number of patients revealed their trust on this method. Keywords: Menorrhagia, Dysmenorrhea, Blooding, Satisfaction, Endometrium.

Lead (Pb) is an abundant and one of the most lethal metals found in the earth’s crust. Its use by humans dates back to thousands of year. Even the low doses of lead are responsible for the production of reactive oxygen species which leads to oxidative load. This oxidative stress mitigates production of malondialdehyde (MDA) and down regulates antioxidant enzyme superoxide dismutase (SOD). Study Design: Quasi experimental Study. Place and duration of study: Department of Biochemistry, ANMCH, Islamabad, Pakistan in collaboration with NIH, Islamabad from November, 2018 to April, 2019. Methodology: A total of 40 BALB/c mice were divided into two groups of 20 mice each. Group  was given normal standard diet. Group  was given lead acetate in drinking water with normal diet without any supplementation. Levels of malondialdehyde were measured by using Thiobarbituric acid reactive substances (TBARS) and Superoxide Dismutase (SOD) was estimated by xanthine oxidase method at the end of study. Results: The results of our study showed increase in MDA and decrease in SOD in lead treated group when compared with the control group. Pearson correlation was applied to assess the degree of association between two parameters, it showed significant negative correlation with value of r = -0.96 and p-value of 0.001 Conclusion: It was concluded from our study that increase in MDA leads to decrease in SOD indicating strong negative correlation in lead poisoned mice. Key words: Lead poisoning, Malondialdehyde, Oxidative Stress, Superoxide Dismutase

Introduction: This study was aimed to determine the common causes of hoarseness of voice in ENT OPD of a military hospital. Materials and Methods: This was an observational study carried out on 93 patients presented with hoarseness of voice in ENT OPD CMH Momenshahi, a peripheral military hospital, for a period of 2 years, from 1st April 2017 to 30th April 2019. Only Fiber Optic Laryngoscopy (FOL) findings were evaluated to diagnose the causes of hoarseness. Data were obtained from FOL findings documentation register. All data were analyzed using IBM SPSS version 25.0. Patients consent was taken. Results: Total 93 cases were studied irrespective of age and sex. Among them 34 (36.60%) were males and 59 (63.40%) were females. Commonly affected age group was 21-30 years. With a mean age of 33.34 years. Majority of the cases were housewife 44 (44.10%). The most common cause of hoarseness was Chronic Laryngitis 25 (26.9%). The other causes were vocal polyp 17 (18.30%), VC nodule 13 (14%), Incomplete Glottal closure 14 (18.30%), leukoplakia of VC 5 (5.40%) and Vocal cord palsy 3 (3.20%). Normal findings were found in 11 (11.80%) cases. Conclusion: Hoarseness is a common symptom of laryngeal dysfunction. Military personnel are frequently affected like general population. Common causes are almost same with a very few variations. FOL should be the basic tool to diagnose the causes of hoarseness. Medicine Today 2021 Vol.33(1): 34-37

Background: There is a global spread of Corona Virus Disease (COVID-19) with Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) being identified as the causative organism. This pandemic has infected over 53 million people globally causing over 1.3 million deaths resulting in lockdowns being implemented across many countries in the world. Global travel has been severely restricted especially in the early phase with far reaching social, economic and emotional implications. In addition to local measures undertaken by each country to curtail the spread of the disease, many countries implemented entry restriction on flights to reduce the risk of importing the disease by potentially infected incoming travellers. The State of Qatar eased travel restrictions from 1st of September 2020 (Phase IV of reopening of pandemic restrictions) [1]. Incoming travellers from high risk countries had to have a mandatory COVID-19 Naso-Oropharyngeal swab negative result before boarding their flight to Qatar. Then they had to commit to two weeks of compulsory quarantine. Travellers from low risk countries had to be swabbed at Hamad international airport on arrival, followed by a week’s mandatory home quarantine. All travellers had to have COVID-19 RT-PCR nasooropharyngeal swab on day 6 after arrival in Qatar. Method: We looked at the data provided by Ministry of Public Health (MOPH), Qatar from 1st of September to 30th of November. This was retrospective observational study looking at the prevalence of COVID positivity of return travellers as compared to the total positive cases in the country [1]. Results: In our review, out of a total of 19,909 COVID-19 positive cases, 2692 were incoming travellers which amounts to about 14 % of total COVID positive cases in Qatar. It was also noted that with each passing day, the ratio of incoming traveller’s in comparison to the total cases have been increasing, with figures of 9% in September 2020 as compared to 21% in November 2020. Conclusion: This figure clearly shows how important it is to screen all return travellers for COVID-19 as travellers are generally asymptomatic and could potentially spread the disease in the local community. All countries should consider implementing similar policies to reduce the risks of importing COVID-19.

PurposeThis paper aims to investigate the influence of supervisor's ethical leadership style on subordinates' green or pro-environmental work behavior in the presence of green human resource management (GHRM) as a mediator and environmental knowledge as a moderator.Design/methodology/approachA questionnaire-based was distributed to 427 supervisor–subordinate dyads working in various Pakistani organizations. Structural equation modeling was used to determine the mechanisms and boundary conditions in the relationship between supervisor's ethical leadership style and subordinates' green behavior.FindingsStructural equation modeling supported a partial mediating role of GHRM in the influence of ethical leadership on green work behavior. Further, the findings revealed that employee's environmental knowledge can magnify the indirect impact of ethical leadership, via GHRM, on green behavior.Research limitations/implicationsCross-sectional survey data are typically associated with common method bias. To counter this bias, we collected data from dual sources, namely, supervisors and their subordinates. The research findings have implications in deepening the understanding of the impact of ethical leadership in improving environmental performance of the organization.Originality/valueThis is the first study that utilizes multi-sourced data to examine the mediating role of GHRM and the moderating role of environmental knowledge in the relationship between ethical leadership and green behavior at work.

Objectives: The objective of the study was to determine the effects of static exercise program verses Swiss ball training for core muscles of the lower back and pelvic region in patients with low back pain after child delivery. Methods: This was a prospective single blind randomized control trial conducted on a sample of 30 patients with low back pain from March 2018to December 2018. Patients were divided into 2 groups through seal envelop method i.e. static core exercises group (n=15) and Swiss ball training group (n=15). The outcome measures used for this study were numeric pain rating scale (NPRS), Oswestry disability index (ODI), goniometry and Core stability assessment scale. Data was analyzed by SPSS 21. Results: The mean age of patients in static core exercises group was 28.38 ± 4.8 years and mean age of Swiss Ball training group was 29.57 ± 3.3 years. Between group analysis showed non-significant difference whereas within group analysis showed significant improvement at post intervention. Conclusions: Both groups showed significant difference in reduction of pain (NPRS), in disability level due to LBP (ODI), better ROM flexion/extension of lumbar and achieving better strength at core stability assessment scale (CSA). These findings suggest that both exercise protocols are equally effective in rehabilitation of postpartum low back pain. Keywords: low back pain Postpartum Swiss ball training Static Continuous...

To assess host factors in pneumocystis jirovecii pneumonia (PCP)-related hospitalizations and compare outcomes between HIV and non-HIV patients.Using the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP.Among all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P.001) and endotracheal intubation (17.0% vs 7.9%, P.001), prolonged hospitalizations (11.5 vs 8.7 days, P.001), higher hospitalization costs (86.8 vs 48.2×10The epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients.

Background In Great Britain, 100,000 injuries due to slips, trips and falls on the level (as opposed to falls from a height, e.g. a ladder) occur in the workplace each year. They are the most common cause of non-fatal injury in the workplace, accounting for 30% of all those injuries reported to the Health and Safety Executive. Nearly 1 million working days are lost because of slips, trips and falls each year. Objectives To assess the clinical effectiveness and cost-effectiveness of 5-star, GRIP-rated, slip-resistant footwear in preventing slips in the workplace compared with usual footwear. Design A two-arm, multicentre, randomised controlled trial with an economic evaluation and qualitative study. Setting Seven NHS trusts in England. Participants NHS staff aged ≥ 18 years, working at least 22.5 hours per week in clinical, general or catering areas who owned a mobile phone. Staff required to wear protective footwear were excluded. Interventions Intervention participants were offered 5-star, GRIP-rated, slip-resistant footwear. The waiting list control group were asked to wear their usual work shoes for the duration of the study and were offered the trial footwear at the end of their participation. Main outcome measures The primary outcome was the incidence rate of self-reported slips in the workplace over 14 weeks. Secondary outcomes included the incidence rate of falls either resulting from a slip or not resulting from a slip, proportion of participants reporting a slip, fall or fracture, time to first slip and fall, health-related quality of life and cost-effectiveness. Results A total of 4553 eligible NHS staff were randomised (2275 to the intervention arm and 2278 to the control arm). In total, 6743 slips were reported [2633 in the intervention group (mean 1.16 per participant, range 0–36 per participant) and 4110 in the control group (mean 1.80 per participant, range 0–83 per participant)]. There was a statistically significant reduction in the slip rate in the intervention group relative to the control group (incidence rate ratio 0.63, 95% confidence interval 0.57 to 0.70; p p = 0.03), the proportion of participants who reported a slip (odds ratio 0.58, 95% confidence interval 0.50 to 0.66; p p = 0.04) and the time to first slip (hazard ratio 0.73, 95% confidence interval 0.67 to 0.80; p Limitations This was an unblinded trial in which outcome data were participant self-reported, which may have led to inaccuracies in the reported slip data. Exposure to the trial footwear was lower than hoped. Conclusions The offer and provision of 5-star, GRIP-rated footwear reduced slips in the workplace, was acceptable to participants and could be cost-effective. Future work Replication of the study within other settings may be required to evaluate the clinical effectiveness and cost-effectiveness in other environments settings, such as catering and factories. Trial registration Current Controlled Trials ISRCTN33051393. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 3. See the NIHR Public Journals Library website for further project information. The Health and Safety Executive provided some research costs.

Background RCTs that have shown improvement in coefficient of fat absorption with pancreatic enzyme replacement therapy (PERT) have seldom evaluated the impact on overall nutritional status. Objective In this study we evaluated factors responsible for persistence of malnutrition after PERT. Methods In this cross-sectional observational study, patients were enrolled based on predefined enrolment criteria. Patients were divided into those taking PERT regularly (Group A), irregularly (Group B) and not taking (Group C) for at least 3 months. Comprehensive evaluation of anthropometric measurements, nutritional assessment and dietary intake was performed. Malnutrition was measured using the Subjective Global Assessment (SGA) tool. Relationship between PERT status, dietary intake and nutritional status were evaluated using standard statistical methods. Logistic regression was performed to identify factors associated with persistence of malnutrition after PERT. Results 377 patients with CP and 50 controls were included. 95 (25.2%) patients with CP were in Group A, 106 (28.1%) in Group B and 176 (46.7%) in Group C. 130 (34.5%) patients were malnourished, of which 76 (58.5%) were continuing PERT. There were no differences in clinical and biochemical nutritional markers between Groups A, B, and C. Calorie deficit and daily intake of calorie, protein, carbohydrates and fats were not different between those with and without PERT, but was significantly less in those with malnutrition. Logistic regression demonstrated inadequate dietary intake as independent risk factor for persistence of malnutrition. Conclusion Even though PERT is effective in PEI, comprehensive nutritional assessment, personalized nutritional counselling and therapy along with PERT is mandatory.

The novel coronavirus has disrupted the normal life of each individual with masks becoming an integral part of life. Mostly every person is well informed about the precautions that need to be taken for the containment of the virus such as regular hand washing, wearing of masks in outdoors, social distancing, etc. Yet there has been little reference to the deleterious habit of smoking that can weigh heavily on one's health. This article aims to look into the connection and intricacies of smoking that may directly or indirectly affect the severity of the symptoms of COVID-19. Smoking is already a known etiologic factor for many cardiovascular and pulmonary diseases such as Chronic Obstructive Pulmonary Disease (COPD), coronary artery disease, carcinoma of the lungs, etc. While COVID-19 is a virus that causes respiratory distress in severe cases, not much is known or emphasized in the medical field of its possible relationship with smoking. Our information is limited to whether the presence of smoking history in infected patients worsens the condition or there is no relationship between smoking and COVID-19. Moreover, with the introduction of lockdown as a measure to contain the virus, it substantially increases the incidence of anxiety, depression and other mental health diseases which can contribute tremendously to the relapses of smoking or convert a non-smoker to a smoker. Hence, it is imperative to look into the possible relationship of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) and smoking.