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

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

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

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

Epidemiology and scale management has been an ongoing project of governments worldwide, including India, focusing on reducing the spread of the virus and reducing the social and financial damage caused by the virus. With the closure of health infrastructure and outbreaks affecting health care workers, there is a need for a cooperative approach to the management of Covid-19 and greater involvement of public enterprises to lead government efforts to control the epidemic. The latest digital technology plays an essential role in monitoring the situation closely, assisting the government, and utilizing high-risk public organizations. Diplomacy—whether regular or non-digital—is affected: seminars and seminars are transmitted to Zoom and various video platforms; governments and international organizations have worked closely with social media, digital technology, and content boards to combat the information that is not in line with COVID-19; foreign policy actors in public and private sectors who have tried to meet new audiences, each online and offline.

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

Salim Ahmad is considered to be the most controversial critic in the history of Urdu criticism. His creative criticism opened a new dimension of discussion. We can disagree with his thoughts but his questions cannot be denied. He also raised many questions on the thought of Iqbal in his book “Iqbal ak shair”. At the same time he also expressed his critical views on Meer,Ghalib,Hali and Akbar Alabadi. Akbar influenced his views about the revival of old muslim’s civilization.This article is the comparative study of the thought of Akbar Alabdi and Iqbal about free Muslim’s state to safeguard Muslim’s civilization.

This abstract describes the enormous advantages of redesigning existing microbial life in the Labs which will carry additional instructions not only to clean up our environmental pollution, but also to produce new food, new fuel, and new medicine to treat every disease known to mankind. Using the toolkit of genetic engineering developed during the completion of the Human Genome Project, we will manipulate microbial life in which we will splice essential amino acid codons in most consumable food such as Corn, Wheat and Rice Genomes to produce the most nutritious food for the bourgeoning population of the world. Similarly, new fuel could be produced by an organism called Methanococcus Jannachil which thrives near high temperature high pressure hydrothermal vents at the bottom of the sea floor by converting Carbon dioxide (a pollutant) to Methane (a fuel). To produce at the industrial scale, in plant genomes, we will splice not only the genes of herbal medicine (such as Artemisinin, Taxol, Reserpine, Belladonna etc.) to produce well-known herbal medicine, but also will insert genes to produce large scale antibiotics (such as Penicillin, Streptomycin, Neomycin, Kanamycin, Paromomycin, Apramycin, Tobramycin, Amikacin, Netilmicin, Gentamicin etc.). At every step of the transgenic genomes, we will confirm the spliced novel genes by using cheaper and faster nanopore gene sequencer. Current speed of developments guarantees humanity’s future survival across the Universe long before our Sun dies

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

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

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

Aim: Incidence of Heparin Resistance after preoperative heparin therapy in patients undergoing open heart surgery. Methods: The Prospective Observational study included 124 patients of different heart diseases undergoing open heart surgery, at cardiac surgery department of Punjab Institute of Cardiology; Lahore Pakistan was performed between 5th October 2013 to 16 March 2014. Both genders age 18-75 were included. All those patients who present with diseases other than heart diseases, age 75 were excluded in the study. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. P-value ≤ 0.05 were considered significant. Results: Our results showed that out of 124 patients, 87(70.16%) were male while 37(29.84%) were females. Clinical characteristics i.e. (hypertension, diabetes mellitus, emergency bypass, smoking, alcohol intake, hyperlipidemias, obesity and family history) were insignificantly associated with heparin resistance. The clinical characteristics i.e. (baseline activated clotting time, albumin and cross clamp time) were significantly associated with the development of heparin resistance as (p-value

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

Over time, the relevance of heroic leadership to contemporary corporate environments has been questioned, with media coverage arguing there is a need for alternate, post-heroic forms of leadership. Using a multimodal media analysis, we show how two leading Australian business magazines frame leadership in response to this debate, identifying three distinct frames of leadership. The first frame emphasizes masculinized heroic leadership as normative which reinforces gendered assumptions through differential framing of men and women’s leadership. We then argue media (re)frames post-heroic leadership as a variation of heroic leadership through two further frames; by subsuming feminized attributes into the repertoire of heroic leadership as ‘softer masculinities’ and through the construction of a masculinized post-heroic hero, both applied exclusively to men’s leadership. This (re)framing of heroic leadership has significant implications for perceptions of credible contemporary business leadership.

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

Assessment techniques are essential for utilization in both digital and online classrooms. The online evaluation must be viewed to evaluate a student's academic performance. Educational institutions are being held to a greater standard of accountability, and learning about online assessment is critical. Perhaps the information presented here can assist teachers in selecting assessment approaches that are appropriate for the pedagogy of online courses. Technology, delivery, pedagogy, learning styles, and learning outcomes must all be balanced in online assessment efficiently and comprehensively assess student learning, while meeting the problems of accountability, reform, and students' learning requirements, a diverse set of online components, methods, assessment criteria, and tools are required. Educators should continue to investigate various types of digital tools and methods for evaluating students in higher education in order to develop novel, efficient, and effective evaluation procedures that will hold institutions accountable for student outcomes in the online environment.

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

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

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

Most surgical procedures are not possible without general anesthesia which necessitates continuous and accurate monitoring of the patients’ level of hypnosis (LoH). Currently, the LoH is monitored using the conventional methods of either observing the patient’s physiological parameters or using electroencephalogram (EEG)-based monitors. To overcome the limitations of the conventional methods, this work implements an accurate EEG-based LoH monitoring processor using a bagged tree machine-learning (BTML) classifier. It is based on 12 temporal and spectral features to incorporate robustness against age variation and achieve high classification accuracy. Spectral features are computed using discrete wavelet transform (DWT) that uses time-multiplexed filter (TMF) architecture. The TMF DWT consumes 110.6-nJ/feature vector for a 100-tap filter while reducing the area by 11% compared with the conventional method. Moreover, the BTML is implemented using a pipelined approach which enables an efficient on-chip implementation to reduce the hardware cost by $15\times $ compared with the parallel approach. The proposed processor is implemented using a 180-nm CMOS process with an active area of 0.9 mm2 while consuming 1.6 mW. The accuracy of the proposed hypnotic state monitor is verified using two EEG databases with a total of 95 patients and achieves a sensitivity and specificity of 95.4% and 97.7%, respectively.

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

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

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

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