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Phenomenology is the qualitative research inquiry that explores the lived experiences of the individual. This paper discusses phenomenology as a qualitative research methodology and its roots, characteristics, and steps to conduct the study. The relevant literature was searched using the database library, including PubMed, Google Scholar, PakMediNet, Medline, and Cumulative Index to Nursing and Allied Health Literature CINAHL. Literature was searched using keywords including phenomenology, qualitative inquiry, roots of phenomenology, steps of phenomenology, and characters of phenomenology. The essential essence of phenomenology is to understand the lived experiences of individuals. The participants truly share the lived experiences which they witnessed. It is concluded that phenomenology is a qualitative inquiry that addresses the real-life experiences of individuals.

It has been recognized that soft drinks have become the third most consumed beverage worldwide. In contrast, it has a detirmental effect on health. Objective: To assess the knowledge, attitude, and practices of soft drink consumption and determine its association with gender among nursing students in Karachi, Pakistan. Methods: This cross-sectional study was accomplished at three nursing institutions in Karachi from 1st January 2018 to 30th June 2018. In this study, there was a total of 369 students of male and female gender were enrolled for the study. Subjects were approached by a non-probability convenient sampling method. Self-structured and pretested questionnaire was used for the collection of data. Results: Among 369 subjects, the majority of 261 (70.7%) were male, and 315 (85.4%) were single. 310 (84%) participants knew the deleterious effects of soft drinks. More than 85% admitted that soft drinks are bad for health. Two knowledge questions heard about soft drinks and the idea of the bad effects of soft drinks showed statistically significant associations with gender variables (p-values < 0.05). Whereas only attitude questions regarding the amount of drink students prefer and one practice question related to favorite drink were found to be significantly associated with gender variable (p-values < 0.05). Conclusion: Most nursing students had a fair knowledge of soft drink and their hazardous effects on their health. Despite knowing the harmful consequences, nursing students consume soft drinks.

The current study aims to evaluate the comparative efficacy of short-term and long-term glucocorticoid treatment in patients with COPD exacerbation. A randomized clinical trial will compare the effectiveness of short-term and long-term glucocorticoid treatments in COPD exacerbation. One hundred ninety patients will be recruited and randomized into two groups: a short-term glucocorticoid group and a long-term glucocorticoid group. The primary outcomes will be assessed at the end of the treatment period to determine the efficacy of the treatments. Secondary effects will include quality of life, length of hospitalization, and adverse events. The results of this study will provide insight into the comparative efficacy of short-term and long-term glucocorticoid treatments in COPD exacerbation. Objective: Comparative efficacy of short-term (5-days) versus long-term (10-days) glucocorticoids at equivalent doses in managing COPD patients with acute exacerbations. Materials and Methods: Pakistan Institute of Medical Sciences (PIMS), Islamabad, conducted this randomized clinical trial in the inpatient pulmonology department. This research took six months following ethical clearance. The experiment included 190 patients in two groups of 95. Patients in the two groups were randomly administered Tab—prednisolone 5mg (40mg/24 Hours) for five days or ten days. Using a carefully constructed pro-forma, postgraduate residents gathered data on five parameters (FEV1, FEV1/FVC, Arterial Blood Gases, mMRC Dyspnoea Scale, Sputum color and amount, presentation with identical symptoms within 30 days following discharge). Results: Patients averaged 58.13 ± 11.12. Long-term patients were 58.34 ± 11.53 years old, whereas short-term patients were 57.93 ± 10.752. The short-term group included 86 (90.53%) male and 9 (9.47%) female cases, whereas the long-term group had 89 (93.68%) male and 6 (6.32%) female cases. Sputum color was normal in all groups after therapy. Short-term and long-term therapy groups had mean FEV1 changes of 8.12±4.85 and 7.14± 1.75, respectively. Following treatment, short-term mMRC was significantly lower (2.14±0.32) than long-term (2.73±0.44), with p-value < 0.001. The short-term group mMRC mean change was 1.67±0.53 compared to the long-term group 1.07±0.26, p-value < 0.001. Sputum amounts changed by 2.63 ± 1.67 in the short-term and 2.49 ± 0.72 in the long-term groups. Both groups had similar mean sputum quantities before, after, and after treatment, with a p-value > 0.05. Both groups had the same ABG parameter mean change following therapy. One month after discharge, neither group relapsed. Conclusion: The efficacy of short-term (5-days) glucocorticoids is better than long-term (10-days) glucocorticoids at equivalent doses in terms of mMRC reduction. At the same time, the therapeutic effect was statistically the same in both groups regarding improvement in FEV1, sputum color, sputum quantity, all parameters of ABGs, and relapse rates. Keywords: COPD, exacerbation, glucocorticoids, efficacy

Objective: To determine frequency of diastolic dysfunction in asymptomatic type 2 diabetic patients by employing twodimensional (2D) echocardiography as a measurement method. Study Design: It was an Analytical Cross sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jul 2021 to Nov 2021 Methodology: Patients, already diagnosed as diabetics for more than 5 years and on dietary control or on medications,presenting to the outpatient department of the hospital were enrolled. They were subjected to a 2D echocardiography in left lateral position. We excluded patients with valvular heart disease, ischemia, congestive heart failure, cardiomyopathy of any aetiology, renal failure, pulmonary illness, anemia, hemoglobinopathies, prior myocardial infarctions in any region, smokers,and hypertension. Diastolic dysfunction was evaluated as per the guidelines of American society of Echocardiography. Results: Overall (n=150) patients were calculated with reference to 11% prevalence of LVDD by sample size calculator, being the part of study who were fulfilling the inclusion criteria. There were 102(68.0%) male and 48(32.0%) female patients; mean age was 45.02±6.07 years. Mean duration of diabetes mellitus in years was 6.93±2.53 with ranges from 5 to 16 years. Patients on oral hypoglycemic were 121(80.7%), on insulin were 5(3.3%), on dietary control were 12(8%) and on mixed treatment were 12(8%). There were 58 (38.7%) patients who had diastolic dysfunction present on echocardiogram. Effect modifiers of durationof diabetes (p=0.2) did not show significant association; however, Age (p=0.001) and Gender (p=0.038) significantly associated with Diastolic Dysfunction. Conclusions: One of the simple and noninvasive approaches to diagnose diastolic dysfunction is doing 2D echocardiography which can identify large percentage of diabetic subjects having pre-clinical diastolic dysfunction. Thus, by on time detection we can initiate treatment and retard the progression of diastolic dysfunction.

Purpose The purpose of this research is to introduce an innovative framework called the waqf cooperative housing framework (WCHF), with an objective to create a synergistic equilibrium between waqf and cooperative housing schemes. To tackle problems related to the dearth of financing, this research postulates an innovative waqf-based source of finance that involves generating revenue from common areas (waqf area) within the vicinity of the condominium. Design/methodology/approach Primary data were collected through interviews and the data were analysed using the NVIVO software. The interviewees comprised managers from property development sectors, public sector officials, university lecturers in Islamic finance, CEOs, top management officials from Islamic financial institutions, community leaders and shariah scholars. Findings A framework was proposed based on the result of the interviews. It was found that innovative models such as WCHF can resolve the issue of affordable housing in Karachi such as decreasing the financial burden on the public exchequer, bringing positive change to the lives of the poor, fulfilling the property developer’s corporate social responsibility, fulfilling the religious duty of the general public and condominium owners towards their fellow beings as well as creating new employment opportunities for people who are working in the financial sector (waqf management companies/trustees) and the construction sector. Research limitations/implications Even though this study has introduced an innovative and practical solution to the financing of affordable housing, it also encountered some limitations. First, it is conducted in Karachi city involving six group of respondents; thus, the findings cannot be generalised with other contexts. Similar research needs to be conducted in different contexts. Originality/value To date, this is among the first studies, to the best of the authors’ knowledge, to investigate cooperative affordable housing with the help of innovative Islamic finance tools in the context of Pakistan. Furthermore, insufficient attention has been given to the enabling and hindering factors behind the acceptance of a framework that seeks to initiate a cooperative scheme based on an innovative waqf financing tool that generates revenue from common areas around a condominium.

DNA-mimicking proteins encoded by viruses can modulate processes such as innate cellular immunity. An example is Ung-family uracil-DNA glycosylase inhibition, which prevents Ung-mediated degradation via the stoichiometric protein blockade of the Ung DNA-binding cleft. This is significant where uracil-DNA is a key determinant in the replication and distribution of virus genomes. Unrelated protein folds support a common physicochemical spatial strategy for Ung inhibition, characterised by pronounced sequence plasticity within the diverse fold families. That, and the fact that relatively few template sequences are biochemically verified to encode Ung inhibitor proteins, presents a barrier to the straightforward identification of Ung inhibitors in genomic sequences. In this study, distant homologs of known Ung inhibitors were characterised via structural biology and structure prediction methods. A recombinant cellular survival assay and in vitro biochemical assay were used to screen distant variants and mutants to further explore tolerated sequence plasticity in motifs supporting Ung inhibition. The resulting validated sequence repertoire defines an expanded set of heuristic sequence and biophysical signatures shared by known Ung inhibitor proteins. A computational search of genome database sequences and the results of recombinant tests of selected output sequences obtained are presented here.

Many researchers have considered the issue of dividend policy over many other factors of profitability namely; profit margin, return on sales, return on assets, return on equity and return on investment however the motive of our study was to focus on the dividend payout ratio which is the one aspect of dividend policy over two main profitability ratios i.e. Return on Asset and Return on Equity therefore with the consideration of these factors this study derived the relationship between the dividend payout ratio and profitability nevertheless the impact of dividend payout ratio over return on asset (a component of profitability) is also derived. Moreover, the data of the listed oil sector companies of Pakistan is undertaken and the regression and correlation tests are applied on the variables to check the relationship and impact on each other besides the result showed that dividend payout ratio is the critical component which affects the performance of the firm since it is identified in our study with the R square of 0.18. Therefore, considering the result of this study it is said that the oil sector companies must pay attention to their dividend policies seeing as it affects the firm’s performance.

Multidrug-resistant Escherichia coli have become a main public health distress in Pakistan and many countries, causing failure in treatment with the resultingenormous health burden. The current study was aimed to find the prevalence of E. coli among clinical isolates and their antibiotics susceptibility pattern using standard procedures. The Purpose of the present study to investigate the Prevalence and antibiotic susceptibility pattern of E. coli detected from clinical patients visiting Khyber teaching hospital Peshawar. In this study a total 415 sample were isolated from the patient of Khyber teaching hospital (KTH) Peshawar. The collected samples were processed for identification including Gram staining and biochemical test. Furthermore, the antibiotic susceptibility pattern of all the positive strains of E. coli was tested using selected antibiotic discs by disc diffusion method as per CLSI guidelines 2019.A total of 415 samples, 112 clinical isolates yielded the growth of E. coli using standard procedures. Out of 112 isolates, 52% were recovered from male patients while 60% were females. The positive samples were obtained from urine (58%), pus (14.3%), swab (8.9%), sputum (10.7%), and others 8.0% respectively. The highest sensitive drugs are FOS (99.1%), AK (98.2%), TZP (97.3%), MEM (93.8%), TGC (91.1%), CN (89.3%), SCF (78.6%), DO (65.2%), CT (60.7%), F (49.1%), ATM (27.7%) AMP (23.2%), CAZ (23.2%), CPM (22.3%) , CRO (19.6%) ,CTX (13.4%) and the lowest sensitive drug is CIP which is (7.1%) . The drugs which show high resistance are CIP (92.9%), CTX (86.6%), CRO (80.4%), CPM (77.7%), CAZ (76.8%), AMP (76.8%) , ATM (72.3%) , CT( 39.3%) , DO (34.8%), SCF (21.4%), CN(10.7%),TGC(8.9%), F(8.9%),MEM(6.3%) ,TZP(2.7%),AK (1.8%) ,and the lowest resistance drug is FOS (0.9%).Drug resistance monitoring and the epidemiological analysis of patient data are needed regularly and can be useful for the adequate management of antimicrobial resistance. Key words: Multidrug-resistant, Antimicrobial Resistance, Clinical Isolates, Bacteria, Peshawar

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD. Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad. Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.

Failure caused by corrosion in industries are the major cause of breakdown maintenance. Acoustic emission during the accelerated corrosion testing is a reliable method for corrosion detection, however, classification of these acoustic emission signals by machine learning techniques is still in its infancy. Proposed approach uses a hybrid technique that combines the detection of corrosion through acoustic emission signals from accelerated corrosion testing with machine learning techniques to accurately predict the corrosion severity levels. Laboratory based experimentation setup was established for accelerated corrosion testing of mild steel samples for different time spans and mass loss of samples were recorded. Acoustic emission signals were acquired at high frequency sampling rate with Sound Well AE sensor, NI Elvis kit and NI Labview software. AE mean, AE RMS, AE energy, and kurtosis were selected as distinct features as they represent a linear relationship with the corrosion process. For multi-class problem, five Corrosion severity levels have been made based on mass loss occurred during accelerated corrosion testing for which Naive Bayes, BP-NN and RBF-NN showed accuracy of 90.4%, 94.57%, and 100% respectively.

Although the field of cardiac regeneration is relatively young, it is progressing rapidly with technological advancements. Genome editing tools are allowing researchers to creatively influence signaling pathways to be able to shed light on them and are important for addressing certain issues and limitations associated with in vitro and in vivo aspects of cardiac regeneration, such as imaging and immune rejection. In this chapter, the pathways involved in cardiac regeneration will be highlighted, and the role of gene-editing tools in endogenous and exogenous approaches to regenerate injured myocardium is discussed.

Background: Morbidity and mortality envisaged by chronic kidney disease (CKD) remains a health menace throughout the world. Complications, incidence, prevalence, the impact of dietary recommendations, risk factors, outcome, and management strategies have not been rationalized due to several adversities resulting in escalated death rates. The objective of this study was to evaluate and establish a malnutrition information score (MIS) as a means of ease of CKD prevention and progression. MIS underlies the consistencies in findings through MIS show higher values can be corroborated to recommend the augmentation parameters in utilizing MICS techniques and other healthcare types of equipments. Methods: A randomized, non-biased sampling of patients presenting to dialysis unit with their maintenance schedule program in the nephrology department of Medical Unit-3 of PIMS, Islamabad were introspected for inclusions. Personal history, BSF thickness and MAC values were measured, and MAMC was calculated by = MAC – (3.1416 x TSF). The study was conducted in the Department of Nephrology, PIMS, Islamabad for a duration of six months. Results: The study conducted across 59 male patients and 33female patients indicate that males are more susceptible to CKD than females as evidenced by clinical stability of 67%. Appetite loss, degree of severity, Co-morbidity, BMI, MIS range, and clinical stability status of 100 study participants show variable indices indicating the stress on personal and family history of the patients. MIS pose as an indicator for determining the apt Malnutrition-Inflammation Complex Syndrome (MICS) and other types of equipments for treating CKD. Conclusion: CKD patients undergoing maintenance hemodialysis analyzed for dietary balance affirm the utility of MIS in determining the MICS and other types of healthcare equipments indirectly in ensuring reduction in morbidity and mortality.

The effects of variation in aluminium oxide nanoparticles in aluminium-based metal matrix composite on the compressive and sliding wear deformation have been investigated. The compressive and sliding wear resistance of the composite increase significantly with the addition of nanoparticles in the matrix. The 5% aluminium oxide nanoparticles in the composite were found to be the optimal weight fraction of added nanoparticles that produced higher static yield strength, hardness, scratch resistance and lower material loss in wear in the composite. The addition of nanoparticles, beyond 5% weight fraction, in the matrix showed adverse effects in the performance of the composite due to its higher brittleness. The effects on wear properties of the composite with added nanoparticles beyond optimal weight fraction were more detrimental than those with lower weight fraction of nanoparticles.

Hepatitis B and C co-infection may leads to cirrhosis resulting in hepatocellular carcinoma with poorer survival rate. Pegylated interferon and ribavirin treatment is considered as gold standard. Despite of adequate treatment, some patients remained nonresponders. Due to this reason, this study was designed to compare different parameters of liver function tests along with HBV- HCV genotyping in non-responders of HBV-HCV co-infection with normal controls. Study population was divided in two groups. Group A (patient group) includes 30 HBV-HCV co-infected patients and Group B (control group).includes 30 normal individuals. Blood samples of both groups were collected. Samples were analyzed for HBV and HCV genotyping using automated kits of Abbott laboratories and Liver Functions testing (ALT, ALP, Bilirubin, Albumin) using ROCHE COBAS-501 automated system. Statistical analysis using chi-square test for ordinal data and t-test for numerical data was used using p value. Key words: Hepatitis B, Hepatitis C, Viral infection, Viral resistant, Biochemical test, genotyping in retroviruses infected patients

Background: In the lower-middle-income countries, Pakistan is the fifth most populous and one of the lowest financiers in the health system country in the world. According to Pakistan’s National Health Vision 2016–2025 report, UHC is the highest priority while some other national programs and policies have also allied to it. Pakistan has OOP is 65% in 2016. Therefore, Pakistan has witnessed the sustainable developmental goal (SDGs) and reached a UHC service index score of 80, while the country score was 40 in 2015 and 50 in 2020. Materials and Methods: This was a comparative cross-sectional study carried out in Peshawar, northwest Pakistan. The outcome was patient satisfaction with “sehat sahulath program “a national insurance scheme in Pakistan. Data on patient satisfaction with the sehat sahulat program was collected from public and private tertiary care hospitals in Peshawar. A total of 410 patients enrolled via an adapted semi-structured questionnaire. Data were analyzed using descriptive statistics for sociodemographic characteristics. Chi-square and Independent sample T-test was run for comparison of patient satisfaction in both public and private tertiary care hospitals. Results: The results, showed that patients’ awareness of sehat sahulath program, fulfillment of patient expectations, and patients’ perceived value of sehat sahulath coverage had directly affected patient satisfaction (p< 0.001). Privat hospitals had a greater level of satisfaction as compared to patients admitted in public tertiary hospital (p< 0.001).\ Conclusions: Our study concludes that the public health insurance programs “The sehat sahulath program” can be introduced in all poor urban and rural regions of Pakistan, to avoid low-income families from facing hardship and financial devastation due to the burden of out-of-pocket expenditure OOP payments.

Forward Osmosis (FO) is a promising separation technology with a wide range of applications in water and wastewater treatment. FO membrane is the core of the forward osmosis process. Recently, the organic membrane has been widely used for forward osmosis applications even though inorganic membrane has excellent mechanical properties, decent chemical resistance, high durability, high porosity, and good hydrophilicity. Nevertheless, the utilization of inorganic membrane is hindered by the heat-intensive steps involved in its fabrication and the use of expensive source material. Geopolymerization provides a cost-effective technique for the preparation of inorganic membranes because of its sintering-free steps and utilization of fly ash as source material. Herein, we present a sintering-free, environmentally friendly, and cost-effective synthesis of geopolymeric membrane for application in forward osmosis. Fly ash was mixed with alkaline activator solution and porous reduced graphene oxide (PRGO) to prepare geopolymer slurry. The hydrogen peroxide and egg albumen were used as foaming agent and surfactant, while the membrane surface was coated with titanium dioxide to enhance the hydrophilicity of the membrane surface. The PRGO content improved the mechanical properties of the geopolymeric membrane. The average maximum flux recorded was 21 L/m

Dilated cardiomyopathy (DCM) is a cardiovascular condition that develops when the left ventricle of the heart enlarges, compromising its function and diminishing its capacity to pump oxygenated blood throughout the body. After patients are diagnosed with DCM, disease progression can lead to heart failure and the need for a heart transplantation. DCM is a complex disease where underlying causes can be idiopathic, genetic, or environmental. An incomplete molecular understanding of disease progression poses challenges for drug discovery efforts as effective therapeutics strategies remain elusive. Decades of research using primary cells or animal models have increased our understanding of DCM but has been hampered due to the inaccessibility of human cardiomyocytes, to model cardiac disease, in vitro, in a dish. Here, our goal is to leverage patient-derived hiPSC-CMs and to combine them with biosensors to understand how cellular signalling is altered in DCM. With high sensitivity and versatility, optical biosensors represent the ideal tools to dissect the molecular determinants of cardiovascular disease, in an unbiased manner and in real-time at the level of single cells. By characterizing the pathobiology of dilated cardiomyopathy in a patient-specific manner using high content biosensor-based assays, we aim to uncover personalized mechanisms for the occurrence and development of DCM and as a pathway to development of personalized therapeutics.

More than 600,000 patients undergo cardiac implantable electronic device (CIED) implantation in a year, which comprise of pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices (CRT). The most common symptom experienced after a CIED implantation is chest pain. In this review, we describe CIED implantation and associated complications causing chest pain.

The global financial crisis had an enormous impact on financial institutions the world over, and Pakistan was never an exemption. Hence this paper investigates the post-financial crisis liquidity risk of conventional banks in Pakistan in consortium with the pre-financial crisis-2008. Methodologically, 15 of 20 conventional banks were selected as a sample, while paired sample t-test was instrumentalized to measuring the pre- and post-financial crisis liquidity risk amongst the sampled banks. As part of the research objectives, the paper equally looks at the chances of the bankruptcy of these institutions through the Altman's Z-Score tool. The paper shows that liquidity risk in the pre and the immediate year following the financial crisis was marginal and insignificant; however, the liquidity risk bar rises and becomes pronounced in the following year. Though the allied demise in Pakistan financial market felt the ruthlessness of this collapse is not comprehensive enough to demolish the financial stability of Pakistan. In addition, despite the sounding performance of Pakistan banking system in the pre and post-financial crisis, the Altman's Z-Score tool is indicative of bankruptcy creeping up amongst the sampled banks in the near future

OBJECTIVE: Rearranged ROS1, present in 1%-2% of non-small cell lung cancer (NSCLC) patients, usually young, never or light smokers, is assessed by fluorescence in situ hybridization (FISH) to determine eligibility for tyrosine kinase inhibitors (TKI). Immunohistochemistry (IHC) for the protein product of ROS1 rearrangement, a cost-effective alternative, is validated on cytology and small biopsy samples.METHODS: From 1 March to 31 December 2019, cytology cell blocks and small biopsy samples from a selected cohort of NSCLC patients were concurrently tested for ROS1 gene rearrangement by Vysis 6q22 Break Apart FISH probe and IHC using Cell Signalling D4D6 antibody. Mismatch cases were tested by an RNA fusion next generation sequencing (NGS) panel.RESULTS: In a prospective population of 95 cases, 91 were negative and two were positive by both FISH and IHC. Both dual positive cases were female never smokers and benefited from TKI treatment. Another two cases were positive by FISH but negative by IHC and repeat by NGS showed one to be negative but one failed. Turnaround time for IHC was 0 to 8 days from request to authorisation, whilst that of FISH was 9 to 42 days at a cost of £51 and £159 respectively.CONCLUSION: IHC to assess for the protein product of ROS1 gene rearrangement on cytology cell blocks and small biopsy samples in a routine setting is a promising screening method to assess eligibility for TKI treatment with positive and indeterminate cases confirmed by FISH or NGS as it has good negative predictive value, faster turnaround time and is cost effective, with proven technical and clinical validation.