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Objective: To assess the effectiveness of multidisciplinary integrated care in the clinical outcomes of atrial fibrillation patients. Methods: Medline, EMBASE, and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on multidisciplinary integrated care in atrial fibrillation patients. The systematic review and meta-analysis included six and five articles, respectively, that compared the outcomes between the integrated care group and control group. Results: Multidisciplinary integrated care was concomitant with a decrease in all-cause mortality (OR 0.52, 95%CI 0.36-0.74, P=0.0003) and cardiovascular hospitalization (OR 0.66, 95%CI 0.49-0.89, P=0.007). Multidisciplinary integrated care had no significant impact on major adverse cardiovascular event (MACE) (OR 0.76, 95%CI 0.37-1.53, P=0.44), cardiovascular deaths (OR 0.49, 95% CI 0.21-1.17, P=0.11), atrial fibrillation (AF)-related hospitalization (OR 0.76, 95%CI 0.53-1.09, P=0.14), major bleeding (OR 1.02, 95%CI 0.59-1.75, P=0.94), minor bleeding (OR 1.12, 95%CI 0.55-2.26, P=0.76), and cerebrovascular events (OR 0.72, 95%CI 0.45-1.18, P=0.19). Conclusion: In comparison to usual care, a multidisciplinary integrated care approach (i.e., nurse-led care along with usual specialist care) in AF patients is associated with reduced all-cause mortality and cardiovascular hospitalization.

Objective: This study aimed to assess the outcomes experienced by patients diagnosed with mucormycosis linked with COVID-19 while they were hospitalized. Study Design: Retrospective study Place and Duration: This study was carried out at Sardar Begum Dental College from January, 2022 to June 2022. Methods: There were 215 patients of both genders had age 18-80 years were presented in this study. Included patients had confirmed coronavirus disease with symptoms of mucormycosis. Patients were provided informed written consent for detailed demographics. Clinical and laboratory outcomes among all cases were assessed. We used SPSS 22.0 to analyze all data. Results: There were majority males 165 (76.7%) and 50 (23.3%) females in this study. Mean age of the patients was 45.6±17.53 years and had mean BMI 26.13±8.17 kg/m2. We found that diabetes mellitus was the most common co morbidity in 140 (65.1%) cases, followed by hypertension in 85 (39.5%) cases. Frequency of rhino orbital mucormycosis was found in 110 (51.2%) cases, sinuses in 70 (32.6%) cases and cerebral in 35 (16.3%) cases. Majority of the cases were treated by steroid. Mean hospitalization was 16.8±7.67 days. Frequency of died patients was 28 (13.02%) because of CKD, renal dysfunction and orbital involvement. Conclusion: We concluded in this study that rhino-orbital involvement, CKD and renal dysfunction were a significantly risk factors for mortality among patients of COVID-19 with mucormycosis. Keywords: Mucormycosis, Covid-19, Mortality, Hospitalization, Steroids

Objective: The primary aim of this research was to study the molecular history of fibroblast growth factor 21 (FGF21) as well as its physiological and pathological functions. Study Design: Observational study Place and Duration: This study was carried out at Hayatabad Medical Complex from December 2021 to April 2022 Methods: There were 77 patients of non-alcoholic fatty disease had age 20-65 years were presented in this study. After obtaining informed written consent details demographics were recorded. Diseases of all the patients were recorded and their relation with the FGF21 levels was observed. SPSS 23.0 was used to analyze all data. Mean standard deviation was use for categorical variables. Results: There were 42 (54.5%) males and 35 (45.5%) females among all cases. Mean age of the patients was 40.11±8.74 years and had mean BMI 27.8±11.34 kg/m2. Majority of the patients 31 (40.3%) had diabetes mellitus, 24 (31.2%) cases had renal failure, 20 (25.97%) cases had cardiovascular disease, mitochondrial disease in 17 (22.1%) cases, energy metabolism disorder in 15 (19.5%), lipid metabolism disorder in 13 (16.9%) and frequency of stroke was 9 (11.7%). We found significantly increased volume of FGF21 among diabetic obese cases which were resistant to insulin with p value

Objective: The purpose of this study was to determine how common uncontrolled HTN is among medicated hypertensive individuals in Pakistan. Study Design: Cross-sectional study Place and Duration: This study was carried out at Hayatabad Medical Complex from Jan 2022 to April 2022 Methods: Total 165 hypertensive patients of both genders were presented. Enrolled cases were aged between 18-80 years. Baseline detailed demographics included age, sex, body mass index and socio economic status were recorded. Frequency of anti-hypertensive medications and uncontrolled hypertension among all cases were assessed. SPSS 24.0 was used to analyze all data. Result: Majority of the patients 95 (57.6%) were females and 70 (42.4%) were males. Mean age of the patients was 60.4±9.30 years and had mean BMI 30.3±17.85 kg/m2. 101 (61.2%) patients had poor socio-economic status. Frequency of married patients was 130 (78.8%) cases and 105 (63.6%) cases were non-educated. Mean duration of hypertension was 5.8±6.20 years. Most frequently used antihypertensive drug was combination therapy. Frequency of uncontrolled hypertension was found in 82 (49.7%) cases. Males, people older than 60, and smokers were more likely to experience uncontrolled hypternsion. Obesity, hyperlipidemia, diabetes, anaemia, malignancy, and reflex or gastric reflux disease were all associated with an increased risk of uncontrolled hypternsion in individuals with comorbid illnesses (P

Objective: This study was conducted to determine the level of student’s satisfaction with online teaching during the COVID-19 pandemic. Methodology: The study was conducted in Sharif Medical and Dental College, Lahore from 10th June to 10th July 2020. It was a cross-sectional survey in which MBBS and BDS students were consecutively enrolled in the study. An online survey was carried out after the completion of 6 weeks of online classes through the Zoom application. A self-designed questionnaire based on a 5-point Likert scale was given to the students to grade the effectiveness of learning through e-classes and their satisfaction level on various parameters. On the Likert scale, 1 & 2 were taken as highly dissatisfied (strongly disagree, &disagree) and 4 & 5 being satisfied (strongly agree, & agree) and 3 was considered as uncertain. Percentages of the respondents in each domain of the questionnaire were calculated. Results: Out of 470 participants, only 72(15.32%) students already had an experience of e-classes. Among the study participants, 327(69.57%) were of MBBS and 143(30.43%) were of BDS. The majority of the students 291(61.91%) were not satisfied with online classes, 99(21.06%) of students were uncertain and only 80(17.02%) of the students were satisfied. Conclusion: The majority of the students 291(61.91%) were not satisfied with online classes in terms of learning environment, technological characteristics, and course management. Keywords: Student’s satisfaction. Online teaching. COVID-19.

Background: The use of physical restraints for patients’ safety and to reduce the interference in treatment is common in psychiatric hospitals. In Psychiatric hospitals, Physical restraint is viewed as a simple solution to maintain patient comfort and safety. Physical restraint is always accompanied by risk of complications but correct application of physical restraints is a central nursing responsibility for patients who are temporarily incapacitated. Objective: To determine the knowledge, attitude and practices of staff nurses regarding the use physical restraints. Methodology: A descriptive cross sectional study design was used to achieve the study objective. The present study was carried out among psychiatric nurses at Punjab institute of mental Health, Lahore during month of January 2022 to March 2022.A convenient sample of 150 nurses who were working in the previously mentioned setting was included. In data collection a structured demographic questionnaire and predesigned questionnaire on level of Knowledge, Attitude and Practices of staff Nurses regarding Physical Restraints was used. Results: The staff nurses mean age was 27.86±3.55 years and mean experience (years) was 4.80±2.53. The mean standard deviation of level of knowledge, attitude & practices of physical restraints scale was 7.01±0.89, 35.04±3.62 and 36.26±1.54 among the respondents respectively. Knowledge and attitude was insignificant with sociodemographic and other factors (p-value >0.05), whereas practices were found significant with gender, marital status, special course attended as well as previous training acquired (p-value

Purpose of the study: This study contextualizes within the border of psychoanalytical perspective specifically focusing on Freud's theory of personality and Lacan’s module of the psyche to evaluate an artist’s mental state that how his/her mental state fluctuates. Methodology: Bali Jatti is taken as an exemplary character to project the reality of being an artist. This analysis presents her three-dimensional world, real, theatrical, and psychological, to represent the challenges she faces as she opts to embrace the life of folk theatre. It explores her psychological life and the chaos in which she spends the rest of her life. It probes into social taboos and stigmas that are associated with her life that makes her a stereotypical icon. Main Findings: This research concludes that the psychological world of folk theatre Bali is under the hegemonic supremacy of the other two worlds, real and theatrical. This diligent inquiry leads the reader through a steady stream of events of Bali's life which is taken as an exemplary character to project the reality of being an artist. Applications of this study: This study provides guidelines to academia and probes into an exploration of the novel concept of Pakistan folk theatre and its artist's three-dimensional world. Novelty/Originality of this study: From a theoretical perspective, this study provides important insights into literature by exploring the most demanding skills in folk theatre artists and their three-dimensional world that formulates their destiny and takes their journey of life from glory to demise.

Background: Bloodstream infections (BSIs) are an important frequent health problem in terms of their high incidence and lethal outcomes. The bacteria that frequently cause bacteremia are Staphylococcus, Streptococcus, Enterococcus, Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Neisseria and Haemophilus. Gram negative rods constitute a significant bulk in BSIs. The bloodstream infections due to multidrug resistant pathogens are on the rise globally making treatment more challenging. Aim: To identify the gram negative organisms causing blood stream infections and assess their susceptibility pattern so as to provide guidance for the empirical treatment hoping for better clinical outcome. Methodology: A retrospective, cross-sectional descriptive study carried out in Pathology Laboratory of Sharif City Hospital, Lahore. All the blood culture samples received in Microbiology laboratory between June 2017 to June 2019 were included in the study by non-probability consecutive sampling. Blood cultures were proceeded by subculturing on 1st and 5th day on MacConkey and Blood agar. The colonies obtained were identified through gram staining and biochemical profile. API20E was used for Enterobacteriaceae. Antibiotic susceptibility testing of the pathogens was by Kirby Bauer disc diffusion method. Results: In the current study 663 blood cultures were analyzed. Only 11.9% exhibited positive microbial growth. 55.7% of the positive cultures revealed gram negative bacteria. Among the pathogens isolated, E.coli was found to be responsible for BSIs in 22.7% cases, followed by Salmonella Typhi 20.4% and Klebsiella pneumoniae 18.1%.The gram negative rods exhibited a very high resistance for penicillins, cephalosporins and fluoroquinolones. The efficacy of aminoglycosides and results for carbapenems susceptibility were hopeful. Conclusion: The study shows that the Gram negative bacteria causing BSIs have shown unsatisfactory susceptibility to most of the commonly prescribed antimicrobials. The rising drug resistance has a major impact on the selection and prescription of antibiotics and calls for judicious use of antibiotics. Keywords: Gram Negative Organisms, Blood Culture, Antimicrobial Susceptibility Pattern

Pakistani English language learners' speech in an academic context has been evaluated in the present research. A catalogue of 350 words that fluctuate in pronunciation from the Basic English pronunciation of these words has been instructed in the present study. Wordlist founded on a remark made over six months has been formulated along with the transcription of these words according to the British, American, and Pakistani phonetic variants to bring out the unique pronunciation of educated Pakistani speakers of English. The deviation may be an outcome of learning rifts or the impact of their native languages such as Urdu, Punjabi, Pashtu and Saraiki. The general contours in the Pakistani pronunciation of these English words have also been examined. The study may not only assist in acquainting the global audience with the distinctive phonetic features of Pakistani English but also make the Pakistani teachers and learners concentrate on these words while teaching or learning how to pronounce them.

Introduction Enteric fever or typhoid fever is a major public health issue affecting greater than 27 million individuals globally and is responsible for greater than 200,000 deaths per year. Due to the extensive overuse of antimicrobials, the world is moving toward a pre-antibiotic era. The emergence and transmission of antibiotic-resistant Salmonella species are a global threat and a serious concern in developing countries such as Pakistan. This study aimed to determine the trends in antimicrobial resistance (AMR) of typhoidal strains of Salmonella in a tertiary care hospital in Pakistan. Materials and methods It was a descriptive, cross-sectional study conducted in the pathology department of Sharif City Hospital, Lahore, after approval by the ethical committee of the institution. A total of 50 blood culture specimens positive for Salmonella typhi and Salmonella paratyphi from January 2019 to March 2020 were included by the non-probability consecutive sampling technique. The samples were processed by conventional bacteriological methods for isolation and identification. The antimicrobial susceptibility testing was done by the Kirby-Bauer disc diffusion method as recommended by the Clinical and Laboratory Standard Institute (CLSI). The statistical package for social sciences (SPSS, IBM Corp., Armonk, NY) version 25 was used for data entry and analysis. Results Among the first-line drugs (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole), 70% of strains were resistant, and only 30% strains were sensitive to them. Among the cephalosporins, 52% strains were sensitive to ceftriaxone, and 48% strains were sensitive to ceftazidime, cefotaxime, and cefepime. Twenty-four percent of strains were sensitive to ciprofloxacin. Only 50% of strains were sensitive to ampicillin-sulbactam, and 92% of strains were sensitive to piperacillin-tazobactam. All the strains were 100% sensitive to imipenem and meropenem; 96% of strains were sensitive to co-amoxiclav, doxycycline, and azithromycin. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella species was 16% and 54%. Conclusion The increasing frequency of MDR and XDR Salmonella species in Pakistan is a major concern. A significant percentage of the typhoidal strains of Salmonella is resistant to the first-line (16%) and second-line (54%) antibiotics. Carbapenems and azithromycin are the last resort of therapy in such cases.

Background: Drought stress seriously affects the cotton fiber development. Universal stress protein gene isolated from native species Gossypium arboreum has the promising tolerance role against these stresses. Objectives: This study aimed to clone, characterize, and genetically transform the GUSP1 gene in local cotton and to observe its expression in transgenic plants under drought stress. Materials and Methods: Universal Stress Protein (GUSP1) gene from Gossypium arboreum was cloned in pCEMBIA (-) 1301plant expression vector by replacing Hygromycin and GUS exon with GUSP1-GFP fusion fragment. The construct was transformed into Agrobacterium tumefaciens and transient expression assay was confirmed by agro-infiltration of Nicotiana benthamiana leaves and green fluorescence under a confocal microscope. Gene integration and expression in transgenic plants was observed through Southern blot and real-time PCR analyses. Cellular localization was observed through a confocal microscope and the copy number of the transgene was observed in progeny plants. Results: Transformation efficiency was 1.9%. Developmental and spatial expression of GUSP1 was observed through Real-time PCR in stem, root, leaf, inflorescence, and seeds of transgenic plants at the vegetative and flowering stage. Integration of GUSP1 revealed a fragment of approximately 500 bp in Southern Blot analyses. Localization of GUSP1 was detected in the intact leaf of transgenic plants through GFP fluorescence in midrib, guard cells of stomata, and trichomes. Single gene copy was detected in the chromosome of transgenic seeds. Conclusion: GUSP1 has cloned from native species of local cotton and its integration and expression in transgenic plants confirmed that the role of GUSP1 will provide direction to breed economically important cotton varieties.

Despite many liver disorders, clinically useful drugs are scarce. Moreover, the available therapies are facing the challenges of efficacy and safety. Alhagi camelorum has been used in folk medicine globally for millennia to treat several ailments. Alhagi camelorum (Ac) is an old plant with a significant therapeutic value throughout Africa, Asia, and Latin America. Our goal was to determine the hepatoprotective activity of Alhagi camelorum against valproic acid induced hepatotoxicity using an animal model.The animals were segregated in 4-groups (6 male rats each) weighing 250-290 g. Group-1 animals were treated with normal saline, Group-2 animals were treated with VPA at the dose of 500 mg/kg i.p for 14 days consecutively, while Group-3 and 4 were treated with valproic acid (VPA) at the dose of 500 mg/kg i.p for 14 days along with 400 mg/kg and 600 mg/kg of Ac hydroalcoholic extract respectively. Subsequently, blood serum samples and liver tissues were collected for biochemical and histopathological analysis. Phytochemical screening was carried out to screen for phytochemical classes and HPLC analysis was conducted to screen polyphenols. The antioxidant activity was carried by different assays such as DPPH, SOD, NO etc. KEY RESULTS: The administration of Ac showed hepatoprotection at the doses of 400 and 600 mg/kg. Ac significantly reduces the elevated serum levels of liver biomarkers compared to the valproic acid-induced hepatotoxic group. These findings were confirmed with histopathological changes where Ac was capable of reversing the toxic effects of valproic acid on liver cells CONCLUSION: It is concluded that Ac showed significant hepatoprotective effects at different doses in the animal model used in this study.

Platooning is a promising concept used within the Intelligent Transportation System to increase efficiency and safety of road transportation. It is based on periodically sharing the kinematic status of the platoon members to allow reducing inter-vehicle distances in a safe way. This coordination is automatic and depends heavily on the wireless channel. A common technique to improve the channel properties is to use Time-Division Multiple Access (TDMA) that organizes the access to the wireless medium in slots assigned exclusively to each vehicle. However, while platoons are physical and dynamic, the corresponding dynamic reconfiguration of a logical TDMA frame is non-trivial. In this paper we address this Cyber-Physical problem resorting to the RA-TDMAp protocol to track the dynamics of a platoon, specifically joining, merging and leaving. In our solution, we include an adequate admission control block, to verify whether joining or merging can be accepted, and we present the state-machine that handles the reconfiguration process. We validate our TDMA reconfiguration mechanism with simulations using the Plexe/Vein/OMNeT++ framework. We show the effectiveness of the proposed mechanisms which ensures a synchronized start of the platoon control with the TDMA frame reconfiguration.

Background The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. Methods EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. Results The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective endocarditis patients according to 2 studies. The surgical intervention and valve-in-valve procedure were reported in 11.4% and 6.4% cases, respectively. Conclusion The incidence of post-TAVI infective endocarditis is low being 3.25% but it is associated with high mortality and complications. The most common complication is heart failure with a cumulative incidence of 37.1%. Enterococciare the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus in 16.1% of cases. Appropriate measures should be taken to prevent infective endocarditis in post-TAVI patients including adequate antibiotics prophylaxis directed specifically against these organisms. Study registration PROSPERO registration number CRD42018115943.

Background: in emergency wards, the situation that mostly handled is epistaxis. Objectives: The objective of this research study was to highlight the association of epistaxis with blood groups, modalities, pattern of epistaxis and its management. Patients and methods: The place selected for this research study was department of ear, throat, heads, nose, and neck surgery, Mayo Hospital Lahore. The time period allocated to this study was from 1st January to 31st December 2018. The people with reasons such as rhinolith granulomatous situation, trauma, blood dyscrasia , foreign bodies and less than one year of age were rejected. The people selected for this study were with serious epistaxis. These patients need hospital treatment. The numbers of the patients excluded from study were 60. The purpose of rejection was granulomatous disorder; tumor of rejection was granulomatous disorder, tumor and blood dyserasia. 100 controls were choose for this study for the purpose of assessment of connection of blood grouping with epistaxis age, blood groups, made of presentation, reason and management modalities of adjacent 160 cases of epistaxis that were hospitalized. Cases of epistaxis that were hospitalize. SPSS was used for data assessment by manual technique. Results: The most ordinary reason above 50years was hypertension. Comparative to females, male patients (72%) suffer from this disorder mostly. Sixty (60%) and seven (7%) were presented with hypertension and chronic rhino sinusitis respectively. Anterior nasal pack was carried for eighty five (85%) patients whereas posterior nasal packing was carried out for 15(15%) patients. The number of patients within 1 to 9 years, 10 to 29 years, 30 to 49 years and above fifty were seven (7%), nine (9%), twenty (20%), and sixty (60%) patients respectively. In control group, 38% patients were having blood group (O) while 47% in other. Conclusion: It was concluded that most of the patients of epistaxis were with blood group ‘O’. Trauma, blood duserasia and granulomatous disorder were excluded from the study so, main reason in hospitalized patients was hypertension. In management of epistaxis, anterior nosal packing is still significant. Keywords: Epistaxis, Hypertension, Nasal packing, Blood groups.

In our population, hepatitis B and C has been increasing. Due to these viral infections, thousands of people have subjected to death. Objectives: Prevalence of hepatitis b and hepatitis c carrier state among healthy blood donors. Subject and Methods: The current research study was organized at Rahim Yar Khan from the time period allocated to this study was from January 2013 to August 2018. Methods: The people enrolled for this study were healthy and young blood donors. By employing ict screening kits, these participants were screened for HBSAG and anti-HIV. Monthly reports of Blood Donors were collected from Blood transfusion units and data was assembled from these reports. Results: Total people selected for this study were 2,17,847. These people were healthy young donors. All participants were screened for HBV and HCV. Out of total, the number of people who were noticed positive for HBsAg and anti-HCV were 5143(2.4%) and 6407(2.2%) respectively.2,03,522 people were screened at the District level. The number of subjects out of total that were found positive for HBsAg and anti-HCV were 4449(2.2%) respectively. Total 14,325 subjects were screened at Tehsil Units. From these, the subjects positive for HBsAG were 624(4.8%) and those who were positive for anti-HCV were 789(5.5%). Conclusion: The study concluded that as compare to surrounding rural areas of district Rahim Yar Khan, the occurrence of HBV and HCV is low in urban areas. Moreover, among healthy blood donors, the incidence of HBV and HCV infection is high. Key Words: Hepatitis B Virus, Hepatitis C Virus, HBsAG, Anti-HCV, Blood Donors.

Vehicular ad-hoc networks (VANET) enable vehicles to exchange information on traffic conditions, dynamic status and localization, to enhance road safety and transportation efficiency. A typical VANET application is platooning, which can take advantage of exchanging information on speed, heading and position to allow shorter inter-vehicle distances without compromising safety. However, the platooning performance depends drastically on the quality of the communication channel, which in turn is highly influenced by the medium access control protocol (MAC). Currently, VANETs use the IEEE 802.11p MAC, which follows a carrier sense multiple access with collision avoidance (CSMA/CA) policy that is prone to collisions and degrades significantly with network load. This has led to recent proposals for a time-division multiple access (TDMA)-based MAC that synchronize vehicles&rsquo, beacons to prevent or reduce collisions. In this paper, we take CSMA/CA and two TDMA-based overlay protocols, i.e., deployed over CSMA/CA, namely PLEXE-slotted and RA-TDMAp, and carry out extensive simulations with varying platoon sizes, number of occupied lanes and transmit power to deduce empirical models that provide estimates of average number of collisions per second and average busy time ratio. In particular, we show that these estimates can be obtained from observing the number of radio-frequency (RF) neighbours, i.e., number of distinct sources of the packets received by each vehicle per time unit. These estimates can enhance the online adaptation of distributed applications, particularly platooning control, to varying conditions of the communication channel.

Vehicular networks are a core component in Intelligent Transportation Systems (ITS) enabling communication among vehicles for collaborative applications. One example of such an application that may bring benefits in reducing travel time, fuel consumption and improving safety is platooning. This application coordinates a group of vehicles that travel together, doing automatic control of inter-distances and speeds [1]. A critical part of this application is the vehicle-to-vehicle (V2V) communication highlighting the importance of improving the channel quality. Existing ITS standards, namely WAVE (USA) and ITS-G5 (Europe), use IEEE 802.11p DSRC (Dedicated Short-Range Communication) [2] that relies on CSMA/CA distributed access arbitration. Despite the Collision Avoidance attribute collisions can still occur and the channel quality can degrade significantly in dense traffic environments.

Objective: To know the prevalence of stress and depression among MBBS students in Pakistan and to find its relation with year, performance and daily activities. Methods: 600 students participated in this study from Allied Hospital Faisalabad, College of Medicine. They belonged to all 5 years of MBBS, students from different years were randomly selected. Kessler 10 stress inventory was filled by all students. Results: 494 students responded, thus 83% was response rate. 19.6% students had severe stress while 57% had mild to moderate stress. Relation between year of undergraduate studies and stress was highly significant. Statistical significance of relation of stress with educational performance couldn’t be concluded as stress prevalence between all 4 years was highly dissimilar. The causes of mental stress were also inquired. Studies was the major factor (60.3%), home related factors were present in 2.8%, 36.9% cases couldn’t explain any cause behind their stress. Conclusion: It was noticed that the stress prevalence during first three years of medical studies was common, better students’ service structure must be defined in order to avoid such issues. Studies related stress was commonly observed thus, better opportunities should be provided where students can discuss their studies related problems. Keywords: Stress, medical students, causes, prevalence

Vehicular Ad-hoc Networks (VANETs) have a significant potential to enable new applications in the vehicular domain, some of which addressing traffic safety. In these networks, the Medium Access Control (MAC) plays an important role in providing an efficient communication channel. Currently, there are two protocols for ITS, proposed in the USA (IEEE WAVE) and in Europe (ETSI ITS-G5). Both cases use the PHY and MAC of IEEE 802.11p, the latter being fully distributed and based on CSMA/CA, thus still prone to collisions. This has led to recent proposals for TDMA-based overlay protocols to prevent collisions but leading to complex synchronization and scalability limitations. In this paper we propose enhancing IEEE 802.11p with an overlay protocol based on Reconfigurable and Adaptive TDMA. We specifically target multiple concurrent applications such as multiple platoons. Our proposal separates between the application level, with its own TDMA round and slots allocated to engaged nodes, e.g., a platoon, and the global level that manages multiple TDMA rounds in a mutually agnostic manner, thus, dynamic and scalable. We believe this is the first applications-oriented MAC protocol proposed for VANETS and we discuss its deployment and potential advantages in two typical uses cases, namely platooning and smart intersections.

Background: Patients who do not attend (DNA) or cannot attend (CNA) outpatient endoscopy procedure appointments can be a source of resource wastage. This study is an analysis of the DNA and CNA rates of an endoscopy unit in a sample district general hospital with the aim of finding reasons for any under or over-utilization. It recommends some solutions to solve the problem. Method: Using the hospital computer records, all patients who did not attend (DNA) or could not attend (CNA) their appointment from 1st January 2014 to 30th June 2014 for endoscopy during weekdays and weekend were identified retrospectively. Results:There were 116 points available per week on average.There was thus 25% wastage in point utilization. Conclusions: This study has shown that common issue for wastage has been poor communication. This lack of communication may be between the doctor and the patient, the endoscopy manager and the patient, or the doctor and the endoscopy managers etc.