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Tidal turbine arrays have undergone extensive research to determine the optimal spacing for efficient performance and reduced wake generation. Small-scale laboratory tests are typically conducted to analyze wake structures prior to deployment. These tests often result in conditions of extreme blockage due to channel narrowing in comparison to turbine size. The primary objective of this study is to investigate flow behavior around turbines under blockage conditions and their performance close to the free surface, both in current-only and wave-and-current scenarios. The methodology employed a combination of blade element momentum theory and computational fluid dynamics (CFD) integrating a virtual blade model (VBM) code. The findings of this study indicate potential enhancements in tidal turbine array performance of up to 7% in lateral arrangements and 11% in streamwise arrangements under blockage conditions. The wake is significantly influenced by surface waves, which also contribute to increased downstream turbine performance. [ABSTRACT FROM AUTHOR]

The steam condenser is a crucial component in power plants, playing a vital role in influencing the overall performance of steam power plants. This paper delves into a detailed assessment of the thermal aspects and evaluation of steam surface condensers. To conduct this rigorous evaluation, we meticulously crafted a three-dimensional (3D) model of a multi-tube single-pass counter-flow heat exchanger using ANSYS Design-Modeller. Within this model, a multiphase mixture model was harnessed to replicate the condensation process that takes place within the condenser. After the model's development, a series of computational fluid dynamics (CFD) simulations were expertly executed utilizing ANSYS Fluent Workbench. The simulations encompassed diverse cooling water flow rates and steam inlet velocities. Notably, two sets of CFD simulations were carried out: the initial set featured a velocity inlet in the condenser, while the second set involved CFD simulations with a pressure steam inlet. The findings derived from these simulations unveiled a noteworthy correlation between the condensation rate within the shell and both the rate of circulating water flow and the operational pressure of the condenser. Additionally, it was discerned that the condensation rate could be further influenced by the specific geometry of the condenser. In sum, this study concludes that optimizing the geometrical configuration and baffle arrangements holds promise for increasing the condensation rate and overall performance of steam condensers employed within steam power plants. [ABSTRACT FROM AUTHOR]

• Syzygium aromaticum extract inhibits the growth of Fusarium oxysporum f.sp. lycopersici. • The chloroform fraction is more effective as compared to synthetic fungicides. • Molecular docking showed that the metabolic factors of F. oxysporum were inhibited in response to clove phytoconstituents. The antifungal potential of the extract of cloves (Syzygium aromaticum) was investigated in this study. The crude extracts of cloves and n -hexane, chloroform and n -butanol fractions were prepared. The antifungal activity of obtained fractions was studied at various concentrations ranging from 1.5 to 200.00 µg/mL. Thiophanate methyl (TM) was used as +ve control in this study. The fractions including methanolic, n -hexane, n -butanol, and chloroform significantly inhibited the growth of Fusarium oxysporum f.sp. lycopersici (FOL) ranging from 93.8 to 100 % when used at 200 µg/mL. The chloroform fraction showed 6.25 µg/mL MIC as compared to TM with 64 µg/mL MIC. GC/MS analysis showed that the chloroform fraction contained Eugenol, Phenol, 2,2′-methylenebis[6-(1,1-dimethylethyl)-4-methyl, 2,4-Di‑tert-butylphenol, n-Hexadecanoic acid, Phenol, and 2‑methoxy-4-(2-propenyl)- acetate. The findings of in-vitro antifungal analysis were further supported by molecular docking studies. Two virulence proteins of FOL i.e., global transcription regulator (SGE1) and DNA binding transcription factor (STE12) were docked with identified phytocompounds in the chloroform fraction by GC/MS analysis. Both of the receptors showed maximum binding affinities with 2-[2-(4-Phenyl-piperidin-1-yl)-ethyl]-isoindole-1,3‑dione (PED) (-12.054 kcal/mol) and 3,5-di‑tert-Butyl-4-hydroxyphenylpropionic acid (BHP) (-13.327 kcal/mol) respectively with strong hydrophilic/phobic interactions with active pocket residues. In conclusion, the chloroform fraction of S. aromaticum can be used to manage FOL. [ABSTRACT FROM AUTHOR]

"Controlling the Capital: Political Dominance in the Urbanizing World" by Tom Goodfellow and David Jackman explores the rise of authoritarianism globally and its impact on capital cities. The book focuses on Sub-Saharan Africa and South Asia case studies, examining how authoritarian regimes establish and sustain dominance in capital cities. It discusses the relationship between cities and political dominance, contributing to debates on authoritarianism, urbanization, political contestation, resistance, development, and the prospects for democracy. The book provides historical and contemporary analysis, covering various political matters and highlighting the challenges faced by urban populations. However, it lacks a serious projection of the future of cities and their potential for democracy, and future research should address this issue. [Extracted from the article]

Ultrasonic-assisted drilling (UAD) is a machining process that is known to improve the hole quality and reduce cutting forces. Previous studies focused on optimizing cutting parameters to improve the hole quality in conventional drilling (CD) and UAD, as well as to finding the optimum vibration parameters (frequency and amplitude) that will increase the effectiveness of the UAD process. However, the influence of cutting tool type during UAD has been largely overlooked. This research aims to address this gap by analyzing the effect of cutting tool type during UAD on the cutting forces and hole quality in GLARE (Glass Laminate Aluminum-Reinforced Epoxy) laminates. Four types of drills, namely, twist drill (TD), double cone drill (DCD), a step drill type 1 (SD1), and step drill type 2 (SD2) with different step length, were selected for this study. The lowest thrust force (47.04 N) and torque (0.079 Nm) were achieved using twist drill, while DCD, SD1, and SD2 exhibited higher thrust forces (12.81%, 20.69%, 41.3%) and torques (94%, 92%, 91%), respectively. In addition, TD produced high-quality holes with lowest surface roughness (Ra 1.66 μm, Rz 10.58 μm) and minimal burr formation (entry burr height 152.3 μm, exit burr height 69.22 μm). Conversely, DCD, SD1, and SD2 showed higher surface roughness Ra (23%, 16%, 24%) and Rz (16%, 37%, 29%), respectively, compared to the TD. Holes drilled using SD1 and SD2 generally had smaller burr height. Overall, UAD system effectively reduced cutting forces at low spindle speed and feed rate. To achieve higher drilling quality, specifically to reduce the surface roughness and exit burr height, a medium spindle speed of 3000 rpm, a feed rate of 225 mm/min is recommended. Drilling at higher cutting parameters using UAD resulted in a decline in hole quality, except for entry burr height. [ABSTRACT FROM AUTHOR]

The clustering analysis approach treats multivariate data tuples as objects and groups them into clusters based on their similarities or dissimilarities within the dataset. However, in modern world, a significant volume of data is continuously generated from diverse sources over time. In these dynamic scenarios, the data is not static but continually evolves. Consequently, the interesting patterns and inherent subgroups within the datasets also change and develop over time. The researchers have paid special attention to monitoring changes in cluster solutions of evolving streams. For this matter, several algorithms have been proposed in the literature. However, to date, no study has examined the effect of variability in cluster sizes on the evolution of cluster solutions. Moreover, no guidance is available on determining the impact of cluster sizes on the type of changes they experience in the streams. In the present simulation study using artificial datasets, the evolution of clusters is examined concerning the variability in cluster sizes. The findings are substantial because tracing and monitoring the changes in clustering solutions have a wide range of applications in every field of research. This study determines the minimum sample size required in the clustering of time-stamped datasets. [ABSTRACT FROM AUTHOR]

This article comprehensively reviews the applications and algorithms used for monitoring the evolution of clustering solutions in data streams. The clustering technique is an unsupervised learning problem that involves the identification of natural subgroups in a large dataset. In contrast to supervised learning models, clustering is a data mining technique that retrieves the hidden pattern in the input dataset. The clustering solution reflects the mechanism that leads to a high level of similarity between the items. A few applications include pattern recognition, knowledge discovery, and market segmentation. However, many modern-day applications generate streaming or temporal datasets over time, where the pattern is not stationary and may change over time. In the context of this article, change detection is the process of identifying differences in the cluster solutions obtained from streaming datasets at consecutive time points. In this paper, we briefly review the models/algorithms introduced in the literature to monitor clusters' evolution in data streams. Monitoring the changes in clustering solutions in streaming datasets plays a vital role in policy-making and future prediction. Of course, it has a wide range of applications that cannot be covered in a single study, but some of the most common are highlighted in this article. [ABSTRACT FROM AUTHOR]

Background: Pakistan is one of the nations with the worst statistics for pregnancy-related outcomes. Health programmes in underdeveloped nations frequently ignore the role of partners in maternal health, which is a crucial contributing factor in these worst situations. This research study aims to explore the role of husbands in maternity care and safe childbirth in Pakistan. Methods: The data for this study comes from the Pakistan Maternal Mortality Survey 2019. The k-Modes clustering algorithm was implemented to generate clusters from the dataset. Cluster profiling was used to identify the problems in pregnancy-related outcomes in cases where women live away from their partners. The chi-square test and logistic regression model were fitted to identify the significant factors associated with women's health and safe childbirth. Results: The finding of the study reveals that the partner's support during and after pregnancy plays a vital role in maternal health and safe child-birth. It was revealed that the women living away from their partners have certain health problems during pregnancy. These problems include Vaginal bleeding, Excessive vomiting, Chest pain, Cough, High B.P, Excessive weight gain, Body aches, Swelling of feet, and Swelling of the face. This also leads to complications and health problems in the postpartum period. Due to a lack of antenatal care from the spouse during pregnancy, the women who lived away from their partners lost their pregnancies. Conclusion: The study concludes that the husband's emotional and financial support substantially impacts the overall health of expecting mothers and the safety of delivery in Pakistan. Given its potential advantages for mother and child health outcomes, male engagement in health education must be acknowledged and addressed. The finding of the study is of immense importance, as it guides the policymakers to arrange various awareness programs for the male partners to support their pregnant spouse and provide proper antenatal care. [ABSTRACT FROM AUTHOR]

Porphyrazines ( P z ) are porphyrinoids, which are macro-cyclic compounds made up of four in-dole rings. P z has various potential and practical uses in health and technology due to their distinctive optical and electrochemical characteristics. Topological descriptors are numerical values given to molecular structures that may be used to predict specific physical characteristics. In this work, we have investigated topological features of the porphyrazine and tetrakis porphyrazine structure based on degree. We have calculated the closed forms of the Zagreb, Randic, geometric-arithmetic, harmonic, augmented and atom-bond connectivity (ABC) indices of the porphyrazine and tetrakis porphyrazine structures. The present research would be beneficial for understanding the structure's biological and chemical activity. [ABSTRACT FROM AUTHOR]

Cobalt, from industrial waste and nuclear laundry, possess health risk to human beings, animals and plants. Number of methods, other than adsorption, have been reported in literature for Co removal from waste water. In this research walnut shell powder after modification has been utilized for Co adsorption. First step of modification involved chemical treatment by four different organic acids for 72 h. Samples were collected at 24, 48 and 72 h. Second step involved thermal treatment of 72 h samples. Unmodified and modified particles have been analyzed by chemical methods and instruments i.e. UV spectrometer, FTIR, cyclic voltammetry (CV) and microscopic imaging. Thermally treated samples have shown augmented Co adsorption. CV analysis showed thermally treated samples with better capacitance. Particles modified by oxalic acid presented better Co adsorption. Oxalic acid treated particles activated for 72 h with thermal treatment provided maximum adsorption capacity 1327 ± 20.6 mg/g against Co(II) at pH 7, stirring 200 rpm, initial concentration 20 ml, adsorbent dosage (5 mg) and contact time 240 min at room temperature. [ABSTRACT FROM AUTHOR]

The clustering approach is widely accepted as the most prominent unsupervised learning problem in data mining techniques. This procedure deals with the identification of notable structures in unlabeled datasets. In modern days clustering of dynamic data, streams play a vital role in policy-making, and researchers are paying particular attention to monitoring the evolution of clustering solutions over time. The data streams evolve continually, and different sources generate data items over time. The clustering solution over this stream is not stationary and changes with the influx of new data items. This paper presents a comprehensive study of algorithms related to tracing the evolution of clusters over time in cumulative datasets. To demonstrate the applications and significance of the tracing cluster evolution, we implement the MONIC algorithm in R-software. This article illustrates how the data segmentation of dynamic streams is done and shows the applications of monitoring changes in clustering solutions with the help of real-life published datasets. [ABSTRACT FROM AUTHOR]

GLARE laminates are multi-layered metal-composite materials created from bonding sheets of metallic alloys with carbon or glass fibre layers. The application of hybrid-conventional machining processes such as ultrasonic-assisted drilling (UAD) is becoming of great interest to the aerospace industry due to its capability in reducing the cutting forces and tool wear which are directly responsible for drilling-induced delamination. There is rich literature on the conventional drilling (CD) of GLARE, but no work reported using UAD process. This study will fill this gap and investigate the UAD of GLARE laminates using an indigenously developed UAD system. The influence of spindle speed and feed rate on thrust force and surface roughness metrics (Ra and Rz) were investigated under CD and UAD regimes. The quality of the borehole and damage mechanisms in the laminate constituents was examined using scanning electron microscopy (SEM). The contribution of the drilling parameters on the measured outputs was further evaluated using the analysis of variance (ANOVA) statistical analysis. It was found that UAD resulted in a significant reduction in thrust force by up to 65% while surface roughness metrics Ra and Rz were unaffected by the type of drilling process used. SEM analysis showed irregular and fuzzier surfaces in glass fibre layers in holes machined using UAD due to the longitudinal vibration of the tool. [ABSTRACT FROM AUTHOR]

Clustering analysis' primary purpose is to divide a dataset into a finite number of segments based on the similarities between items. In recent years, a significant amount of study has focused on the spatio-temporal aspects of clustering. However, clusters are no longer regarded as static objects since changes influence them in the underlying population. This paper describes an R package implementing the MONIC framework for tracing the evolution of clusters extracted from temporal datasets. The name of the package is clusTransition, which stands for Cluster Transition. The algorithm is based on re-clustering cumulative datasets that evolve at successive time-points and monitoring the transitions experienced by the clusters in these clustering solutions. This paper's contribution is to demonstrate how the package clusTransition is developed in the R programming language, and its workflow is discussed using hypothetical and real-life datasets. [ABSTRACT FROM AUTHOR]

This study enumerates the evolution of basic human values orientations and the dynamic relationship between them, computed from Schwartz's value survey conducted in European nations. For this purpose, eight datasets related to the human value scale were extracted from the European Social Survey; each corresponds to a single round conducted cross-sectionally every two years since 2001. Change detection algorithm was implemented to the cluster solutions of temporal datasets, and the evolution of important clusters was traced. Finding of the study reveals that Universalism and Benevolence values are on the rise in European societies in the last couple of decades. Most of the European inhabitants believe in the smooth group functioning and form the organismic needs of cooperation. The people prefer anxiety-free life, and love for nature, environment, humanity, and kindness to other beings in society are essential constructs for them. They avoid self-centred behaviour and prefer social physiognomies. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: The femoral shaft fractures constitute 50% of all femoral fractures. The objective is to observe the outcome of diaphyseal femur fracture treatment of femur shaft with the union and full weight bearing by bridge plate osteosynthesis among adults. METHODOLOGY: A Prospective observational study was conducted in the department of Orthopaedic Surgery, Postgraduate Medical Institute/Lahore General Hospital. A sample of 30 patients was calculated using WHO calculator. Convenient sampling was used for patient selection. After reducing the fracture (indirectly), the other end of the plate was also fixed with screws. Data was collected at 6th months post-operatively to see radiological union and weight-bearing status. Data analysis was done using SPSS version 25. Fisher exact test was applied. p-value≤0.05 was considered significant. RESULTS: Mean age of the patients was 34.66±9.22 years. Gender distribution of patients shows that 17% of the patients were females, and 83% of the patients were male. At the 6th month follow-up, all 30 (100%) patients had achieved bony union. At the 5th month, 14(46.7%) of the operated cases were allowed to bear 36-45 Kg weight (p=0.024), and in the 6th month, there were 20(66.7%) operated cases were allowed to bear full weight after the radiological union (p=0.013). CONCLUSION: Bridge plating technique is a safe, easy, and effective method of fixation for comminuted diaphyseal fractures of long bones in terms of bony union and weight bearing. It has a high rate of union with fewer complications. [ABSTRACT FROM AUTHOR]

Automatic Traffic Sign Detection and Recognition (TSDR) provides drivers with critical information on traffic signs, and it constitutes an enabling condition for autonomous driving. Misclassifying even a single sign may constitute a severe hazard, which negatively impacts the environment, infrastructures, and human lives. Therefore, a reliable TSDR mechanism is essential to attain a safe circulation of road vehicles. Traffic Sign Recognition (TSR) techniques that use Machine Learning (ML) algorithms have been proposed, but no agreement on a preferred ML algorithm nor perfect classification capabilities were always achieved by any existing solutions. Consequently, our study employs ML-based classifiers to build a TSR system that analyzes a sliding window of frames sampled by sensors on a vehicle. Such TSR processes the most recent frame and past frames sampled by sensors through (i) Long Short-Term Memory (LSTM) networks and (ii) Stacking Meta-Learners, which allow for efficiently combining base-learning classification episodes into a unified and improved meta-level classification. Experimental results by using publicly available datasets show that Stacking Meta-Learners dramatically reduce misclassifications of signs and achieved perfect classification on all three considered datasets. This shows the potential of our novel approach based on sliding windows to be used as an efficient solution for TSR. [ABSTRACT FROM AUTHOR]

American bollworm (Helicoverpa armigera) is poly-phagous pest which infects major fiber, pulses and vegetable crops, e.g., cotton, soybean, chickpea, brinjal, tomato, peas, beans, okra, and chili in Pakistan. Farmers use the different dosage of insecticides to control American bollworm on various crops that might be due to the existence of genetically diverse American bollworm population. So, it is essential to explore and get an understanding of this genetic variation existing among American bollworm, feeding on different host plants. The current study was conducted to observe the genetic variation existing among seven American bollworm populations by RAPD-PCR system collected from host plant including cotton, pea, green bean, chili, green chili, tomato and okra. Overall, 210-bands were obtained from thirty RAPD primers, out of these, 34-bands were polymorphic, and 176-bands were monomorphic. PIC values ranged from 0.2149 to 0.5014, with a mean of 0.2838. Genetic similarity ranged from 92.38% (produced by cotton and peas) to 99.52% (produced by chili and green beans) and the genetic distance range from 0.48% to 7.92%. A most important result was the clustering of the population occurring on green bean, chili, green chili, tomato and okra in one cluster. In contrast, the population occurring on cotton and pea were designated separate clusters, respectively. These results showed that population occurring on cotton and pea were most dissimilar to other populations indicating that populations are closely related to each other. There might be an interspecific crossing frequency among these populations. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between hospital environment, mental health and turnover intention among doctors. Study Design: Cross-sectional analytical study. Place and Duration of Study: Mayo Hospital Lahore and Jinnah Hospital, Lahore Pakistan, from Feb to July 2019. Methodology: Using convenient sampling, a sample of 100 doctors (males=50 and females=50) was recruited. This study did not include participants with less than one year of work experience. The hospital environment was examined using the Organizational Environment Scale. The mental health of doctors was assessed using the Mental Wellbeing Scale, and their turnover was measured through the Turnover Intention Scale. Results: Hospital environment and doctors' mental health positively correlated (p<0.001). Doctors who perceived the hospital environment as good had good mental health and less intention to turnover their jobs (p<0.001). Furthermore, female doctors had poorer health and higher turnover intention than male doctors (p<0.001). Conclusion: The hospital environment affects doctors' mental health. A good hospital environment significantly positively predicted good mental health. [ABSTRACT FROM AUTHOR]

Polyurethane (PU), designed with pre-polymer method involving polyol as cross-linker, has been utilized for shape memory applications. Neat PU or PU-PS (polystyrene) interpenetrating network (IPN) samples have been prepared. Functionalized multiwall carbon nanotubes (FMWCNTs) have been utilized as reinforcements. PU composites have been studied for shape recovery time and found better than neat PU. 1wt% incorporation of FMWCNTs in PU has reduced shape recovery time to 22 s for 100% shape recovery, in comparison to neat PU with 62 s of 100% shape recovery. PU-PS IPN has reduced 100% shape recovery time to 17s. Superior hydrogen bonding in neat PU has been suggested as per longer shape recovery time against thermal actuation, in comparison to PU composite and IPNs with FMWCNTs. Decreased thermal stability has been observed with FMWCNTs incorporation, indicating enhanced heat dissipation. Field emission scanning electron microscopy analyses confirmed the difference of morphologies in neat PU, PU composite, and IPNs. A distinctive filler-matrix interaction in IPNs has been observed. XRD confirmed the presence of amorphous component. Rutherford Backscattering Spectrometry and Thermal Gravimetric Analysis have been utilized for analyses. Shape recovery study has been made by a simple experimental set up prepared in lab. [ABSTRACT FROM AUTHOR]

The current findings concluded the reverse impacts of arsenic (As) stress on ten contrasting maize varieties (Malika 2016, Sahiwal 2002, Agaitti 2002, Pearl, Akbar, Pak Afghoi, Neelum, Pioneer, Sadaf, MMRI-Yellow). A pot experiment was designed to screen out the tolerant and susceptible maize varieties at Government College University Faisalabad. Genetic variability among the maize varieties explodes their individual coping traits either tolerant or sensitive against As accumulation. The exposure to different levels of As (50, 100 mg/kg) stress were examined. Application of As stress substantially decreased the growth attributes in all maize varieties. Arsenic also induced a significant decline in chlorophyll contents in all maize varieties, especially in sensitive varieties. Remarkable decrease was observed in growth and chlorophyll attributes, while increase was recorded in malondialdehyde (MDA), hydrogen peroxide (H2O2), ascorbic acid (ASA), superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activities. Results of current study show that variety Pearl of maize was more tolerant with minimum decrease in growth, while Akbar variety was more sensitive with maximum decrease in all growth attributes against As stress. Furthermore, maize varieties namely Neelum, Sahiwal, Poineer and Pak Afghoi also presented as tolerant varieties, while Sadaf, MMRI and Malika proved as moderately sensitive against As stress. The higher As tolerance of Pearl variety was associated with persistency to maintain higher growth and chlorophyll contents under As stress as compared to the other varieties. [ABSTRACT FROM AUTHOR]

Fucosyltransferase 2 (FUT2) catalyzes the biosynthesis of A, B, and H antigens and other important glycans, such as (Sialyl Lewisx) sLex, and (Sialyl Lewisy) sLey. The production of these glycans is increased in various cancers, hence to design and develop specific inhibitors of FUT2 is a therapeutic strategy. The current study was designed to identify the inhibitors for FUT2. In silico screening of 300 synthetic compounds was performed. Molecular docking studies highlighted the interactions of ligands with critical amino acid residues, present in the active site of FUT2. The epitope mapping in ligands was performed using the STD-NMR experiments to identify the interactions between ligands, and receptor protein. Finally, we have identified 5 lead compounds 4, 5, 26, 27, and 28 that can be studied for further development as cancer therapeutic agents. [ABSTRACT FROM AUTHOR]

One of the notes worthy problems in analysis of clinical and observational studies is missing data and nonresponse from patients. Turning a blind eye to the missing behavior may provide biased results with overestimated standard errors. The potential impact of the problem may even have more severe impression in estimating health-related quality of life index. This index is an important indicator, widely used in clinical trials for assessing effectiveness of available interventions. Amongst many available measures for estimation of the index, the most rising approach is the EQ-5D preference-based health classifier. This study suggests a cluster-based heuristic algorithm for imputation of missing values in the EQ-5D health classifier to overcome the said problem. The use of auxiliary variable and other dimension's values as evidences increases the chance of correct identification of the missing value and hence makes it unbiased. Comparisons of bootstrap samples suggest that it overcomes the problem of standard errors and provides efficient estimates. [ABSTRACT FROM AUTHOR]

Background: The shortage of medicines represents a complex global phenomenon that triggers patient care and safety issues. The study was undertaken to explore the impact of medicines shortages on patients in Pakistan. The study also identified barriers which hinder the solutions of medicines shortages issue.Methods: A qualitative study design was adopted and the data was collected in stages between July and September 2019using an in-depth interview approach. The purposive and convenient sampling strategy was used to recruit the study participants. Sample size was limited by using the saturation point criteria. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: A total of 35 stakeholders including 13 physicians, 12 pharmacists and 10 patients participated in the study. The findings of the study were classified into five key themes and seven subthemes. The five themes included, 'impact of medicine shortages on patients', 'patients' practices in response to medicine shortages', 'influence of medicines shortages on medical practice or pharmaceutical business', 'barriers to solutions for medicines shortages', and 'suggestions to assuage the impact of medicine shortages.'This study showed that the medicine shortages had significant clinical and financial impact on patients. Patients' opted for a number of risk-prone practices to avoid treatment disruption during shortages. An array of pharmaceutical market, medicines quality and patient related factors refrain physicians to switch from brand name medicine to generics and lead to ineffective management of medicines shortages. Promotion of generic prescription, implementation of punitive policies and proper patient consultation was advised to assuage the impact of medicine shortages on patients.Conclusion: The adverse clinical, economic and humanistic impact affirmed in this study demand the introduction of risk-management strategies for medicines shortages in hospital and community settings in accordance with the international standards. Promotion of effective patient counselling by the healthcare professionals to deter risk-prone practices associated with medicines shortages is mandatory. [ABSTRACT FROM AUTHOR]

Objective: To determine diagnostic accuracy of Tc-99m labelled Ubiquicidin (29-41) SPECT/CT for detection of osteomyelitis in diabetic foot patients by taking bone biopsy as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, from Apr 2017 to Mar 2018. Methodology: Study assessed 122 patients of both genders, aged between 30-80 years (mean age=55.3 years), presenting with diabetic foot ulcers having suspicion of osteomyelitis, by Tc-99m-Ubiquicidin (29-41) SPECT/CT followed by bone biopsy (histopathology and culture) taken as gold standard. Results: Among 122 patients [94 male (77%) and 28 female (23%)], osteomyelitis was histopathologically confirmed in 113 patients. 107 out of these patients were positive for osteomyelitis on Tc-99m-UBI (29-41) SPECT/CT (true positives) while 6 were false negative. Out of 9 patients declared negative for osteomyelitis on histopathology and culture, 8 were negative on Tc-99m-UBI (29-41) SPECT/CT as well (true negative) while only 1 case came out to be positive (false positive). Thus, the Tc-99m-UBI (29-41) scan showed 94.6% sensitivity, 88.89% specificity, 99% positive predictive value, 57% negative predictive value with overall 94.2% diagnostic accuracy. Conclusion: Tc-99m labelled Ubiquicidin (29-41) SPECT/CT scan can precisely localize infective focus, in diabetic foot osteomyelitis, with simultaneous discrimination between bone and soft tissues. [ABSTRACT FROM AUTHOR]

This document introduces a novel concept involving an Omni-Directional Guided Vane (ODGV) encompassing a vertical axis wind turbine (VAWT) with the goal of improving its overall performance. Extensive three-dimensional computational analysis of the airfoils used in this novel ODGV structure is conducted to investigate the impact of various geometric parameters. Diverse geometric configurations of the ODGV are explored to analyze wind flow behavior across the turbine utilizing a well-validated computational fluid dynamics (CFD) model. The numerical investigations employ the Reynolds Averaged Navier–Stokes (RANS) modeling approach with the k-epsilon turbulence model. The steady state governing equations are solved using the validated CFD solver STAR CCM+. The study considers three distinct inlet velocities: 3, 6, and 9 m/s, with the aim of improving flow behavior and velocity through the ODGV. Four different modifications of the ODGV are examined, and the accuracy of the CFD model is affirmed through comparison with NACA airfoil data. Integration of the ODGV results in an enhanced self-starting behavior of the VAWT, leading to a reduction in the cut-in speed. Validation results demonstrate a strong agreement with the data obtained from CFD simulations. These results suggest that most shape ratios, except for 0.3 and 0.4 at Tip Speed Ratio (TSR) of 1.3 and 3, contribute to enhancing power and torque coefficients. Furthermore, the findings indicate that with a Sharpe ratio of 0.56, both torque and power coefficients could be improved by up to 48% and 58%, respectively. [ABSTRACT FROM AUTHOR]

Background: The emerging threat of antibiotic resistance is growing exponentially and antibiotic stewardship programs are cornerstone to fight against this global threat. The study aimed to explore the knowledge, perspectives and practices of physicians regarding various aspects of antibiotic stewardship program including antibiotic stewardship activities, rational use of antibiotics, antibiotic resistance, prescribing practices and factors associated with these practices.Methods: In this qualitative study, a total of 17 semi-structured, in-depth interviews with doctors of three tertiary care public sector hospitals in Bahawalpur and Rahim Yar Khan were conducted. The convenient sampling method was adopted to collect the data and the saturation point criterion was applied to determine the sample size. Thematic analysis approach was used to draw conclusions from the data.Results: The analysis of data yielded five themes, 12 subthemes and 26 categories. The themes included, (i) perception about antibiotic use and antibiotic stewardship, (ii) antibiotic prescription practices, (iii) antibiotic resistance, (iv) limited strategies adopted by hospital administration to ensure quality and safe distribution of antibiotics, (v) implementation of antibiotic stewardship program: barriers, suggestion and future benefits. Doctors had misconceptions about the rational use of antibiotics. The perception regarding antibiotic stewardship programs was poor. Moreover, very few activities related to ASP existed. The participants gave many suggestions for successful implementation of ASP in order to reduce the burden of antibiotic resistance, including development of guidelines for the use of antibiotics, strict legislation regarding use of antibiotics, active participation of healthcare professionals and awareness program among general public about the use of antibiotics.Conclusion: This study concluded that poor knowledge of doctors regarding ASP, non-existence of antibiogram of hospital and lack of rules for the safe use of antibiotics were the main driving factors associated with irrational antibiotic prescription practices and development of AR. [ABSTRACT FROM AUTHOR]

Applied materials from bio-wastes are becoming the center of attention for researchers due to convincing concerns for their effectiveness, bio-sustainability, affordability, and environmental friendliness. In this research, different forms of carbon particles (CP) were produced from walnut shells to check their response against acne. Surface chemistry of CPs was modified in two steps: first, by thermal or oxidative-thermal treatment, and second, by biochemical treatment with the drugs triamcinolone acetonide (TA) or hydrocortisone sodium succinate (HSS) at pH 4 and 7. Prepared CPs have been analyzed for their surface chemistry, morphology and bioactivity. With the exception of GTOT, surface modifications have decreased oil absorption capacity and drug release pattern while increasing dispersion, pH and base contents. The GTOT and PTOT-N1 samples exhibited highest oil absorption capacities of 0.137 g/0.05 g and 0.130 g/0.05 g, respectively. Additionally, thermal and thermo-chemical modifications have slightly decreased in-vitro anti-inflammatory activity but substantially decreased cytotoxicity (almost 5–6 folds in comparison to unmodified particles). Anti-inflammatory response has been checked against P. acnes. Among various prepared samples, it was observed that Bio-PUT-4 and Bio-PTOT-7 exhibited the most significant levels of anti-inflammatory activity, at 94.19 % and 93.54 % respectively. Thermally modified samples, additionally, have shown magnetic behavior. [Display omitted] • Bio-waste (Walnut shell) as source of carbon particles. • Thermal, Thermo-chemical, Biochemical surface modification. • Preparation of eco-friendly skincare product. • Promoting environmental sustainability through the recycling of bio-waste materials. [ABSTRACT FROM AUTHOR]

Background: Sepsis is one of the major causes of neonatal mortality in Pakistan. This study aimed to investigate the treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending a tertiary care hospital in Pakistan. We also aimed to identify the factors affecting mortality in neonatal sepsis patients. Methods: A descriptive, cross-sectional study was conducted in the pediatric wards of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. All eligible neonatal sepsis patients who were registered at the study site from January 1, 2019 to June 30, 2019 were included in the study. The data collection form included information on patient's characteristics, antibiotic use and its sensitivity pattern, laboratory and microbiological data, and final treatment outcomes. Treatment outcomes included, discharged (with treatment success), leave against medical advice (LAMA), discharged on request (DOR) and death. Multivariable binary logistic regression analysis was used to find the independent factors associated with death. A p-value of less than 0.05 was considered statistically significant. Results: Among the total 586 patients, 398 (67.9%) were male, 328 (56%) were preterm, 415 (70.8%) were diagnosed with early onset sepsis, 299 (51%) were born with low birth weight. Most of the patients (n = 484, 82.6%) were treated with amikacin+cefotaxime at the start of treatment. Culture was positive in 52 (8.9%) patients and the most commonly identified bacteria included, Klebsiella species (n = 19, 36.5%) followed by E. coli (n = 15, 28.5%) and Staphylococcus aureus (n = 8, 15.4%). The identified bacterial isolates showed high level of resistance against the antibiotics initiated at the start of the treatment, while resistance against piperacillin+tazobactam, imipenem, vancomycin and linezolid was very low. Just under half of the patients (n = 280, 47.8%) successfully completed the treatment (i.e., discharged with treatment success), while 123 (21%) patients died during treatment. In multivariable binary logistic regression, the factors which still remained significantly associated with neonatal death included, preterm delivery (AOR 9.59; 95% CI 4.41, 20.84), sub-optimal birth weight (AOR 5.13; 95% CI 2.19, 12.04), early onset sepsis (AOR 2.99; 95% CI 1.39, 6.41) and length of hospital stay (AOR 0.76; 95% CI 0.67, 0.88). Conclusion: The mortality rate associated with sepsis was high in our study cohort. The bacterial isolates showed high level of resistance against the antibiotics started as the empiric therapy. Rational use of antibiotics can decrease the adverse outcomes in neonatal sepsis patients. [ABSTRACT FROM AUTHOR]

Background: There is limited published data form Pakistan on treatment success rate among extrapulmonary tuberculosis (EPTB) patients. The aim of this study was to assess clinical form, treatment outcomes, and identify the factors associated with unfavorable treatment outcome among EPTB patients. Methods: A retrospective study was conducted at the Chest Disease Unit of the Bahawal Victoria Hospital, Pakistan. Medical records of EPTB patients, registered at the study site from January 1, 2015 to September 30, 2017, were reviewed to obtain the data. Final treatment outcomes among EPTB patients were evaluated in accordance with the standard Word Health Organization (WHO) criteria. Multivariate binary logistic regression analysis was used to identify the factors associated with unfavorable treatment outcome. Results: A total of 651 EPTB patients were included in the study. Highest proportion of patients had pleural TB (n = 217, 33.3%). Out of the total 651 patients, 463 (71.1%) successfully completed the treatment. Among 177 (27.2%) patients with unfavorable treatment outcome, 10 (1.5%) died, while 165 (25.4%) lost to follow-up the treatment. Lymph node TB (AOR 0.65, 95% CI 0.422, 0.989) and meningeal TB (AOR 2.1, 95% CI 1.065, 4.144) were significantly associated with unfavorable treatment outcome. Conclusion: The treatment success (favorable outcome) rate among EPTB patients was less than the target (i.e., ≥ 90%) set by the WHO. Highest proportion of patients lost to follow-up during the treatment. [ABSTRACT FROM AUTHOR]

Background: Pharmacists possess significant potential for providing health services to the public when it comes to issues of weight management. However, this practice has not been observed in most parts of the world including low- and middle-income countries (LMICs) such as Pakistan. The aim of this study was to explore the potential role of pharmacists in providing healthy weight management (HWM) services to adults in Pakistan, and the barriers associated with the implementation of this type of role.Methods: This descriptive qualitative study was set in seven hospitals (public and private) and three chain pharmacies in Lahore, Punjab - a province of Pakistan. Data was collected from in-depth individual interviews with pharmacists (n = 19) and medical doctors (n = 15). Purposive sampling techniques were applied to recruit both types of study participants. Telephone contact was made by the trained data collectors with the pharmacists to set the date and time of the interview after explaining to them the purpose of the study and obtaining their willingness and verbal recorded consent to participate. Registered medical doctors were recruited through snowball sampling techniques. The sample size was determined by applying the point at which thematic saturation occurred. All interviews were audio-recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.Results: Through inductive qualitative analysis eight themes emerged; potential role for community pharmacists, collaborative approaches, barriers, ideal pharmacist-based weight management program, professional requirements and need for training, potential for implementation, current scenario in pharmacies and level of trust of pharmacists. The first six themes were common to both pharmacists and medical professionals. The unique theme for doctors was the 'level of trust of pharmacists', and for the pharmacists was the 'current scenario in pharmacies'.Conclusion: The majority of participants in our study had strong convictions that Pakistani pharmacists have the potential for provide effective HWM services to their communities. Of concern, none of the participating pharmacies were offering any sort of weight management program and none of the medical professionals interviewed were aware of HWM programs taking place. Medical doctors were of the opinion that pharmacists alone cannot run these programs. Doctor participants were firm that after being adequately trained, pharmacists should only carry out non-pharmacological interventions. To implement a HWM pharmacy model in Pakistan, it is necessary to overcome barriers outlined in this study. [ABSTRACT FROM AUTHOR]

In the wake of atrocious rise in COVID-19 cases, developed countries are leveraging a range of community pharmacy services with the goal of improving access to essential medication and healthcare services. While in the developing nations, including Pakistan, pharmacists are unable to perform COVID-19 containment roles in community, since presence of pharmacists at community pharmacy settings and delivery of pharmacy services have historically been plagued by shortcomings at various levels. In this document, we identified these shortcomings which need to be resolved on many fronts. Broadly, a number of intertwined government related, public related, academic curricula and pharmacist related, and drug retailers' related factors refrain community pharmacists from performing and facilitating Pakistan's fragile public and healthcare system in the midst of COVID-19 pandemic. Government led multifaceted approaches are urgently needed to strengthen this unrecognized domain and thereby effectively combat COVID-19 by utilizing community pharmacy services, as evidenced in the developed world. [Note: Part of this article is published in Pakistan Observer Newspaper; dated 17 May 2020). [ABSTRACT FROM AUTHOR]

Surface modification of carbon black (CB) is an important tool to refashion properties of its composites. CB surface modification is usually practiced through thermal procedures. However, environmental concerns have provided the base to rethink for alternate methods, particularly photochemical methods that are considered comparatively eco-friendly due to reduced chemical and thermal waste. Present investigation is based on a photochemical method for CB surface modification that has effectively modified particle surface with alkoxysilane. This method carries the active centers, generated by photoinitiator, to the shaded areas which otherwise are not possible to reach. Hence, this reaction scheme has prevailed over huge activation barrier without thermal support. A photo-thermal modification method has also been utilized for comparative analysis. Effectiveness of photochemical modification method to alter the surface of CB has been confirmed through different instrumental techniques, including XPS, TGA, FTIR, Raman and SEM. [ABSTRACT FROM AUTHOR]

The study was designed to synthesize bromide-bridged mercury(II) symmetric and non-symmetric N-heterocyclic carbene complexes. The preparation of benzimidazolium salts (4–6) was accomplished by symmetrical and non-symmetrical substitution on benzimidazole. The salts were subjected to an in-situ process for metallation to get [Hg(II)-NHC] complexes [(HgBr-NHC)(µ2Br)2] (7–9) by reacting benzimidazolium salts (4–6) with mercury(II) acetate at room temperature. Compounds were characterized by elemental analyses, FT-IR and NMR spectroscopy. Single crystals of 7 and 8 were analyzed by X-ray crystallographic technique which showed tetrahedral dinuclear complexes with two bridging bromides. An attempt to explore the feasibility of redox transmetallation approach (RTM) for synthesis of ytterbium complexes was also carried out by reacting 7–9 with ytterbium powder under inert atmosphere. The products were metallic mercury, benzimidazolium salts, and ytterbium bromide instead of ytterbium complexes. [ABSTRACT FROM AUTHOR]

In this work, the comb-like poly(2-methyl-2-oxazoline) copolymer, poly(2-aminoethyl methacrylate-random-poly(2-methyl-2-oxazoline) (PMOXA-r-AEMA, PMA) is synthesized, and the CuSO4/H2O2-triggered dopamine/PMA co-deposition process is investigated. Ellipsometry, water contact angle (WCA), and X-ray photoelectron spectroscopy (XPS) are used to characterize the thickness, hydrophilicity, and surface composition of PMA-based coatings. PMA is facilely anchored to substrates within 60 min with the assistance of dopamine/polydopamine triggered by CuSO4/H2O2, and the coating thickness can achieve about 13 nm. Anti-protein adsorption and anti-blood platelet adhesion measurements are also studied to verify their antifouling properties. The adsorption capacity of FITC-BSA can be reduced to 5% of the original surface, and PMA-based coatings present excellent protein-resistant properties (∼95% reduction relative to gold surface) according to surface plasmon resonance (SPR) measurement, and it can resist adhesion of almost all blood platelets. Moreover, it is applied to a capillary inner wall for surface modification. An alkaline protein mixture and egg white proteins are successfully separated, and present excellent stability. The relative standard deviation (RSD) of migration time is lower than 0.71%. The practicability of this promising PMA-based coatings with this preparation strategy can be used for further proteomics analysis. [ABSTRACT FROM AUTHOR]

Surface chemistry of carbon black (CB) plays a major role towards its dispersion in liquid media. In this study a simple approach of surface modification has been implemented on two different types of particles to increase their dispersion in polymer matrix. FTIR, XPS, DLS, and TGA analyses have been utilized to categorize as well as compare surface functionalities before and after treatment for both types of CBs. As a result of surface oxidative treatment enhanced dispersion of modified CB particles in epoxy monomer along with rise in conductivity has been observed. [ABSTRACT FROM AUTHOR]

The induction of graft tolerance remains the holy grail of transplantation. This is important as chronic allograft dysfunction and the side effects of immunosuppression regimens place a major burden on the lives of transplant patients and their healthcare systems. This has mandated the need to understand the immunobiology of graft rejection and identify novel therapeutics. Regulatory T (Treg) cells play an important role in modulating pro‐inflammatory microenvironments and maintaining tissue homeostasis. However, there are fundamental unanswered questions regarding Treg cell immunobiology. These cells are a heterogeneous entity with functionally diverse roles. Moreover, the adoption of novel deeper immunophenotyping and genomic sequencing technologies has identified this phenotype and function to be more complex than expected. Hence, a comprehensive understanding of Treg cell heterogeneity is needed to safely and effectively exploit their therapeutic potential. From a clinical perspective, the recent decade has seen different clinical teams commence and complete first‐in‐man clinical trials utilising Treg cells as an adoptive cellular therapy. In this review, we discuss these trials from a translational perspective with an important focus on safety. Finally, we identify crucial knowledge gaps for future study. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of intravenous lidocaine infusion on postoperative pain scores and narcotic consumption in patients undergoing abdominal surgery under general anesthesia. Study Design: Randomized, double blinded controlled trial. Place and Duration: Department of Anesthesia, Combined Military Hospital, Khuzdar from 15th November 2018 to 20th May 2019. Methodology: A total of 80 adult patients were randomly assigned into two groups of 40 each to receive IV lidocaine bolus, 1 mg/kg followed by IV infusion, 2mg/kg/h (group L) or similar volume/kg of saline (group S). Each patient's level of pain was measured with a visual analogue scale (VAS) on arrival in post anesthesia care unit, at 2, 4, 8, 12, and 24 hours after surgery. Total postoperative morphine consumption and the incidence of side effects were also recorded. Results: Intraoperative lidocaine infusion resulted in effective analgesia in first 12 h postoperatively, seen by low pain scores (P=<0.05). The total morphine consumption was also reduced in the lidocaine group (P=<0.05). No signs of systemic lidocaine toxicity were observed. Conclusion: Intraoperative lidocaine infusion should be considered as an adjunct to opioids for postoperative pain management. [ABSTRACT FROM AUTHOR]

This article presents the isolation of arabinoxylan (AX) from Plantago ovata seed husk and its oxidation using periodate to create oxidized‐AX (OAX) with distinct functionalities. Utilizing the solution casting method, biocompatible blends of arabinoxylan/chitosan (AX/CS) are prepared at various weight ratios, and their properties are assessed. Fourier transform infrared spectroscopy (FT‐IR), x‐ray diffraction (XRD), and thermogravimetric analysis (TGA) are employed to gauge compatibility and thermal traits of AX and OAX with CS. Solubility tests reveal partial and limited solubility of AX and OAX in distilled water, respectively. OAX displays favorable compressibility and flow rate through Carr's index, Hausner's ratio, and angle of repose analyses. FT‐IR data confirm intermolecular hydrogen bonding between CS′s −NH2− group and OAX′s carbonyl group, with XRD showing low crystallinity. Diclofenac sodium (DC) is loaded as a model drug into AX/CS and OAX/CS blends for release studies in pH 6.8 phosphate buffer. Results exhibit OAX/CS blends with sustained drug release, surpassing AX/CS blends. Among ratios tested, the OAX/CS (1 : 2) blend emerges as a superior excipient, demonstrating enhanced in‐vitro release potential, highlighting oxidized blends′ promise in sustained drug delivery systems. [ABSTRACT FROM AUTHOR]

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Climate change has caused changes in environmental conditions, leading to both low temperature (LT) and high humidity (HH) stress on crops worldwide. Therefore, there is a growing need to enhance our understanding of the physiological and molecular mechanisms underlying LT and HH stress tolerance in cucumbers, given the significance of climate change. The findings of this study offer a comprehensive understanding of how the transcriptome and hormone profiles of cucumbers respond to LT and HH stress. In this study, cucumber seedlings were subjected to LT and HH stress (9/5 °C day/night temperature, 95% humidity) as well as control (CK) conditions (25/18 °C day/night temperature, 80% humidity) for 24, 48, and 72 h. It was observed that the LT and HH stress caused severe damage to the morphometric traits of the plants compared to the control treatment. The concentrations of phytohormones IAA, ethylene, and GA were lower, while ABA and JA were higher during LT and HH stress at most time points. To gain insights into the molecular mechanisms underlying this stress response, RNA-sequencing was performed. The analysis revealed a total of 10,459 differentially expressed genes (DEGs) with annotated pathways. These pathways included plant hormone signal transduction, protein processing in the endoplasmic reticulum, MAPK signaling pathway, carbon fixation in photosynthetic organisms, and glycerolipid metabolism. Furthermore, 123 DEGs associated with hormone signaling pathways were identified, and their responses to LT and HH stress were thoroughly discussed. Overall, this study sheds light on the LT and HH tolerance mechanisms in cucumbers, particularly focusing on the genes involved in the LT and HH response and the signaling pathways of endogenous phytohormones. • Low temperature and high humidity (LTHH) stress significantly affects morphometric and physiological traits in cucumber. • In cucumber, LTHH stress leads to elevated levels of phytohormones ABA and JA. • DEGs related to hormone signaling under LTHH stress were identified using RNA seq. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the effect of subanesthetic dose of ketamine on postoperative pain scores and narcotic consumption in patients undergoing abdominal surgery under general anesthesia. Study Design: Randomized, double blinded controlled trial. Place and Duration: At the Department of Anesthesia, Combined Military Hospital, Khuzdar from 1st February 2018 to 31st January 2019. Methodology: Adult patients were randomly allocated into two groups of equal size to receive either IV ketamine bolus, 0.25mg/kg followed by IV infusion, 0.15mg/kg/h (group A) or the same volume/kg of saline (group B). A visual analogue scale (VAS) was used to measure each patient's level of pain on arrival in post anesthesia care unit, at 1, 3, 6, 12, and 24 hours after surgery. Total postoperative morphine consumption and the incidence of side effects were also recorded. Results: Intraoperative low dose ketamine resulted in effective analgesia in first 12 h postoperatively, seen by low pain scores (P=<0.05). The total morphine consumption was also reduced in the ketamine group (P=<0.05). No serious psychomimetic side effects were noted in both the groups. Conclusion: Intraoperative low dose ketamine infusion should be considered as an adjunct to opioids for postoperative pain management. [ABSTRACT FROM AUTHOR]

Reliability analysis comprises statistical analysis techniques that make inferences based on life time data. Swift progress has been observed in life time data analyses during the last few decades. Accelerated life testing models are regarded as the most popular techniques for engineering life time data analysis. Their main aim is to model life times under different stress levels that are more severe than the usual stress level. The existing techniques consider life times as precise measurements and do not contemplate the imprecision of observations. In fact, life time measurements are not precise quantities but more or less fuzzy. Therefore, in addition to standard statistical tools, fuzzy model approaches are also essential. The current study generalizes some parametric and nonparametric classical estimation procedures for accelerated life testing in order to accommodate both fuzziness and random variation. The proposed estimators cover both uncertainties, which make them more applicable and practicable for life time analysis. The results of fuzzy life times are considered under various stress conditions, and comparisons with precise life time analysis are further presented in examples. [ABSTRACT FROM AUTHOR]

This descriptive, cross-sectional, questionnaire-based study was designed to assess the extent of depression and mild cognitive impairment (MCI) and their possible determinants among the elderly with type 2 diabetes mellitus in Pakistan. The study was carried out at the diabetes outpatient clinics of two tertiary care hospitals in Lahore, district of Punjab in Pakistan using convenience sampling techniques between December 1, 2015 and February 28, 2016. All consenting patients were interviewed to complete the Geriatric Depression Scale (GDS-15) and the Montreal Cognitive Assessment (MoCA). Standard scoring schemes were used for these scales. Multiple logistic regression analysis was carried out to identify any statistically significant variables from the univariate analysis, to segregate independent factors. A p value < .05 was taken as the mark of statistical significance for tests. A total of 490 elderly patients with type 2 diabetes mellitus were approached. Of those, 400 patients agreed to participate, resulting in a response rate of 81.6%. GDS-15 scores suggest that only 130 (32.5%) patients were not depressed to some degree. High HbA1C and MCI were significant predictors of depression. MoCA scores indicated that 269 (67.3%) patients had MCI, and depression was the only predictor of MCI among the study patients. The implications of the findings include the need by healthcare providers to consider the assessment and management of depression and MCI as part of diabetes treatment protocols so that elderly patients can achieve positive diabetes outcomes and have improved health-related quality of life. [ABSTRACT FROM AUTHOR]

The unplanned anthropogenic activities and raced industrial revolution detrimentally causes serious threat to terrestrial and aquatic life. A high discharge of wastewater from industries using dyes affects living organisms and the environment. This paper presents studies on polycationic selenides (PCS) synthesized by hydrothermal methods for photocatalytic degradation of dyes. The synthesized PCS were confirmed by various characterization techniques such as FTIR, SEM, EDX, UV/Vis, and XRD. The FTIR spectra revealed characteristic band at 843, 548 cm−1, and 417 cm−1 due to the M − Se stretching and intrinsic stretching vibrations, respectively. The optical bandgap of polycationic selenide lies in the visible light region (2.36 eV). The SEM images showed that PCS has a spherical shape with an average crystallite size of 29.23 nm calculated from XRD data using Scherer's equation. The PCS has a point of zero charge (PZC) at pH 7. The efficiency of synthesized PCS photocatalyst was confirmed in terms of its activity towards Eosin (EY) and Crystal violet (CV) dyes mineralization. The photocatalytic degradation for EY and CV dyes at optimum conditions was 99.47% and 99.31% and followed second order reactions kinetics with 1.4314 and 0.551 rate constant, respectively. The polynomial quadratic model is the best-fitted response surface methodology (RSM) model having a maximum desirability factors value and significant terms, with R2 (0.9994) and adj R2 values (1.0). [Display omitted] • Green fabrication of new ternary metallic selenides nanostructured materials. • Structural/morphological characteristics of ternary metallic selenides by advanced techniques. • Efficient photocatalytic degradation of textile contaminants under sunlight irradiation. • Operating factors influencing the degradation phenomena are investigated. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Ageing and its associated physiological changes make elderly more prone to chronic diseases, ultimately leading to escalated drug use. The aim of this study was to execute retrospective drug utilization evaluation among elderly patients discharged from the hospital. Methods: A descriptive, retrospective, cross‐sectional study design was employed. Data were collected from the medical records of discharged elderly patients admitted between July 2016 and December 2016 in Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan. Statistical Package for Social Sciences (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, version 21.0. Armonk, NY, USA: IBM Corp.) was used for analysing the data. Multiple linear regression analysis was used to find the independent factors associated with increased utilization of drugs. P‐value < 0.05 was considered statistically significant. Key findings: The average number of drugs per prescription was 4.74 (SD = 1.4). The most commonly prescribed drug classes were as follows: A – alimentary tract and metabolism (77.8%), J: anti‐infectives for systemic use (68.5) and C: cardiovascular system (67.5%) respectively. The total drug consumption varied between 0.02 defined daily dose (DDD)/1000 patient days and 77.1 DDD/1000 patient days. The maximally consumed drug in all the medical wards was omeprazole. 48.3% patients were prescribed at least one potentially inappropriate medication independent of disease or condition. 10.2% patients were prescribed at least one inappropriate medication dependent on disease or condition. 61.8% prescriptions had drug interactions. The total number of drug interactions found in the prescriptions was 781, and among them, majority (74.2%) were moderate interactions. Conclusions: Our study identified that drug use in elderly is not appropriate and special emphasis must be put on rationalizing the drug use in this population. The findings of this study may provoke the policymakers and healthcare professionals to formulate appropriate strategies for ensuring rational drug use. [ABSTRACT FROM AUTHOR]

Background: Patients’ knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients’ lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan. Methods: This was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis. Results: The analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities and liaison. The patient related subthemes included: eagerness of the patients and lack of understanding and misconception. The system-related factors included: patients with special needs, perceived role of the pharmacist, prescription and medicines, and staff workload. Conclusion: Healthcare professional related, patient related and system related factors have a significant influence on patients’ knowledge about dispensed medicines. The non-professional behaviour of doctors, increased staff workload, inadequate time and attention provided by healthcare professionals to patients, illiteracy of patients, lack of specialized labelling on medicines for illiterate patients and absence of pharmacists at the hospital, were the major concerns identified in this study. The study points to a need for appropriate patient education and counselling with regards medicines, improved coordination between hospital staff, and provision of some basic system-related facilities which are pivotal for enhancing patients’ knowledge and adherence to their treatment regimens. [ABSTRACT FROM AUTHOR]

The quality of the captured point cloud and the scanning speed of a structured light 3D camera system depend upon their capability of handling the object surface of a large reflectance variation in the trade-off of the required number of patterns to be projected. In this paper, we propose and implement a flexible embedded framework that is capable of triggering the camera single or multiple times for capturing single or multiple projections within a single camera exposure setting. This allows the 3D camera system to synchronize the camera and projector even for miss-matched frame rates such that the system is capable of projecting different types of patterns for different scan speed applications. This makes the system capturing a high quality of 3D point cloud even for the surface of a large reflectance variation while achieving a high scan speed. The proposed framework is implemented on the Field Programmable Gate Array (FPGA), where the camera trigger is adaptively generated in such a way that the position and the number of triggers are automatically determined according to camera exposure settings. In other words, the projection frequency is adaptive to different scanning applications without altering the architecture. In addition, the proposed framework is unique as it does not require any external memory for storage because pattern pixels are generated in real-time, which minimizes the complexity and size of the application-specific integrated circuit (ASIC) design and implementation. [ABSTRACT FROM AUTHOR]

Background: Interim treatment outcomes at 6-months for multidrug-resistant tuberculosis (MDR-TB) treatment are among the most basic performance monitoring and key evaluation indicators in the Stop and End TB strategy of the World Health Organization (WHO). Therefore, this study was conducted to evaluate the interim treatment outcomes of MDR-TB patients in Pakistan.Methods: This study was conducted at the Programmatic Management Unit for Drug-resistance TB (PMDT) site of the National Tuberculosis Program (NTP), Pakistan. It is located in the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Data was collected between April 1, 2014 and December 31, 2015. The medical records, Electronic Nominal Recording Reporting System (ENRS) data and MRD-TB notification forms of the MDR-TB patients registered at the PMDT site were reviewed to obtain data. For reporting and calculation of interim treatment outcomes, standardized WHO methodology was adopted. Simple logistic regression analysis was used to examine the possible association between the dependent variable (i.e. unsuccessful interim treatment outcome) and selected socio-demographic and clinical variables.Results: A total of 100 drug-resistant TB (DR-TB) patients (all types) were registered during the study period. Out of these, 80 were MDR-TB patients for whom interim results were available. Out of the 80 MDR-TB cases, 48 (60%) were classified under the successful interim treatment outcome category. The remaining 40% had unsuccessful 6-month treatment outcomes and 12 (15%) patients died, while nine (11.3%) were lost to follow-up by six months. The final predictors of unsuccessful interim treatment outcomes were; being resistant to ofloxacin (AOR 3.23, 95% CI 0.96-10.89; p-value = 0.04), having above normal baseline serum creatinine levels (AOR 6.49, 95% CI 1.39-30.27; p-value = 0.02), and being culture positive at the second month of treatment (AOR 6.94, 95% CI 2-24.12; p-value = 0.01).Conclusions: Despite free treatment and programmatic efforts to ensure patient adherence, the high rate of unsuccessful interim treatment outcomes is concerning. The identified risk factors for unsuccessful interim treatment outcomes in the current study provides clinicians an opportunity to identify high-risk patients and ensure enhanced clinical management and greater treatment success rates. [ABSTRACT FROM AUTHOR]

Background: Reports from drug utilization reviews are important tools employed in the assessment of healthcare practices. The objective of this study was to evaluate drug utilization patterns among elderly hospitalized patients on poly-pharmacy regimens in Pakistan. Methods: A descriptive, non-experimental, cross-sectional study was carried out from December 2015 to March 2016 in six tertiary-care hospitals in the Punjab province of Pakistan. The population under study were patients aged ≥60 years, taking ≥5 medicines per day (i.e., patients on poly-pharmacy) and who were hospitalized in the selected tertiary-care hospitals. In this study, data was collected from 600 hospitalized elderly patients (100 patients per hospital). All medicines prescribed on each in-patient chart were noted on a pre-designed pro-forma sheet and were classified under the Anatomical Therapeutic Chemical (ATC) classification system. Multiple linear regression analysis was used to determine the independent factors associated with poly-pharmacy in this cohort. Statistical Package for Social Sciences (SPSS) was used to analyze the data. P-value < .05 indicated statistical significance. Results: In 600 hospitalized in-patient (male 52.7% and female 47.3%) medication charts, 3179 medicines were prescribed. The most commonly prescribed drug classes were: A: alimentary tract and metabolism 80% (A02: drugs for acid related disorders 64.5%, A03: drugs for functional gastrointestinal disorders 21.5%), N: nervous system 66.3% (N02: analgesics 67.2%, N03: antiepileptic's 11.2%), J: anti-infectives for systemic use 62.2% (J01: antibacterial for systemic use 82.5%, J04: antimycobacterials 15.3%) and C: cardiovascular system 48.3% (C07: beta blocking agents 19.8%, C10: lipid modifying agents 16.5%), respectively. The most commonly prescribed active substances were: A02BC01 (omeprazole 51.3%), N02BE01 (paracetamol 50.8%) and J01DD04 (ceftriaxone 40.2%), respectively. In multiple linear regression analysis, male gender (95% CI -.205, -.006, p = .039, B = -.091), being divorced (95% CI -.604, -.136, p = .002, B = -.130) and presence of comorbidity (95% CI .068, .267, p = .001, B = .144) were the independent factors associated with increased drug use among elderly hospitalized patients on poly-pharmacy. Conclusions: The rational use of medicines is of utmost importance, most particularly in the elderly population. More consideration should be given to rationalizing pharmacotherapy in elderly hospitalized patients who are on poly-pharmacy regimens in Pakistan. [ABSTRACT FROM AUTHOR]

Due to the rapid race of industrialization natural assets like fresh water has been deteriorated causing lethal effects in living organisms. In the current study robust and sustainable composite of in-situ antimony nanoarchitectonics in chitosan/synthesized carboxymethyl chitosan matrix were synthesized. To improve solubility, metal adsorption and water decontamination, chitosan was modified into carboxymethyl chitosan and the modification was confirmed through various characterization techniques. The characteristic bands in the FTIR spectrum confirm substitution of carboxymethyl group in the chitosan. This was further illustrated that the characteristic proton peaks of CMCh observed at δ = 4.097 to 4.192 ppm, suggesting O-carboxy methylation of chitosan by 1H NMR. The second order derivative of potentiometric analysis confirmed 0.83 degree of substitution. The antimony (Sb) loaded modified chitosan were confirmed by FTIR and XRD analysis. The potential effectiveness of chitosan matrix was determined and compared toward reductive removal of the Rhodamine b dye. Rhodamine b mitigation is following first order kinetics with R2 value of 0.9832 and 0.969 with a constant rate of 0.0977 and 0.2534 ml/min for Sb loaded chitosan and carboxymethyl chitosan respectively. The Sb/CMCh-CFP enables us to achieve 98.5 % mitigation efficiency within 10 min. The CMCh-CFP chelating substrate was found stable and efficient even after 4th batches of cycles with <4 % decrease in efficiency. The in-situ synthesized material was found tailored composite, in terms of dyes remediation, reusability and biocompatibility as compared to chitosan. • COOH group substitution in chitosan to produce its derivative carboxymethyl chitosan • Degree of substitution, structural and morphological characterization • Elimination efficiency of chitosan and carboxy methyl chitosan were investigated. • Quadratic model as best fitted model of response surface methodology [ABSTRACT FROM AUTHOR]