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Climate change, as a critical global concern, has fueled our efforts to address it through different strategies. In response to the critical worldwide issue of climate change, we suggested a Photovoltaic (PV) system at the National University of Sciences and Technology (NUST) in Islamabad, Pakistan (latitude: 33.724530 N, longitude: 73.046869, terrain elevation: 552 m). Islamabad is located in a region blessed with enormous solar resources, boasting a daily horizontal solar irradiance of 1503.45 kWh/m 2 and an average daily solar irradiance of 5.89 kWh/m 2 , with an exceptional solar fraction of 98.99%. The ambient air temperature, averaging 23.21 °C, reaches its maximum in June and its minimum in December. Our research thoroughly evaluates the system's performance, accounting for various losses and utilizing modern PVsyst software. Over the course of 18 years, our PV system is expected to save 75,478.60 tons of CO 2 , the equivalent of planting 348,754 teak trees. Furthermore, the cost of energy generation is an affordable 0.0141 US $/kWh, much lower than traditional rates, including the Sherif cost of 0.028$/kWh. Along with the performance research, we conducted a detailed cost analysis, projecting the starting cost and cash flow, and discovered that the plant would be in surplus within 12 years of installation. Our system is positioned to generate 11,270,771 kWh/year with a respectable performance ratio (PR) of 76.2% and a Capacity Utilization Factor (CUF) of 16%. Our findings not only highlight the potential of renewable energy but also provide important insights for future sustainable energy programs., (© 2024. The Author(s).)

Objective: The aim of this study was to comprehensively compare the clinical and biomechanical efficiency of anterior cervical discectomy and fusion (ACDF) with anterior cervical disc replacement (ACDR) for treatment of multilevel cervical disc disease using a meta-analysis and systematical review., Methods: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library for articles published between January 1960 and December 2017. Both clinical and biomechanical parameters were analyzed. Statistical tests were conducted by Revman 5.3. Nineteen studies including 10 clinical studies and 9 biomechanical studies were filtered out., Results: The pooled results for clinical efficiency showed that no significant difference was observed in blood loss (P = 0.09; mean difference [MD], 7.38; confidence interval [CI], -1.16 to 15.91), hospital stay (P = 0.33; MD, -0.25; CI, -0.76 to 0.26), Japanese Orthopaedic Association scores (P = 0.63; MD, -0.11; CI, -0.57 to 0.34), visual analog scale (P = 0.08; MD, -0.50; CI, -1.06 to 0.05), and Neck Disability Index (P = 0.33; MD, -0.55; CI, -1.65 to 0.56) between the 2 groups. Compared with ACDF, ACDR did show increased surgical time (P = 0.03; MD, 31.42; CI, 2.71-60.14). On the other hand, ACDR showed increased index range of motion (ROM) (P < 0.00001; MD, 13.83; CI, 9.28-18.39), lower rates of adjacent segment disease (ASD) (P = 0.001; odds ratio [OR], 0.27; CI, 0.13-0.59), complications (P = 0.006; OR, 0.62; CI, 0.45-0.87), and rate of subsequent surgery (P < 0.00001; OR, 0.25; CI, 0.14-0.44). As for biomechanical performance, ACDR maintained index ROM and avoided compensation in adjacent ROM and tissue pressure., Conclusions: Multilevel ACDR may be an effective and safe alternative to ACDF in terms of clinical and biomechanical performance. However, further multicenter and prospective studies should be conducted to obtain a stronger and more reliable conclusion., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Despite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US., Methods: This retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories., Results: The prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease., Conclusion: TB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial/ethnic minorities who bear the greatest burden of the disease.

Objective: The study was done to determine the quantity of orthodontics and the type of appliance used for orthodontic treatment by general dentist., Materials and Methods: A total of 410 dentists completely participated in the study. The study included questions to know the positive effects of orthodontic treatment done by general dentists and their opinions and qualities regarding the provision of treatment., Statistical Analysis: Statistical analysis was done using SPSS version of 16.0 was used at p ≤ 0.05., Results: One forty six (35.6%) dentists answered that they practice orthodontic treatment to their patients, of which most were providing removable appliances (39.5%). There was a significant difference between the groups toward the benefits of orthodontic treatment according to experience of service and locality. General dentist were providing this treatment mainly in the mixed dentition period i.e. 96(65.8%). Most of the participants gave positive response regarding expansion of their syllabus related to orthodontics., Conclusion: A significant difference in response to the benefits of the treatment were seen according to experience and are of practice and most of the participants showed positive response increasing their courses in orthodontics at undergraduate level.

A convenient synthesis of oximes of steroidal chalcones (4a-4j) was performed and structural assignment of the products was confirmed on the basis of IR, (1)HNMR, (13)C NMR, MS and analytical data. The synthesized compounds were screened for in vitro antioxidant activity by using DPPH method and in vitro antimicrobial activity against different bacterial and fungal strains by agar diffusion method. The activity of the tested compounds against each microbe varied due to structural differences between them. Presence and position of different substituents on the benzene ring of the chalconyl pendent had a marked effect on the activity of the compounds. From the results it can be inferred that the compounds 4a-j showed significant antioxidant activity and antimicrobial activity against all microbial strains used for testing., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The Objective Structured Clinical Examination (OSCE) was first described by Harden in 1975 as an alternative to the existing methods of assessing clinical performance (Harden et al. 1975). The OSCE was designed to improve the validity and reliability of assessment of performance, which was previously assessed using the long case and short case examinations. Since then the use of the OSCE has become widespread within both undergraduate and postgraduate clinical education. We recognise that the introduction of the OSCE into an existing assessment programme is a challenging process requiring a considerable amount of theoretical and practical knowledge. The two parts of this Guide are designed to assist all those who intend implementing the OSCE into their assessment systems. Part I addresses the theoretical aspects of the OSCE, exploring its historical development, its place within the range of assessment tools and its core applications. Part II offers more practical information on the process of implementing an OSCE, including guidance on developing OSCE stations, choosing scoring rubrics, training examiners and standardised patients and managing quality assurance processes. Together we hope these two parts will act as a useful resource both for those choosing to implement the OSCE for the first time and also those wishing to quality assure their existing OSCE programme.

The organisation, administration and running of a successful OSCE programme need considerable knowledge, experience and planning. Different teams looking after various aspects of OSCE need to work collaboratively for an effective question bank development, examiner training and standardised patients' training. Quality assurance is an ongoing process taking place throughout the OSCE cycle. In order for the OSCE to generate reliable results it is essential to pay attention to each and every element of quality assurance, as poorly standardised patients, untrained examiners, poor quality questions and inappropriate scoring rubrics each will affect the reliability of the OSCE. The validity will also be influenced if the questions are not realistic and mapped against the learning outcomes of the teaching programme. This part of the Guide addresses all these important issues in order to help the reader setup and quality assure their new or existing OSCE programmes.

Background: The General Medical Council (GMC) is holding consultations in order to decide on the proposed changes to the undergraduate medical assessment. In the last round of consultation only eight medical students formally responded nationally., Aim: To determine the views of a larger proportion of final year medical students across the country on the proposed changes to the undergraduate medical assessment., Method: An online national survey of 10 medical schools, from which 401 responses from final year medical students were collected., Results and Discussion: The results indicate the medical students' views on the GMC's proposed changes to standardise the assessment system. The majority of the students were in favour of having a say in any changes to their future assessment. They agreed with the principle that there should be a consistency between assessments at different medical schools and currently their results did not represent preparedness to practice.

Purpose: To describe the successful removal of a knotted Seldinger wire from a subclavian vein, and review the design and structure of guidewires to formulate recommendations to minimize complications associated with the Seldinger technique., Clinical Features: An 81-yr-old patient suffered from an intravascular knotting of a Seldinger wire during subclavian venous cannulation. We describe a technique for successful removal of knotted guidewire under fluoroscopic guidance using the vessel dilator of a central venous cannulation kit. In this case, the technique was successful without associated immediate or delayed complications. Although central venous cannulation with the Seldinger technique is a commonly performed procedure, it may result in numerous complications, including kinking, and rarely complete knotting of the guidewire., Conclusions: A thorough understanding of procedural complications and physical characteristics of the guidewire is vital in order to ensure patient safety when using the Seldinger technique for central venous cannulation. We have reviewed the relevant literature for guidewire design and structure, associated complications, and provide recommendations for safe use of guidewires.

Objective: To determine the antimicrobial activity of Cefaclor against common respiratory tract pathogens isolated from patients in Pakistan., Setting: Department of Microbiology, Liaquat National Postgraduate Medical Centre, Karachi., Method: A laboratory analysis was done on 466 isolates of respiratory tract pathogens collected from 13 laboratories from all over Pakistan. Antibiotic sensitivity test was done by Kirby Bauer disc diffusion method and MIC of Cefaclor was determined by 'E' test., Result: Of the 163 Streptococcus pneumoniae, 87 Moraxella catarrhalis and 216 Haemophilus influenzae > 95% isolates were susceptible to Cefaclor. The MIC 90 of all these pathogens were < 2 ug., Conclusion: Resistance of respiratory tract pathogens to the 2nd generation Cephalosporin, Cefaclor is very low. MIC 90 of Cefaclor against all three common respiratory tract pathogens is < 2 ug, which indicates that Cefaclor would be effective in more than 90% of cases infected with these bacteria.

The microflora of 55 patients with leprosy skin ulcers was studied and related to a weighted inflammatory score (IS). The control group consisted of 18 ulcers with different underlying pathology. Leprosy ulcers were characterized by the exclusive presence of two types of branching gram-positive rods; a particular interesting proposal is that Mycobacterium leprae share common antigens with these unusual "leprosy ulcer associated" organisms and group G beta-hemolytic streptococci. In the leprosy group, corynebacteria and branching rods accounted for 97% of gram-positive bacilli and Bacillus species constituted only 3%. In the control group, B. species formed 50% of gram-positive rods; the rest were corynebacteria (p = 0.03). In the leprosy group, one third of the gram-positive bacteria were branching rods; none of them was acid fast. Ten of them were identified as Arcanobacterium haemolyticum, and the remaining 7 could not be identified. The IS of leprosy patients was lower than in the control group. The presence of more than two species of facultative or aerobic gram-negative rods or single species of pyogenic gram-positive cocci correlated with a high IS. The presence of two or more different pyogenic cocci resulted in a lower IS. Further studies into the nature of leprosyunique organisms as well as the inflammation inhibition factors in mixed infections are warranted. It is recommended that management of ulcers should consist of the application of local disinfection and early treatment of episodes of inflammation with a combination of fluoroquinolone and penicillin.