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This study induced a weak Hopf algebra from the path coalgebra of a weak Hopf quiver. Moreover, it gave a quiver representation of the said algebra which gives rise to the various structures of the so-called weak Hopf algebra through the quiver. Furthermore, it also showed the canonical representation for each weak Hopf quiver. It was further observed that a Cayley digraph of a Clifford monoid can be embedded in its corresponding weak Hopf quiver of a Clifford monoid. This lead to the development of the foundation structures of weak Hopf algebra. Such quiver representation is useful for the classification of its path coalgebra. Additionally, some structures of module theory of algebra were also given. Such algebras can also be applied for obtaining the solutions of “quantum Yang–Baxter equation” that has many applications in the dynamical systems for finding interesting results.

This paper checks the relative effectiveness of monetary and fiscal policies on real and nominal sides of economy in 11 selected developing countries. The paper employed panel (ARDL) method of pooled mean group estimators using the annual data from 1961 to 2020. To check the robustness of PMG results, the study employed panel DOLS and panel FMOLS. The findings of this study indicated that fiscal policy has a stronger effect than monetary policy in case of developing county on real sector. While, the influence of monetary policy is stronger in changing the nominal side of economy such as price level. In addition to this, the findings also revealed that fiscal policy has no impact on nominal side such as price level. Interestingly, the obtained results are according to economic theory. Finally, the results are consistent and have very important policy implication.

Systemic side effects of anti-cancer therapy remain a major limiting factor for patients, even with targeted therapy. Bevacizumab is an example of targeted cancer therapy which targets the vascular endothelial growth factor receptor (VEGFR) that has been approved for the treatment of various cancers and has been evaluated in metastatic urothelial carcinoma (MUC). We report a case of MUC on bevacizumab containing regimen who developed temporary asymptomatic sinus bradycardia with sinus pauses. That adverse event was thought to be related to the bevacizumab in her cancer regimen. Her Holter monitoring recording for a total duration of 28 days and 14 h after discharge did not show recurrence of sinus pauses. This case indicates the necessity for observation for the cardiac conduction defects as side effects in patients receiving bevacizumab, especially since they might be asymptomatic and transient.

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Fluorouracil (5-FU) is a chemotherapy medication often used alone or in combination with other agents (e.g., FOLFOX regimen) to treat gastrointestinal malignancies. Adverse effects of 5-FU include pancytopenia, alopecia, cardiotoxicity, and gastrointestinal symptoms. We describe a rare case of pulmonary toxicity associated with 5-FU. CASE PRESENTATION: The patient is a 78-year-old female with a history of unresectable metastatic cholangiocarcinoma on maintenance FOLFOX chemotherapy without Oxaliplatin (discontinued due to peripheral neuropathy and thrombocytopenia) presented with acute onset of dyspnea and pleuritic chest pain five days after a 5-FU and Leucovorin infusion. On initial evaluation, a chest radiograph showed pulmonary infiltrates for which she was treated with oral Levofloxacin as an outpatient. Despite this, she had progressive worsening of dyspnea, prompting further evaluation. Blood work revealed normal WBC and platelet counts, mild anemia with hemoglobin 9.4 g/dL, and normal BNP and troponin levels. ECHO showed normal systolic function. She was noted to be hypoxemic, requiring supplemental oxygen necessitating hospitalization. Repeat Chest radiograph showed worsening left upper lobe and lingular infiltrates. Her oxygen requirements rapidly increased from 3-4 L/min via nasal cannula to 12L/min via Oxymask. Despite treatment with broad-spectrum IV antibiotics, her dyspnea and hypoxia persisted. CTA chest was then performed, revealing extensive bilateral infiltrates and reactive enlarged mediastinal/hilar lymph nodes with no evidence of pulmonary embolism. She had a negative infectious workup, including a COVID-19 PCR. She underwent diagnostic bronchoscopy, which showed no endobronchial lesions or secretions. Bronchoalveolar lavage of the right middle lobe with three serial aliquots obtained progressively bloody returns diagnosing diffuse alveolar hemorrhage (DAH). The procedure was complicated by worsening hypoxia, and the patient required emergent intubation and transferred to the critical care unit, where she was treated with pulse dose steroids for three days. She was extubated to supplemental O2 via NC within 24 hours of treatment. Further lab evaluation showed negative ANA, ANCA, Anti GBM antibodies, Anti-dsDNA, and normal C3, C4 levels. Cytology of BAL was negative for malignancy. Given negative infectious and autoimmune workup, the diagnosis of DAH due to 5-FU was made. Steroid dose was reduced to Prednisone 1mg/kg with slow taper with improvement in clinical status and oxygen requirements. DISCUSSION: The diagnosis of 5-FU related pulmonary toxicity is based on clinical suspicion upon exclusion of infection, autoimmune disease, heart failure, and cancer progression. CONCLUSIONS: 5-FU induced pulmonary toxicity presenting as DAH is a rare entity. Prompt diagnosis can lead to early drug cessation and the use of high-dose steroids can improve patient outcomes. REFERENCE #1: Fernandez, L., Dominguez, A., Martinez, W., Sanabria, F., Leib, C. S., & Biomedical Research Group in Thorax. (2018). Pulmonary Toxicity Due to 5-Fluorouracil (5-FU) Manifested as Diffuse Alveolar Hemorrhage: Case Report. In D34. LUNG TRANSPLANT AND DRUG INDUCED LUNG DISEASE: CASE REPORTS (pp. A6577-A6577). American Thoracic Society. DISCLOSURES: No relevant relationships by Rajesh Kunadharaju, source=Web Response No relevant relationships by Puja Mehta, source=Web Response No relevant relationships by Ahmed Munir, source=Web Response No relevant relationships by Vandana Pai, source=Web Response No relevant relationships by Musa Saeed, source=Web Response

Hemosuccus pancreaticus is a rare but life-threatening cause of upper gastrointestinal bleeding through the main pancreatic duct. This clinical entity is a difficult diagnosis due to its rarity, intermittent nature of the hemorrhage, and peculiar clinical presentation. It is still considered a surgical problem but advances in medical therapy may enable clinically stable patients to undergo less-invasive angiographic embolization. We chronicle here a unique case of hemosuccus pancreaticus in a patient presenting with melena who could not be diagnosed on multiple standard forward-viewing esophagogastroduodenoscopies and computed tomography angiography. Eventually, side-viewing duodenoscope identified the intermittent bleeding through the ampulla of Vater. This paper illustrates that clinicians should be vigilant for this etiology, especially in patients with intermittent crescendo-decrescendo abdominal pain, acute gastrointestinal hemorrhage, and elevated serum lipase levels. A multidisciplinary team approach with the centralization of gastrointestinal bleed services and a well-established management protocol is of paramount importance to reduce the morbidity and mortality of this disorder. Additionally, this article serves to outline our current understanding of the epidemiology of and risk factors for hemosuccus pancreaticus, the pathophysiology of this disease, and currently available approaches to diagnosis and treatment.

Over the past decade, political framework in the energy sector all over the world has provoked a strong focus on the production of renewable energies. The study focuses on agent-based modelling approach to identify the suitable and economical distribution of biogas power plants over time in the area of interest. For sufficient supply of biomass (silage maize) on a regional basis to run biogas power plants economically and smoothly, different thematic layers with defined rules for Agent Analyst used to simulate the future installations of power plants. In conjunction with ArcGIS, the Agent Analyst software generates simulations that prove the robustness of the model in finding the suitable location of power plants. The resultant location from the model is analysed in different aspects. The designed methodology could be implemented in other areas with minor edits as per requirement of the area.

There is a global realization in all governmental setups of the need to provoke the efficient appraisal of crop water budgeting in order to manage water resources efficiently. This study aims to use the satellite remote sensing techniques to determine the water deficit in the crop rich Lower Bari Doab Canal (LBDC) command area. Crop classification was performed using multi-temporal NDVI profiles of Landsat-8 imagery by distinguishing the crop cycles based on reflectance curves. The reflectance-based crop coefficients (Kc) were derived by linear regression between normalized difference vegetation index (NDVI) cycles of the Moderate Resolution Imaging Spectroradiometer (MODIS) MOD13Q1 and MYD13Q1 products and Food and Agriculture Organization (FAO) defined crop coefficients. A MODIS 250 m NDVI product of the last 10 years (2004-2013) was used to identify the best performing crop cycle using Fourier filter method. The meteorological parameters including rainfall and temperature substantiated the reference evapotranspiration (ET0) calculated using the Hargreaves method. The difference of potential ET and actual ET, derived from the reflectance-based Kc calculated using reference NDVI and current NDVI, generates the water deficit. Results depict the strong correlation between ET, temperature and rainfall, as the regions having maximum temperature resulted in high ET and low rainfall and vice versa. The derived Kc values were observed to be accurate when compared with the crop calendar. Results revealed maximum water deficit at middle stage of the crops, which were observed to be particularly higher at the tail of the canal command. Moreover, results also depicted that kharif (summer) crops suffer higher deficit in comparison to rabi (winter) crops due to higher ET demand caused by higher temperature. Results of the research can be utilized for rational allocation of canal supplies and guiding farmers towards usage of alternate sources to avoid crop water stress.

Primary gastrointestinal lymphoma is a rare neoplasm that accounts for less than 5% of all gastrointestinal malignancies. We present a case of a 37-year-old woman positive for human immunodeficiency virus who presented with abdominal pain and vomiting for three months. She underwent endoscopic biopsy and was found to have high-grade diffuse large B-cell lymphoma in the jejunum. This report discusses her treatments and includes a brief literature review highlighting the rarity of this entity, the etiological agents implicated in its pathogenesis, and the lack of specific guidelines for treatment.

Response modification factors (R-Factor) are used to modify the elastic seismic response obtained from the linear elastic analysis to account for the effect of allowed damage. Recent studies show that UBC-97 code-based response modification factors are not valid for high-rise buildings. Where wind governs the design, their validity comes in question further. In this study, an actual 40- storied tall RC building located in Bangkok, Thailand is investigated in detail to determine the actual R-factor in each and every significant mode located in low to moderate seismic risk area with mean hourly wind gust of 90 MPH and exposure type-B. The code based designed building is analyzed using elastic displacement-based pushover analysis procedure in each and every mode to determine the modified R- factor. It is found that actual R-factor is in the order of only 1 to 1.25 in all significant modes.

Seismic response of the multi-storey buildings is created by the interaction of both the structure and underlying soil medium. The seismic design philosophy is incorporated using response modification factor “R”. Current Code based values of “R” factor does not reflect the SSI problem as it is based on fixed base condition. In this study, the modified values of “R” factor for moment resisting frame (MRF) considering SSI are evaluated. The response of structure with and without SSI has been compared using equivalent linear static and nonlinear static pushover analyses for 10- storied moment resisting frame building. The building is located in seismic zone 2B situated on different soils with shear wave velocity (Vs) of 300m/sec (SD) and 1200m/s (SB). Code based “R” factor value for building frame system has been taken as 5.5. Soil medium is modelled using identical but mutually independent horizontal and vertical springs. It was found that the modified “R” factor values have been decreased by 47% and 43% for soil SD & SB respectively as compared to that of code based “R” factor.

A 52-year-old man was referred to our medical centre for the evaluation of persistent dyspepsia for several months. He denied nausea, vomiting, regurgitation, weight loss, haematemesis or melena. He had no history of pre-existing gastrointestinal disorders or non-steroidal anti-inflammatory drug use

Background Dengue is identified as serious vector born infectious disease by WHO, threating around 2.5 billion people around the globe. Pakistan is facing dengue epidemic since 1994 but 2010 and 2011 dengue outbreaks were worst. During 2011 dengue outbreak 22,562 cases were reported and 363 died due to this fatal infection in Pakistan. In this study, Lahore District was chosen as it was severely affected in 2011 dengue outbreak with 14,000 reported cases and 300 deaths. There is no vaccine developed yet for the disease control, so only effective early warning, prevention and control measures can reduce the potential disease risk. Methods This study proposes a method for detecting spatial autocorrelation of temporal dynamics of disease using Local Index of Spatial Autocorrelation (LISA) using three temporal indices: (a) how often the dengue cases occur, frequency index; (b) how long the epidemic wave prevails, duration index; (c) how significant dengue cases occur in successive periods, severity index. Overlay analysis of LISA value for each temporal index resulted in eight risk types. Results The mapping of spatio-temporal risk indices and their overlay analysis identified that 10.6% area of Lahore (184.3 km 2 and population density 119,110 persons/km 2 ) had high values for frequency, duration, and severity index ( p Conclusion Spatial risk identification by using local spatial-autocorrelation helps in identifying other possible causes of disease risk and further strategic planning for prevention and control measures.

Primary esophageal diffuse large B-cell lymphoma (DLBCL) is an extremely rare clinicopathologic entity. We report one case from our clinical experience and undertake a review of the previously published cases. A systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 15 cases fulfilled the inclusion criteria. The data on patients’ characteristics, epidemiology, clinical features, HIV status, gross appearance of the lesion, esophageal location, treatment, and outcome were collected and analyzed. Primary esophageal DLBCL was more common among males, primarily in the fifth and sixth decades of life. Dysphagia was the most common initial clinical presentation. Tissue biopsy with immunohistochemistry was an indispensable diagnostic modality. The mainstay of treatment was chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisone regimen, in addition to anti-CD20 antibody rituximab, with or without radiotherapy. This review serves to outline our current understanding of the epidemiology of and risk factors for primary esophageal DLBCL, the pathophysiology of this disorder, and currently available approaches to diagnosis and management.

To assess knowledge, attitude and practice of water-pipe smoking among medical students.The cross-sectional study using self-administered questionnaire was conducted at Rawalpindi Medical College, Rawalpindi, in 2011, and included all five batches of medical students. SPSS 17 was used for statistical analysis of the data.The final sample comprised 724 participants; 505 (69.7%) being female and 219 (30.2%) being male students. Besides, 625 (86.6%) participants knew about shisha smoking, and 140 (22.4%) reported to have smoked shisha. Curiosity (n = 44; 31.4%) and social trends (n = 41; 29.2%) were cited as main reasons for shisha smoking. Overall, 572 (91.5%) participants thought shisha was dangerous for health, with majority 261 (41.8%) believing it to be more dangerous than cigarettes.There was awareness among medical students about the hazards of shisha smokng. Even then water-pipe smoking was relatively common among them.

To describe the correlation between Self-directed Learning (SDL) and medical students' attitude towards research, based on the premise that self-directed learners are independent, motivated, and curious learners.Observational cross-sectional study.Rawalpindi Medical College, Rawalpindi, from August 2011 to January 2012.One hundred and ninety-four students of final (5th) year class at Rawalpindi Medical College, Rawalpindi participated in this cross-sectional study. SDL ability of students was measured using Oddi's Continuing Learning Inventory (OCLI) whereas Attitude Towards Research (ATR) scale was used to measure their research attitudes. Spearman's rank-order analysis was performed to measure correlation between SDL scores on OCLI and all the 18 items on ATR scale.Statistically significant relationships with correlation coefficients ranging from +0.12 to +0.32 were found for the correlation between scores on the OCLI and eleven statements highlighting research use and positive attributes of research (14 items). Those students who participated in extra-curricular research projects (n=58, 29.9%) had relatively higher scores on OCLI as compared to those who did not participate (n=136, 70.1%, p=0.041).Self-directed learners show a positive attitude towards research, though the relationship is not strong.

In recent years there has been an increase in the use of percutaneous Impella LVAD supported high risk coronary interventions. Currently this technique requires large diameter arteriotomy via Common Femoral Access (CFA) to allow equipement passage. Most commonly up to 14 French size sheaths are

World experience in last few decades has shown that aircraft usage varies from aircraft to aircraft, mission to mission and user to user. This paper describes the procedure to predict the remaining life of an in service aircraft based on the data from onboard flight data recorders. The proposed method uses 'rain flow cycle counting' and 'Palmgren-Miners' techniques to correlate flight parameters with usage frequency for structural life prediction and computes the impact of the actual loads resulting in 'strength degradation' and 'expected remaining life'. It identifies the most stressed areas along with fatigue life cycles thus estimating the remaining life cycles. The data acquired through the successful application of proposed methodology is also assistive in determining the maintenance cycle and its revision, which is a major cost driver during operations. The results attained through computations directly correspond to the severity of usage.

A mobile wireless sensor network owes its name to the presence of mobile sink or sensor nodes within the network. The advantages of mobile wireless sensor network over static wireless sensor network are better energy efficiency, improved coverage, enhanced target tracking and superior channel capacity. In this chapter we will present and discuss different classifications of mobile wireless sensor network as well as hierarchical multi-tiered architectures for such networks. This architecture makes basis for the future pervasive computing age. The importance of mobility in traditional wireless sensor network (WSN) is highlighted in this chapter along with the impact of mobility on different performance metrics in mobile WSN. A study of some of the possible application scenarios for pervasive computing involving mobile WSN is also presented. These application scenarios will be discussed in their implementation context. While discussing the possible applications, we will also study related technologies that appear promising to be integrated with mobile WSN in the ubiquitous computing. With an enormous growth in number of cellular subscribers, we therefore place the mobile phone as the key element in future ubiquitous wireless networks. With the powerful computing, communicating and storage capacities of these mobile devices, the network performance can benefit from the architecture in terms of scalability, energy efficiency and packet delay, etc. For mobile wireless sensor networks, there are basically two sensing modes, local sensing and remote sensing. By allowing and leveraging sink mobility and sink coordination, mobile WSN can achieve the goal of lower and balanced energy consumption with the following features:  Single-hop clustering. By allowing only single hop transmission between sensor and sink node, most previous multi hop relaying sensor nodes may become unnecessary. In fact, sensor nodes can enter sleep mode until the sink approaches. Therefore, the original energy budget for multi hop relaying can be saved.  Sink mobility and coordination. For a delay tolerant application, single mobile sink in fact equals virtually multiple static sinks at different positions. Multi-sink deployment can bring more uniform energy dissipation, therefore the possibility of energy hole will be reduced and network coverage will be improved. 1

This paper deals with the development and implementation of a framework of Intranet-SCADA using LabVIEW based Data Acquisition and Management. The system is robust, low on system requirements and easy to implement. This paper describes configuration of Remote Terminal Units to access and transmit real time data over the Intranet or Internet, receiving the IP data at the Master Terminal Unit and issuing responses to the Remote Terminal Units, logging all the data in a historian for future references at a centralized location, keeping the human operator updated via Human Machine Interface, and providing measures for any emergency and enabling control via e-mail over the internet giving true remote control capabilities.

This paper presents energy analysis of a new routing protocol CIDRSN (Cluster ID based Routing in static Sensor Networks) with closedform probability oferror and bit energy expression in Nakagami-m fading channel. CIDRSN takes the cluster ID as next hop address instead of cluster-head ID in routing table and eliminate the cluster formation phase and routing phase from being executed in each round, which reduces the energy consumption and increases the network life to about 16%. Robustness is increased by multi-path routing. Simulation results show that the proposed protocol outperforms the preceding hierarchical routing protocols.

Clustering approach is one of the most used routing methodologies for wireless sensor network. However, most of the clustering practices make use of greedy cluster head formation process, wherein each node broadcasts its interest in becoming cluster head which is both energy and network intensive. In this paper we present a mechanism for efficient clustering formation, wherein an optimal number of nodes are identified which can take part in clustering formation process. The gains achieved are both energy efficiency and reduced network traffic. In a uniformly placed sensor nodes network, our algorithm comes up with an energy efficient clustering scheme by reducing the number of nodes which take part in clustering process. We have made use of network density as a parameter for creating cluster in the network. A numerical analysis is presented for varying network topologies and simulations are conducted to verify that with increased area coverage, the number of edge nodes become increasingly large, thus contributing to energy gain and less network traffic size.

Background: Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. Methods: All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. Results: Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. Conclusion: Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU.

To evaluate the in-hospital mortality and complications of acute myocardial infarction in diabetic and non-diabetic patients.Descriptive study.Coronary Care Unit and Cardiology Ward of Nishtar Hospital, Multan from 1st October 2002 till 15th May 2003.Four hundred and forty-eight (448) consecutive patients who fulfilled the inclusion criteria were studied while they were admitted to the hospital. Patients were divided into two groups of diabetics and non-diabetics depending on the presence of diabetes mellitus. In-hospital mortality and complications were compared between the two groups by Chi-square method.Diabetic patients presented in more advanced Killip class as 32(26.7%) patients presented in Killip class II, 13(10.8%) patients presented in Killip class III and 6(5%) patients presented in Killip class IV. In the non-diabetic group, 68(20.7%), 24(7.3%) and 11(3.4%) patients presented in these Killip classes respectively (p0.042). The total in-hospital mortality was 17%. Mortality was 28(23.3%) in diabetics and 48(14.6%) in non-diabetics (p0.03). In-hospital mortality was almost double in diabetics as compared to non-diabetics. Mechanical complications were observed in 42(35%) patients in diabetic group and 80(24.4%) patients in non-diabetic group. Left ventricular failure was the most commonly observed mechanical complication. Electrical complications were observed in 84(70%) diabetic and 162(49.4%) non-diabetic patients (p0.205).In patients with acute myocardial infarction, presence of diabetes mellitus was associated with worse in-hospital outcome leading to increased mortality and complications as compared to non-diabetic patients.