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The automobile industry has been evolving with rapid growth over the last two decades. Conventionally, the narrow band dedicated short-range communications is used for the wireless connectivity of vehicular networks in the automobile industry. However, due to its shorter wireless range, higher latency, and lower capacity; cellular-assisted vehicular communications can be adopted to improve networks performance by disrupting the nearby infrastructure. The performance of cellular-assisted vehicular communications is typically compromised if jammers are present in their vicinity. Thus, it is important to characterize the interference in cellular-assisted vehicular communications with jammers. In this paper, we investigate jamming interference due to clustered-jammers for vehicular networks by considering that vehicles, road-side units, and pedestrians are modeled using an independent one-dimensional Poisson line process while cellular base stations are modeled using an independent two-dimensional homogeneous Poisson point process. The results show that jamming disrupts the performance of the vehicular networks and that this performance is severely compromised by increasing the density of jamming clusters and their transmission power. Therefore, the prime focus of the system designers should be to introduce anti-jamming scenario, when the transmission power and the number of jamming clusters in a network increase.

Bipartite quantum entanglement has numerous practical applications in quantum computation and communication. Here, we study the temporal evolution of bipartite entanglement of a two-mode Gaussian state at the output of a correlated spontaneous-emission laser. The lasing medium is coupled with a strong classical field and two quantized modes of the cavity field, which are initially considered in two arbitrary single-mode Gaussian states. The influence of various parameters of the system on the bipartite entanglement of the two-mode Gaussian state is analyzed in detail. In presence of the cavity damping rates, we show that the amount and the time evolution of entanglement increases with the nonclassicality of the initial states. However, the purity of the initial states shows the absence of obvious effects on the entanglement dynamics. Further, the time interval of entanglement enhances with the Rabi frequency of the classical pump field. In addition, the photon number statistics of the two evolved modes of the cavity field is studied.

Background: Medication therapy management (MTM) continues to offer pharmacists the opportunity to use their knowledge, assist patients and caregiver in improving therapeutic outcomes, however the change is slow. Health information technology has been noted as an important driver in the success of MTM and has a potential role in improving therapeutic outcomes and reducing medication errors. Objective: This research aimed to design an integrated clinical pharmacist menu (CPM) software along with clinical decision support tools, optimizing MTM services and reducing medication errors. Methods: The integrated CPM software was designed abridged with decision support tools. A comparative study was conducted in a setting of integrated CPM software versus paper-based clinical pharmacy services (P-CPS) for the evaluation of MTM services. Clinical decision support systems (CDSS) and automated significant laboratory and medication alerts were analyzed for the improvement of MTM and impact on the identification and resolution of medication errors. Results: MTM improved after the application of the CPM software with a difference of 100% in “medication history generation” and “patient care plan,” with a reduction in medication errors by 39.8%. The identification of medication errors and verification of medication order significantly improved from 49% to 82% (p = 0.00) and from 4.5% to 7.0% (p = 0.00), respectively, in the CPM setting. The CDSS tool in the CPM software generated 730, 1802, and 198 auto alerts for “drug–drug interaction,” “inappropriate dose,” and “dose adjustment in an abnormal clinical laboratory test,” respectively, which improved the resolution and identification of medication errors. Conclusion: The CPM is user-friendly, which improved the MTM services. Medication error identification and resolution were significantly improved by the CPM software.

Quantum discord, an appropriate measure of quantum correlation, is analyzed in a two-mode Gaussian state of the cavity field evolved by a system of quantum beat laser. In the laser system, two arbitrary single-mode Gaussian states of the cavity fields and an external classical field couple to the atomic lasing medium. We calculate the time-dependent expression for the quantum discord both analytically and numerically, by following the reduced density matrix equation of the resulting cavity field. In this framework, we investigate the generation and control of Gaussian quantum discord in the two-mode Gaussian state of the cavity field at the output in terms of the purity and non-classicality of the two input cavity modes, the Rabi frequency of the classical driving field, the relative phase of the coupling parameters, and the damping rates of the cavity modes. The behaviour of quantum discord appears oscillatory due to the quantum beats in the output cavity field developed by the classical driving field in the medium as time passes. Moreover, we find that quantum discord switches on and off while adjusting the relative phase of the coupling parameters. Analysis of the analytical results agrees well with our numerical simulations.

Objective: To identify the effect of cognitive behaviour hypnotherapy on nonsuicidal self-injury condition. Methods: The quasi-experimental study was conducted from May 2019 to April 2020 in Islamabad and Rawalpindi, Pakistan, and comprised students aged 18-25 years at various universities and colleges in the twin cities. The participants were screened using deliberate self-harm inventory for >2 events without suicidal intention in line with the Diagnostic and Statistical Manual of Mental Disorders 5th edition. They were then divided into two intervention and control groups. Over the following three months, the intervention group received cognitive behaviour hypnotherapy, while the control group did not receive any treatment. The groups were assessed post-intervention. The final phase comprised follow-up assessment of the condition. Data was analysed using SPSS 25. Results: Of the 60 subjects, there were 30(50%) in each of the two groups. Overall, there were 41(68%) males and 19(32%) females. The majority of the subjects were aged 21-23 years 29(48%). More than 5 self-harm incidents were reported by 48(80%) subjects, while suicidal ideation was detected in 6(10%) students. The effect size of the study was good in terms of pre- and post-intervention values (d=4.90), the post-intervention and follow-up assessment values (d=0.32) and the pre-intervention and follow-up values (d=5.42). The comparison between treatment and no treatment groups indicated the effectiveness of treatment over no-treatment, F (1, 58) = 53.16, p < .001. Conclusion: Cognitive behaviour hypnotherapy was found to be effective in treating the nonsuicidal self-injury condition. Continuous...

In this work, cost-effective reduced graphene oxide/copper oxide (rGO/CuO) nanocomposite was synthesized by the reduction of GO to rGO and deposition of CuO on the surface of rGO using single step simple chemical method. The prepared nanocomposite was characterized using energy-dispersive X-ray spectroscopy (EDX), scanning electron microscopy (SEM), X-ray diffraction (XRD), ultraviolet–visible (UV–Vis) and Fourier-transform infrared (FT-IR) spectroscopy. The appearance of peak at 2θ = 11.03° confirmed the synthesis of GO and peaks at 25.65°, 36.14°, 43.09°, 49.91° and 69.52° indicated the synthesis of the nanocomposite. It was found that the normal particulate size of the prepared nanocomposite was in range of 30 to 50 nm. SEM analysis was done to demonstrate the external morphology of the prepared GO and the nanocomposite. The prepared rGO/CuO nanocomposite was analyzed towards photo-catalytic activity for the degradation of methylene blue (MB) and for the catalytic reduction of 4-nitrophenol (4-NP) to 4- aminophenol (4-AP). It was found that about 81% of MB was degraded in 240 min under UV light and complete conversion of 4-NP to 4-AP was done in only 2 min. The prepared rGO/CuO nanocomposite was also analyzed for anti-microbial activity. It was found that the rGO/CuO nanocomposite exhibits better anti-bacterial and anti-fungal activities than GO. The results indicated the increased biocompatibility of the rGO/CuO nanocomposites than GO.

Water pollution is one of the key ecological issues of the present time. Water pollution causes serious problems to human beings. Industries of cosmetics, mining, dyeing, pigments, batteries, PVC stabilizers, metallurgical engineering, nuclear power operations, printing, electric appliances, electroplating, etc. produce several types of the pollutants that are usually discharged into the running water, which make the water unfit for drinking and other domestic purposes. It is need of present time to develop simple and cost effective advance technology for the purification of the contaminated water. In this regard, the nanocomposites play a key role in wastewater treatment. In this study, we reported the single step preparation of rGO/Ag2O nanocomposite for the wastewater treatment. The prepared rGO/Ag2O nanocomposite was characterized using EDX, SEM, XRD, UV–Vis and FT-IR spectroscopy. XRD data confirmed the synthesis of rGO/Ag2O nanocomposite. The appearance of peak at 2θ = 10.9° indicated the formation of graphene oxide (GO). The four diffraction peaks at 2θ = 38.12°, 44.28°, 64.43° and 77.47° indicated the successful synthesis of rGO/Ag2O nanocomposite. SEM analysis of the rGO/Ag2O nanocomposite showed that the sheet of carbon was randomly decorated with Ag2O. The average particle-size of the rGO/Ag2O nanocomposite was calculated to be 24.62 nm. The rGO/Ag2O nanocomposite showed effective catalytic reduction of 4-nitrophenol to 4-aminophenol. The rGO/Ag2O nanocomposite also displayed extraordinary photocatalytic activity for the degradation of methyl blue and brilliant green.

Seed priming is a pre-sown treatment and it is often used to improve the performance of plants in any environment, especially germination. In the current study, various concentrations of nitric oxide (NO) were used to evaluate its role for the induction of physiological variations within seven different wheat (Triticum aestivum L.) genotypes. Two experiments were conducted during 2013 and 2014 and the data were statistically analysed for significance. All these genotypes after treatment with sodium nitroprusside (SNP) as NO donor at 10−4 and 10−5 M concentrations were sown following randomized complete block design with triplicates in the fields of District Muzaffarabad, Pakistan. The concentration of NO at 10−4 M showed promising results and most of the studied characters were found improved compared to control. Wheat varieties primed with 10−4 M SNP showed highest germination speed and germination percentage. NARC-2011 and Uqab-2002 showed much improvement in physiological attributes at both concentrations of NO priming. However, Uqab-2002 and Punjab-2011 showed a significant increase in chlorophyll contents and leaf moisture content with 10−4 and 10−5 M SNP priming compared to control. Highest relative water content was observed within unprimed Lasani, whereas the relative injury was found to be decreased at 10−4 M SNP primed Faisalabad-2008. Wheat varieties Punjab-2011 and Faisalabad-2008 showed the highest increase in grain yield and biological yield by 10−4 M SNP. Hence, it is concluded that sowing of crops after priming at 10−4 M NO concentration can improve the germination, biochemistry and physiology that ultimately lead to an increase in crop yield.

In medical education, different teaching methods are being used, and it is believed that methods involving active learning are usually stronger, motivate learners as they can control their learning process. So, the study was designed to evaluate the effectiveness of traditional teaching augmented with interactive sessions (TT+IS) as a new teaching approach in Biochemistry teaching.Methodology: Students of second-year MBBS were taught two topics of Biochemistry having the same difficulty level one by Modified Team-Based learning (MTBL) and the other by TT+IS by the same instructor. A post teaching test was taken. A feedback form was also filled by the participants at the end of the teaching sessions. Results and the students' responses were compared for both teaching methodologies.Results: There was a significant increase in the positive responses for TT+IS when compared with MTBL. The means of the test scores were strongly correlated (p

Quantum state teleportation is an important protocol that plays a pivotal role in various quantum information tasks. Here we theoretically investigate quantum state teleportation by exploiting a general two-mode Gaussian entangled state produced by a parametric converter when two single-mode Gaussian states (SMGSs) in terms of the non-classicality and purity are employed as inputs to the parametric converter. In particular, the time-dependent teleportation fidelity is analyzed with respect to the squeezing parameter and phase-space quadratures of the teleported squeezed coherent state. We show that the teleportation fidelity is maximal when ratio of the expectation values of photon number in the two modes of the evolved Gaussian entangled state is equal to 1. Quantum state teleportation in terms of the purity and non-classicality of the general two SMGSs seems to be a good choice for experimental realization of quantum communication and information processing.

In this study, we quantify quantum steering, quantum entanglement, and quantum discord and their interconnection using the technique of parametric down-conversion. Initially, two single-mode Gaussian states together with a non-linear crystal in a cavity are considered. The behavior of the three kinds of quantum correlations depend on the phase of the coherent pump field, purity, and non-classicality of the input states, and the damping rates of the cavity. The amount and time evolution of the quantum correlations enhances with the difference between the non-classicality of the initial states. In presence of the damping rates, the quantum steering and quantum entanglement (quantum discord) increase (decreases) with the purity of the input cavity field. We note that the amount and survival time of the quantum correlations can be controlled by varying the relative phase associated to the coherent pump field. The boundaries of the three kinds of quantum correlations are defined and explained with respect to each other, which form a hierarchy.

As an active quantum system, the correlated spontaneous emission laser has many valuable applications in quantum information processing. Here, we report on temporal evolution of the quantum correlations such as quantum discord, entanglement, steering, and Bell non-locality for the field retrieved in the form of two-mode Gaussian state using a system of correlated spontaneous emission laser. We consider the initial modes of the cavity field as two independent arbitrary single-mode Gaussian states inside the cavity. The density matrix for the resulting cavity field is evaluated both analytically and numerically with respect to the time evolution of the laser system. The influences of the non-classicality and purity of the initial cavity modes, the Rabi frequency of the classical coupling field, and the cavity damping rates are studied thoroughly. We show explicitly that the boundaries for the four kinds of the temporal quantum correlations of the cavity field retrieved satisfy a strict hierarchy.

Software Defined Networks (SDN) is a new approach to change the conventional networking and is being researched in the various networking domains. To test and prototype SDN based concepts, a lightweight and closer to reality option is Mininet emulator. Mininet emulates SDN behavior by creating a virtual network of elements using Network Namespaces on a single Linux kernel machine. In this work, we have developed a Mininet topology that emulates the structure of a WDM Switch. The topology mirrors the paths that can be used by the wavelengths in a WDM switch fabric. The SDN controller can find a path for communication between hosts through this network. We simulated our Mininet topology, which mirrors an architecture for three wavelengths. The Ping command results show that only a set of hosts can be reached out by a particular host; which is the requirement of a WDM switch, and this verifies that Mininet topology is mapping a WDM switch.

© 2018 IEEE. In today's optical networks, Light paths are established through Network Management System and Element Management System, which is a manual and cumbersome process. Paths are computed and pre-setup according to the known traffic d emands, a nd p rovisioning a ny new service takes time. Several efforts have recently been made to make the path establishment process dynamic, including the Software Defined N etworking a pproach. H owever all of this work has assumed fully interconnected fabrics of the network devices which is generally not the case. The task of end to end path establishment between network elements and through fabric are interrelated, and this task remains incomplete, without consideration of the switch's limitations. This work highlights for the first time the issue of path establishment dynamically through a switch fabric. The paper briefly e xplains t he p roblem a nd s uggests an SDN based solution using the OpenFlow protocol. This work contributes a represention of the basic framework which will be required to make the complete path setup process dynamic. The paper also includes an operational description.

We study the entanglement dynamics of two-mode Gaussian state (TMGS) in a quantum beat laser driven by two classical fields in Raman configuration using Simon’s criterion of quantum state separability. The two modes of the cavity field are considered initially in general single-mode Gaussian states. The effect of the non-classicality, purity, and relative phase of the cavity modes on the entanglement phenomenon is studied thoroughly. We show that in the presence of cavity decay rates, the higher the non-classicality of the initial states, the higher is the inseparability of the evolved TMGS of the cavity field. The inseparability, on the other side, is independent of the purity of the initial states. Moreover, the time scale of the entangled state increases with the relative intensity of the driving fields, whereas the relative phase switches the entangled state into the disentangled state of the cavity field and vice versa. The quantum statistics of the mean photons number of the cavity field is analyzed.

Beam splitters are important components in numerous tasks of quantum information protocols used either in simple or in an interferometric arrangement or together with other quantum systems. This report shows interesting aspects of the quantum correlations of two-mode Gaussian state (TMGS) for the photons retrieved via a linear beam splitter when they are initially employed at the input of either pure or mixed two single-mode Gaussian states (TSMGSs). The quantum correlations obey the boundaries of quantum non-locality, steering, entanglement and discord for pure input states. Though Bell inequality does not violate, quantum steering, entanglement and discord exist in the quantum state evolved by the beam splitter when input states become mixed. Specifically, the quantum steering, entanglement and discord persist to some degrees against the thermal photon number, the Bell inequality is, nonetheless, obeyed by the quantum state except in a very sharp regime.

Hepatitis C infection imposes a high economic burden globally. It has been estimated that in 2012, the healthcare cost of Hepatitis C virus (HCV) was $6.5 billion. Furthermore, it has been projected that the cost will reach at $9.1 billion by the year 2024.Frequency of hepatitis C in Pakistan is significantly higher (4.5%) when compared to the populations like India (0.7%), Nepal (1.0), Myanmar (2.5%), Iran (0.8%), China (1%) and Afghanistan (1.1%). The current standard of care for chronic infection with hepatitis C virus is 24 or 48 weeks of therapy with Pegylated interferon-alfa-2a (Peg INF) +Ribavirin (RV) or Interferon alfa-2a (INF) + RV. The objective of this study was to determine that which combination is more effective and the gain in sustained virologic response (SVR) is worth the incremental cost. In total 84 patients were enrolled who received current standard treatment of care for chronic infection with HCV either 24 or 48 weeks of therapy with Peg INF + RV or INF + RV. A pharmacoeconomic analysis was done including fixed and variable cost (comprising concomitant therapies, emergency visits and hospital admissions) of both treatment regimens were calculated and compared with the SVR accomplished by the patients. It was concluded that the Peg INF + RV is cost effective as compared with conventional INF + RV for the treatment of adult patients infected with HCV genotype 3a under a varied array of possibilities regarding treatment costs and effectiveness.

In the regime of the Raman–Nath approximation we show coherence control of three-dimensional atom localization with high precession and resolution via probe absorption when a five-level atomic system is cyclically driven by three orthogonal standing optical wave-fields together with one traveling optical wave-field and two microwave wave-fields in an optical cavity. We apply wavevector mismatch and subsequently the Doppler-free technique to the atom localization system to minimize the imprecision in the atom's position in the standing wave-field caused by its high velocity in the cavity. The position of the single atom is freed from the two effects by collinear coupling of the driving fields with the atom in the cavity. The atomic position is controlled in the sub-wavelength domain of the standing wave-field with probability and high quality resolution by adjusting the relative phase and amplitude of the driving fields.

Background The aim of drug therapy is to attain distinct therapeutic effects that not only improve patient’s quality of life but also reduce the inherent risks associated with the therapeutic use of drugs. Pharmacists play a key role in reducing these risks by developing appropriate interventions. Whether to accept or reject the intervention made by the pharmacist is a relevant consultant’s decision. Objective To evaluate the impact of electronic prompts and follow-up of rejected pharmacy interventions by clinical pharmacists in an in-patient setting. Setting Shaukat Khanum Cancer Hospital & Research Center, Lahore, Pakistan. Method The study was conducted in two phases. Data for 3 months were collected for each phase of the study. Systematic and quantifiable consensus validity was developed for rejected interventions in phase 1, based on patient outcome analyses. Severity rating was assigned to assess the significance of interventions. Electronic prompts for follow-on interventions in phase 2 were then developed and implemented, including daily review via a multidisciplinary team (MDT) approach. Main outcome measure Validity of rejected interventions, acceptance of follow-on interventions before and after re-engineering the pharmacy processes, rejection rate and severity rating of follow-on interventions. Result Of a total of 2649 and 3064 interventions that were implemented during phase 1 and phase 2, 238 (9%) and 307 (10%) were rejected, respectively. Additionally, 133 (56%) were inappropriate rejections during phase 1. The estimated reliability between pharmacists regarding rejected interventions was 0.74 (95% CI of 0.69, 0.79, p 0.000). Prospective data were analysed after implementing electronic alerts and an MDT approach. The acceptance rate of follow-on interventions in phase 2 was 60% (184). Conclusion Electronic prompts for follow-on interventions together with an MDT approach enhance the optimization of pharmacotherapy, increase drug rationality and improve patient care.

Cancer is a complex disease and is difficult to treat. Until the early twentieth century, it was treated by surgical removal which later on was combined with chemotherapy, radiotherapy and immunotherapy. However advances in molecular biology and genetics lead to the establishment of virotherapy. The geneticmodification of oncolytic viruses have improved their tumorspecificity, targeted delivery and increased efficacy, leading to thedevelopment of new weapons for the war against cancer especially in those cancer patients in which tumor is inoperable. In this review, we describe the basis of oncolyticvirotherapy and how the genetically modified tumor-specific viruses are developed. Utility of oncolytic virotherapy to treat cancer, clinical trials and their success rate are also discussed. We conclude with current and future challenges in oncolyticvirotherapy and the safety concerns raised by the trialsconducted so far.

In vitro studies were carried out to evaluate the antifungal activity of methanolic , pet ether and dichloromethane extract of aerial parts of Withania coagulans and Tamarix aphylla against seven fungal strains (Trichoderma viridis ,Aspergillus flavus , Fusarium laterifum , Aspergillus fumigatus , Candida albicans , Trichophyton mentogrophytes and Microsporum canis). Assessment revealed that all extracts of Withania coagulans caused significant inhibition in biomass production of all test fungi (0.5mg/ml), while dichloromethane extract of Tamarix aphylla showed significant results (1.0mg/ml) against the tested fungal strains only.

‘What about that article in the Guardian about the study on the PSA test? Can I please have the new urine test (PCA3) instead? Will I be OK if the test result is normal?’ are the kind of questions that I have been asked about the prostate cancer screening and the prostate-specific antigen (PSA) test. This article should help the reader to have an informed discussion with men requesting the PSA test.

Euphorbia prostrata, Euphorbia hirta, Euphorbia splendens, Ricinus communis and Jatropha integearrima (Family: Euphorbiaceae) were selected to explore the phytochemical and pharmacognostical properties. Species of Euphorbiaceae are extensivley used as remedies against several diseases and complaints such as cancer, diabetes, diarrhoea, heart diseases, hemorrhages, hepatitis, jaundice, malaria, ophthalmic diseases, rheumatism and scabies etc. The dried leaves of Euphorbia splendens, Ricinus communis and Jatropha integearrima and dried whole plants of Euphorbia prostrata and Euphorbia hirta extracted with methanol. The Phytochemical screenings was done to identify the presence of carbohydrates, proteins, alkaloids, phytosterol, phenol, flavonoids, tannins, saponins and phlobatannins that is helpful in the confirmation of the authenticity of the plants.

Tea is the most common beverage after it is extracted from the leaves of Camellia sinenesis. It is classified in to fermented tea (Black Tea) and non-fermented tea (green tea). Methanolic extract of tea diluted in methanol and ethanol, which were tested for antibacterial activity against Streptococcus mutans. Methanol was found to be best antimicrobial solvent. The MIC value of methanolic extracts of Black Tea diluted in ethanol was 0.1 mg/ml. Synergistic results of antibacterial activity of methanolic extracts (diluted in ethanol) were found poor. Synergistic activity of Black tea sample with antibiotics (Chloramphenicol, Tetracycline, Levofloxacin and Gentamycin) showed best response against most of the bacteria (0.1mg/ml).

Heliotropium sterigosum is an annual herb found in south Punjab of Pakistan. Extract of whole plant in methanol was tested for anti bacterial activity against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Streptococcus pneumoniae, Bacillus subtilus, and Sarcina lutae. Minimum Inhibitory Concentration of methanolic extract was determined and found to be bactericidal in concentration of 1000 μg/ml against streptococcus pneumoniae, Escherichia coli, and Streptococcus pneumoniae. Synergistic antibacterial activity of methanolic extracts was tested with respective solvent extracts of seeds of Withania coagulans, whole plant of Hypericum perforatum and Pinus roxburgii (bark). Staphylococcus aureus was synergistically inhibited by methanolic extract of Heliotropium sterigosum and Pinus roxburgii (bark) (1μg/ml) and Withania coagulans (1μg/ml). Methanolic extract of Heliotropium sterigosum inhibits the growth of Sarcina lutae in combination with Pinus roxburgii (bark) methanolic extract (0.5μg/ml). Highest synergistic activity was observed by Heliotropium sterigosum and Withania coagulans methanolic extracts against Pseudomonas aeruginosa (0.5μg/ml) and Bacillus subtilus (1μg/ml).

Background: Medication errors in chemotherapy are frequent and lead to patient morbidity and mortality, as well as increased rates of re-admission and length of stay, and considerable extra costs. Objective: This study investigated the proposition that computerised chemotherapy ordering reduces the incidence and severity of chemotherapy protocol errors. Method: A computerised physician order entry of chemotherapy order (C-CO) with clinical decision support system was developed in-house, including standardised chemotherapy protocol definitions, automation of pharmacy distribution, clinical checks, labeling and invoicing. A prospective study was then conducted in a C-CO versus paper based chemotherapy order (P-CO) in a 30-bed chemotherapy bay of a tertiary hospital. Both C-CO and P-CO orders, including pharmacoeconomic analysis and the severity of medication errors, were checked and validated by a clinical pharmacist. A group analysis and field trial were also conducted to assess clarity, feasibility and decision making. Results and Conclusion: The C-CO was very usable in terms of its clarity and feasibility. The incidence of medication errors was significantly lower in the C-CO compared with the P-CO (10/3765 [0.26%] versus 134/5514 [2.4%]). There was also a reduction in dispensing time of chemotherapy protocols in the C-CO. The chemotherapy computerisation with clinical decision support system resulted in a significant decrease in the occurrence and severity of medication errors, improvements in chemotherapy dispensing and administration times, and reduction of chemotherapy cost.

Objective: To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method. Study Design: Prospective observational study. Place and Duration of Study: Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014). Methods: A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard. Results: In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013). Conclusion: The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested.

It is generally acknowledged that autoimmune diseases are more prevalent in females worldwide. These diseases are caused by interaction of genetic and environmental factors that result in the failure of immune mechanisms responsible for self-tolerance. One of these mechanisms includes regulatory T cells which play an essential role in maintaining peripheral tolerance. These cells are a subset of CD4+ helper T cells which express high levels of CD25 on their surface. These cells suppress cells of both innate and adaptive immune systems in an antigen nonspecific manner through cell-cell contact and production of cytokines. As females have a higher incidence of autoimmune diseases and regulatory T cells play a crucial role in preventing autoimmunity, it was reasonable to hypothesize that the females might have a lower number of T(reg) as compared to males.50 apparently healthy males and 47 females aged 19 - 26 years were recruited for the study. The percentage of regulatory T cells in their peripheral blood was determined using flow cytometery. Mann Whitney rank sum test was applied to estimate the significance of gender related difference in their frequency.Significant difference was observed in regulatory T cells percentages of males and females, p0.02 showing that there is a lower regulatory T cell percentage in females than in males (2.89 +/- 1.46% vs. 3.32 +/- 1.39%).This study shows a significant difference in the frequency of regulatory T cells among males and females which could be one of the reasons for increased predisposition of females to autoimmune diseases.

International medical graduates often consider it essential to get clinical attachments in order to familiarise themselves with the NHS and obtain some local references. Sadia Quereshi looks at attachments to general practice