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Background: Oral health is one of the key indicators of the quality of life, overall health and well‑being of the general population. Globally, the high prevalence of the periodontal disease, excessive tooth loss, dental caries experiences, oral cancers and xerostomia are the major issues reported among adult populations. Timely access to oral healthcare facilities preserves the function, morbidity and mortality. The best possible health outcomes are only possible if the personal health care services are accessible timely. So, the primary objective of this study was to explore the barriers to the access of oral health care facilities among adults. In addition, the study also determined the association between adult’s demographic factors and their visits to dental clinics. Subjects and methods: This exploratory study was conducted for two months between November 2019 and January 2020. The study recruited 400 adults including 200 males and 200 females visiting outpatient department (OPD) of public hospital i.e. Jinnah Hospital, Lahore. Participants were included in this study if they were 18 years of age or older and had provided written informed consent before data collection. Data were collected using a structured questionnaire whereas barriers to access the oral healthcare facilities was confirmed by asking an open-ended question. Statistical Package for Social Sciences (SPSS) software was used to calculate descriptive statistics (i.e., mean, standard deviation, percentages). The study also determined the association between sociodemographic factors of adults and their tendency to visit dental clinics just for routine checkups using the chi-square test. Results: The average age of the participants was 36.81±9.29 years ranged from 18 – 63 years. Of the 400 participants, 259 (64.75%) reported costly treatment as a barrier affecting access to oral healthcare facilities followed by difficulty in access to dental clinics (27.75%) and fear of the pain of dental procedures (20.25%). Only 52 (13%) adults were regularly visiting dental clinics for routine check-ups whereas 21 (5.25%) respondents never had been to the dentist throughout their life. Nearly, half of the respondents i.e. 189 (47.25%) stated that dental care expenditures were borne by them and none of them was health insured. Statistically, a significant association was found between demographics (i.e. education, rural background and income) and the tendency to visit the dental clinics (p

Mental health conditions pose a major challenge for individuals, healthcare systems and society-and the COVID-19 pandemic has likely worsened this issue. According to the Mental Health Foundation of New Zealand, one in five people will develop a serious mood disorder, including depression, at some time in their life. Co-designed solutions to increase resilience and well-being in young people have specifically been recognised as part of the National Suicide Prevention Strategy and the New Zealand Health Strategy. Virtual Reality (VR) in mental health is an innovative field. Recent studies support the use of VR technology in the treatment of anxiety, phobia, and pain management. However, there is little research on using VR for supporting, treating and preventing depression. There is also very little work done in offering an individualised VR experience to improve mental health. In our earlier work, we presented iVR, a novel individualised VR experience for enhancing peoples' self-compassion, and in the long run, their mental health, and described its design and architecture. In this paper, we outline the results of a feasibility study conducted recently. Most participants believed introducing elements of choice within iVR enhanced their user experience and that iVR had the potential to enhance people's self-compassion. We also approached seven mental health professionals for feedback, who felt that introducing elements of choice within iVR would increase their knowledge of clients. Our contribution can pave the way for large-scale efficacy testing, clinical use, and cost-effective delivery of intelligent individualised VR technology for mental health therapy in future Refereed/Peer-reviewed

Mental health conditions pose a major challenge to healthcare providers and society at large. Early intervention can have significant positive impact on a person's prognosis, particularly important in improving mental health outcomes and functioning for young people. Virtual Reality (VR) in mental health is an emerging and innovative field. Recent studies support the use of VR technology in the treatment of anxiety, phobia, eating disorders, addiction, and pain management. However, there is little research on using VR for supporting, treatment and prevention of depression - a field that is very much emerging. There is also very little work done in offering individualised VR experience to users with mental health issues. This paper proposes iVR, a novel individualised VR for improving users' self-compassion, and in the long run, their positive mental health. We describe the concept, design, architecture and implementation of iVR and outline future work. We believe this contribution will pave the way for large-scale efficacy testing, clinical use, and potentially cost-effective delivery of VR technology for mental health therapy in future.

Background: Diabetes prevalence has risen more rapidly in middle- and low-income countries and has emerged as the seventh highest cause of death in such countries. Socio-demographics, patient knowledge and clinical factors, such as family history of diabetes, have a vital effect on the disease outcomes. This study assessed self-care practices among patients with type 2 diabetes to determine the probability of self-care by predictor variables, including socio-economic and clinical factors, and quantify the marginal effects of these independent variables on different self-care practices among diabetic patients. Methods: This exploratory study collected data from 200 type 2 diabetes patients at a branch of private pharmacy in Pakistan using a convenient sampling technique and a semi-structured questionnaire. An ordered probit regression model was used to analyze the different self-care practices among diabetic patients. With self-practices ordered in four classes from poor to good, the marginal effects of each socio-economic and clinical factors were also calculated on the likelihood of aforesaid self-care practices among diabetic patients. Results: Results showed that the relationships of household income, patient’s choice of private or public hospital for treatment, and patient’s weight with self-care probability were statistically significant. These socio-demographics and clinical indicators significantly influenced each category of self-care practices. Conclusion: Socio-demographic and clinical factors played a decisive role in the healthcare practices among type-2 diabetes patients. Monthly household income, patient’s choice of private or public hospital for treatment, and patient’s weight influenced different levels of self-care practices. Income had a negative contribution in poor and fair self-care levels of practices, whereas it had a positive role in average and good self-care levels of practices. Keywords: type 2 diabetes; self-care practices; socio-economic factors; developing country

Purpose: Health care costs attributable to breast cancer are substantial. In countries with high poverty, lack of public health infrastructure and low availability of health insurance, the economic burden of disease does not accrue solely to health care, but also on patients and their families. This study was conducted to explore the cost burden (i.e. direct medical costs, direct non-medical costs and indirect non-medical costs) incurred by breast cancer patients and their families over diagnosis and treatment. Methods: Data was collected from 200 breast cancer patients at two hospitals in Lahore, provincial capital of Punjab, Pakistan, by employing purposive sampling technique. Costs were aggregated into three categories and compared with each other as per their weightage. Results: The study found that direct medical care (US$ 1262.18 / Local currency (PKR) 129,717) is the largest expense, followed by direct non-medical (US$ 310.88 / PKR 31,950) and indirect non-medical costs (US$ 273.38 / PKR 28,096). Conclusions: The results of this study provide rich insight into the financial burden borne by households of breast cancer patients and suggest policy implications.

Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31–128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.

This study examines how environmental concerns impact the connectivity amid formal, informal control and performance based on data gathered from different 156 construction companies. The empirical outcomes illustrate that behaviour, outcome relationship between variables and clan control affirmatively affect performance on construction projects. However, self-control is unimportantly identified with project execution. This research uncovers that in construction projects, the adequacy of managerial control varies. The results further suggest that interior environmental concerns contrarily moderate the consequence of control of cleaner merchandise enactment during projects. However, external natural hazards emphatically direct the adequacy of project control, showing noteworthy and assorted roles played by different ecological dangers in the assembly of control and project execution. The interactive empirical outcomes between formal control and external environmental hazards are significantly related to project performance(t > 2, and p 0.05). The study concluded the least significant of all controller means towards the enactment of construction projects. Results showed that for complex projects, operative control approaches should be prioritised over ineffective control methods.

Pakistan is an emerging economy. It provides great opportunity for organized corporate driven retailing. There have been few global retailers who have already tasted some success with their cash-n-carry and supermarket formats. Some home grown retailers have also made forays into this market. There is a lot of need to understand the consumer behavior towards modern retail practices in Pakistan. This research study is conducted with an objective to find out how various factors influence shoppers' behavior towards supermarkets with 300 respondents consisting of 150 males and 150 females by using shop intercept method in the cities of Lahore and Faisalabad in Pakistan. The outcomes of this study provide the insights to understand the influence of several factors like promotion and special offers, easy access to supermarket, geographically convenience and locality, customer services, exploration, pricing factor, socio-economic effects, cleanliness, aesthetics and escape from routine work on the consumer's perception.

1. Recent evidence from studies in mice lacking the opioid receptor-like (ORL-1) receptor and from experiments using antibodies raised against orphanin FQ/nociceptin (OFQ/N) suggest that this peptide may be involved in morphine tolerance. In the present study we sought to investigate if administration of exogenous OFQ/N would modulate the development of tolerance to the antinociceptive effect of morphine. 2. Rats were treated for 3 days with either saline or morphine (10 mg kg(-1), s.c.) followed, 15 and 75 min later, by two intracerebroventricular injections of either artificial cerebrospinal fluid (aCSF) or OFQ/N. The dose of OFQ/N was doubled each day (7.5, 15, 30 nmol). On day 4, rats were tested on a hot plate apparatus before and 30, 60 and 90 min after morphine administration. 3. Repeated OFQ/N treatment did not affect basal nociceptive responses or morphine-induced antinociception. However, the same treatment significantly attenuated the development of morphine tolerance. 4. Since learning and memory could contribute to the development of morphine tolerance, in subsequent studies, we examined the effect of OFQ/N administered in the CA3 region of the hippocampus, where OFQ/N has been shown to block LTP and impair spatial memory. A greater attenuation of morphine tolerance with no alteration of baseline hot plate latency or morphine-induced antinociception was observed when OFQ/N was administered in this area of the rat brain. 5. Taken together, our results demonstrate that OFQ/N may act in the hippocampus to attenuate morphine tolerance.

Application of Rotary Steerable Systems (RSS) requires a value proposition that exceeds the conventional method of drilling the well. The most quoted value proposition is savings in time for drilling wells of complex geometry. This time saving is achieved because drilling of geometrically complex wells requires oriented drilling with conventional motors. This in turn reduces the rate of penetration (ROP) significantly and increases the amount of time required to drill the section. Rotary Steerable Systems on the other hand can be used to drill these wells without stopping rotation and in turn maintaining the rotating ROP throughout the section. The real value proposition of rotary steerable systems is however in allowing options that would otherwise be impractical i.e. precise control due to closed loop systems, extended drilling due to continuous rotation or ability to utilize components that may be difficult to use with conventional motors. This paper compares the drilling performance with and without rotary steerable system in the 12 ¼" sections on client wells. It also describes the benefits achieved when a rotary steerable application enabled the use of Polycrystalline diamond compact (PDC) bit in drilling 12 ¼" section. This resulted in significant time savings for client by saving a bit trip which was always required when tri cone insert bits (TCI) were used. Additional benefit of higher ROP was also realized due to increased effectiveness of PDC bit in comparison with TCI bits. This PDC bit was not favored for use with conventional drilling systems due to difficulty in maintaining tool face during oriented drilling operation. Even though the bit was effective in drilling the formation, its unsuitability with drilling system rendered it unusable until the full benefits were realized by incorporating it in a rotary steerable BHA. The application of Rotary Steerable System with the PDC bit resulted in an average on bottom ROP improvement of 67% as compared to the wells drilled in the same field with conventional motor assemblies. During this run 3590 feet of hole section was drilled with a circulation time of 180 Hrs. In addition to improved ROP, trip time for changing the bit was also saved which at the given depths could be 8 to 10 hrs. of rig time.

Intensive application engineering analysis, extensive technology research and proven field tests have delivered a new generation of PDC technology for drilling carbonates. This new technology will be a step improvement and benchmark for flawless drilling performances and cost saving well economics. Different carbonate applications in Oman require PDC bits that deliver extended lengths of intervals drilled, high speed, exceptional steering capability in case of deviated wells and low cost per foot runs. In-depth engineering analysis for each application with different customers culminated in the right choice of bit for every operation. The latest state of the art PDC bits, with significant enhancements to the bit features, are delivering outstanding performance for drilling carbonates in the Sultanate of Oman. The first trial of this technology was conducted in field A. This application utilized a steerable motor in a typically fast ROP environment to drill through a carbonate section up to KOP and then drill the nudge section of 25-35 degrees at a 2-4 deg/100’ build up rate. The accumulated length drilled with the new PDC bit technology amounted to approximately 5500 ft. The bit also managed to improve penetration rate up to 46% as compared to the previous record and 37% (1.5 days) savings in time were achieved when compared to the best composite time for this field. The success of the first new technology PDC run was an encouragement to proceed with a trial in a more challenging application. Different designs of the new PDC bit were tested for Field B in Deep Gas exploration wells. The application in Field B was vertical drilling through +2000m interval of interbedded carbonate with a stringer of shale. The new PDC, in combination with a Rotary Steerable system and low speed motor, drilled the section achieving 28% faster ROP than the best fastest drilled record interval for the field. At the same time it also delivered 55.5% (3.98 days) savings in time as compared to the best composite time record for this field. Another accomplishment of the new technology was in Field C, which utilized the same bit design as was run in Field B. The application was vertical motor drilling through long intervals of interbedded carbonate, shale and hard as well as abrasive sandstone. The new technology PDC managed to set a new field record in the first run, drilling the longest, deepest, and fastest run in the field. The bit was 11% faster than best previous run, and came out in an excellent dull condition. The new technology has delivered a step change in drilling performance, improved ROP, extended run lengths, better steerability, and lower cost per foot. The authors will describe the technologies included in the new generation of PDC bits. The target applications and objectives will be discussed and several cases studies will be provided to show the exceptional performance and major cost saving benefits of the new technology.

Engro Fertilizer and Siemens PTI jointly completed a study on the supply reliability situation and on the asset management process in Engro Fertilizer's Daharki (Pakistan) plant. This project complemented earlier projects on, e.g., the overall design and the dynamic performance of the captive generation units in this industrial power supply system. Probabilistic reliability calculations validated that the reliability level throughout the plant is adequate and rather constant. A few individual exceptions are well-known to the operators and covered by explicit processes and measures. Also the asset management process was reviewed from the perspective of the plant's overall reliability performance, and the development plans existing with Engro Fertilizer were confirmed. For certain individual assets or groups of assets, the investigations indicated the need for faster implementation in order to maintain the required risk levels for the plant's operation. (4 pages)

The operator has attempted to efficiently drill the 8-3/8, 5-7/8 sections using roller cone tungsten carbide inserts (TCI) and polycrystalline diamond compact (PDC). In the 8-3/8 5-7/8 sections abrasive wear caused by hard/sharp sandstone limited PDC life. Even the toughest cutter could not withstand the abrasivity. The operator required new cutter and PDC technology. Engineers used numerical models to optimize the interface between the diamond table and substrate that determines the cutter's response to residual and service stresses. Diamond table properties were changed to increase durability and wear resistance. The result is an abrasion-resistant cutter capable of maintaining a sharp edge in hard carbonates and abrasive sands. Patented depth-of-cut control technology provided increased stability. Directionally drilling 8-3/8 section through hard/abrasive sandstone with 105pcf overbalanced mud is challenging. TCI, delivered poor ROP while sliding while wear resulted in short runs, lost cones, causing fishing/milling. PDC was tried previously in similar formations with minimal success (cutter wear). A baseline was set using three TCI with diamond enhancements which drilled 75ft in 36.5hrs, at average ROP of 2ft/hr (cost/ft $2240). Using the new cutter technology, four bits drilled 543ft in 116hrs at average ROP of 4.68 ft/hr at cost/ft $778. One bit drilled a record 279ft at 4.73ft/hr. The new PDC technology achieved 65% reduction in drilling cost, saving over $750,000 on one well by reducing drilling time and eliminating fishing operations The 5-7/8" lateral is drilled through the abrasive Jauf reservoir. In the Hawiyah field, the new PDC technology drilled 1620ft of hard/abrasive sand using three bits. The first sidetrack, took nine roller cones and two PDCs to drill 1207ft. The cost/foot reduction was $283/ft for a total savings of $460,000 over this section. With improved cutter technology, a second well was drilled in the same field that required two PDCs to drill 2368ft at 16ft/hr. This performance set the lowest cost per foot horizontal section in this application. In the 5-7/8" vertical application drilling the Unayzah formation in the Ghazal Field, new PDC technology drilled 517ft of hard abrasive formation using two bits, compared to the best offset for the same section using one impregnated bit and four TCI. The cost/foot reduction was $229/ft for a total savings of $118,000.