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Secure and reliable identity is essential for identifying a user accurately and providing services. The traditional centralized identity systems have several security weaknesses and do not support user control. Self-sovereign identity (SSI) has been proposed to provide user control and secure identity model. User record privacy and security is a critical factor for any healthcare information system. Healthcare is also a domain where SSI solutions can counter patient information privacy and security threats. This paper reviews the applicability of blockchain-based SSI solution in healthcare, their advantages and requirements. It further provides a model use case for demonstrating the SSI application in healthcare.

Blockchain technology has a great potential for improving efficiency, security and privacy of Electronic Health Records (EHR) sharing systems. However, existing solutions relying on a centralized database are susceptible to traditional security problems such as Denial of Service (DoS) attacks and a single point of failure similar to traditional database systems. In addition, past solutions exposed users to privacy linking attacks and did not tackle performance and scalability challenges. In this paper, we propose a permissioned Blockchain based healthcare data sharing system that integrates Blockchain technology, decentralized file system and threshold signature to address the aforementioned problems. The proposed system is based on Istanbul Byzantine Fault Tolerant (IBFT) consensus algorithm and Interplanetary File System (IPFS). We implemented the proposed system on an enterprise Ethereum Blockchain known as Hyperledger Besu. We evaluated and compared the performance of the proposed system based on various performance metrics such as transaction latency, throughput and failure rate. Experiments were conducted on a variable network size and number of transactions. The experimental results indicate that the proposed system performs better than existing Blockchain based systems. Moreover, the decentralized file system provides better security than existing traditional centralized database systems while providing the same level of performance.

In the data-driven world, data is created in huge volume and then analyzed by several organizations to get benefit from them. Smart city is one of the examples to use big data to offer improved services for its resident and tourist. However, some countries face certain obstacles to analyze the big data integration for sustainability in smart city development. Therefore, the purpose of this research paper is to identify and analyze the significant barriers related to sustainable smart city development. To accomplish this objective, fourteen barriers of big data analytics are selected through the combined approach of literature review and expert input. After that, these barriers are evaluated using the best worst method for obtaining deeper insights. The result of this study reveals that the most significant barrier is ‘lack of technologies for BDA’, ‘lack of BDA framework’, ‘nature of big data’, and ‘low availability of analytics platforms for big data’. These barriers need to address on priority to develop a sustainable smart city. This study is helpful to the urban planner, government, and consultancy agencies to decide on the adoption of BDA for sustainable smart city development. Further, they can also optimize their resources in the best possible manner to achieve the sustainable development of the existing smart cities.

This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States.Despite improvements in medical therapy and coronary revascularization, patients with previous CAD account for a disproportionately large portion of CV events and pose a challenge for noninvasive stress testing.From the Stress Perfusion Imaging in the United States (SPINS) registry, we identified consecutive patients with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was nonfatal myocardial infarction (MI) or cardiovascular (CV) death. Major adverse CV events (MACE) included MI/CV death, hospitalization for heart failure or unstable angina, and late unplanned coronary artery bypass graft. The prognostic association and net reclassification improvement by ischemia for MI/CV death were determined.Out of 755 patients (age 64 ± 11 years, 64% male), we observed 97 MI/CV deaths and 210 MACE over a median follow-up of 5.3 years. Presence of ischemia demonstrated a significant association with MI/CV death (HR: 2.30; 95% CI: 1.54-3.44; P 0.001) and MACE (HR: 2.24 ([95% CI: 1.69-2.95; P0.001). In a multivariate model adjusted for CV risk factors, ischemia maintained strong association with MI/CV death (HR: 1.84; 95% CI: 1.17-2.88; P = 0.008) and MACE (HR: 1.77; 95% CI: 1.31-2.40; P 0.001) and reclassified 95% of patients at intermediate pretest risk (62% to low risk, 33% to high risk) with corresponding changes in the observed event rates of 1.4% and 5.3% per year for low and high post-test risk, respectively.In a multicenter cohort of patients with known CAD, CMR-assessed ischemia was strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, especially in those considered to be at intermediate risk. Absence of ischemia was associated with a2% annual rate of MI/CV death. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).

Background and Purpose: The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies. Methods: We analyzed individual patient data stored in the VISTA (Virtual International Stroke Trials Archive) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up. Results: Of 10 821 patients, 1017 (9.4%) had a total of 1076 pneumonias. Six hundred eighty-nine (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the third day and the median time of onset was 4.0 days after stroke (interquartile range, 2–12). The presence of a pneumonia was associated with an increased risk of poor outcome (adjusted odds ratio, 4.8 [95% CI, 3.8–6.1]) or death (adjusted hazard ratio, 4.1 [95% CI, 3.7–4.6]). These associations were present throughout the 90 days of follow-up. Conclusions: Two out of 3 pneumonias in the first 3 months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first 4 days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death.

Background Among stroke survivors, the risk of stroke recurrence is high, and stroke survivors' perception of the risk of recurrence is crucial to promote healthy behaviours. Objectives This study aimed to explore the perceptions of stroke survivors about their risk of recurrence and healthy behavioural modifications. Design A qualitative interview study was carried out. Results We interviewed 19 stroke survivors from 3 hospitals. Thematic analysis showed that the perceptions of recurrence risk and healthy behavioural changes differed between first‐ever and recurrent stroke survivors. Three themes were generated from the data of first‐ever stroke survivors: indifference to and unawareness of the risk of stroke recurrence, the need for professional information support and different awareness of the importance of different healthy behaviours. For first‐relapse stroke patients: worry but feel powerlessness towards recurrent event, accurate information is still warranted, regret of unhealthy behaviour patterns. For the survivors suffered two or more times recurrences: perceived severity of recurrences, increased psychological care need, incorrect perceptions of healthy behaviour. Discussion and Conclusion Stroke survivors with or without recurrence hold different perceptions towards the risk of recurrence and behavioural changes. The need for information related to warning signs, recurrence risk and risk factors remained consistently unmet. The benefits of healthy behaviours could be a double‐edged sword for the prevention of stroke recurrence if the survivors fail to understand these accurately. It is strongly recommended that a specific recurrence risk communication tool and related health education plan be explored on the basis of the number of times patients have experienced stroke recurrence to inform secondary prevention of stroke in the future. Patient/Public Contribution The patients were involved in the formulation of interview questions and conduct of this study. No public was involved in this study.

The hybrid algorithm was designed to assist with initial and subsequent crossing strategy selection in chronic total occlusion (CTO) percutaneous coronary interventions (PCIs). However, the success of the initially selected strategy has received limited study.We examined the impact of adherence to the hybrid algorithm recommendation for initial CTO crossing technique selection in 4178 CTO PCIs from a large multicenter registry.The initial crossing strategy was concordant with the hybrid algorithm recommendation in 1833 interventions (44%). Patients in the concordant group had a similar age to those in the discordant group but a lower mean J-CTO score (2.0 ± 1.4 vs 2.8 ± 1.1; P .01). The concordant group showed higher technical success with the first crossing strategy (68% vs 48%; P .01) and higher overall technical success (88% vs 83%; P .01) with no difference in the incidence of in-hospital major adverse events (1.8% vs 2.3%; P = .26). In multivariable analysis, after adjustment for age, prior myocardial infarction, prior PCI, prior coronary artery bypass grafting, J-CTO score, and scheduled CTO PCI, nonadherence to the hybrid algorithm was independently associated with lower technical success of the initial crossing strategy (odds ratio, 0.55; 95% confidence interval, 0.48-0.64; P .01).Adherence to the hybrid algorithm for initial crossing strategy selection is associated with higher CTO PCI success but similar in-hospital major adverse cardiac events.

Resumen Introduccion y objetivos El algoritmo hibrido se diseno para ayudar en la seleccion de las estrategias de cruce inicial y siguientes en la intervencion coronaria percutanea (ICP) para la oclusion cronica total (OTC); sin embargo, el exito de la estrategia de inicio seleccionada se ha estudiado poco hasta ahora. Metodos Se estudio el impacto de la adherencia a la recomendacion del algoritmo hibrido para la seleccion de la tecnica de cruce inicial en 4.178 ICP de OTC en un registro multicentrico de gran tamano. Resultados La estrategia de cruce inicial coincidio con la recomendacion del algoritmo hibrido en 1.833 casos (44%). Los pacientes en el grupo concordante tuvieron una edad similar, pero un indice J-OTC menor (2,0 ± 1,4 frente a 2,8 ± 1,1; p Conclusiones La adherencia al algoritmo hibrido para la seleccion de la estrategia inicial de cruce se asocio con mayor exito de la ICP para la OTC y similar tasa de eventos cardiovasculares hospitalarios graves.

Substitution box is the most significant component of block cipher. The property of nonlinearity is of great importance for the design of secure substitution boxes. Therefore, it is necessary to develop new methods for the production of substitution boxes with a high non-linearity score. In this paper, we have introduced a novel group theoretic method to construct a robust S-box with non-linearity score 113.75 greater than that of AES S-box. The performance of generated S-box is found to be excellent, when examined through various other well-known algebraic criteria such as strict avalanche criterion, bit independence criterion, differential uniformity and linear approximation probability. The suitability of proposed S-box is tested for image encryption applications through different statistical analyses. We got very encouraging outcomes from all these examinations which certify that the generated S-box meets all the criteria needed to be reliable for secure communication and image encryption.

Background The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. Methods We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. Results All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. Conclusion Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria’s efforts in measles control and elimination.

Background As global effort is made towards measles elimination, the use of innovative technology to enhance planning for the campaign has become critical. GIS technology has been applied to track polio vaccination activities in Nigeria with encouraging outcomes. Despite numerous measles vaccination campaigns after the first catch up campaign in 2005, sub-optimal outcomes of previous measles supplemental immunization activities necessitated the use of innovative ideas to achieve better outcomes especially when planning for the 2017/2018 measles vaccination campaign. This led to the application of the use of the GIS technology for the Northern states in 2017/2018 campaign. This study is a report of what was achieved with the use of the GIS in the 2017/2018 measles vaccination campaign in Nigeria. Methods GIS generated ward maps were used for the microplanning processes for the 2017/2018 measles vaccination campaign. These ward maps had estimates of the target population by settlements, the number and location of vaccination posts ensuring that a vaccination post is sited within one-kilometer radius of a settlement, and the number of teams needed to support the vaccination campaign as well as the catchment area and daily implementation plans. The ward microplans were verified by checking for accuracy and consistency of the target population, settlements, number of teams, vaccination posts and daily implementation work plans using a standard checklist. The ward maps were deployed into use for the measles vaccination campaign after the state team driven validation and verification by the National team (Government and Partners) Results The Northern states that applied the GIS technology had a closer operational target population to that on the verified microplan than those of the non-GIS technology states. Greater than 90% of the ward maps had all that is expected in the maps - i.e settlements, target populations, and vaccination posts captured, except Kaduna, Katsina and Adamawa states. Of all enumeration areas sampled during the post-campaign survey in states with GIS ward maps, none had a zero-vaccination coverage of the surveyed children, with the exception of one in Borno state that had security issues. In the post campaign coverage survey, the percentage of responses that gave vaccination post being too far as a reason for non-vaccination of children in the Northern zones that used GIS generated ward maps was less than half the rate seen in the southern zones where the GIS microplanning was not used. Conclusion The use of GIS-generated wards maps improved the quality of ward micro plans and optimized the placement of vaccination posts, resulting in a significant reduction in zero-dose clusters found during the post campaign coverage survey.

Objectives: The present study is aimed to determine frequency of bacteria in urine and pus sample along with the antibiotic resistance profile of isolated bacteria. Study Design: Cross-Sectional Study. Setting: Real-Time PCR Laboratory at Dabgari Garden, Peshawar with the Collaboration of Health Biotechnology Laboratory, Department of Biotechnology, Abdul Wali Khan University, Mardan. Period: June 2018 to July 2019. Material & Methods: The urine and pus samples were collected from suspected patients and were cultured on appropriate culture media. The biochemical tests were also performed after growing on culture plates for identification and confirmation of bacterial isolates. The disc diffusion technique was used to evaluate the antibiotic pattern of retrieved isolates. Result: A total of 525 samples of pus and urine samples were collected from different regions of Peshawar. Out of the total, 237 (45.1%) samples were found positive for bacterial growth whereas the remaining (54.9%) were observed negative. Among total positive isolates, 220 (92.8%) were from urine samples, and 17 (7.2%) were from pus samples. The predominant isolate was Escherichia coli (E. coli) (90.3%) retrieved from positive samples, followed by Pseudomonas aeruginosa (7.2%), Klebsiella pneumonia (1.3%), and Staphylococcus aureus (1.3%). The most effective antibiotic was Fosfomycin against bacteria whereas Nalidixic acid, Nitrofurantoin, and Amoxicillin/clavulanic acid were found less effective against bacterial isolates. Conclusion: Most frequent bacteria isolated was E. coli and the most efficient drug was Fosmomycin and the least was Nitrofurantoin, and Amoxicillin.

Artificial intelligence (AI) pertains to the ability of computers or computer-controlled machines to perform activities that demand the cognitive function and performance level of the human brain. The use of AI in medicine and health care is growing rapidly, significantly impacting areas such as medical diagnostics, drug development, treatment personalization, supportive health services, genomics, and public health management. AI offers several advantages; however, its rampant rise in health care also raises concerns regarding legal liability, ethics, and data privacy. Technological singularity (TS) is a hypothetical future point in time when AI will surpass human intelligence. If it occurs, TS in health care would imply the replacement of human medical practitioners with AI-guided robots and peripheral systems. Considering the pace at which technological advances are taking place in the arena of AI, and the pace at which AI is being integrated with health care systems, it is not be unreasonable to believe that TS in health care might occur in the near future and that AI-enabled services will profoundly augment the capabilities of doctors, if not completely replace them. There is a need to understand the associated challenges so that we may better prepare the health care system and society to embrace such a change - if it happens.

Omohyoid muscle syndrome (OMS) is one of the rare causes of lateral neck swelling during swallowing and it is often a worrisome observation due to the concern of malignancy and cosmetic deformity. Anatomical variation, congenital weakness, or trauma may cause incompetence of the fascial-retaining mechanism and subsequently OMS. Its prevalence is unknown as only a few cases were reported in the past and none in Malaysia. Diagnosing OMS is very challenging. Hence, imaging techniques like real time ultrasound or dynamic computed tomography can be useful in assessing the affected muscles.

Modern block ciphers have been used to design security schemes to fulfil the security requirements in different areas of applications. The substitution boxes, significant components, used in block ciphers must have strong cryptographic strength so as to mitigate different attacks. There is no obvious distribution in the cryptographic properties of S-boxes, which is the main difficulty in creating an S-box. This paper proposes a novel group theoretic construction which can inherit the algebraic properties of S-box and able to construct as many as 2,359,296 different S-boxes. As an illustration, the proposed approach is applied to AES S-box and few S-boxes out of 2,359,296 are reported and assessed against standard performance parameters to validate the proposed findings.

In the medical era the Brain tumor is one of the most important research areas in the field of medical sciences. Researcher are trying to find the reliable and cost effective medical equipment’s for the cancer and its type for the diagnosed, especially tumor has deferent kinds but the major two type are discussed in this research paper. Which are the benign and Pre-Malignant, this research work is proposed for these factors such as the accuracy of the MRI image for the tumor identification and actual placing were taken into consideration. In this study, an algorithm is proposed to detect the brain tumor from magnetic resonance image (MRI) data simple. As enhance the image quality for the easiness the tumor treatments and diagnosed for the patients. The proposed algorithm enhances the MR image quality and detects the Brain tumor which helps the Physician to diagnose the tumor easily. As well this algorithm automatically calculates the area of tumor, size and location of the tumor where it is present for diagnostic the Patient.

Hyperlipidaemia is an condition that increases the chance of coronary heart disease (CHD) and atherosclerotic disease (ASHD) in blood vessels. Hyperlipidaemia occurs in response to smoking, obesity, sedentary lifestyle, and other risk factors to extend CHD. Cardiovascular disease (CVD) is the reason for death. Hyperlipidaemia is divided into two broad classifications: Primary (familial) and Secondary (acquired). Primary hyperlipidemia has been generated by hereditary defects and climatic factors or by undisclosed mechanisms. Secondary hyperlipidemia concern to the metabolic disorders linked with the diabetes mellitus, liver complication, thyroid, and kidney complications. Hyperlipidemia also refers to as elevated levels of lipids within the blood. Circulating lipid are carried in lipoproteins that transport the lipids to varied tissues for energy use, lipid deposition, hormone production, and steroid formation. The lipoprotein consists of esterified and unesterified cholesterol, triglycerides, phospholipids, and protein. The general public who have hyperlipidemia experience no symptoms. Hyperlipidemia is most oftenly correlated with high-fat diets, a stationary lifestyle, obesity and diabetes mellitus. Four different classes of cholesterol-lowering drugs namely, statins, niacin, resins, and fibrates are available to treat hyperlipidemia; however, statins are now considered to be the first line therapy. The preventable causes of hyperlipidemia can include: Smoking, Being overweight, Physical inactivity, Steroid use, Alcohol consumption & Diet high in saturated fat, & cholesterol such as cheese, meat, fried & processed foods and egg yolk. The treatment of hyperlipidemia includes statins, bile acid sequestrants, fibric acids, niacin, and cholesterol absorption inhibitors. There are some of the novel drugs which are selected for the treatment of hyperlipidemia which includes: Evolocumab, Alirocumab, Bempedoic acid, Lomitapide, Evinacumab, and Sebelipase alfa.

Purpose This study aims to examine the role of Islamic social finance (ISF) instruments such as Zakah, Sadaqah and Waqf in the provision of social services by Islamic faith-based organizations (IFBOs) in Southwest Nigeria. Design/methodology/approach This study adopts exploratory approach based on field interviews conducted with leaders of IFBOs, whereas purposive sampling technique was used to select three case study organizations. Data collected from interviews and documents of case study organizations was analyzed using content and narrative analyses. Findings The first findings indicate faith in the Unseen God, scriptural texts and socio-economic factors as major motivation that accounted for the IFBOs’ concern for social services. The second finding shows that the ISF strategies used by the IFBOs to improve access to social services include Zakah, Awqaf, Sadaqah and gifts. The third finding reveals that the IFBOs have efficient stand-alone and windows operational structures that align with IFBOs corporate governance. The fourth finding also reveals the challenges facing the IFBOs such as inadequate funding, dearth of manpower, lukewarm and uncooperative attitude of Muslims and attitudinal behaviour of givers and takers. Research limitations/implications Absence of documented directory about the role IFBOs usage of ISF in providing social services in Southwest Nigeria affected the study. Many IFBOs were eliminated during the process of selection because of lack of records to indicate their social services relevant to the study. As such, information that could have been collected from the eliminated IFBOs could have contributed significantly to the study. Practical implications The major implications of the study are that ISF has been reinvented as an ethical social welfare framework for supporting the disadvantaged members of the society with ISF instruments and also highlighted the dichotomy existing between IFBOs in the North and Southwest Nigeria with respect to the legal and operational activities of IFBOs usage of ISF. Originality/value This study has contributed to a better understanding of the role of ISF instruments in the provision of social services in an area that is largely under-researched in Nigeria.

Academic planning is an essential function of Higher Education Institutes (HEIs). The extent towhich academic planning functions are performed determines to a large degree the attainment of the goals of HEIs in Nigeria. This research was conducted toexamine if academic planning functions as a predictor of goal achievement in the Colleges of Education in Kwara State, Nigeria. Survey research method was used to establish the relationship between academicplanning functions and goal achievement in/for the above mentioned colleges. A sample size of 421 out of 1,668 staff was determined using research advisors. The sample size of 421 participants comprised 147 academic staff and 274 non-teaching staff selected using a stratified and proportionate samplingtechnique. Two instruments were designed and used to collect the relevant data for this study. These instruments were Academic Planning Functions Questionnaire (APFQ) and Goals AchievementQuestionnaire (GAQ). The data collected were analyzed using Smart PLS 3.1.4. The findings showed that program accreditation, information processing, and monitoring functionspredicted goal achievement in the said colleges, while program initiation, internal quality assurance, resourceprojection, and financial planning functions did not predict goal achievement. Based on the findings, recommendations weremade to improve the academic planning unit for increased efficiency, effectiveness, and productivity in these colleges.

Background There are no robust national prevalence of Human Papillomavirus (HPV) genotypes in Nigerian women despite the high burden of cervical cancer morbidity and mortality. The objective of study This study aims to determine the pooled prevalence and risk factors of genital HPV infection in Nigeria through a systemic review protocol. Methods Databases including PubMed, Scopus, Google Scholar and AJOL were searched between 10 April to 28 July 2020. HPV studies on Nigerian females and published from April 1999 to March 2019 were included. GRADE was used to assess the quality of evidence. Results The pooled prevalence of cervical HPV was 20.65% (95%CI: 19.7–21.7). Genotypes 31 (70.8%), 35 (69.9%) and 16 (52.9%) were the most predominant HPV in circulation. Of the six geopolitical zones in Nigeria, northeast had the highest pooled prevalence of HPV infection (48.1%), while the least was in the north-west (6.8%). After multivariate logistic regression, duration (years) of sexual exposure (OR = 3.24, 95%CI: 1.78–9.23]), history of other malignancies (OR = 1.93, 95%CI: 1.03–2.97]), history of sexually transmitted infection (OR = 2.45, 95% CI: 1.31–3.55]), coital frequency per week (OR = 5.11, 95%CI: 3.86–14.29), the status of circumcision of the sexual partner (OR = 2.71, 95%CI: 1.62–9.05), and marital status (OR = 1.72, 95%CI: 1.16–4.72), were significant risk factors of HPV infection (p

Healthcare remote monitoring applications dominate the market of new technologies due to their valuable aid to patients, families, and medical staff. They provide ubiquitous remote health services for patients with chronic diseases or specific conditions and can provide ubiquitous communication between patients and caregiver(s). This paper presents an ontology reasoning-based healthcare monitoring system called Do-Care. The proposed system supports the supervision and follow-up of outdoor and indoor patients suffering from chronic diseases. Collected data, from wearable 1 , nearable 2 or usable 3 devices forms the instances for entities from the proposed Do-Care ontology used by the reasoner when applying a set of SWRL 4 rules to determinate the health situation of a patient as Normal, Abnormal or Wrong. The main contribution in this paper is a modular and dynamic ontology composed of FOAF 5 , SSN 6 /SOSA 7 and ICNP 8 ontologies with a scalable set of inference rules. The proposed rule based methodology is dynamic and adjustable to meet possible changes in the medication market, medical discoveries, and personal users’ profiles. The presented experimental results show the efficiency of the proposed DO-Care system.

This study aims to find the influence of corporate governance on firm performance for the listed non-financial firms on the Pakistan Stock Exchange (PSX) for the period 2005-15. The article has measured corporate governance by the large boards with more independent directors, independence of audit committee, ownership concentration, non-existence ofCEOduality, and presence of foreign and institutional investors. To address this endogenous nature of institutional ownership and performance in this study we have used instrumental variables (IV) techniques using a two-stage least square (2SLS) by instrumentalizing institutional ownership with firm size and firm age. The study found that firms with large and independent boards outperform their counterparts. Similarly, the study found that firms having the joint position ofCEOand chairperson performs lower than counterparts. In Pakistan firms with foreign and institutional owners better than others. We found that firms with concentrated owners have a lower level of agency problem and ultimately perform well. Furthermore, we found that firms with a lower level of agency problem type II (measured via ownership concentration contestability) perform better in Pakistan.

The paroxysmal dyskinesias are a diverse group of genetic disorders that manifest as episodic movements, with specific triggers, attack frequency, and duration. With recent advances in genetic sequencing, the number of genetic variants associated with paroxysmal dyskinesia has dramatically increased, and it is now evident that there is significant genotype-phenotype overlap, reduced (or incomplete) penetrance, and phenotypic variability. In addition, a variety of genetic conditions can present with paroxysmal dyskinesia as the initial symptom. This review will cover the 34 genes implicated to date and propose a diagnostic workflow featuring judicious use of whole-exome or -genome sequencing. The goal of this review is to provide a common understanding of paroxysmal dyskinesias so basic scientists, geneticists, and clinicians can collaborate effectively to provide diagnoses and treatments for patients.

BACKGROUND Hypertension is one of the most common diseases all over the world. Lead is a common environmental and industrial pollutant with no beneficial biological role. The contribution of environmental lead exposure to hypertension is an important public health concern. The objective of this study was to determine the blood lead levels in hypertensive patients and to investigate the correlation between blood lead (B-Pb) levels and the values of blood pressure in hypertensive patients. METHODS This is a hospital based analytical cross-sectional study conducted over a period of one and half years. Subjects included 50 newly detected hypertensive and 50 healthy subjects recruited who were both age and sex matched. Mean of age, blood lead levels, systolic blood pressure (SBP), diastolic blood pressure (DBP) with standard deviation were assessed. Linear regression was used to estimate the predicted systolic blood pressure (BP) and diastolic BP with lead levels. Pearson correlation was used to estimate the correlation between blood lead and blood pressure levels. RESULTS In this study, 52 % of cases and controls were in the age group of 41 - 60 years. 22 % of the subjects were more than 61 years of age. 45 % of the total subjects were females and 55 % were males. 46 % of the controls and 44 % of the cases were females. Comparison of the serum lead levels (mcg / dl) between cases and controls showed that serum lead levels (mcg / dl) were higher in Cases group with a t-value of -7.38 and was statistically significant with a P-value of < 0.001. Comparison of the serum lead levels (mcg / dl) between the males and females showed that serum lead levels (mcg / dl) were higher in female group with a t-value of - 0.151 and was statistically non-significant with a P-value of 0.881. This study showed that there is an increase in blood lead levels in hypertensive patients compared to the control group. Stage 2 hypertension has higher serum lead level value of 21.228 compared to stage 1. Serum lead levels were higher in females compared to males. CONCLUSIONS Our study indicated that blood lead level is significantly and positively correlated to blood pressure among newly detected hypertensive patients. Increase in blood lead levels causes increase in both systolic and diastolic blood pressures. KEY WORDS Hypertension, Lead, Systolic Blood Pressure, Diastolic Blood Pressure

BACKGROUND: The number of people injured following a road traffic accident (RTA) are as high as 2–5 crores around the world every year. The literature from western population suggests that ACL injuries are encountered mostly following high velocity sports injuries in clinical practise. But, in India there are a large group of individuals presenting with ACL injuries following RTAs. METHODS: We performed a retrospective analysis of all patients with ACL injuries presenting to our hospital following RTAs. All the information pertaining to the ligaments injured, vehicular factors, time of the day and environmental factors were recorded. The data was then analysed statistically. RESULTS: Most injuries occurred in the 31–40 year age group and velocity in the same range. Injuries due to bike skid predominated in our study amounting to 55.9%. Interestingly, very low velocities accidents due to stray dogs accounted to 43.8% and they occur mostly at night. CONCLUSION: The number of patients presenting with RTA related ACL injuries in our country are numerous. Hence, we have made an attempt to show that ACL injuries can occur even at low velocity following motor vehicle accidents in contrast to the western population, where sports related injuries are the most common etiology for such mishaps.

Objective: The objective of this research was to study the effect of Berberis lyceum (herbal plant) in reduction of liver enzyme ALT in mice. Study Design: Quasi- experimental Study. Setting: Peshawar Medical College, Peshawar. Period: December, 2016 to May, 2017. Materials & Methods: It was an experimental study which was carried out at Peshawar Medical College Warsak Road Peshawar. Total 30 (thirty) mice were used divided in six different groups with five mice in each group. After inducing hepatotoxicity with acetaminophen in the mice, blood samples were taken and LFTs were performed to observe serum ALT values and the effects of different doses of the plant extract were evaluated. Results: The ALT levels of negative control and experimental group were compared and it was shown that ALT levels in experimental groups were 232±42.3, 143±32.5 and 62.2±18.2 whereas serum ALT value of negative control group was 571.4±123.3 which showed that ALT had been decreased by increasing the dose of plant extract. Conclusion: It was concluded that Berberis Lycium, a herbal plant has a potentially active hepato protective role in bringing serum ALT to normal. This plant can be useful in reversing the hepatotoxicity in drug induced elevation of liver enzyme ALT.

This study aimed to examine the impact of organizational culture on quality management and innovation practices among manufacturing SMEs in Nigeria. Empirical data were collected from 570 manufactu...

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

STUDY QUESTION How accurately do women report a diagnosis of endometriosis on self-administered questionnaires? SUMMARY ANSWER Based on the analysis of four international cohorts, women self-report endometriosis fairly accurately with a > 70% confirmation for clinical and surgical records. WHAT IS KNOWN ALREADY The study of complex diseases requires large, diverse population-based samples, and endometriosis is no exception. Due to the difficulty of obtaining medical records for a condition that may have been diagnosed years earlier and for which there is no standardized documentation, reliance on self-report is necessary. Only a few studies have assessed the validity of self-reported endometriosis compared with medical records, with the observed confirmation ranging from 32% to 89%. STUDY DESIGN, SIZE, DURATION We compared questionnaire-reported endometriosis with medical record notation among participants from the Black Women’s Health Study (BWHS; 1995-2013), Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N; 1990-2006), Growing Up Today Study (GUTS; 2005–2016), and Nurses’ Health Study II (NHSII; 1989–1993 first wave, 1995–2007 second wave). PARTICIPANTS/MATERIALS, SETTING, METHODS Participants who had reported endometriosis on self-administered questionnaires gave permission to procure and review their clinical, surgical, and pathology medical records, yielding records for 827 women: 225 (BWHS), 168 (E3N), 85 (GUTS), 132 (NHSII first wave), and 217 (NHSII second wave). We abstracted diagnosis confirmation as well as American Fertility Society (AFS) or revised American Society of Reproductive Medicine (rASRM) stage and visualized macro-presentation (e.g. superficial peritoneal, deep endometriosis, endometrioma). For each cohort, we calculated clinical reference to endometriosis, and surgical- and pathologic-confirmation proportions. MAIN RESULTS AND THE ROLE OF CHANCE Confirmation was high—84% overall when combining clinical, surgical, and pathology records (ranging from 72% for BWHS to 95% for GUTS), suggesting that women accurately report if they are told by a physician that they have endometriosis. Among women with self-reported laparoscopic confirmation of their endometriosis diagnosis, confirmation of medical records was extremely high (97% overall, ranging from 95% for NHSII second wave to 100% for NHSII first wave). Importantly, only 42% of medical records included pathology reports, among which histologic confirmation ranged from 76% (GUTS) to 100% (NHSII first wave). Documentation of visualized endometriosis presentation was often absent, and details recorded were inconsistent. AFS or rASRM stage was documented in 44% of NHSII first wave, 13% of NHSII second wave, and 24% of GUTS surgical records. The presence/absence of deep endometriosis was rarely noted in the medical records. LIMITATIONS, REASONS FOR CAUTION Medical record abstraction was conducted separately by cohort-specific investigators, potentially introducing misclassification due to variation in abstraction protocols and interpretation. Additionally, information on the presence/absence of AFS/rASRM stage, deep endometriosis, and histologic findings were not available for all four cohort studies. WIDER IMPLICATIONS OF THE FINDINGS Variation in access to care and differences in disease phenotypes and risk factor distributions among patients with endometriosis necessitates the use of large, diverse population samples to subdivide patients for risk factor, treatment response and discovery of long-term outcomes. Women self-report endometriosis with reasonable accuracy (>70%) and with exceptional accuracy when women are restricted to those who report that their endometriosis had been confirmed by laparoscopic surgery (>94%). Thus, relying on self-reported endometriosis in order to use larger sample sizes of patients with endometriosis appears to be valid, particularly when self-report of laparoscopic confirmation is used as the case definition. However, the paucity of data on histologic findings, AFS/rASRM stage, and endometriosis phenotypic characteristics suggests that a universal requirement for harmonized clinical and surgical data documentation is needed if we hope to obtain the relevant details for subgrouping patients with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by Eunice Kennedy Shriver National Institute of Child Health and Development grants HD48544, HD52473, HD57210, and HD94842, National Cancer Institute grants CA50385, R01CA058420, UM1CA164974, and U01CA176726, and National Heart, Lung, and Blood Institute grant U01HL154386. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AS, SM, and KT were additionally supported by the J. Willard and Alice S. Marriott Foundation. MK was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. LA Wise has served as a fibroid consultant for AbbVie, Inc for the last three years and has received in-kind donations (e.g. home pregnancy tests) from Swiss Precision Diagnostics, Sandstone Diagnostics, Kindara.com, and FertilityFriend.com for the PRESTO cohort. SA Missmer serves as an advisory board member for AbbVie and a single working group service for Roche; neither are related to this study. No other authors have a conflict of interest to report. Funders had no role in the study design, conduct of the study or data analysis, writing of the report, or decision to submit the article for publication. TRIAL REGISTRATION NUMBER N/A.

OBJECTIVE The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. METHODS We compared in-hospital outcomes of CTO PCI between patients ≥80 vs.

The detection of epileptic seizures by classifying electroencephalography (EEG) signals into ictal and interictal classes is a demanding challenge, because it identifies the seizure and seizure-free states of an epileptic patient. In previous works, several machine learning-based strategies were introduced to investigate and interpret EEG signals for the purpose of their accurate classification. However, non-linear and non-stationary characteristics of EEG signals make it complicated to get complete information about these dynamic biomedical signals. In order to address this issue, this paper focuses on extracting the most discriminating and distinguishing features of seizure EEG recordings to develop an approach that employs both fuzzy-based and traditional machine learning algorithms for epileptic seizure detection. The proposed framework classifies unknown EEG signal segments into ictal and interictal classes. The model is validated using empirical evaluation on two benchmark datasets, namely the Bonn and Children’s Hospital of Boston-Massachusetts Institute of Technology (CHB-MIT) datasets. The obtained results show that in both cases, K-Nearest Neighbor (KNN) and Fuzzy Rough Nearest Neighbor (FRNN) give the highest classification accuracy scores, with improved sensitivity and specificity percentages.

Objective: Ovarian cancer recurrence is often a major problem for patients who have undergone treatment. This prospective study was undertaken to evaluate the diagnostic accuracy of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG)/ computed tomography (CT) in patients with suspected for ovarian cancer recurrence. Methods: A total of 43 women who underwent surgery or chemotherapy for ovarian cancer were enrolled in this study. They underwent18 F-FDG PET/CT scan due to raised CA-125 levels, clinical suspicion of ovarian cancer recurrence, or alterations detected on CT.18 F-FDG PET/CT findings for the women were compared with the final diagnosis. Results: CA-125 was elevated in 13 patients, while 34 patients presented with alterations on CT, and 9 patients presented with both results’ positivity. 17 patients confirmed to have an ovarian cancer recurrence, all with abnormal findings on PET/ CT. 20 patients remained disease-free during follow-up, all with normal PET/CT findings. There were 9 patients with raised CA-125 levels and normal conventional imaging, all with positive18 F-FDG PET/CT. Among the 30 patients with normal CA-125 levels, 9 patients presented with a positive PET/CT scan. Lymph nodes were the most frequent site. Its sensitivity, specificity, positive predictive value, and negative predictive valuewere 94%, 91%, 77%, and 95%, respectively. Conclusion: 18F-FDG PET/CT is a useful modality for evaluating the cancer recurrence and extent of the disease. Lymph nodes were the most frequent site. However, there was no statistical significance found between CA-125 levels and 18F-FDG PET/CT findings. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.302-312

Entrepreneurship is an important element of economic development because it does not only produce physical products and provides services but it also generates employment at the same time. Entrepreneurs develop new ideas through creativity and innovativeness and harness available resources to reap profit from their business endeavors. Realizing the importance of entrepreneurship that spurs economic growth, the government of Malaysia encourages future entrepreneurs to participate in entrepreneurship training programs to ensure they increase entrepreneurship capabilities and achieve sustainability in their ventures. In order to do so, training programs should cater to the important requirements of effective training in order to deliver the expected objectives. Thus, this paper aims to explore the determinants of the effectiveness of an entrepreneurship- training program using UMK?s students as the sample. Entrepreneurship students? perception on this is vital as they might be the entrepreneurs who will be involved in an entrepreneurship training program once they graduate from the university. This study adopted the purposive sampling method, where 50 students from the Faculty of Entrepreneurship and Business were selected to answer the structured questionnaires. The results of the study revealed that the trainees? readiness and learning approach were determinants of the effectiveness of the training program. On the other hand, the other two variables, entrepreneur?s orientation and trainer skills, did not have a significant relationship with the effectiveness of the training program. The findings should be treated with caution due to the small number of students involved in the study.

Stroke is one of the major causes of morbidity and mortality globally, with devastating effects. It is diagnosed mainly by clinical assessment and brain imaging; however, it is challenging to discriminate stroke from similar conditions with parallel presentations. While brain imaging provides detection of stroke infarcts, it does not provide useful information on the biology and prognosis of the underlying disease process. The complex pathophysiology of stroke infarcts is a barrier in developing sensitive diagnostic tools, which consequently has a detrimental effect on development of treatment regimens. Early diagnosis of stroke is vital for better management, but currently there is no diagnostic blood-based biomarker. The cargo of exosomes can give an insight into the physiological or pathophysiological status of the cell. Exosomes have gained great interest as a means of intercellular communication and recently have been explored as a potential biomarker tool. Circulating exosomes in the blood result from of a contribution from all tissues. The sub-population of exosomes released from brain cells circulating in body fluids are known as neuronal exosomes. This overview presents the vital diagnostic function that could be performed by circulating exosomes of neuronal origin in identifying the subtype of stroke, its severity, and the recovery stages. A number of potential biomarkers that are obtained from circulating exosomes have showed promising potential to function as stroke biomarkers; however, further work is needed to characterize the neuronal exosomes and its payload and to determine the pathways it uses in the complex pathophysiology of stroke. The identification is a subset of exosomal biomarkers that are specific to stroke will enhance the early detection and prognosis of the disease.

Background: During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime. Methods: Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis. Results: The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care. Conclusions: Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime. Clinical Trial Registration: NCT01778335

The optimal timing of anticoagulation after stroke in patients with atrial fibrillation (AF) is unknown. We aimed to objectively assess the rate of radiological hemorrhagic transformation (HT) associated with early anticoagulation. A prospective, open label study (NCT04435418) of patients with AF treated with apixaban within 14 days of ischemic stroke/TIA onset was conducted. Baseline and follow-up CT scans were assessed for HT and graded using European Cooperative Acute Stroke Study (ECASS) criteria. The primary endpoint was symptomatic HT. Incident HT rates were assessed as Objective Performance Criteria. One-hundred AF stroke patients, with a mean age of 79 ± 11 years were enrolled. Median infarct volume was 4 (0.5–10.75) ml. Median time from index event onset to apixaban initiation was 2 (1–6) days, and median baseline NIHSS was 4 (1–9). Asymptomatic HT on baseline imaging was present in 15 patients. Infarct volume (OR = 1.1, [1.02–1.12], p

Additive Manufacturing (AM) technologies are used to manufacture a physical part quickly through the inputs of a three-dimensional computer-aided design system. 3D printing represents a technological component of additive manufacturing. Here a part is built by layer by layer deposition of material until its entire segments have been made. Many advantages visualise the need for 3D printing manufacturing over conventional manufacturing methods, all in terms of processes, materials, and environment. 3D printing takes challenges the manufacturing ability of subtractive manufacturing by producing designs of complex nature. It allows engineers to have creative liberty while designing components, test them quickly as the manufacturing time is lessened, and help with advanced and conventional materials. There is an adverse impact of conventional manufacturing on the environment, and it has become essential to switch to alternatives like AM that. Some are saying that it is less harmful effects on the environment. This study aims to understand how much sustainable it is to switch to additive manufacturing technologies. This paper reviews the impact of 3D printing on the environment and compares it with existing manufacturing methods based on critical associated parameters. The significant parameter considered is the entire process's energy, the impact on global warming, freshwater, marine water, terrestrial toxicity, and acidification. The study will help researchers to identify the sustainability of printing technologies of AM.

Funder: ALK-Abello A/S, BACKGROUND: This paper reports the duration of moderate and severe exacerbations in patients with house dust mite induced allergic asthma and the impact on patients' quality of life. METHODS: Post-hoc analyses were conducted using data collected during a phase III multi-national trial (MT-04) that investigated time to moderate or severe asthma exacerbation among 485 patients during withdrawal from inhaled corticosteroids. Patient diaries were analysed to ascertain duration of exacerbations. The impact on patients' quality of life was measured by calculating utilities for five health states using the EuroQol-5 Dimension (EQ-5D-3L) and Asthma Quality of Life Questionnaire (AQL-5D). A regression analysis predicted the disutility of moving from 'well controlled asthma' to the other four health states: 'partially controlled asthma', 'uncontrolled asthma', 'moderate exacerbation' and 'severe exacerbation'. RESULTS: Two hundred four patients experienced exacerbations. Moderate and severe exacerbations involved statistically significant reductions in lung function compared to the constant peak expiratory flow observed for patients without exacerbations. Lung function decline occurred for 28 days, decreasing approximately 14 days before an exacerbation followed by a return to baseline over 14 days. Asthma symptoms, the use of short-acting β2-agonists, and frequency of nocturnal awakening all increased, starting 10-14 days before an exacerbation, and returned to baseline within 10-28 days following exacerbations. Compared to 'well controlled asthma', the disutility of having a 'moderate exacerbation' ranged from - 0.0834 to - 0.0921 (EQ-5D-3L) and from - 0.114 to - 0.121 (AQL-5D); and of having a 'severe exacerbation' from - 0.115 to - 0.163 (EQ-5D-3L) and from - 0.153 to - 0.217 (AQL-5D), depending on the length of the observation period. CONCLUSIONS: The impact of moderate and severe exacerbations in house dust mite induced allergic asthma extends 14 days before and 28 days after the peak exacerbation event. The impact of exacerbations on patients' health-related quality of life (HRQoL) continues long after their occurrence.

Objective: To study the diagnostic accuracy of Adenosine deaminase enzyme (ADA) in the diagnosis of tuberculous pleural effusion (TPE).Material and Methods: It was a cross-sectional descriptive study conducted in the Pulmonology departments of Lady Reading and Khyber Teaching Hospital Peshawar and department of Pathology, Khyber Medical College, Peshawar from April 2015 to Jan 2016. A total of 210 tuberculous and non-tuberculous pleural effusion patients were selected through consecutive non-probability sampling techniques. After physical and systemic examination, 3cc of pleural fluid was taken. ADA was estimated by Non-Guisti and Galanti method through the simple colorimetric method. All the data was entered in a specially designed proforma and SPSS v16 was used for statistical analysis.Results: Out of 210 tuberculous and non-tuberculous pleural effusions, the commonest cause of pleural effusion was tuberculosis followed by malignancy. In our study, Pleural fluid ADA levels have sensitivity, specificity, positive predictive value( PPV), and negative predictive value (NPV) of 95.5%, 92.3%, 92.4%, and 96% respectively in differentiating tuberculous pleural effusions from non-tuberculous lymphocytes predominant pleural effusions. Conclusion: Tuberculosis is the commonest infectious disease worldwide. A pleural fluid ADA level of ≥ 35 U/L in lymphocyte-predominant effusions makes mycobacterium tuberculosis most likely etiology. This test is not only very sensitive and specific but also it is very cheap, quick, and easy to perform by routine colorimetric method.

Lung cancer is a common cause of death among people throughout the world. Lung cancer detection can be done in several ways, such as radiography, magnetic resonance imaging (MRI) and computed tomography (CT). These methods take up a lot of resources in terms of time and money. However, CT has good for lung cancer detection, offers a lower cost, short imaging time and widespread availability. Early diagnosis of lung cancer can help doctors to treat patients in order to reduce the number of mortalities. This paper presents designation of thorax and nonthorax regions for lung cancer detection in CT Scan images using deep learning. The primary aim of this research is to propose an intelligent, fast and accurate method for lung cancer detection. As initial stage we proposed a thorax and non-thorax slice detection for CT scan images using deep convolutional neural network (DCNN) so that later it can be used to simplify the process of lung cancer detection. The proposed method involved the development of DCNN network architecture. It comprises the following steps which involves designed the convolution layer, activation function, max pooling, fully-connected layer and output size. We present three DCNN structures to find the most effective network for thorax and non-thorax region detection. All networks were trained using 12866 images and validate the performance using 5514 images. Simulation results showed that DCNN 2 and DCNN 3 were able to classify the thorax and non-thorax regions with good performance. The most efficient network is the DCNN with fivelayer structure (DCNN 2). This DCNN model achieved an accuracy of 99.42% with moderate duration of training time.

Security issues like Distributed Denial of Service (DDoS) attacks are becoming the main threat for Software-Defined Networking (SDN). Controller placement is a fundamental factor in the design and planning of SDN infrastructure. The controller could be seen as a single dot of failure for the whole SDN and it's the alluring point for DDoS attack. Single controller placement implies a single point of SDN control. So, there is a very high chance to fail the entire network topology as the controller associated with all switches. As a result, legitimate clients won't have the capacity to use SDN services. This is the reason why the controller is the suitable center dot of attack for the aggressor. To protect SDN from this type of single purpose of failure, it is essential to place multiple smart backup controllers to guarantee the SDN operation. In this paper, we propose a novel Integer Linear Programming (ILP) model to optimize the security issue by placing powerful smart backup controller. Result obtained from the simulation shows that our proposed novel ILP model can suggest single or multiple smart backup controller placement to support several ordinary victim controllers which has the capacity to save the cost of multiple ordinary controllers by sharing link, maximum new flows per second of controller and port, etc.

This article examines the concept of federalism in the oil and gas industry in Malaysia. The petroleum industry is one of the 12 National Key Economic Areas (NKEAs) to enhance national growth under Malaysia’s Economic Transformation Programme (ETP). Due to its economic significance, the petroleum industry was given priority by the Government of Malaysia. The development of the oil and gas industry in Malaysia can be divided into two stages, ie the period before 1974 and after 1974. Prior to 1974, the ownership of hydrocarbon resources was placed under the jurisdiction of the respective 13 states forming part of Malaysia. In 1974, the Petroleum Development Act (PDA) was passed by the Parliament of Malaysia. Pursuant to the PDA, a national oil company has been established in the form of a public listed company which is called Petroliam Nasional Berhad (Petronas). The national oil company was granted the entire ownership and the exclusive rights, powers, liberties and privileges of exploring, winning and obtaining petroleum onshore and offshore Malaysia. Each state permanently conferred its ownership, rights, powers, liberties and privileges in the petroleum by executing the vesting instrument specified in the PDA. This article examines the rights of ownership of the Federation and the various states of Malaysia with regards to the hydrocarbon resources at the time of the formation of the Federation of Malaysia, and the gradual changes in the ownership of the hydrocarbon resources from the states to the absolute ownership of the Federal government in 1974. Furthermore, this article examines the legislation regulating petroleum resources and the role of the states and federation in the upstream oil and gas industry prior to 1974 and after the enactment of the PDA.

Prostate cancer is the most commonly diagnosed malignancy and leading cause of cancer-related deaths in men worldwide. The disease is heterogeneous in nature exhibiting various clinical subtypes and genetic/transcriptomic features. Long non-coding RNAs (lncRNAs) are transcripts of more than 200 nucleotides that does not encode any protein and play important role in several biological processes as well as pathologic states. Deregulation of lncRNAs has been associated with human diseases. In prostate cancer, numerous key lncRNAs have been identified as novel players that contribute to the pathophysiology of the disease primarily regulated by androgen and its cognate receptor. The present review attempts to summarize the potential role of lncRNA and their mechanisms of action in prostate cancer with particular focus on lncRNAs regulated by androgen receptor expressed in castration-resistant and neuroendocrine differentiated subtypes. We also emphasize the potential of these lncRNAs for their development as therapeutic targets in prostate cancer.

A spinal cord injury (SCI) is caused by damage to neurons in the spinal cord, which interrupts neural signal conduction via axonal tracts, causing either total or partial paralysis. Researchers have proven that photobiomodulation therapy (PBMT) can affect nerve repair, causing enhanced functionality. Many PBMT studies have examined contusion SCIs in rats by employing a fixed fluence applied to the skin over the course of the treatment without considering the animal weight, which could affect the fluence delivered to the SCI site. This study performed Monte Carlo simulations using four computer-simulated rat models, all 11 weeks of age but each one having a different weight, and used various irradiation parameters to assess the impact of these factors on the fluence delivery at the SCI site. When the weight of the rat decreased, the fluence delivered to the SCI site increased. The findings also demonstrated that the greatest percentage rise in the fluence delivered to the SCI site occurred when employing a 660 nm Gaussian beam. The rat weight and irradiation parameters had a significant effect on the fluence delivered to the SCI site in rats. Thus, when assessing the effectiveness of PBMT, researchers must consider how much fluence reaches the injury site rather than how much fluence is applied to the skin.

Background and aims The impact of measures taken to contain COVID-19 on lifestyle-related behaviour is undefined in Indian population. The current study was undertaken to assess the impact of COVID-19 on lifestyle-related behaviours: eating, physical activity and sleep behaviour. Methods The study is a cross-sectional web-based survey. A validated questionnaire to assess the changes in lifestyle-related behaviour was administered on adults across India using a Google online survey platform. Results A total of 995 responses (58.5% male, mean age 33.3 years) were collected. An improvement in healthy meal consumption pattern and a restriction of unhealthy food items was observed, especially in the younger population (age, Highlights • COVID-19 has affected every aspect of the lifestyle of citizens. • Slight improvement was seen in eating behavior, majorly by reduction in intake of high fat, sugar, salt and sugar foods. • A significant decline was seen in overall physical activity coupled with increase in sitting and screen time. • One third of the sample gained weight during COVID-19.

Background:Acute ischemic stroke may affect women and men differently. We aimed to evaluate sex differences in outcomes of endovascular treatment (EVT) for ischemic stroke due to large vessel occlusion in a population-based study in Alberta, Canada.Methods and Results:Over a 3-year period (April 2015–March 2018), 576 patients fit the inclusion criteria of our study and constituted the EVT group of our analysis. The medical treatment group of the ESCAPE trial had 150 patients. Thus, our total sample size was 726. We captured outcomes in clinical routine using administrative data and a linked database methodology. The primary outcome of our study was home-time. Home-time refers to the number of days that the patient was back at their premorbid living situation without an increase in the level of care within 90 days of the index stroke event. In adjusted analysis, EVT was associated with an increase of 90-day home-time by an average of 6.08 (95% CI −2.74–14.89, p-value 0.177) days in women compared to an average of 11.20 (95% CI 1.94–20.46, p-value 0.018) days in men. Further analysis revealed that the association between EVT and 90-day home-time in women was confounded by age and onset-to-treatment time.Conclusions:We found a nonsignificant nominal reduction of 90-day home-time gain for women compared to men in this province-wide population-based study of EVT for large vessel occlusion, which was only partially explained by confounding.