Evidence doesn’t change prescribing patterns…so what does?

The authors write in support of critical analysis of clinical research, as a corrective to the physician\u27s urge to do something even when no evidence of benefit exists

Investigation into the effect of wind power based embedded generators on distribution networks.

Wind turbine-generators are usually integrated into utilities' electrical networks at distribution voltage levels, and they are commonly known as "Embedded Generators" (EGs). Recently, it has been reported that the integration of wind power-based embedded generators (WPBEGs) into distribution networks could cause maloperation of automatic voltage control (AVC) relays. Further investigation is therefore required to improve the performance of AVC relays in the presence of EGs. On the other hand, the dynamic effects of WPBEGs on distribution networks (DNs) have been investigated for many years, but no attempt has been made to evaluate the effects of WPBEGs on the "Critical Clearing Time" (CCT) of faults on load feeders emanating from the substation where EGs are connected to the network. Based on these findings, the work conducted and reported in this thesis covers two main aspects. The first aspect is related to the effect of EGs on the operation of AVC relays, including the compensation of voltage drop along distribution feeders. This is preceded by an introduction to the operating principles of conventional AVC relays. A new model of an AVC relay based on the application of Artificial Neural Networks (ANN) is then presented. The model is designed and trained to calculate the AVC voltage that is used to initiate the operation of the tap-changer of an appropriate transformer as conditions necessitate. In the process of the development of an ANN-based relay, a power flow program has been specially designed to generate training files using FORTRAN. The second aspect reported in this thesis deals with the investigation of the effect of WPBEGs on the CCT of faults on load feeders. It has been concluded that CCT of faults, which is required to maintain the stability of WPBEGs, can be several times less than that of the operating time of conventional protection schemes usually used on distribution feeders. The results obtained from the investigation related to both aspects are presented and discussed. In summary, this thesis reports on the outcome of the investigation related to the design of an ANN based AVC relay capable of accommodating EGs and the effect of the dynamic behaviour of EGs on the CCT of faults on load feeders

Evaluation of Cr (VI) remediation potential of Eichornia sp in conjunction with chromium-resistant bacterial strains

Purpose: Evaluation of Cr (VI) removal by indigenous chromium resistant bacterial strains alone and in combination with Eichornia sp.Methods: Three chromium resistant bacterial strains S-4 Ochrobactrum grignonense, SF-5 Bacillus sp. and S-6 Ochrobactrum pseudogrignonenses were isolated from industrial effluent. The isolated chromium-resistant bacterial strains were subjected to heavy-metal resistance profiling. Cr (VI) reduction was evaluated in mobilized as well as immobilized forms. The phytoremediation potential of Eichornia sp. in conjunction with chromium resistant bacterial isolates was also determined. Fourier transform infra-red (FTIR) spectroscopy was performed to rule out the involvement of various functional groups in the binding activity of Cr (VI).Results: Three bacterial strains resisted up to 1000 μg/mL of potassium dichromate (K2CrO4). Bacterial strains S-4, SF-5 and S-6 showed significant Cr (VI) removal in mobilized state (84.93, 85.85 and 83.97% respectively) compared with immobilized state (41.27, 37.99, 37.96 %) at an initial concentration of 500 μg/mL of chromate. Bacterial strains caused reduction in chromate uptake in inoculated plants relative to control plants. FTIR spectra revealed significant changes in the absorption peaks, reflecting the binding of Cr (VI) ions with bacterial cell surface under stress conditions.Conclusion: The selected isolates tested possess the ability to remove Cr (VI) synergistically with Eichornia sp.Keywords: Phytoremediation, Heavy-metal, Pollution, Chromium-resistant bacteri

Intimate partner violence against women in Pakistan: A review of qualitative research

Objective: To consolidate research data and provide an insight into areas that need further research regarding intimate partner violence.Methods: The review targeted qualitative research-based studies done in the English language and conducted in Pakistan from 2008 to 2018 regarding intimate partner violence against women. A thorough search of Google Scholar and PubMed databases was done. Data from each selected article was extracted using a data-extraction template.Results: Of the 2,479 results, 21(0.8%) articles were selected along with 4(0.16%) texts from grey literature. An in-depth analysis led to six broad categories: experiences/perspectives of married women facing intimate partner violence; perspectives of married men towards intimate partner violence; perspectives of religious leaders who support the idea of men controlling their wives; societal norms, such as dowry, patriarchy and daughters being considered a burden; impact on women and family as damage to the women\u27s physical and mental health affects not only her but also the society as a whole; and coping strategies used by most women.Conclusions: The review helps in understanding the common trends and situation of Pakistani women who are exposed to violence, the common limitations faced by researches, and areas which require further research to prevent intimate partner violence

Optimal Assignment of Customer-Desired Items to the Fetching Robots in Superstores

This paper discusses a task assignment problem. The scenario under consideration is a superstore with a team of fetching robots. There is a set of customers each requiring a unique set of items. The goal is to assign the task of fetching the items to the available robots in such a way that the time and effort required for fetching the item is minimized. For this purpose, a Markov Decision Process based model has been proposed. The proposed-model is solvable using stochastic dynamic programming algorithms such as value iteration for the calculation of optimal task assignment policy. The analysis of the characteristics of the resulting optimal policy has been presented with the help of a numerical case study

Characteristics of ⟨a⟩\langle a \rangle Screw Dislocations Basal Slip in Titanium

Plasticity in hexagonal close packed (HCP) metals and alloys such as Titanium (Ti) and Zirconium (Zr) is carried out by the motion of $\langle a \rangle$ dislocations. Above room temperature, in situ transmission electron microscopy straining experiments have shown that basal slip of $\langle a \rangle$ screw dislocations in Ti is activated and its preponderance increases with temperature. To discern the mechanism of basal slip of these dislocations in pure Ti, molecular dynamics (MD) simulations and nudged elastic band (NEB) calculations were performed for a screw dislocation gliding on the basal plane. From MD simulations, basal and pyramidal slip were shown to be intertwined. The screw dislocation glides by kink pair nucleation and propagation mechanism on one of the two equiprobable pyramidal planes adjacent to the maximum resolved shear stress basal plane, before switching to the other pyramidal plane, thus leading to an average basal slip at low stress and/or high temperature. On the other hand, NEB calculations revealed that at low stresses kinks do not nucleate in the pyramidal plane but rather directly in the basal plane fully compatible with the motion of a screw dislocation confined to the basal plane, in agreement with experimental observations in Ti and Zr. The discrepancy between these two mechanisms is shown to be related to the thermal activation of the cross-slip from the pyramidal to the prismatic core configuration of the $\langle a \rangle$ screw dislocation

ECG classification using an optimal temporal convolutional network for remote health monitoring

Increased life expectancy in most countries is a result of continuous improvements at all levels, starting from medicine and public health services, environmental and personal hygiene to the use of the most advanced technologies by healthcare providers. Despite these significant improvements, especially at the technological level in the last few decades, the overall access to healthcare services and medical facilities worldwide is not equally distributed. Indeed, the end beneficiary of these most advanced healthcare services and technologies on a daily basis are mostly residents of big cities, whereas the residents of rural areas, even in developed countries, have major difficulties accessing even basic medical services. This may lead to huge deficiencies in timely medical advice and assistance and may even cause death in some cases. Remote healthcare is considered a serious candidate for facilitating access to health services for all; thus, by using the most advanced technologies, providing at the same time high quality diagnosis and ease of implementation and use. ECG analysis and related cardiac diagnosis techniques are the basic healthcare methods providing rapid insights in potential health issues through simple visualization and interpretation by clinicians or by automatic detection of potential cardiac anomalies. In this paper, we propose a novel machine learning (ML) architecture for the ECG classification regarding five heart diseases based on temporal convolution networks (TCN). The proposed design, which implements a dilated causal one-dimensional convolution on the input heartbeat signals, seems to be outperforming all existing ML methods with an accuracy of 96.12% and an F1 score of 84.13%, using a reduced number of parameters (10.2 K). Such results make the proposed TCN architecture a good candidate for low power consumption hardware platforms, and thus its potential use in low cost embedded devices for remote health monitoring

Nasal High-Frequency Oscillatory Ventilation versus Nasal Intermittent Positive Pressure Ventilation In Pre-terms With Respiratory Distress Syndrome During Early Neonatal Period: A Randomized Controlled Trial

Objective: To determine the effectiveness of NHFOV versus NIPPV in reducing the need for invasive mechanical ventilation in preterm neonates with RDS (moderate-severe) during the first seven days of the life of neonate. Study Design: Randomized controlled study (ACTRN: 12622000291785). Place and Duration of Study: Neonatal Unit, PNS Shifa Hospital, Karachi Pakistan, from Jan to Aug 2021. Methodology: Forty-eight preterm neonates, with the gestational age of 27 weeks to 34 weeks with Respiratory distress Syndrome, were randomized to NHFOV Group (n=24) and NIPPV Group (n=24). The primary outcome was the need for invasive mechanical ventilation (IMV). The secondary outcomes were the duration of hospitalization, non-invasive respiratory support, mortality, abdominal distention, pneumothorax, need for surgery for patent ductus arteriosus, spontaneous intestinal perforation, and necrotizing enterocolitis, intraventricular haemorrhage≥ Grade-3, bronchopulmonary dysplasia, retinopathy of prematurity Stage-3. Results: There was no significant difference between NHFOV (64.7%) versus NIPPV (35.3%) groups in need of Invasive Mechanical Ventilation (p=0.13). Secondary outcomes were not significant between the two groups, air leak (p=0.31),necrotising enterocolitis (p=1.00), broncho-pulmonary dysplasia (p=0.31), retinopathy of prematurity (p=0.15).There was no intraventricular haemorrhage found between the two groups. Conclusion: Nasal high-frequency oscillatory ventilation was less statistically significant than NIPPV in reducing the need for invasive mechanical ventilation in the initial seven days of life in neonates with Respiratory distress syndrome