Analysis of Infrastructure Investment and Institutional Quality on Living Standards: A Case Study of Pakistan (1990-2013)

In this study, the relationship of Infrastructure Investment and Institutional Quality (CIM) on Living Standards of people was analysed for Pakistan. This paper comprises of trend analysis of institutional quality for different periods of governments of Pakistan coupled with an empirical analysis of the model. The empirical estimates are comprised of unit root test, Johansen Cointegration, VAR analysis and Granger Causality tests for the sample of 1984– 2013. The trend analysis depicts fluctuations of Institutional Quality in different governments due to different political conditions of every period. The empirical analysis shows that there exists long standing relationship between the Institutional Quality, Infrastructure Investment and living standards of people. However, the VAR analysis shows that the coefficients of only Institutional Quality and Living Standards of People (previous year i.e. lag variables) resulted significance in affecting living standards of the people. The Granger causality result shows bidirectional and uni-directional relationships among variables. The results in our study indicate bi-directional relationships of Living Standards of People (GDPC) with Institutional Quality (CIM). Secondly, CIM and Infrastructure Investment (Developmental Expenditure) are having uni-directional relationship. Thirdly, Population and Institutional Quality (Contract Intensive Money) are having uni-directional relationship. Fourthly, GDPC and Infrastructure Investment carry a uni-directional relationship. JEL Classification: E02, F41, H53, O1, O4, P23. Keywords: Institutional Quality (Contract Intensive Money (CIM), Infrastructure Investment (Developmental Expenditure), Trade Openness, GDP per Capita, and Population

Heart Disease Prediction Using Stacking Model With Balancing Techniques and Dimensionality Reduction

Heart disease is a serious worldwide health issue with wide-reaching effects. Since heart disease is one of the leading causes of mortality worldwide, early detection is crucial. Emerging technologies like Machine Learning (ML) are currently being actively used by the biomedical, healthcare, and health prediction industries. PaRSEL, a new stacking model is proposed in this research, that combines four classifiers, Passive Aggressive Classifier (PAC), Ridge Classifier (RC), Stochastic Gradient Descent Classifier (SGDC), and eXtreme Gradient Boosting (XGBoost), at the base layer, and LogitBoost is deployed for the final predictions at the meta layer. The imbalanced and irrelevant features in the data increase the complexity of the classification models. The dimensionality reduction and data balancing approaches are considered very important for lowering costs and increasing the accuracy of the model. In PaRSEL, three dimensionality reduction techniques, Recursive Feature Elimination (RFE), Linear Discriminant Analysis (LDA), and Factor Analysis (FA), are used to reduce the dimensionality and select the most relevant features for the diagnosis of heart disease. Furthermore, eight balancing techniques, Proximity Weighted Random Affine Shadowsampling (ProWRAS), Localized Randomized Affine Shadowsampling (LoRAS), Random Over Sampling (ROS), Adaptive Synthetic (ADASYN), Synthetic Minority Oversampling Technique (SMOTE), Borderline SMOTE (B-SMOTE), Majority Weighted Minority Oversampling Technique (MWMOTE) and Random Walk Oversampling (RWOS), are used to deal with the imbalanced nature of the dataset. The performance of PaRSEL is compared with the other standalone classifiers using different performance measures like accuracy, F1-score, precision, recall and AUC-ROC score. Our proposed model achieves 97% accuracy, 80% F1-score, precision is greater than 90%, 67% recall, and 98% AUC-ROC score. This shows that PaRSEL outperforms other standalone classifiers in terms of heart disease prediction. Additionally, we deploy SHapley Additive exPlanations (SHAP) on our proposed model. It helps to understand the internal working of the model. It illustrates how much influence a classifier has on the final prediction outcome

Anatomical and Functional Outcomes of Scleral Buckling for Rhegmatogenous Retinal Detachment Surgeries.

Purpose: The aim of the study is to analyze the anatomical and functional outcomes of scleral buckling surgeries for non-complicated rhegmatogenous retinal detachment surgeries.Materials and Methods: This was a retrospective analysis 2602 cases that underwent scleral buckling for the repair of rhegmatogenous retinal detachments. The study was conducted at the ophthalmology department of Lahore General Hospital from 2003 to 2015. Pre-operatively patients were assessed and data collected for age, refractive error, the status of the intraocular lens, proliferative vitreoretinopathy, number and morphology of breaks, type of buckling procedure. Post-operatively best-corrected visual acuity and reattachment rates were observed. Results: A total of 2602 patients with primary rhegmatogenous retinal detachment who underwent scleral buckling repair were included in the study. The mean age was 30.2 ± 15.6 years (range 3 - 69). 73% of patients were pseudophakic, 17% were aphakic and 10% were phakic. Myopic refractive error less than 6 diopters were present in 75% patients and 25% had more than 6 diopters. Out of 73% of pseudophakia patients, 341 ± 114.6 patients had eventful cataract surgery done before the procedures with a posterior capsular defect. Majority of patients 878 ± 46.7 had proliferative vitreoretinopathy grade B. 65% of patients had a single break. In terms of anatomical location 271 ± 87.3 had superior breaks, 197 ± 63.4 had temporal breaks, 137 ± 51.2 had inferior breaks and 64 ± 13.2 had nasal breaks. Morphologically the majority had a horseshoe-shaped break. In terms of buckling procedures, 58% of patients underwent segmental buckle, 12% underwent complete encirclement and 30% had a combined procedure. 397 eyes had to undergo a redo surgery, pars plana vitrectomy with oil. Best corrected visual acuity ranging from finger counting to 6/9 on Snellens was achieved by 89% of the treated eyes.Conclusion: Primary rhegmatogenous retinal detachment surgery utilizing scleral buckling operation achieves high anatomical and functional success rates

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- A nd middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Regulation of hypnosis in Propofol anesthesia administration based on non‐linear control strategy

Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi‐tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed‐loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter‐patient variability. This paper proposes a closed‐loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures

Regulation of hypnosis in Propofol anesthesia administration based on non-linear control strategy

Abstract Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures

Control Law Design for Propofol Infusion to Regulate Depth of Hypnosis: A Nonlinear Control Strategy

Maintaining the depth of hypnosis (DOH) during surgery is one of the major objectives of anesthesia infusion system. Continuous administration of Propofol infusion during surgical procedures is essential but increases the undue load of an anesthetist in operating room working in a multitasking setup. Manual and target controlled infusion (TCI) systems are not good at handling instabilities like blood pressure changes and heart rate variability arising due to interpatient variability. Patient safety, large interindividual variability, and less postoperative effects are the main factors to motivate automation in anesthesia. The idea of automated system for Propofol infusion excites the control engineers to come up with a more sophisticated and safe system that handles optimum delivery of drug during surgery and avoids postoperative effects. In contrast to most of the investigations with linear control strategies, the originality of this research work lies in employing a nonlinear control technique, backstepping, to track the desired hypnosis level of patients during surgery. This effort is envisioned to unleash the true capabilities of this nonlinear control technique for anesthesia systems used today in biomedical field. The working of the designed controller is studied on the real dataset of five patients undergoing surgery. The controller tracks the desired hypnosis level within the acceptable range for surgery