The Economics of Outsourcing in a De-integrating Industry

Many large firms in low scale economy industries are actively considering outsourcing options, in the face of competition from smaller more efficient players. Based on a review of the theoretical literature and a case-study of outsourcing decisions at two large vertically integrated footwear manufacturers in Pakistan, a framework is developed for determining which set of products and activities to outsource and which to keep in-house. The framework suggests activities being considered for outsourcing be evaluated in terms of level of proprietary knowledge, economies of scale, inefficiencies of vertical integration, transactional costs, and the existence of reliable vendors. It is suggested that activities with low levels of proprietary knowledge and activities where cost savings due to outsourcing justify the increased transaction costs, should be outsourced.footwear, Outsourcing, Pakistan, case-study

Accuracy of computed tomography in differentiating perforated from nonperforated appendicitis, Taking histopathology as the gold standard.

Introduction Acute appendicitis is one of the more common causes of acute abdominal pain. It occurs when the lumen of the appendix is obstructed, leading to inflammation and finally perforation. The preoperative differentiation of perforated from nonperforated appendicitis is important and helpful to define prognosis and determine an adequate therapeutic approach, including consideration for nonsurgical treatment. This study recommends computed tomography (CT), a noninvasive method of investigation, be used frequently in clinically suspected cases of perforated appendicitis in the Pakistani population for better patient outcomes. Objective To determine the diagnostic accuracy of CT in differentiating perforated from nonperforated appendicitis by using histopathology as the gold standard. Material and methods A total of 236 patients with a clinical suspicion of appendicitis were included in this study. CT was performed in Liaquat National Hospital and Medical College. At the time of scanning, intravenous contrast was administered. Histopathology was used as the diagnostic gold standard. CT findings were documented using a proforma. The patient was returned to the referring department and followed after surgery for histopathology. Results Sensitivity, specificity, and positive and negative predictive values, as well as the accuracy of CT in the detection of perforated appendicitis, was 71.4%, 90.7%, 62.5%, 93.6%, and 87.3%, respectively. Conclusion CT findings can be used to select patients with perforated appendicitis for initial nonoperative management

Gestational diabetes mellitus--a forerunner of chronic disorders in mother and child

Gestational Diabetes Mellitus (GDM) can have serious immediate as well as long term consequences, both for the mother as well as the off-spring. It seems that women of south Asian origin are not only more likely to have GDM but also suffer more from the adverse consequences of the disorder. These consequences include the development of type 2 DM in women with a history of GDM and a higher risk of obesity and metabolic syndrome in the off-spring. Pakistani physicians should consider GDM seriously because the WHO states that rise in the prevalence of type 2 DM will mainly occur in developing countries such as ours. Since GDM can lead to development of type 2 DM, efforts should be made to prevent type 2 DM through lifestyle modification strategies in this high risk population. It is important that we develop some clear cut guidelines for prevention and treatment of GDM

Diagnostic efficiency of multidetector computed tomography in the evaluation of clinically equivocal cases of acute appendicitis with surgical correlation

Acute appendicitis is one of the most frequent causes of lower abdominal pain and requires immediate surgical intervention. The diagnosis often poses a lot of challenge even to experienced surgeon. Those patients with equivocal symptoms may require different imaging modalities like radiography, contrast examination and ultrasound with limited utility. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, however, resulted in improved diagnostic accuracy and also reduction of negative surgeries. Objective We intend to determine the diagnostic efficiency of MDCT in clinically equivocal cases of acute appendicitis correlating it with surgical/histopathological findings. Materials and methods A group of 116 patients was included in this study. Spiral MDCT was performed in all these cases after administration of oral and intravenous contrast. All these patients underwent surgery and the CT findings were correlated with histopathology. Out of these 116 patients, 60 patients were male and 56 female. The age range was from three to seventy years and mean age was 28+1 years. Results The results proved that MDCT had a sensitivity of 97.5%, specificity of 97.0%, and accuracy of 97.4% for the diagnosis of appendicitis with one false positive and two false negative cases. The study showed 100% accuracy in diagnosing acute appendicitis in children. In 33 patients, an alternate cause was identified with CT. The alternate diagnosis made on CT findings was consistent with the final diagnosis in 27 (81.8%) of 33 patients in whom there was no evidence of acute appendicitis. The clinical diagnosis disagreed with the CT diagnosis in six patients (18.18%). Conclusion Our study verifies that MDCT plays an important role in evaluation and consequent management of equivocal cases of acute appendicitis. MDCT is also able to diagnose appendicitis or detect alternative diagnosis in pediatric population

An Efficient Optimized DenseNet Model for Aspect-Based Multi-Label Classification

Sentiment analysis holds great importance within the domain of natural language processing as it examines both the expressed and underlying emotions conveyed through review content. Furthermore, researchers have discovered that relying solely on the overall sentiment derived from the textual content is inadequate. Consequently, sentiment analysis was developed to extract nuanced expressions from textual information. One of the challenges in this field is effectively extracting emotional elements using multi-label data that covers various aspects. This article presents a novel approach called the Ensemble of DenseNet based on Aquila Optimizer (EDAO). EDAO is specifically designed to enhance the precision and diversity of multi-label learners. Unlike traditional multi-label methods, EDAO strongly emphasizes improving model diversity and accuracy in multi-label scenarios. To evaluate the effectiveness of our approach, we conducted experiments on seven distinct datasets, including emotions, hotels, movies, proteins, automobiles, medical, news, and birds. Our initial strategy involves establishing a preprocessing mechanism to obtain precise and refined data. Subsequently, we used the Vader tool with Bag of Words (BoW) for feature extraction. In the third stage, we created word associations using the word2vec method. The improved data were also used to train and test the DenseNet model, which was fine-tuned using the Aquila Optimizer (AO). On the news, emotion, auto, bird, movie, hotel, protein, and medical datasets, utilizing the aspect-based multi-labeling technique, we achieved accuracy rates of 95%, 97%, and 96%, respectively, with DenseNet-AO. Our proposed model demonstrates that EDAO outperforms other standard methods across various multi-label datasets with different dimensions. The implemented strategy has been rigorously validated through experimental results, showcasing its effectiveness compared to existing benchmark approaches.publishedVersio

Role of interventional radiology in the management of peripheral vascular malformations: a tertiary care center experience.

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100

A Comprehensive Survey on Signcryption Security Mechanisms in Wireless Body Area Networks

WBANs (Wireless Body Area Networks) are frequently depicted as a paradigm shift in healthcare from traditional to modern E-Healthcare. The vitals of the patient signs by the sensors are highly sensitive, secret, and vulnerable to numerous adversarial attacks. Since WBANs is a real-world application of the healthcare system, it’s vital to ensure that the data acquired by the WBANs sensors is secure and not accessible to unauthorized parties or security hazards. As a result, effective signcryption security solutions are required for the WBANs’ success and widespread use. Over the last two decades, researchers have proposed a slew of signcryption security solutions to achieve this goal. The lack of a clear and unified study in terms of signcryption solutions can offer a bird’s eye view of WBANs. Based on the most recent signcryption papers, we analyzed WBAN’s communication architecture, security requirements, and the primary problems in WBANs to meet the aforementioned objectives. This survey also includes the most up to date signcryption security techniques in WBANs environments. By identifying and comparing all available signcryption techniques in the WBANs sector, the study will aid the academic community in understanding security problems and causes. The goal of this survey is to provide a comparative review of the existing signcryption security solutions and to analyze the previously indicated solution given for WBANs. A multi-criteria decision-making approach is used for a comparative examination of the existing signcryption solutions. Furthermore, the survey also highlights some of the public research issues that researchers must face to develop the security features of WBANs.publishedVersio

Modelling the determinants and Sustainability of Current Account of Pakistan

The study investigated the determinants of the current account deficit from 1976 to 2020 for the economy of Pakistan, and its sustainability. The persistent deficit is necessary to be sustainable if it will be paid off shortly otherwise it will pile up external debt. The conventional methodology concluded that current account deficit (CAD) of Pakistan is unsustainable, albeit one measure suggests sustainability. There is cointegration among variables and domestic saving, external debt, fiscal deficit and trade deficit has positive whereas exchange rate and worker’s remittances have a negative relation with the current account, all the results are significant. The negative sign of the error correction term confirms restoration of equilibrium and it is also significant. Bidirectional causality is reported between the worker’s remittances, exchange rate and external debt with CAD. Unidirectional causality is seen from CAD to trade deficit and fiscal deficit. The diagnostic tests of the model confirm robustness. The government should favour an investment-friendly environment to increase economic activity in the country besides improving domestic savings and reducing the external deficit

Assessment of the Predictors and Mortality in Patients of Acute on Chronic Liver Failure; A Prospective Study

Objective: To evaluate the predictors of short-term mortality in patients with acute-on-chronic liver failure (ACLF). Methodology: This prospective study was conducted at the gastroenterology department of the Asian Institute of Medical Sciences Sindh, Pakistan from January 2018 to December 2018. All the patients with acute-on-chronic liver failure (ACLF) aged more than 25 years and of either gender were included. A complete history was obtained including demographic profile and specifics on clinical characteristics (jaundice, ascites, gastro-intestinal bleed, grade of encephalopathy, records of vital parameters etc.). Serum electrolytes, viral serology, autoimmune profile, liver function tests, serum creatinine, prothrombin time, and INR were among the laboratory tests performed on each patient. Results: A total of 99 patients were studied; their average age was 40.90+13.93 years; and there was a male predominance (73.5%). HCV and HBV+HDV were the most common etiological factors. According to the frequency of organ failure, hepatic failure was in 59.8% of the cases, renal failure was in 43.6% of the cases, CNS failure was in 38.5% of the cases, 41.0% of the cases had circulatory failure, coagulation failure was in 55.6% of the cases, and respiratory failure was seen in 17.1% of the cases. Overall, the 30-day mortality rate was 61.5%. Hepatic failure, renal failure, CNS failure, coagulation failure, SBP, and grading of ACLF were significantly associated with short-term survival rate (p= <0.05). While gender, etiology, circulatory failure and respiratory failure were statistically insignificant (p= >0.05). MELD score >28, CTP score >13, organ failure >3 and ACLF grade II and III were also highly significantly linked to short term survival rate (p-0.0001). Conclusion: According to the study's findings, hepatic failure, renal failure, CNS failure, coagulation failure, and ACLF grading, CTP score > 13, MELD score > 28, and the presence of hepato-renal syndrome were found to be significant predictors of short-term mortality in patients with Acute On-Chronic Liver Failure (ACLF)