ANALYSIS OF BORDER GATEWAY PROTOCOL, ITS TYPES AND MEASURES TO AVOID RISK

This is the age of digital communication. The process involves sending messages from one end of the network to other end using the internet, extranets and the Internet of Things (IOT) Technologies. Initially, the internet is a small community. But today internet becomes a global community as thousands of different administrative entities own and operate the internet. The process of transferring data across the network is known as routing. The process of routing is performed by using routers. Routers use certain protocols to achieve this task. The Broader Gateway Protocol (BGP) is an interdomain routing protocol that is used to connect two different autonomous systems. The autonomous system is collection of network that runs under a single administrative entity. This paper includes analysis and important techniques of border gateway protocol, types of BGP, its attributes, security threats and measures to avoid risks

Assessment of cardiovascular risk in primary care.

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Patients’ Satisfaction About Health Care Services in Outpatient Department of General Surgery at PIMS, Islamabad

Objective: To assess the Patients’ satisfaction about health care services in the outpatient department of General Surgery at PIMS, Islamabad. Methodology: This is a prospective cross sectional study done for six months at General Surgery OPD, PIMS, Islamabad. All patients who attended the outpatient department of GSU-III were included. After consent patients answered a specially designed 30-item cross-sectional questionnaire regarding general convenience and satisfaction aspects regarding the OPD. Questions depicting the interpersonal relationships and the role of Doctors and the paramedic staff at the hospital are also included. All data was collected, recorded and analyzed using SPSS 17 and excel 2013. Results: A total of 410 patients were included with the mean age of 41 years and male to female ratio was≈ 1:3. 57.4% patients had completed their secondary or higher secondary education. 12.1% were labourers, 19.5% were students, 19.5% were unemployed and 34.1% were housewives. Most of the population was already registered at the general surgery department PIMS. Response to various questions regarding general convenience and satisfaction aspects regarding the OPD were averagely rated ‘agree’ or ‘strongly agree’ by 96.3% patients, while 14.6% had their reservations. Answers depicting the interpersonal relationships and the role of Doctors and the paramedic staff at the hospital were appreciable in 71.95% and 64.6% of the cases respectively. 16.2% and 19.5% negated respectively. Interviews from all patients were taken into account in data analysis and conclusion. In sum, the patient’s satisfaction (58.5%) with the overall care (62.1%) were satisfactory. 59.7% patients wished to recommend this service to others. Conclusion: Most of the patients who visited the Outpatient department of General Surgery Unit III were satisfied regarding the overall care and the behavior of doctors and paramedical staff interacting with them

Patient satisfaction with regards to health care services provided in general surgery ward at PIMS, Islamabad

Objective: To assess the patient’s satisfaction about health care services in the general surgery ward at PIMS, Islamabad.Methodology: This is a cross-sectional study done for three months at General Surgery ward PIMS, Islamabad. All patients admitted and discharged from General Surgery Unit-III from March to May 2018 were included in the study. After formal permission from the patients, a specially designed 30-item cross-sectional questionnaire pertaining to general patient satisfaction and convenience aspects, interpersonal relationships and the role of doctors and paramedic staff of the general surgery ward were noted. All data was collected, recorded and analyzed using SPSS 17 and Excel 2013.Results: A total of 251 patients were incorporated in the study with an average age of 45 years with Male to Female ratio of 1:2. General convenience and satisfaction aspects pertaining to the general surgical ward were averagely rated by the patients. They agreed or strongly agreed by 82.8% patients, while 17.2% had uncertainties. Interpersonal relationships and the role of Doctors and the paramedic staff at the hospital were appreciated by 77.1% and 68.9% respectively, while 22.9% and 31.1% negated respectively. Patient’s interviews were incorporated in data examination and deductions. Patient’s satisfaction was evaluated to be 56.3% while overall care was 59.7%. 65.2% patients wished to recommend these services, to others in need.Conclusion: Most of the patients admitted at General Surgery Ward were satisfied with overall care and behavior. Areas that need more attention are cleanliness, privacy, seeking patient views in their illness discussion, explaining them the prescription drugs and lab investigations

Perceptions of COVID-19 Disease Among Patients in Isolation Ward

Objective: To explore the perceptions about COVID – 19 disease among patients admitted in Isolation ward and to improve management ideas. Methodology: This qualitative cross sectional interview based study was conducted at Isolation ward, Pakistan Institute of Medical Sciences Islamabad from April to June 2020. Patients who were reported positive for SARS COV-2 through nasopharyngeal or oropharyngeal swabs and were admitted for at least one day in isolation ward, were included in the study. Patients who were too ill to talk for the interview and those who could not survive the disease were excluded. After taking informed consent and following the standard operating procedures (SOPs) of Corona Isolation ward; data was obtained by conducting in depth interviews arranged as per patients’ convenience on mobile calls. Data was analyzed using Narrative Analysis. Themes were delineated and organized to groups for understanding. Results: Twenty two patients participated with the mean age of 34.64±7.26 years. Majority of the patients had anxiety and fear for the COVID-19 disease however also were hopeful to face it. The delineated themes were anxiety & depression, fear, hopefulness & moving forward, health facilities & related issues, living in isolation and physiological disturbances like sleep, appetite, smoking or addiction, exercise. Conclusion: Covid-19 patients depict mixed perceptions while admitted in Isolation ward and this provide us an insight to this catastrophic illness. Their experiences help the health authorities to address this issue. &nbsp

Effect of Dilution of Propofol on Pain at Site of Injection: Comparison Between 1% vs. 0.33% Formulation

Objective: To study the effect of propofol dilution on pain at injection site with formulations of 1% and 0.33%. Methodology: A randomized controlled trial was conducted for 24 months at the Department of Anaesthesia and Critical Care, Pakistan Institute of Medical Sciences Islamabad. A total of 100 patients were included in the study. Patients were divided into two equal groups: group C received 1% propofol while patients of group D received 0.33% formulation diluted with distilled water. Patients received propofol at the start of anesthesia before any premedication. A 5ml volume was injected over a period of 5s in an 18G cannula over dorsum of hands. Behaviourial pain scale was used and descriptive data analysis was done. Results: Then mean age of patients was 37.36±14.77 with 46 males and 56 females. Pain at the injection site was experienced in 20 (40%) patients of group C whereas 16 (32%) patients experienced pain in group D. There was no association of pain with a strength of propofol solution (p value 0.405). Conclusion: Strength of propofol solution has no association of pain at the injection site and dilution has no better effect in terms of pain scor

Prevalence and Molecular Diagnosis of Fasciola hepatica in Sheep and Goats in Different Districts of Punjab, Pakistan

A study was conducted to determine the prevalence and molecular diagnosis of fasciolosis in Lohi sheep and Beetal goats in Okara, Sahiwal and Lahore districts of Punjab province. A total of 800 samples including 200 fecal and 200 bile, each from Lohi sheep and Beetal goats were collected and processed for microscopic examination of Fasciola eggs as well as its confirmation through polymerase chain reaction (PCR). Of the fecal samples, 3.5 and 2% samples whereas from bile samples, 6.5 and 4% bile samples from sheep and goats were found microscopically positive for Fasciola hepatica, respectively. By PCR, 4.5 and 3.5% fecal samples and 8.5 and 5% bile samples from sheep and goats, respectively were confirmed for F. hepatica. Statistically sheep and goats species were found equally likely acquiring the F. hepatica diagnosed by either source of material (fecal and bile samples) similarly fecal and bile samples were equally likely showing fasciolosis in either of sheep and goats

Numerical optimization of (FTO/ZnO/CdS/CH₃NH₃SnI₃/GaAs/Au) perovskite solar cell using solar capacitance simulator with efficiency above 23% predicted

The presented study deals with the investigations of the methyl ammonium tin halide (CH3NH3SnI3) based perovskite solar cells for optimized device performance using solar capacitance simulations software. Several necessary parameters such as metal work functions, thickness of structural layers, charge carrier’s mobility and defect density have been explored to evaluate the device performance. Calculations reveal that for the best efficiency of device the maximum thickness of the perovskite (CH3NH3SnI3) absorber layer must be 4.2 μm. The thickness values of 0.01 μm for ZnO electron transport layer (ETL), 0.871 μm for GaAs hole transport layer and 0.001 μm for CdS buffer layer have been found which proved to be optimum for maximum power conversion efficiency (PCE) of 23.80% for the device. The variation of open circuit voltage (Voc), Short circuit current (Jsc), Fill Factor (FF %), quantum efficiency (QE) against thickness of all layers and interface defect densities in FTO/ZnO/CdS/CH3NH3SnI3/GaAs/Au composition have been critically explored and their crucial role for the device performance has been reported. Heterojunctions between ZnO-ETL and CdS buffer layers have shown improved device performance and PCE. Current investigations may prove to be useful for designing and fabrication of climate friendly, non-toxic and highly efficient solar cells

Assessing Gait & Balance in Adults with Mild Balance Impairment:G&B App Reliability and Validity

Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&amp;Balance smartphone application (G&amp;B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&amp;B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&amp;B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&amp;B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&amp;B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&amp;B App measures of steadiness. Notably, G&amp;B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&amp;B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.</p