In Pakistan, power outages have become frequent over the past two decades, due to a continuing en... more In Pakistan, power outages have become frequent over the past two decades, due to a continuing energy crisis. Reliance on machines for thermal comfort of buildings has led to high energy demands of the increasing population. The negative impacts of artificial environments have, also, diminished the sense of place, biophilia and cultural values. Moreover, globalization has standardized the built environments, causing a lack of regional identity and an absence of climate sensitivity in design. Keeping all these issues in focus, this article re-examines the fundamental aspects of traditional architecture and aims to stimulate architects and designers to create sustainable and life-enriching designs, which are appropriate for contemporary times. In this research, the first two levels of Deep Beauty functional and typological, are used as a conceptual framework for sustainable design. For this, research findings of the book, A Pattern Language: Towns, Buildings, Construction, are employe...
This abstract is an exploration of the presence of what Michael Mehaffy calls "deep symm... more This abstract is an exploration of the presence of what Michael Mehaffy calls "deep symmetry" in Kamil Khan Mumtaz's design of the Baba Hassan Din Shrine (2005) in Lahore, Pakistan. The project signifies the creation of meaningful and beautiful architecture in contemporary times, through compound symmetries that interrelate, transform and combine, forming a coherent structure that is considered essential for human well-being.
Bacterial species from currency notes and coins obtained from people belonging to different profe... more Bacterial species from currency notes and coins obtained from people belonging to different professions of Lahore, Pakistan were evaluated for their antagonistic activity against bacillus species isolated from the same source. A total of twenty nine isolates were identified based on morphology, growth on selective and differential media and biochemical tests. Spot-on-the-lawn deferred antagonism method was used to observe the antagonistic activity of the bacillus sp. isolates. It was found that six bacillus sp. isolates [Bacillus cereus (B.c), Bacillus subtilis (B.s), Bacillus mycoides (B.m), Bacillus licheniformis (B.l), Bacillus vallismortis (B.v) and Bacillus thuringiensis (B.t)] showed antagonism against the other bacterial isolates. Three isolates viz., B.c, B.s and B.l showed broad spectrum of antagonistic activity (+++), B.s, B.l, B.m and B.t showed antagonistic activity (+) while B.s, B.c, B.m, B.v, B.l and B.t showed antagonistic activity. This study concluded that the Baci...
Background: The global prevalence of diabetes mellitus has more than doubled since 1980 and is ex... more Background: The global prevalence of diabetes mellitus has more than doubled since 1980 and is expected to continue to rise at alarming rates . An estimated 336 million people worldwide now have T2DM. T2DM results from an interaction between genetic and environmental factors that impair β-cell function and insulin action. Diabetes is diagnosed clinically by elevated plasma glucose levels, however, loss of β-cell function is progressive over time and β-cell dysfunction is far advanced by the time diabetes is diagnosed clinically. Therefore, methods for preserving or restoring β-cell function are important in our attempts to prevent and treat T2DM. In this project, we discuss current evidence for causes of the progressive loss of β-cell function in T2DM, and the effects of current therapeutic strategies on preservation of β-cell function and the prevention and treatment of T2DM. Objectives: To measure beta cell function mass and metabolic control in patients with type 2 diabetes melli...
This study was conducted to find out the antibacterial effects of different components including ... more This study was conducted to find out the antibacterial effects of different components including standard antibiotics, herbal extracts and commercially available essential oils by applying different bacteria and to evaluate their effect on chicken meat as a preservative. For this purpose, 8 different types of antibiotic discs of 0.5 mm were applied on the bacteria isolated from chicken obtained taken from the Laboratory of Microbiology, Institute of Microbiology and Biotechnology, The University of Lahore. Similarly herbal extracts and commercially available essential oils were also applied on the same bacteria by disc diffusion method. Then finally clove extract and clove oil were mixed in the concentrations of 5% and 10% v/w in the minced chicken meat to observe their preservative effects. The bacteria were not significantly seen to resist the action of antibiotics applied while ethanolic clove (Syzygium aromaticum) extract, clove oil and cinnamon (Cinnamomum zeylanicum) oil showe...
Pakistan Journal of Engineering and Applied Sciences, 2020
Social Realism, an artistic movement introduced in the second quarter of the twentieth century, i... more Social Realism, an artistic movement introduced in the second quarter of the twentieth century, influenced an entire generation of artists all over the world. It explores the themes ranging from poverty to anti-state demonstrations, and from depictions against imperialism to class inequality, gender oppression and social injustice. Elements of social realism are not surprising to encounter in the Pakistani art world, considering the ideals of the style and the turbulent history of the country since its independence in 1947. Pakistani artists have always been sensitive to the social and political issues of the country, which have somewhat become fragments of its identity, especially as ascertained by the western gaze. Women’s persecution and social exclusion is one such subject that has become an identifier for Pakistan, although a human development report of the United Nations recognizes the country having better gender equality than neighboring India. Nevertheless, women oppression...
Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Ex... more Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical com...
Cell culture-based viral vaccines are used globally to immunize humans against infections. The ce... more Cell culture-based viral vaccines are used globally to immunize humans against infections. The cell culture is continuous process of developing substrates for the safe production of viral vaccines. However, increased global demand and strict safety rules for novel vaccines to control and eradicate viral diseases have forced researchers and manufacturers toward cell culture-based vaccines. The choice of cell substrate is a critical step that cannot be generalized for every vaccine formulation, therefore, manufacturers intend to optimize the required processes for particular applications. The recently established cell lines, innovative bioreactor concepts and cultivation schemes are necessary to increase the potential of vaccine production. In this review, we have focused on current cell culture-based viral vaccines and their future prospects.
, underwent >10 levels fusion (HR: 2.58, CI: 1.70-3.91, p<.0001) and transforaminal lumbar interb... more , underwent >10 levels fusion (HR: 2.58, CI: 1.70-3.91, p<.0001) and transforaminal lumbar interbody fusion compared to anterior lumbar interbody fusion (HR: 2.41, CI: 1.23-4.72, p=.01). High dose BMP-2/levels fused was associated with a lower risk of RF (HR: 0.57, CI: 0.43-0.75, P<.0001). RF occurred in 51 pts (53%) in 3 years, 23 pts (24%) at 3-5 years and 22 pts (23%) at 5-10 years, postoperatively. Only 40 pts (41.2%) with RF had revision. RF and NRF pts had significant improvements in HRQOL as measured by ODI and SRS-30 scores (all p<.0001). The overall improvement of ODI and SRS-30 scores compared to baseline was similar in both groups except SRS satisfaction (p=.007) and self-image domain scores (p=.01). From preop to latest follow-up, RF pts had less improvement in SRS satisfaction (0.86 vs 1.31, p=.002) and SRS self-image domain scores (0.73 vs 1.02, p=.004). CONCLUSIONS: The incidence of RF after ASD surgery fused to sacrum is 18.4%. Increasing age, greater BMI, more severe deformity, implant choices and magnitude of operation may affect RF rates. RF impacts patient satisfaction and self-image improvement at latest follow-up. Patients need longer follow-up time up to at least 5-10 years to detect RF after ASD surgery. FDA DEVICE/DRUG STATUS: rhBMP-2 for Posterior Spinal Fusion (Not approved for this indication).
Surgeries were performed between March 2012 and December 2013. The study size derives from the nu... more Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. OUTCOME MEASURES: Anesthesia/surgery times and blood loss were recorded for all patients by clinic staff and entered into the EMR database immediately after surgery. Because no suction is used in OLLIF procedures, blood loss for the OLLIF group was measured by weighing sponges and subtracting dry weight. To monetize the cost per minute for an OR per case and for an average hospital day, a published reference for this amount was identified in the medical literature and adjusted by using consumer price index for medical costs. These values were reported both in aggregate and stratified based on the number of levels they had addressed at the time of their surgery (one, two, three or four). METHODS: All procedures were completed by the same surgeon as single surgeon procedures. To eliminate selection bias, the TLIF control group was selected from patients who underwent surgery before the surgeon started performing OLLIF. All 124 procedures were performed in two Minnesota hospitals. Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. We present 69 OLLIF procedures, vs 55 open TLIFs on 125 levels, and monetize quantifiable differences in the resource utilization. RESULTS: Overall, across all surgeries studied, LOS for OLLIF surgeries was 58.5% of that seen with TLIF surgeries (3.1 vs 5.3 days). The trend of shorter LOS for OLLIF surgeries remained consistent when surgeries were stratified and matched for the same number of levels involved. Overall, when LOS was converted to inpatient operating costs of the hospital, the difference in cost of surgical admission was $6,701 for OLLIF vs $11,583 for TLIF.
, radiographic, and surgical variables were analyzed. Recursive partitioning was utilized to iden... more , radiographic, and surgical variables were analyzed. Recursive partitioning was utilized to identify potentially modifiable variables that can predict iEOC<MA. RESULTS: Administrative direct cost data was obtained from 4 of 11 centers with a total of 210 patients. Ninety-five (45%) of the 210 patients had iEOC below the MA threshold. Variation was significant across the 4 centers in both the mean iEOC cost ($56,788-$78,878, p<.000) and reimbursement ($40,623-$91,351, p<.000). This was seen across deformity-specific DRGs (453,454,456,457). Academic centers were more likely to have iEOC costs below reimbursement (67.2% vs 8.9%, p<.000). Recursive partitioning (r2=0.309) identified rhBMP-2 (BMP) use of <24 mg, sagittal plane deformity, a combined anterior/posterior approach, and an SF36-MCS >39 as predictive for iEOC cost below the MA threshold. When comparing ASD surgeries with ≥ 9-level fusions in patients with similar comorbidities or complications, performing an anterior/posterior approach reimburses between 14.7%-121.1% more (2.2-fold) than posterior-only approach. This change in DRG allows iEOC to be more likely below the Medicare Allowable threshold. CONCLUSIONS: There is significant institutional (private vs academic) variation in ASD reimbursement. BMP use, deformity type, approach, and baseline mental health can all impact ASD surgery cost being below Medicare reimbursement. ASD surgeries with anterior/posterior approaches are in DRGs that can potentially reimburse 2.2-fold the posterioronly surgery, making it more likely to fall below the Medicare allowable threshold.
Surgeries were performed between March 2012 and December 2013. The study size derives from the nu... more Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. OUTCOME MEASURES: Anesthesia/surgery times and blood loss were recorded for all patients by clinic staff and entered into the EMR database immediately after surgery. Because no suction is used in OLLIF procedures, blood loss for the OLLIF group was measured by weighing sponges and subtracting dry weight. To monetize the cost per minute for an OR per case and for an average hospital day, a published reference for this amount was identified in the medical literature and adjusted by using consumer price index for medical costs. These values were reported both in aggregate and stratified based on the number of levels they had addressed at the time of their surgery (one, two, three or four). METHODS: All procedures were completed by the same surgeon as single surgeon procedures. To eliminate selection bias, the TLIF control group was selected from patients who underwent surgery before the surgeon started performing OLLIF. All 124 procedures were performed in two Minnesota hospitals. Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. We present 69 OLLIF procedures, vs 55 open TLIFs on 125 levels, and monetize quantifiable differences in the resource utilization. RESULTS: Overall, across all surgeries studied, LOS for OLLIF surgeries was 58.5% of that seen with TLIF surgeries (3.1 vs 5.3 days). The trend of shorter LOS for OLLIF surgeries remained consistent when surgeries were stratified and matched for the same number of levels involved. Overall, when
This research studies the strategic level decision-making in the biofuel industry by considering ... more This research studies the strategic level decision-making in the biofuel industry by considering the effect of investment and disinvestment delay. Under uncertain environments, the delay causes additional risk exposure to decision makers, and the optimal decision reflects the effect of delay. This research provides the concise and comprehensive profile of the optimal investment and disinvestment policy by taking investment and disinvestment delay into consideration. The results show that the trend of fuel price plays a crucial role to determine the effect of delay. If the trend is favorable to the alternative biofuel plant, longer exercise delays provide the decision makers an incentive to act more quickly, and shorter delays provide an opposite incentive. By applying the suggested model to the bioenergy investments cases in the state of Georgia, the United States, we provide managerial insights for the strategic decision makers in the biofuel industry.
A clinical study was carried out among patients with tinea infections in Okara during the year 20... more A clinical study was carried out among patients with tinea infections in Okara during the year 2013-2014 with respect to age, gender and clinical presentation of the infection. A total number of 150 samples were collected from tinea infected patients out of which only 120 were found positive for Trichophyton spp and Microsporum spp and no Epidermophyton was observed. Among positive cases Trichophyton spp was most dominant (68.3%) followed by Microsporum spp. (38%). The most effected age group was 0-10 years (40.8%). Male patients were infected more as compared to females and male to female ratio among positive cases was observed as 17:13. Rural community was observed to be most affected by the dermatophyte fungus. This study manifests the importance of correct mycological diagnosis for effective disease management.
Rice is delightful food used extensively all over the Asian countries including Pakistan and cons... more Rice is delightful food used extensively all over the Asian countries including Pakistan and consumption rate is very high. The aim of the present observation was to estimate the microbial load of the rice in the Lahore city of Pakistan. A total of 168 rice samples of raw and cooked categories were collected from different food-stalls and karyana stores from Raiwind, Lahore. Highest average of mean Viable Count (6.19 log10CFUg-1) of uncooked rice samples while in the cooked samples the highest mean Viable Count (3.84 log10CFUg-1) was recorded. It was also found that the overall percentage of Bacillus cereus and Bacillus subtilis in raw rice 38% and 52% while in cooked rice samples were 46% and 25% respectively. Fungal species isolated cooked rice samples were found in the order of Aspergillus niger (14%), Rhizophus stolonifer (12%), Pencillium chrysogenum (9%), Aspergillus flavus (8%), Fusarium equiseti (8%), Aspergillus fumigatus (0%), Fusarium avenaceum (0%), and Alternaria altern...
Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in ev... more Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow‐up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases.
In Pakistan, power outages have become frequent over the past two decades, due to a continuing en... more In Pakistan, power outages have become frequent over the past two decades, due to a continuing energy crisis. Reliance on machines for thermal comfort of buildings has led to high energy demands of the increasing population. The negative impacts of artificial environments have, also, diminished the sense of place, biophilia and cultural values. Moreover, globalization has standardized the built environments, causing a lack of regional identity and an absence of climate sensitivity in design. Keeping all these issues in focus, this article re-examines the fundamental aspects of traditional architecture and aims to stimulate architects and designers to create sustainable and life-enriching designs, which are appropriate for contemporary times. In this research, the first two levels of Deep Beauty functional and typological, are used as a conceptual framework for sustainable design. For this, research findings of the book, A Pattern Language: Towns, Buildings, Construction, are employe...
This abstract is an exploration of the presence of what Michael Mehaffy calls &quot;deep symm... more This abstract is an exploration of the presence of what Michael Mehaffy calls &quot;deep symmetry&quot; in Kamil Khan Mumtaz&#39;s design of the Baba Hassan Din Shrine (2005) in Lahore, Pakistan. The project signifies the creation of meaningful and beautiful architecture in contemporary times, through compound symmetries that interrelate, transform and combine, forming a coherent structure that is considered essential for human well-being.
Bacterial species from currency notes and coins obtained from people belonging to different profe... more Bacterial species from currency notes and coins obtained from people belonging to different professions of Lahore, Pakistan were evaluated for their antagonistic activity against bacillus species isolated from the same source. A total of twenty nine isolates were identified based on morphology, growth on selective and differential media and biochemical tests. Spot-on-the-lawn deferred antagonism method was used to observe the antagonistic activity of the bacillus sp. isolates. It was found that six bacillus sp. isolates [Bacillus cereus (B.c), Bacillus subtilis (B.s), Bacillus mycoides (B.m), Bacillus licheniformis (B.l), Bacillus vallismortis (B.v) and Bacillus thuringiensis (B.t)] showed antagonism against the other bacterial isolates. Three isolates viz., B.c, B.s and B.l showed broad spectrum of antagonistic activity (+++), B.s, B.l, B.m and B.t showed antagonistic activity (+) while B.s, B.c, B.m, B.v, B.l and B.t showed antagonistic activity. This study concluded that the Baci...
Background: The global prevalence of diabetes mellitus has more than doubled since 1980 and is ex... more Background: The global prevalence of diabetes mellitus has more than doubled since 1980 and is expected to continue to rise at alarming rates . An estimated 336 million people worldwide now have T2DM. T2DM results from an interaction between genetic and environmental factors that impair β-cell function and insulin action. Diabetes is diagnosed clinically by elevated plasma glucose levels, however, loss of β-cell function is progressive over time and β-cell dysfunction is far advanced by the time diabetes is diagnosed clinically. Therefore, methods for preserving or restoring β-cell function are important in our attempts to prevent and treat T2DM. In this project, we discuss current evidence for causes of the progressive loss of β-cell function in T2DM, and the effects of current therapeutic strategies on preservation of β-cell function and the prevention and treatment of T2DM. Objectives: To measure beta cell function mass and metabolic control in patients with type 2 diabetes melli...
This study was conducted to find out the antibacterial effects of different components including ... more This study was conducted to find out the antibacterial effects of different components including standard antibiotics, herbal extracts and commercially available essential oils by applying different bacteria and to evaluate their effect on chicken meat as a preservative. For this purpose, 8 different types of antibiotic discs of 0.5 mm were applied on the bacteria isolated from chicken obtained taken from the Laboratory of Microbiology, Institute of Microbiology and Biotechnology, The University of Lahore. Similarly herbal extracts and commercially available essential oils were also applied on the same bacteria by disc diffusion method. Then finally clove extract and clove oil were mixed in the concentrations of 5% and 10% v/w in the minced chicken meat to observe their preservative effects. The bacteria were not significantly seen to resist the action of antibiotics applied while ethanolic clove (Syzygium aromaticum) extract, clove oil and cinnamon (Cinnamomum zeylanicum) oil showe...
Pakistan Journal of Engineering and Applied Sciences, 2020
Social Realism, an artistic movement introduced in the second quarter of the twentieth century, i... more Social Realism, an artistic movement introduced in the second quarter of the twentieth century, influenced an entire generation of artists all over the world. It explores the themes ranging from poverty to anti-state demonstrations, and from depictions against imperialism to class inequality, gender oppression and social injustice. Elements of social realism are not surprising to encounter in the Pakistani art world, considering the ideals of the style and the turbulent history of the country since its independence in 1947. Pakistani artists have always been sensitive to the social and political issues of the country, which have somewhat become fragments of its identity, especially as ascertained by the western gaze. Women’s persecution and social exclusion is one such subject that has become an identifier for Pakistan, although a human development report of the United Nations recognizes the country having better gender equality than neighboring India. Nevertheless, women oppression...
Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Ex... more Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical com...
Cell culture-based viral vaccines are used globally to immunize humans against infections. The ce... more Cell culture-based viral vaccines are used globally to immunize humans against infections. The cell culture is continuous process of developing substrates for the safe production of viral vaccines. However, increased global demand and strict safety rules for novel vaccines to control and eradicate viral diseases have forced researchers and manufacturers toward cell culture-based vaccines. The choice of cell substrate is a critical step that cannot be generalized for every vaccine formulation, therefore, manufacturers intend to optimize the required processes for particular applications. The recently established cell lines, innovative bioreactor concepts and cultivation schemes are necessary to increase the potential of vaccine production. In this review, we have focused on current cell culture-based viral vaccines and their future prospects.
, underwent >10 levels fusion (HR: 2.58, CI: 1.70-3.91, p<.0001) and transforaminal lumbar interb... more , underwent >10 levels fusion (HR: 2.58, CI: 1.70-3.91, p<.0001) and transforaminal lumbar interbody fusion compared to anterior lumbar interbody fusion (HR: 2.41, CI: 1.23-4.72, p=.01). High dose BMP-2/levels fused was associated with a lower risk of RF (HR: 0.57, CI: 0.43-0.75, P<.0001). RF occurred in 51 pts (53%) in 3 years, 23 pts (24%) at 3-5 years and 22 pts (23%) at 5-10 years, postoperatively. Only 40 pts (41.2%) with RF had revision. RF and NRF pts had significant improvements in HRQOL as measured by ODI and SRS-30 scores (all p<.0001). The overall improvement of ODI and SRS-30 scores compared to baseline was similar in both groups except SRS satisfaction (p=.007) and self-image domain scores (p=.01). From preop to latest follow-up, RF pts had less improvement in SRS satisfaction (0.86 vs 1.31, p=.002) and SRS self-image domain scores (0.73 vs 1.02, p=.004). CONCLUSIONS: The incidence of RF after ASD surgery fused to sacrum is 18.4%. Increasing age, greater BMI, more severe deformity, implant choices and magnitude of operation may affect RF rates. RF impacts patient satisfaction and self-image improvement at latest follow-up. Patients need longer follow-up time up to at least 5-10 years to detect RF after ASD surgery. FDA DEVICE/DRUG STATUS: rhBMP-2 for Posterior Spinal Fusion (Not approved for this indication).
Surgeries were performed between March 2012 and December 2013. The study size derives from the nu... more Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. OUTCOME MEASURES: Anesthesia/surgery times and blood loss were recorded for all patients by clinic staff and entered into the EMR database immediately after surgery. Because no suction is used in OLLIF procedures, blood loss for the OLLIF group was measured by weighing sponges and subtracting dry weight. To monetize the cost per minute for an OR per case and for an average hospital day, a published reference for this amount was identified in the medical literature and adjusted by using consumer price index for medical costs. These values were reported both in aggregate and stratified based on the number of levels they had addressed at the time of their surgery (one, two, three or four). METHODS: All procedures were completed by the same surgeon as single surgeon procedures. To eliminate selection bias, the TLIF control group was selected from patients who underwent surgery before the surgeon started performing OLLIF. All 124 procedures were performed in two Minnesota hospitals. Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. We present 69 OLLIF procedures, vs 55 open TLIFs on 125 levels, and monetize quantifiable differences in the resource utilization. RESULTS: Overall, across all surgeries studied, LOS for OLLIF surgeries was 58.5% of that seen with TLIF surgeries (3.1 vs 5.3 days). The trend of shorter LOS for OLLIF surgeries remained consistent when surgeries were stratified and matched for the same number of levels involved. Overall, when LOS was converted to inpatient operating costs of the hospital, the difference in cost of surgical admission was $6,701 for OLLIF vs $11,583 for TLIF.
, radiographic, and surgical variables were analyzed. Recursive partitioning was utilized to iden... more , radiographic, and surgical variables were analyzed. Recursive partitioning was utilized to identify potentially modifiable variables that can predict iEOC<MA. RESULTS: Administrative direct cost data was obtained from 4 of 11 centers with a total of 210 patients. Ninety-five (45%) of the 210 patients had iEOC below the MA threshold. Variation was significant across the 4 centers in both the mean iEOC cost ($56,788-$78,878, p<.000) and reimbursement ($40,623-$91,351, p<.000). This was seen across deformity-specific DRGs (453,454,456,457). Academic centers were more likely to have iEOC costs below reimbursement (67.2% vs 8.9%, p<.000). Recursive partitioning (r2=0.309) identified rhBMP-2 (BMP) use of <24 mg, sagittal plane deformity, a combined anterior/posterior approach, and an SF36-MCS >39 as predictive for iEOC cost below the MA threshold. When comparing ASD surgeries with ≥ 9-level fusions in patients with similar comorbidities or complications, performing an anterior/posterior approach reimburses between 14.7%-121.1% more (2.2-fold) than posterior-only approach. This change in DRG allows iEOC to be more likely below the Medicare Allowable threshold. CONCLUSIONS: There is significant institutional (private vs academic) variation in ASD reimbursement. BMP use, deformity type, approach, and baseline mental health can all impact ASD surgery cost being below Medicare reimbursement. ASD surgeries with anterior/posterior approaches are in DRGs that can potentially reimburse 2.2-fold the posterioronly surgery, making it more likely to fall below the Medicare allowable threshold.
Surgeries were performed between March 2012 and December 2013. The study size derives from the nu... more Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. OUTCOME MEASURES: Anesthesia/surgery times and blood loss were recorded for all patients by clinic staff and entered into the EMR database immediately after surgery. Because no suction is used in OLLIF procedures, blood loss for the OLLIF group was measured by weighing sponges and subtracting dry weight. To monetize the cost per minute for an OR per case and for an average hospital day, a published reference for this amount was identified in the medical literature and adjusted by using consumer price index for medical costs. These values were reported both in aggregate and stratified based on the number of levels they had addressed at the time of their surgery (one, two, three or four). METHODS: All procedures were completed by the same surgeon as single surgeon procedures. To eliminate selection bias, the TLIF control group was selected from patients who underwent surgery before the surgeon started performing OLLIF. All 124 procedures were performed in two Minnesota hospitals. Surgeries were performed between March 2012 and December 2013. The study size derives from the number of surgeries accomplished in this time frame. We present 69 OLLIF procedures, vs 55 open TLIFs on 125 levels, and monetize quantifiable differences in the resource utilization. RESULTS: Overall, across all surgeries studied, LOS for OLLIF surgeries was 58.5% of that seen with TLIF surgeries (3.1 vs 5.3 days). The trend of shorter LOS for OLLIF surgeries remained consistent when surgeries were stratified and matched for the same number of levels involved. Overall, when
This research studies the strategic level decision-making in the biofuel industry by considering ... more This research studies the strategic level decision-making in the biofuel industry by considering the effect of investment and disinvestment delay. Under uncertain environments, the delay causes additional risk exposure to decision makers, and the optimal decision reflects the effect of delay. This research provides the concise and comprehensive profile of the optimal investment and disinvestment policy by taking investment and disinvestment delay into consideration. The results show that the trend of fuel price plays a crucial role to determine the effect of delay. If the trend is favorable to the alternative biofuel plant, longer exercise delays provide the decision makers an incentive to act more quickly, and shorter delays provide an opposite incentive. By applying the suggested model to the bioenergy investments cases in the state of Georgia, the United States, we provide managerial insights for the strategic decision makers in the biofuel industry.
A clinical study was carried out among patients with tinea infections in Okara during the year 20... more A clinical study was carried out among patients with tinea infections in Okara during the year 2013-2014 with respect to age, gender and clinical presentation of the infection. A total number of 150 samples were collected from tinea infected patients out of which only 120 were found positive for Trichophyton spp and Microsporum spp and no Epidermophyton was observed. Among positive cases Trichophyton spp was most dominant (68.3%) followed by Microsporum spp. (38%). The most effected age group was 0-10 years (40.8%). Male patients were infected more as compared to females and male to female ratio among positive cases was observed as 17:13. Rural community was observed to be most affected by the dermatophyte fungus. This study manifests the importance of correct mycological diagnosis for effective disease management.
Rice is delightful food used extensively all over the Asian countries including Pakistan and cons... more Rice is delightful food used extensively all over the Asian countries including Pakistan and consumption rate is very high. The aim of the present observation was to estimate the microbial load of the rice in the Lahore city of Pakistan. A total of 168 rice samples of raw and cooked categories were collected from different food-stalls and karyana stores from Raiwind, Lahore. Highest average of mean Viable Count (6.19 log10CFUg-1) of uncooked rice samples while in the cooked samples the highest mean Viable Count (3.84 log10CFUg-1) was recorded. It was also found that the overall percentage of Bacillus cereus and Bacillus subtilis in raw rice 38% and 52% while in cooked rice samples were 46% and 25% respectively. Fungal species isolated cooked rice samples were found in the order of Aspergillus niger (14%), Rhizophus stolonifer (12%), Pencillium chrysogenum (9%), Aspergillus flavus (8%), Fusarium equiseti (8%), Aspergillus fumigatus (0%), Fusarium avenaceum (0%), and Alternaria altern...
Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in ev... more Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow‐up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases.
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Papers by Rabia Qureshi