A framework for manufacturing system reconfiguration and optimisation utilising digital twins and modular artificial intelligence

Digital twins and artificial intelligence have shown promise for improving the robustness, responsiveness, and productivity of industrial systems. However, traditional digital twin approaches are often only employed to augment single, static systems to optimise a particular process. This article presents a paradigm for combining digital twins and modular artificial intelligence algorithms to dynamically reconfigure manufacturing systems, including the layout, process parameters, and operation times of numerous assets to allow system decision -making in response to changing customer or market needs. A knowledge graph has been used as the enabler for this system-level decision-making. A simulation environment has been constructed to replicate the manufacturing process, with the example here of an industrial robotic manufacturing cell. The simulation environment is connected to a data pipeline and an application programming interface to assist the integration of multiple artificial intelligence methods. These methods are used to improve system decision-making and optimise the configuration of a manufacturing system to maximise user-selectable key performance indicators. In contrast to previous research, this framework incorporates artificial intelligence for decision -making and production line optimisation to provide a framework that can be used for a wide variety of manufacturing applications. The framework has been applied and validated in a real use case, with the automatic reconfiguration resulting in a process time improvement of approximately 10%.

Evaluation of Neutrophil Percentage to Albumin Ratio as Predictor of Mortality in Patients with Covid-19

Background: Inflammatory acute respiratory syndrome (SARS) is caused by the COV-2 virus. Neutrophils have been implicated in the pathophysiology of the COVID-19 pandemic since its inception, particularly in individuals with advanced disease. This is confirmed by a large number of studies. Method(s): The study included 200 patients, of whom 100 were in the critical group (group 1) and 100 were in the non-critical group (group 2). White blood cell (WBC) percentage, neutrophil count, albumin, and demographic information were recorded. Neutrophil percentage x 100 /Albumin (g/dl) was used to construct the neutrophil count to albumin ratio (NPAR). To determine whether the measure may be utilized as a predictor for mortality, the NPAR is then compared between groups 1 and 2, as well as between discharge and mortality groups. Result(s): Age and gender had no statistically significant differences in either group. There were no significant variations in the median (IQR) values of neutrophil count (89 vs 91.25), WBC (15.65 vs 14.9), and NPAR (41.3 vs 43.7) between the two groups. Significant differences in albumin (3.330.521 vs. 3.10.51) were identified between the critical and non-critical groups. Conclusion(s): According to our research, the COVID-19 patients' NPAR is a poor predictor of mortality. More study is still required to verify and elucidate the clinical implications of these findings.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Updates in vaccine development against COVID-19

As per latest updates on the vaccines by the World Health Organization (WHO), the total number of vaccines currently under development is more than 192. About 151 are presently investigated in the preclinical phases, while 42 of these vaccine candidates are in the various phases of clinical trials. Ten of these are in the advanced stages of clinical investigation, and promising results in the phase 3 trials will pave the way for their regulatory approvals and subsequent dissemination for global use. Preliminary and interim results of some of these candidate vaccines are already being analyzed for public dissemination. Once safe and effective vaccines are available, the next limiting step would be their mass manufacturing by these companies to fulfill the global demand. Here we describe these vaccines and how their manufacturers are speeding up the efforts to bring them to market. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

Drugs for the treatment of COVID-19

Currently, there are no drugs or other therapeutic agents approved by the U.S. Food and Drug Administration (FDA) to prevent or treat COVID-19. Current standard of care includes prevention of infection and control measures and supportive care, including supplemental oxygen and, when required, mechanical ventilatory support. This chapter outlines important drugs that have the potential to be used as Covid-19 remedies. Several landmark clinical trials are discussed, and clinical evidence is sought for the claims made for the efficacy of these drugs in treating Covid-19. Literature searches suggest that dexamethasone reduces mortality in severely ill patients and may also reduce the need of mechanical ventilation in such patients compared to the standard care. However, no irrefutable evidence was found for the efficacy claims of hydroxychloroquine. The role of many other drugs is still uncertain as there are very few large-scale randomized clinical trials to show their effectiveness in Covid-19. However, many new and exciting molecules are being tested in the laboratories. Large, randomized, controlled, double-blind trials are underway to investigate the safety and efficacy of several new and old drugs. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

Knowledge, Attitude and Practice Among Covid-19 Health Care Workers A Quantitative Study on the Covid 19 Health Care Workers of Sindh Infectious Disease Hospital Karachi Pakistan

Background: As per the World Health Organization (WHO), the coronavirus diagnosis 2019 (COVID-19) increase in the prevalence has turned into a pandemic, to date world has witnessed 5 waves of COVID- and it has now infected over 200 countries / regions, resulting in over 7.5 million infections and 4,19,568 fatalities worldwide Objective: To assess the knowledge, attitudes, and practices among COVID-19 Health care workers of COVID-19. Methodology: This was cross sectional studyand carried at Sindh Infectious Disease Hospital and Research Centre (SIDH & RC), a specialized COVID-19 hospital. Data will be collected through questionnaires and the respondents will be healthcare workers (doctors/medical practitioners and nurses) dealing with COVID 19 patients. Data was analysed by the SPSS version: 21. Result(s): In total, there are 111 participants;56.8% of them are male COVID-19 health care workers Most of the Healthcare worker age range was 21-30 years. The received responses from 3 persons aged 51 and older, which represented 2.7% of the total population. The knowledge attitude and practices among the COVID-19 health care workers and all of them found that Awareness of COVID-19 among medical professionals is high. As people age, they get a more mature perspective on COVID19 infection, which in turn leads to more responsible behavior. Conclusion(s):89% of the healthcare professionals who were evaluated have the necessary understanding of COVID-19. On the basis of the findings of this research, future efforts to increase awareness and educate people can more effectively target specific knowledge and practice gaps. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

COVID19 and Its Impact on the North and East of Scotland Orthopaedic Trainees

Aim: We conducted a trainee survey at the first peak of the pandemic to investigate the impact of COVID-19 on the North of Scotland (NoS) and East of Scotland (EoS) orthopaedic trainees. Method: An online survey was distributed to all NoS and EoS orthopaedic trainees. All data collection was anonymous. Results: Across both Scottish deaneries, 28 trainees had responded: 39% from EoS and 61% from NoS. Trainees at all stages of training responded to the survey, with the most responses received from specialist trainees in third year of training (ST3) (25%). In response to the pandemic, 18% of trainees had been redeployed and they were from NoS. Since the reconfiguration of service, 18% of trainees had done >20 operations in a month and they were senior trainees. If COVID-19 outbreak is likely going to reduce operating opportunities for a long period, only 36% of trainees would be open to the idea of making standard surgical specialty training longer whereas 57% of trainees would be open to longer working hours to achieve certification in Trauma and Orthopaedic surgery within 96 months. Conclusion: The outbreak of COVID-19 has impacted both deaneries orthopaedic training and urgent restoration of surgical training is essential for individual trainees. Changes in working practices necessitated by COVID-19 have known to impact theatre efficiency. Actions should be taken to improve the theatre efficiency while prioritizing training opportunities.

The Effect of COVID-19 on Orthopaedic Trauma Theatre Efficiency and Surgical Training in the North and East of Scotland Major Trauma Centres - a Year On

Aim: To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic. Method: All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the 'new normal' (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used. Results: There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland. Conclusion: The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.

Genome Scale Phylogenetic Analysis Differentiates SARS-CoV-2 Strains in Pakistani and Indian COVID-19 Patients with and without Travel History

The COVID-19 virus spread around the globe very rapidly during early 2020. Identification of the evolution pattern, and genome scale mutations in SARS-CoV-2 is essential to study the dynamics of this disease. The genomic sequences of thousands of SARS-CoV-2 infected patients from different countries are publicly available for sequence based in-depth analysis. In this study, the DNA sequences of SARS-CoV-2 from the COVID-19 infected patients (having or lacking a travel history) from Pakistan and India, the two highest populous neighboring countries in South Asia, have been analyzed by using computational tools of phylogenetics. These analyses revealed that the SARS-CoV-2 strain in Pakistani traveler COVID-19 patients is closely related to Iranian strains, the strain in non-traveler patients is related to the strain of Wuhan, China. Likewise, in India, the SARS-CoV-2 strains in travelers and non-travelers are closely related to Italy, Germany, and Mexico. The selected approach has also been utilized to find out the identical genomic regions and similar strains around the world. Collectively, our study suggested distinct strains and routes of viral transmission in Pakistan and India. These differences may infer partially the reason for the decline phase in viral propagation in Pakistan two months after the peak COVID-19 load, and rapid viral propagation in India making it the second worst-hit country in the world after the USA.

Diagnostic Accuracy of CT-Scan Chest in Distinguishing Ground-Glass Opacities from Covid-19 Causes and Other Causes of Ground-Glass Opacities

Introduction: Evaluation of the effectiveness of diagnostic computed tomography of the chest in differentiating between coronavirus 2019 (COVID-19) ground glass opacities and other reasons of ground glass opacities (GGO) not related to COVID-19. Place and Duration: In the department of Radiology, Miangul Abdul Haq Jahenzeb Kidney Hospital Swat for six-months duration from March 2021 to August 2021. Methods: 90 total covid-19 confirmed patients by RT-PCR having GGO (53 males and 37 females, with 47.20 ± 15.10 years mean age) and 110 patients (63 males and 47 males) who were confirmed GGO on chest CT but not due to Covid-19 were selected for the study. The experienced radiologists studied all chest CT scans after removing all descriptive information from the images. They tested negative or positive for COVID-19 and noted other features of CT of the lungs, including laterality, distribution pattern and lobe involvement. The laboratory results and clinical data were documented. Results: This study consisted of 90 COVID19 patients and 100 non-COVID-19 with ground glass opacities on CT chest. In terms of age;no statistically significant alteration was noted amid the 2 groups (p-value = 0.129). Non-COVID-19 cases with GGO;6 patients have atypical bacterial pneumonia, 42 patients have GGO after viral pneumonia, 14 patients have interstitial pneumonia, 5 patients have PJP, eosinophilic pneumonia in 3 patients, 9 patients have hypersensitivity pneumonia, 6 patients have drug-induced lung injury, 5 patients have pulmonary alveolar hemorrhage and pulmonary edema in 11 patients (cardiogenic and noncardiogenic). Conclusion: Chest CT is rational for distinguishing ground glass opacities form COVID-19 and non-COVID-19 reasons, with less specificity for distinguishing COVID-19 from viral pneumonia and intermediate specificity for distinguishing COVID-19 from other reasons of ground glass opacities.

Latest updates on novel Covid-19 virus Outbreak and Its Genomic Characterization

The main source of Covid-19 pandemic is Severe acute respiratory syndrome coronavirus 2 (SARSCoV2);belongs to beta-coronavirus genus and first case of coronavirus was revealed in Wuhan city of China in 2019. In severe cases there is high occurrence of multiple organ dysfunctions, elevated d-dimer levels, oxygen saturation rate is less than 94. SARS COV2 genome consisting of M(Membrane), N(Nucleocapsid), S(Spike), ORF (Open Reading Frame) and E(Envelope) genes that encodes the structural proteins like M, N, S and E gene. Open reading frame (ORF) are largely non-structural accessory proteins in genes. M gene is an integral membrane protein that are responsible for the virus's shapes, encourage membrane curvature and involve in the attachment to the envelope proteins like E, S, and HE as well as with the nucleocapsid or in the formation of intracellular virus without the involvement of S protein. N gene encodes nucleocapsid protein which is structural protein responsible for various cell activities, replication and transcription, used for diagnostic purposes on the basis of primer and probe sequencing. Whereas, S gene is responsible for pathogenesis, producing host immune response by their antigenic property and neutralizing antibodies to protect from infectivity. In this review we summarized background, clinical symptoms, pathological features and genetic characteristics of SARS-CoV-2. Previously known coronavirus intermediate host was cat and giraffe whereas SARS-CoV-2 host is currently unknown. We recapitulate the current knowledge of structural and non-structural genes of coronavirus. On the surface of S gene there is a receptor called ACE2 (Angiotensin-Converting Enzyme 2) where virus binds and entered into the cell. We also discuss the vaccines that are used to reduce mortality and morbidity rate of viral infection. But the duration of immunity induced by vaccine is still unknown

Knowledge, Attitude, Practice and Risk Assessment of Frontline Healthcare Professionals Related To Covid-19 in Lahore

Novel Coronavirus is the causative agent of severe acute respiratory syndrome (SARS-CoV) in human. At present, in the outbreak of the novel corona virus (COVID-19), the Health care professionals (HCPs) are frontline workers who directly exposed to covid-19 patients. So, it is of great importance to assess the level of knowledge, attitude, practice and risk assessment of healthcare workers (HCWs) associated with the outbreak. A cross-sectional study involving doctors, dentists and nurses who work in public and private hospitals was conducted. A total 55 matters questionnaire based on WHO (world Health organization) risk assessment was shared with the participants. Total 1073 participants were included in the survey. Out of 1073 participants 53.4% n=573 were male and 46.6% n= 500 were female. HCWs have a good knowledge, attitude, practice and risk assessment 15.82 +/- 3.47, 14.35 +/- 1.71, 11.10 +/- 1.66 and 8.25 +/- 1.09 respectively but 61.7% HCWs not well known about the knowledge of symptom to COVID-19. Kruskal-Wallis independent sample test showed significant p-value (<0.05) in the attitude, practices and risk assessment among HCWs. Spearman's rho correlation shows significant correlation between knowledge and attitude (r=.069, p < 0.05) and significant correlation between attitude and practice (r=.218, p < 0.01). Further investigation and follow-up to the disaster management and risk assessment can help the policy makers to improve the management of future outbreaks.

An Emerging Marker Predicting the Severity of Covid-19: Neutrophil-Lymphocyte Count Ratio

Objective: To assess the efficacy of neutrophil-lymphocyte count ratio in predicting the severity of covid-19 Materials and Methods: The patients with positive results for COVID-19 were shifted to COVID ITC, CMH, Multan. The clinical histories of confirmed patients of COVID-19 during February 2020 to May 2021 were reviewed. The patients were divided into 4 classes, mild, common, severe, and fatal, according to guidelines of COVID-19 i.e., trial version 7. Data was collected regarding age, sex, smoking history, temperature, epidemiological history, clinical symptoms, and laboratory findings of all included patients including NLCR. Results: The mean NLCR of Mild and Severe Group was 2.77±1.23 and 20.31±4.45, respectively, (p=0.000). (Table. II). The area under the curves of NLCR was larger than neut, suggesting the optimal performance of NLCR with cut-off value 5.89. The sensitivity and specificity of NLCR was 85% and 95%, respectively. (Table. III). Conclusion: It can be concluded that an increase in NLCR levels can indicate that the covid-19 disease is moving towards exacerbation. NLCR can be recommended as a novel and highly sensitive and specific indicator for severity prediction in Covid-19 patients.

Competing risks survival data under middle censoring—An application to COVID-19 pandemic

Survival data is being analyzed here under the middle censoring scheme, using specifically quantile function modelling under competing risks. The use of middle censoring scheme has been shown to be very appropriate under the COVID-19 pandemic scenario. Cause-specific quantile inference under middle censoring is employed. Such quantile inferences are obtained through cumulative incidence function based on cause-specific proportional hazards model. The baseline lifetime is assumed to follow a very general parametric model namely the Weibull distribution, and is independent of the censoring mechanism. We obtain estimates of the unknown parameters and cause specific quantile functions under classical as well as a Bayesian set-up. A Monte Carlo simulation study assesses the relative performance of the different estimators. Finally, a real life data analysis is given applying the proposed methods.

Satisfaction of Pakistan’s Islamic banking system during the COVID-19 pandemic Logistic model-based identification of the determinants to improve customer

Purpose: This study aims to explore the potential determinants of customers’ satisfaction with the Islamic banking system and highlights the fact that both internal and external factors play key roles in customer satisfaction (CS) during the COVID-19 pandemic. Design/methodology/approach: Primary data from six Islamic banks (Al Baraka Bank Ltd, BankIslami Pakistan Ltd, Burj Bank Ltd, Dubai Islamic Bank Ltd, Meezan Bank Ltd and MCB-Islamic Bank Ltd) were analysed using a binary logit method. Findings: The results showed that internal factors such as hand sanitisation facilities, strict compliance with wearing a mask before entering the bank, the distance between customers and dealing officers, an organised network of branches (in terms of health safety protocols), the behaviour of dealing officers and extended banking hours contributed significantly to enhancing the satisfaction of Islamic banking customers during the pandemic in Pakistan. The results showed that high service charges on loans have a significant adverse impact on CS. Concerning external factors, the results showed that mass media platforms that can update customers about new services and customer transactions’ processing timing, the number of operational branches in the pandemic period, available parking space in front of a bank and recommendations from family and friends to open an account with a particular bank increase CS levels. Practical implications: The study’s results will be helpful for the policymakers and practitioners to design such policies that can promote the Islamic banking system in developing countries such as Pakistan. Originality/value: Under the pandemic situation, the present study highlights the internal and external determinants of Islamic banking customers’ satisfaction in Pakistan. The study provides a foundation for Islamic Banks to revise their policy frameworks and marketing strategies to attract customer interest and improve their satisfaction levels. © 2021, Emerald Publishing Limited.

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19).

INTRODUCTION: We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. METHODS: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data. RESULTS: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). CONCLUSIONS: Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.

A Meta-Analysis of Foreign Direct Investment and Economic Growth: An Empirical evidence from Pakistan during COVID 19 Policymaking

Purpose: Present study is based on the impact of Foreign Direct Investment on the Economic Growth of Pakistan. In this paper, a time-series data has been collected for the variables Foreign Direct Investment (FDI), Gross Capital Formation (GCF), Inflation rate (IR), and Gross Domestic Product (GDP) since the year 1970-2018 from World Bank Development Indicators. Some tests have been performed regarding the significance of data using regression, correlation analysis, and normality test (Kolmogorov-Smirnov) using SPSS software. In this research, an alternative hypothesis has been built to analyze the significance of this data. Discussions and recommendations have been given in this paper to implicate on the economy for growth and development measures.Design/Methodology/Approach: The data from WDI and other worldwide authentic sources were used from 1970-2018 to perform models using regression analysis and advanced machine learning methods.Findings: Regression and correlation analysis have been used on the variables. Its result indicates a positive relationship among the variables FDI and GDP whereas it shows a negative correlation among the variables GCF, IR concerning GDP.Limitations: Data is predictable based on the variables taken. It has been collected for the recent years up till 2018. It can only predict a certain variation caused by the increase of a particular independent variable that is FDI, GCF, and IR. Future variation in variables cannot be predicted. The results are specifically related to Pakistan and cannot be justified for other countries.Practical implications: Strong industrial network clusters must be formed by the policymakers to gain investor loyalty and will also help companies to form capital and also sustain a strong supply chain management. Higher FDI inflows will aid the ongoing project of Pakistan which is the Diamer Bhasha Dam. Due to the pandemic stated as COVID-19, FDI will actively play a role in maintaining ventilators in hospitals that have become a current need. An increase in inflation shows a negative impact on the economy of Pakistan. Considering the prevailing situation where unemployment level, job opportunities not being available and no productivity level is being achieved due to the current Pandemic i.e. COVID-19, policymakers must take initiative in reducing consumer prices so that all the preceding situations could have positive effects on the economic growth of Pakistan © 2020 IEEE.