Reducing acquisition time may improve patient throughput, increase camera efficiency, and reduce costs; reducing acquisition time also increases image noise. Newly available software controls the effects of noise by maximum a posteriori reconstruction while maintaining resolution with resolution-recovery methods. This study compares half-time (HT) gated myocardial SPECT images processed with ordered-subset expectation maximization with resolution recovery (OSEM-RR) (with and without CT-based attenuation correction [AC]) with full-time (FT) images obtained with a standard clinical protocol and reconstructed with filtered backprojection (FBP) and OSEM (with and without AC). Methods: A total of 212 patients (mean age, 57 y; age range, 27-86 y) underwent 1-d rest/stress 99m Tc-tetrofosmin gated SPECT. FT (12.5 min, both rest and stress) and HT (rest, 7.5 min; stress, 6.0 min) images were acquired with low-dose CT for AC in 112 patients. HT acquisitions were processed with OSEM-RR (with and without AC) using software, and FT acquisitions were processed with FBP and OSEM (with and without AC). In another 100 patients, test-retest repeatability was assessed using 2 sets of FT images (FBP reconstruction) that were acquired one immediately after the other. Radiologists unaware of the acquisition and reconstruction protocols visually assessed all reconstructed images for summed stress, summed rest, and summed difference scores and regional wall motion using a 17-segment model. Automated analysis on gated SPECT was used to determine left ventricular volumes, ejection fraction, and dilation (end-diastolic volume, end-systolic volume, left ventricular ejection fraction, and transient ischemic dilation [TID]). A clinical diagnosis was also determined. Results: All measurements resulted in significant correlations (P , 0.01) between the HT and FT images. The only significant difference in mean values was for OSEM-RR plus AC; this method led to an increase in TID by 4% over FT imaging. The concordance in the clinical diagnosis for HT versus FT was 106 to 112 (k 5 0.88) for no AC and 102 to 106 (k 5 0.91) for AC, similar to the repeatability of FT versus FT (98/100, k 5 0.95). Conclusion: HT images processed with the new algorithm provided a clinical diagnosis in concordance with that from FT images in 95% (no AC) to 96% (AC) of cases. This concordance is similar to the test-retest repeatability of FT imaging.

Background: Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular diseases (CVDs). This study is an attempt to determine the correlation between hemoglobin A1c (HbA1c) and serum lipid profile and to evaluate the importance of HbA1c as an indicator of dyslipidemia in Afghani patients with T2DM. Methods: A total of 401 Afghani patients with T2DM (men, 175; women, 226; mean age, 51.29 years) were included in this study. The whole blood and sera were analyzed for fasting blood sugar (FBS), HbA1c, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Diabetes was defined as per American Diabetes Association criteria. The correlation of FBS, HbA1c with lipid ratios and individual lipid indexes were analyzed. The statistical analysis was done by SPSS statistical package version 16.0. Results:The mean age ± standard deviation of male and female patients were 51.71 ± 11.70 and 50.97 ± 10.23 years respectively. There was a significant positive correlation between HbA1c, TC, TG, LDL-C and LDL-C/HDL-C ratio. The correlation between HbA1c and HDL-C was negative and was statistically nonsignificant. Furthermore, HbA1c was found to be a predictor of hypercholesterolemia, LDL-C and TG via a linear regression analysis. Patients with HbA1c value greater than 7.0% had significantly higher value of cholesterol, LDL-C, and LDL-C/HDL-C ratio compared with patients with an HbA1c value up to 7.0%. Conclusions: Apart from a reliable glycemic index, HbA1c can also be used as a predictor of dyslipidemia and thus early diagnosis of dyslipidemia can be used as a preventive measure for the development of CVD in patients with T2DM.

BackgroundWe define the repeatability coefficients (RC) of key quantitative and visual perfusion and function parameters that can be derived by the QGS/QPS automated software and by expert visual observer from gated myocardial perfusion SPECT (MPS) scans.MethodsStandard QGS/QPS algorithms have been applied to derive quantitative perfusion and function parameters in 200 99mTc-tetrofosmin rest/stress MPS scans, obtained in 100 consecutive patients who underwent 2 separate gated rest/stress scans on the same camera. Variables included stress, rest, and ischemic total perfusion deficit (TPD), ejection fraction, motion, and thickening. Visual perfusion/motion scores were derived by an expert reader using randomized scan order and normalized to % myocardium.ResultsQuantitative and visual parameters were highly reproducible with smaller RC for some quantitative measures as compared to visual measures (P < .0001). RC for quantitative measures were 3.3% for stress TPD, 1.8% for rest TPD, and 3.2% for ischemic TPD and for visual scoring 4.8% for stress, 3.8% for rest, and 4.3% for ischemic (P ≤ .002). The results in each vessel territory showed that in the right coronary artery (RCA) territory the quantitative approach had improved reproducibility as compared to visual reading. Visual thickening scoring was more reproducible than motion scoring (P < .0001).ConclusionsThis study demonstrates that standard perfusion and function parameters derived from MPS by visual or quantitative analysis are highly reproducible with some advantages to the quantitative approach.

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Purpose – The purpose of this paper is to present an IDEF0 framework model for the post-occupancy evaluation of school facilities, and the findings of a case study to demonstrate the applicability of the framework. Design/methodology/approach – The framework model consists of five sequential processes, namely: first, identify the performance requirements of school facilities; second, conduct a walk-through evaluation and a focussed group discussion; third, develop and administer a user satisfaction survey; fourth, analyze the collected data and report the findings; and fifth, develop a plan of remedial actions. Findings – The case study demonstrates the applicability of the framework through presenting the findings of an indicative evaluation of the major technical and functional elements of performance carried out on a school building in city of Khobar, Eastern Province of Saudi Arabia. The school users were satisfied with the qualities of the thermal comfort, visual comfort, fire protection, functional spaces in the school and the interior and exterior appearance of the school. The case study also resulted in developing a plan of remedial actions to improve the performance of the school. Practical implications – The framework model provides a descriptive and systematic approach for evaluating the technical and functional performance of existing school facilities. The approach followed in collecting the data, designing the user satisfaction survey, analyzing and reporting the findings can be applied to any school building, upon the needed customization, irrespective of location. Originality/value – The paper is particularly beneficial for design professionals, school administrators and facilities managers responsible for the design and operation of school facilities.

Objective:This study aims to determine the prevalence and susceptibility pattern of Pseudomonas aeruginosa and multidrug-resistant (MDR) isolates in patients suffering from respiratory tract infection.Methods:A cross sectional study was conducted from January to December 2014 in Northwest General Hospital and Research Centre, Peshawar. A total of 615 sputum samples were collected from both in and out-patients. Sputum samples were collected as per standard procedure and were inoculated on Blood, MacConkey and Chocolate agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute (CLSI) guidelines using Kirby-Bauer’s disc diffusion method.Results:Out of 615 sputum samples, 354 (57.56%) were culture positive. Out of these a total of 71 (20.05%) strains of Pseudomonas were isolated, where 54.93% was from males and 45.07% were from females (Mean age was 44.29 ± 22.72:). Highest sensitivity was seen to Amikacin (92.86%) followed by Meropenem (91.55%) while lowest sensitivity was seen to Cefoperazone + Sulbactam (16.9%). There were 39.44% MDR strains, out of which 25% were Extensively Drug Resistant (XDR) and 10.71% were Pan Drug Resistant (PDR). In vitro susceptibility of MDR isolates showed highest sensitivity to Amikacin (82.14%) followed by Carbapenems (78.57%). All MDR isolates were resistant to Cefoperazone + Sulbactam. Resistance to Piperacillin + Tazobactam was 96.43%.Conclusion:Pseudomonas aeruginosa is one of the commonly isolated organisms and it is becoming more resistant to commonly used antibiotics. Carbapenems and aminoglycosides were the two classes of drugs that showed highest activity against Pseudomonas aeruginosa.

Objective: This study intends to evaluate the knowledge, attitude and awareness of medical doctors toward influenza vaccination and the reasons for not getting vaccinated.Methods: A cross-sectional study was carried out among medical doctors in three major tertiary care health settings in Peshawar, Khyber Pakhtunkhwa (KP), Pakistan. A web-based, pre-tested questionnaire was used for data collection.Results: A total of (n = 300) medical doctors were invited, however only (n = 215) participated in the study with a response rate of 71.7%. Among the participants, 95.3% (n = 205) were males with a mean age of 28.67 ± 3.89 years. By designation, 121(56.3%) were trainee medical officers and 40 (18.6%) were house officers. The majority 102(47.4%) had a job experience of 1–2 years. Of the total sample, 38 (17.7%) doctors reported having received some kind of vaccination, whereas only 19 (8.84%) were vaccinated against influenza. The results identified that the major barriers toward influenza vaccinations included (1) Unfamiliarity with Influenza vaccination availability (Relative Importance Index RII = 0.830), (2) Unavailability of Influenza vaccines due to lack of proper storage area in the institution (RII = 0.634), (3) Cost of vaccine (RII = 0.608), and (4) insufficient staff to administer vaccine (RII = 0.589). Additionally, 156 (72.6%) of doctors were not aware of the influenza immunization recommendation and guidelines published by the Advisory Committee on Immunization Practices (ACIP) and Centre for Disease Control and Prevention (CDC). Physicians obtained a high score (8.27 ± 1.61) of knowledge and understanding regarding influenza and its vaccination followed by medical officers (8.06 ± 1.37). Linear Regression analysis revealed that gender was significantly associated with the knowledge score with males having a higher score (8.0± 1.39) than females (6.80 ± 1.61 β = −1.254 and CI [−2.152 to −0.355], p = 0.006).Conclusion: A very low proportion of doctors were vaccinated against influenza, despite the published guidelines and recommendations. Strategies that address multiple aspects like increasing awareness and the importance of the influenza vaccine, the international recommendations and enhancing access and availability of the vaccine are needed to improve its coverage and health outcomes.

The obesity epidemic has become the most blatantly visible public health problem globally. Industrialization, urbanization, and globalizations have resulted in the adoption of proobesity lifestyle. The incidence of non-communicable diseases (NCDs) is increasing at alarming rates globally. As of 2014, more than 1.9 billion adults 18 years and older were classified as overweight and more than 600 million as obese. Combined overweight and obesity account for more deaths worldwide than underweight [1][2][3].Obesity and its associated twin diabetes together comprise a major public health problem. The term diabesity is being used frequently to better describe the current twin epidemic [4].Body mass is the simplest and the most widely used parameter for measuring obesity. Body mass index (BMI) is calculated by dividing body weight in kilograms by height in meters squared (BMI = kg/m 2 ). It is the epidemiological and clinical parameter used to define obesity in most of the studies. According to the World Health Organization (WHO), a BMI of greater than or equal to 25 is classified as overweight and a BMI of greater than or equal to 30 is classified as obese. This is the most useful population-level measure of overweight and obesity. It does not measure the body fat directly and hence is an indirect measure of obesity [3]. Hence, it has several drawbacks. A person's body fat composition changes with age and increases as the person gets older. This is not necessarily reflected by the person's weight and height. Furthermore, the correspondence between BMI and body differs for both men and women. For example, a man and woman of the same height and weight may have the same BMI but women have higher body fat composition compared to men. Taking the debate one step further, several long-term studies have shown that individuals classified as overweight with respect to their BMI, by and large, had the same or in some instances better health profile outcomes as compared to those who had a normal BMI. These and other such studies have opened a new avenue for the researchers to look into the intrinsic limitations of BMI in differentiating adipose tissue from lean body mass [5,6].It is a well-accepted fact that central or abdominal fat is far more likely to be associated with chronic metabolic disorders rather than the overall excess weight reflected by BMI; several studies have reported a higher incidence of metabolic abnormalities in Indian population. The same studies have further gone on to document a higher incidence of cardio-metabolic abnormalities in Indians for any given level of BMI [7,8] Considering these observations, the WHO had lowered BMI cutoffs for overweight and obesity in Asians to 23 and 27 kg/ m 2 , respectively, mainly for public health action [9]. However, evidence used to establish this classification was obtained from only limited numbers of prevalence studies, not from more conclusive incidence or mortality data. This has generated debate about the appropriateness of ethnic-specific cutoff points for defini...