Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care.
Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) on an iPad4 tablet as compared to a 2 MP display monitor.
Methods: This is a cross-sectional study. It was carried out in the Radiology department at Aga Khan University Hospital -Nairobi (AKUHN).
The images of selected CT KUB examinations were anonymised, coded and stored in a PACS folder.The calculated sample size (n) was 115 CT KUB images.
These were then reviewed by two radiologists independently on an iPad and on a 2 MP PACS workstation 4 weeks later to minimize recall bias.
Data analysis: Study data was recorded by entered into a spreadsheet (Excel, Microsoft Corporation). Analysis was done using the statistical program for social scientists (SPSS) version 17. Two by two tables, were constructed. Diagnostic accuracy (sensitivity and specificity), were calculated from this data.
Results: The IPAD tablet showed a sensitivity of 92.3% and specificity of 93.4%. Area under curve (AUC) for the IPAD tablet as compared to the 2 MP display monitor was 0.93 (95% CI 0.87-0.99) showing a very high diagnostic accuracy of iPad tablets. The two display instruments showed a very high degree of agreement of 93% with a kappa statistic of 0.847, p<0.001.
Discussion: These findings therefore mean that the iPad 4 has high sensitivity and specificity for the diagnosis of urolithiasis and can be used to view these images. These findings replicate other similar studies
Recommendations: This study and many other studies have shown a high sensitivity and specificity of the iPad in the diagnosis of pathology in CT images of the chest, head and abdomen. As such the radiology department should adopt the tablet to enable remote access of images.
قرآن مجید میں کثیر آیاتِ مبارکہ ہیں جن میں استفہامیہ اندازِ خطاب اپنایا گیا ہے ۔ چونکہ قرآنِ مجید کا یہ اعجاز ہے کہ اس میں بہت سے اسرار و رموز چھپے ہیں جو کہ گرائمر اور علوم و فنون کے اعتبار سے مختلف ہیں۔ لہذا فصل ہذا میں قرآن مجید سےحروف ِ استفہامیہ اور اسمائے استفہامیہ پر مشتمل آیات کو نقل کیا جائے گا اور تفسیری اسرار و حکم کو بیان کیا جائے گا۔
تُعنى هذه الدراسة ببيان نظام الحكم الديمقراطي عند سبينوزا ، والذي له أهمية كبيرة في الفلسفة الحديثة بصورة عامة، والفلسفة السياسية بصورة خاصة ، والذي يصفه سبينوزا بأنه الأفضل من بين أنظمة حكم الدولة الموجودة، وكل ذلك من خلال بيان الفلسفة السياسية عنده ، لتكون الصورة واضحة ومتكاملة، وقد استخدمنا المنهج الوصفي في بيان أفكاره السياسية ، وتتبع هذه الأفكار بصورة تفصيلية، من خلال مقدمة ومجموعة من المحاور وخاتمة ونتائج لهذه الدراسة، والتي توصلنا من خلالها إلى إن ما يدعو إليه سبينوزا من خلال فلسفة السياسية في إدارة الدولة هو النظام الديمقراطي، لأنه أفضل الأنظمة السياسية التي تحقق العدالة والمساواة والحرية للمجتمع ، والطمأنينة والسلام والسعادة للفرد.
The study explores dynamics of Pakistan’s Counter Terrorism (CT) strategy since 9/11 from a neoclassical realist perspective. It argues that Pakistan’s strained regional security milieu, weak civilian law enforcing and CT coordination agencies, coupled with asymmetric relationship with the US, have been shaping Pakistan’s CT policy since 9/11. Terrorist attack on mainland USA on 9/11, 2001, triggered a paradigm shift in the landscape of international and regional security having impact on Pakistan’s polity and national security. South Asia, particularly Afghanistan and Pakistan figured out prominently in the US national security objectives. US succeeded to garner international coalition and brought about tremendous pressure on Pakistan to support US war on terror against Al-Qaida and Taliban regime in Afghanistan. India seized the strategic opportunity by not only aligning with the US counter terrorism strategy in the region but offering military bases as well. This strategic move by India precipitated Pakistan’s security dilemma with two front threat scenario. US- Pakistan divergence over prosecution of war on terror impacted a comprehensive response against this menace of global, regional and domestic security. India by capitalized on antiPakistan international sentiment strengthened its position in Kashmir and attempted to lump freedom struggle with terrorism. Internal religious-political polarization in Pakistan, psyche of ruling elite and capacity constraints of civilian law enforcement, CT coordination agencies and prosecution and judicial institutions complicated the effective fight against terrorism at home. The external support to domestic terrorist entities destabilized Pakistan and paved way for horrific APS Peshawar carnage in December 2014. However, the event acted as a catalyst in uniting Pakistani nation and vowing to eliminate this scourge comprehensively. By 2018, Pakistan military with national support succeed in defeating terrorist groups and purged FATA of all terrorist entities. However, non-kinetic aspects of National Action Plan (NAP) merit enforcement in true letter and spirit. The study too, provides a comprehensive framework for combating terrorism in Pakistan.