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Numerous indigenous plants may grow on Pakistan's soil due to its suitable climate. A few of these are now exploited as a source of expensive pharmaceuticals with therapeutic benefits. Since 4000-5000 B.C., people have used these native herbs as medicines. The Cordia gharaf plant is one of them. There are several phytochemicals found in plants, including flavonoids, alkaloids, tannins, phenolic compounds, and others, that can protect against disease. Many phytochemicals have a broad range of biological activities that help to protect against chronic illnesses, and around the world, they have been used to treat several different human ailments. According to a World Health Organization (WHO) report, more than 80% of the world's population uses traditional medicines for treatment and maintaining their health, and many valuable medications have been extracted from these medicinal plants. Therefore, scientific investigation is necessary to make enormous profits from these priceless medicinal plants. Due to the importance of the primary and secondary metabolites produced by these medicinal plants, our purpose includes the idea of examining biologically active components from these plants. Keeping in mind the foregoing, the goal of our research is to examine the phytochemicals from the selected species of Cordia gharaf that have disease-preventive properties.

This study investigated learner engagement with emerging technologies as a viable teaching and learning tool. This explorative study was conducted in a public university located in Sichuan Province, China involving 160 sophomore students. Data were collected via a questionnaire consisting of open and close-ended questions. The findings revealed that EFL students frequently used Tencent as the preferred platform for online distance learning. Besides that, the findings demonstrated students’ positive perception of learner-to-learner, learner-to-instructor, and learner-to-content interaction through the support of emerging technologies. Thus, it implies that emerging technologies have the potential to boost a quality learning environment. Keywords: EFL students, learner engagement, emerging technologies eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia.. DOI: https://doi.org/10.21834/ebpj.v8i24.4652

Research reveals that several factors affect the quality of learning environments. Therefore, this study investigated significant factors that affect postgraduate students’ learning environment with regard to graduate on time (GOT). The study was conducted in a private Malaysian university involving 50 PhD students. Data were collected via tests, a questionnaire, and focus-group interviews. The findings revealed that critical reading skills and supervisory factors were significant factors affecting students’ ability to GOT. This implies that universities should integrate early intervention training programs to hone students’ critical literacy skills and provide effective supervisory practices for a sustainable quality postgraduate learning environment. Keywords: postgraduate students; graduate-on-time; quality learning environment; influencing factors eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia.. DOI: https://doi.org/10.21834/ebpj.v8i24.4649

This study aimed to examine Sino-Foreign Joint School (SFJS) students’ speaking performance in the EFL learning environment and explore the relationship among anxiety, motivation, willingness to communicate (WTC) and English language performance of EFL students. The study adopted an explanatory sequential research design with a mixed method approach wherein data were collected via a survey and semi-structured interviews. The findings revealed that EFL students in SFJS were rather anxious when it came to speaking in English and but they possessed higher integrated motivation. The structural equation modelling analysis revealed SPCC (Self-Perceived Communication Competence) mediated WTC to their language achievement. Keywords: English as a foreign language (EFL); anxiety; motivation; willingness to speak eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v8i24.4653

Effective reading skills are often viewed as the foundation to learning a foreign language as it is a ‘comprehensible input’ when learning a language. Therefore, this study aimed to examine EFL tertiary students’ metacognitive awareness of reading strategies. The study was conducted in one provincial university in China, involving 424 EFL students. The study utilised an explanatory sequential research design. Data were collected via a reading test, a questionnaire and interviews. The findings revealed that students possessed medium levels of metacognitive awareness with global and problem-solving strategies significantly affecting EFL students’ reading comprehension performance. Keywords: Metacognitive Awareness; Reading Strategies; Quality EFL Teaching and Learning eISSN: 2398-4287 © 2023. The Authors. Published for AMER & cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), and cE-Bs (Centre for Environment-Behaviour Studies), College of Built Environment, Universiti Teknologi MARA, Malaysia.. DOI: https://doi.org/10.21834/ebpj.v8i24.4654

Geogrid-stabilised soil has been widely adopted to enhance performance in transportation and infrastructure sectors. In this study, the performance of unstabilised and triaxial-geogrid-stabilised sandy soils in terms of dynamic deformation modulus and elastic modulus was measured using lightweight deflectometer (LWD) and plate load tests (PLTs), respectively. The objective of the study was to evaluate: (a) dynamic deformation modulus of sandy soils with different relative compactions from deflectometer testing and compare with the elastic modulus of sandy soils from PLTs for a given relative compaction of 97%; (b) modulus improvement factors (MIFs) of triaxial-geogrid-stabilised sandy soils through extensive laboratory testing and (c) compaction quality control of well-graded gravel using deflectometer testing through a field study. The triaxial-geogrid-stabilised sandy soil layer showed MIFs of 1.51 and 1.37 obtained from deflectometer and plate load tests corresponding to an embedded depth of 50 mm, respectively. The percentage differences in these values are in the range of 4–9% for all the embedded depths. Hence, an LWD can be used instead of a PLT as a quick and low-cost alternative for determining the MIF of geogrid-stabilised sand soil, both in the laboratory and in the field.

Ever increasing global population necessitates the need to increase availability of affordable foods with high nutritional quality. Chickpea being the second most important grain legume cultivated worldwide has the great potential to alleviate problems of protein malnutrition and hidden hunger. The objective of the present investigation was to characterize a diverse set of 402 germplasm comprising of more than 100 commercial cultivars widely cultivated and utilized by breeders for grain protein in two contrasting environments to explore the magnitude of natural genotypic diversity present in the cultivated chickpea and the scope for enhancing it and its quality through breeding. The cultivars containing more than 25 to 30.44% grain protein have been found in the study and large scale production of such protein rich cultivars is expected to increase availability as well as consumption of high quality chickpea necessary to overcome all forms of malnutrition. Trait specific germplasm containing grain protein up to 33.56% are also identified for their further utilization as potential donors in the chickpea improvement programme. The amino acid profiling of selected high and low protein containing genotypes showed considerably greater average amino acid score for all the essential amino acids than the WHO recommended requirement values and is comparable to those of the ‘complete protein’ sources of food suggesting that chickpea deserves to be considered as a ‘complete protein’ source.

Introduction: Appendiceal goblet cell adenocarcinoma is a rare cancer that usually has histological features of both well-differentiated carcinoid tumors and adenocarcinomas (neuroendocrine cells are not required for the diagnosis). Appendiceal goblet cell adenocarcinoma can present as acute appendicitis, abdominal pain, a mass, or be discovered incidentally following appendectomy. Case Report: A 67-year-old female presented with signs of acute appendicitis and underwent laparoscopic appendectomy. Pathological evaluation showed evidence of both acute appendicitis/periappendicitis and an incidental appendiceal intramucosal well-differentiated adenocarcinoma in the lamina propria of a 12 mm long segment in the middle of the proximal half of the appendix. Conclusion: Appendiceal goblet cell adenocarcinoma can sometimes be an incidental finding. It can be difficult to identify it, especially when it is in the form of only a few cells and clusters of cells limited to lamina propria. This case is the first reported incidence of an intramucosal goblet cell adenocarcinoma that was present in a 12 mm long segment in the middle of the proximal half of the appendix. The location of this tumor provides justification for making submission of an appendix in its entirety for histologic examination as a standard-of-care.

Aim: The present study is an attempt to evaluate the impact of earthworm diversity on physico-chemical parameters of soil in different cropping systems (i.e. basmati-wheat, basmati-chickpea, soybean-wheat, moong-wheat) under organic and conventional farming systems. Place and Duration of Study: The study was conducted at the School of Organic Farming, Punjab Agricultural University, Ludhiana, Punjab, India from June, 2020 to March 2021. Methodology: The four earthworm species found during the study period are Metaphire posthuma, Lampito mauritti, Amynthas morissia and Travoscolides chengannure, which belong to two families i.e. Megascolicidae and Octochateidae. Out of these Travoscolides chengannure was reported for the first time in Punjab. Results: The results indicate that richer earthworm diversity was found in the organic farming systems as compared to the conventional farming systems. The correlation analysis of earthworm abundance with the physicochemical parameters of soil in different farming systems revealed that the abundance of earthworms in organic farming system shows positive but non-significant correlation with pH, nitrogen and potassium levels. In conventional farming system, significant positive correlation (p=0.01) was found for organic carbon, electric conductivity and nitrogen. Conclusion: The findings of this encourage switching from conventional to organic farming practices. These practices not only increase earthworm diversity, but enrich the soil with many major and micro-nutrients. The agriculture practices which are earthworm-friendly should be adopted for long-term soil productivity.

The TGFβ signaling mediator SMAD4 is frequently mutated or deleted in colorectal and pancreatic cancers. SMAD4 acts as a tumor suppressor and its loss is associated with poorer patient outcomes. The purpose of this study was to find synthetic lethal interactions with SMAD4 deficiency to find novel therapeutic strategies for the treatment of patients with SMAD4-deficient colorectal or pancreatic cancers. Using pooled lentiviral single-guide RNA libraries, we conducted genome-wide loss-of-function screens in Cas9-expressing colorectal and pancreatic cancer cells harboring altered or wild-type SMAD4. The small GTPase protein RAB10 was identified and validated as a susceptibility gene in SMAD4-altered colorectal and pancreatic cancer cells. Rescue assays showed that RAB10 reintroduction reversed the antiproliferative effects of RAB10 knockout in SMAD4-negative cell lines. Further investigation is necessary to shed light on the mechanism by which RAB10 inhibition decreases cell proliferation of SMAD4-negative cells. Significance: This study identified and validated RAB10 as new synthetic lethal gene with SMAD4. This was achieved by conducting a whole-genome CRISPR screens in different colorectal and pancreatic cell lines. A future RAB10 inhibitors could correspond to a new therapeutic solution for patients with cancer with SMAD4 deletion.

Continued demand for polyolefins can be met by recycling plastic materials back to their constituent monomers, ethylene and propylene, via thermal cracking in a pyrolysis reactor. During pyrolysis, saturated polyolefin chains break carbon-carbon and carbon-hydrogen bonds, yielding a distribution of alkanes, alkenes, aromatic chemicals, light gases, and solid char residue at temperatures varying from 400-800 °C. To design a pyrolysis reactor that optimizes the chemistry for maximum yield of light olefins, a detailed description of the chemical mechanisms and associated kinetics is required. To that end, the reaction kinetics of isothermal films of low-density polyethylene (LDPE) have been measured by the method of ‘Pulse-Heated Analysis of Solid Reactions,’ or PHASR, which allows for quantification of intrinsic kinetics via isothermal reaction-controlled experimental conditions. The evolution of LDPE films from 20 milliseconds to 2.0 seconds for five temperatures (550, 575, 600, 625, and 650 °C) was characterized by measurement of the yield of chromatography-detectable compounds (

Background: The objective was to study and analyze maternal serum alpha-fetoprotein levels as a biomarker of placental adherence in low lying placenta. Methods: This was a prospective observational study analysing the conditions and the data of 80 cases with low lying placenta in a tertiary care hospital. The analysis was done for the association of MSAFP with MRI, perinatal and maternal outcome. Results: The level of MSAFP was found higher in 12 out of 13 cases (93.3%) of placenta previa with placental adherence. There was significant surgical intervention (80%) and increased maternal morbidity (68.8%) in the study group with placental adherence and raised MSAFP respectively. Conclusions: MSAFP is an important biomarker for prognostication of placental adherence in low lying placenta.

We present a charge distribution-based emission model that calculates the infrared spectrum of fullerenes (C60). Analysis of the modelled spectrum of C60 in various charge states shows that the relative intensity of the features in the 5–10 μm versus 15–20 μm can be used to probe the C60 charge state in interstellar spectra. We further used our model to simulate emission from polycyclic aromatic hydrocarbons (PAHs) and C60 at five positions in the cavity of reflection nebula NGC 7023. Specifically, we modelled the 6.2/11.2 band ratio for circumcoronene and circumcircumcoronene and the 7.0/19.0 band ratio for C60 as a function of the ionization parameter γ. A comparison of the model results with the observed band ratios shows that the γ values in the cavity do not vary significantly, suggesting that the emission in the cavity does not originate from locations at the projected distances. Furthermore, we find that the C60-derived γ values are lower than the PAH-derived values by an order of magnitude. We discuss likely scenarios for this discrepancy. In one scenario, we attribute the differences in the derived γ values to the uncertainties in the electron recombination rates of PAHs and C60. In the other scenario, we suggest that PAHs and C60 are not co-spatial resulting in different γ values from their respective models. We highlight that experiments to determine necessary rates will be required in validating either one of the scenarios.

Flaxseed is a useful source of omega-3 fatty acid and many health-promoting phytochemicals. Baked products are extensively consumed in the Arabic countries. This study mainly aimed to improve the nutritional quality of pan and Arabic flat breads by adding whole and crushed flaxseed. The study objects were pan and Arabic flat breads wholegrain and white wheat flour with whole or crushed flaxseed at different amounts. The proximate composition, texture, color characteristics, and sensory analysis were evaluated by standard methods. The fat content increased in both the white wheat flour and in the wholegrain wheat flour pan breads with 8% of crushed flaxseed. The addition of 8% of crushed flaxseed to the white wheat flour bread also increased its specific loaf volume, while the addition of 8% of whole flaxseed significantly decreased the specific loaf volume of the wholegrain wheat flour bread. Crushed flaxseed did not affect the L* values, but significantly increased the a* values in the white wheat flour pan bread. Supplementing the white wheat flour pan bread with 8% of whole flaxseed decreased the compression force, thus indicating a softer texture. 8% of whole flaxseed significantly increased fat and protein contents of the white wheat and wholegrain wheat flour pan breads. Similar trends were observed for the Arabic breads, thus proving the enhancing effect of flaxseed on the nutritional quality of these baked products. The addition of crushed flaxseed to white wheat flour Arabic bread adversely affected its appearance and crust color, as well as significantly increased its ash, fat, protein, and dietary fiber contents. However, it did not have any adverse effect on the texture, flexibility, and flavor. Flaxseed grains in the amount of 8% can be recommended to produce baked products with good sensory and nutritional qualities.

Purpose To assess optic nerve head (ONH) and macular blood flow in young healthy volunteers using laser speckle flowgraphy (LSFG). Methods This is a prospective single-center study conducted at the Department of Ophthalmology, University Hospital Zurich from May to November 2021. Young, healthy men aged ≥ 18 years without ocular or systemic diseases were included. A corrected visual acuity (VA) of 0.0 logMAR or better in both eyes and an intraocular pressure (IOP) of 21 mmHg or lower were required for inclusion. Subjects exceeding a spherical equivalent (SE) of ± 6 diopters (dpt) were excluded. Blood flow in the macula and the ONH was recorded using the Nidek LSFG RetFlow device (Nidek Company, Ltd., Hirioshi-cho, Japan). Laser power was set to 0.5 Millivolts (mV). Mean blur rate (MBR) was recorded as a parameter for blood flow. MBR is a calculated parameter that represents relative blood flow velocity correlated with the real anatomical blood flow rate. Colored heat maps of the recorded retinal area were generated automatically by the RetFlow device. Results Final analyses included 83 eyes of 43 male volunteers. Mean age was 21.9 years (SD ± 1.5, range: 20 to 29). Mean corrected VA was − 0.1 logMAR (SD ± 0.05, range: − 0.2 to 0.0), mean IOP was 15.4 mmHg (SD ± 2.5, range: 8.5 to 18.5), and mean SE was − 0.3 dpt (SD ± 1.2, range: − 5.0 to 1.2). Mean ONH MBR was 37.44 (SD ± 7.9, range: 22.5 to 53.5) and mean macular MBR was 27.8 (SD ± 9.7, range: 6.4 to 57.7). Pearsonʼs Test showed a strong correlation between macular and papillary blood flow (p Conclusion This study provides both ONH and macular blood flow data in a healthy young male population, showing a strong correlation between ONH and macular blood flow in the examined eyes. Further investigations are required to assess the validity of MBR as a parameter for the combined evaluation of retinal blood flow at the macula and ONH in healthy volunteers and patients with various diseases.

Augmented reality (AR) is a significant Fourth Industrial Revolution (IR4.0) technology that employs computer-generated display, sound, text, and effects to enhance the user's real-world experience via wearable devices. Order picking processes have had a substantial influence on overall operational efficiency in warehouse management systems (WMS). The conventional picking process is challenging to handle, which may result in deviations from the intended picking performance. Pick-by-vision, a new technological solution for order picking, is receiving growing attention and is now considered a significant WMS-supporting technology. This article explores the positive implications and prospects of utilizing AR pick-by-vision technology in the warehouse picking processes by performing a narrative review of the previous review articles. To demonstrate the focus of the main area, this study also presents the hierarchical classification structure of AR implementation in WMS and highlights the pick-by-vision method. The analysis provided important key findings by evaluating 23 articles (original articles and case studies) on AR pick-by-vision technology applications, which are significant to the prospective advantages of AR pick-by-vision deployment in warehouse operations. This study gathers knowledge and insight that can be used by both academics and professionals who are interested in optimizing this new advanced technology for future research.

This review article is focused on internal flesh browning (IFB)-related physiological disorders affecting apple (Malus domestica Borkh.) fruit. The expression of different physiological and metabolic IFB-related disorders during post-harvest storage are investigated along with the pre-harvest factors contributing to development. The effectiveness of commercially available pre-harvest technologies for preventing IFB-related disorders are also examined. Internal flesh browning-related disorders are erratic and devastating disorders that result in post-harvest deterioration of fruit quality in apples. Internal flesh browning-related disorders can result in severe economic losses to the apple industry through reduced consumer trust and market acceptability of susceptible cultivars. There are several IFB-related disorders and incidence can range from 0 to 100% of a crop, with severity ranging from no brown flesh to browning of the entire fruit flesh. While IFB-related disorders are found in several apple cultivars, some cultivars are more prone than others. The development of IFB-related disorders involve complex mechanisms depending upon the different types and causes, or factors involved in loss of structural integrity and functional stability of the cell membranes and cell components. Membrane disruption followed by enzymatic oxidation of fruit phenolic compounds by polyphenol oxidases and the production of brown polymers is considered to be the general underlying mechanism causing the browning of flesh tissue. It can be observed in different patterns based on the injured portion of the fruit flesh and the cause of membrane disruption. Three broad categories of IFB-related disorders, including chilling injury, internal CO2 injury, and senescent-related browning disorders, are discussed along with their sub-types. The development of IFB-related disorders can be influenced by both pre-harvest factors and post-harvest conditions and their interactions. Although commonly associated with storage, IFB can also be found immediately after harvest and sometimes in unharvested fruit prior to full maturity. As pre-harvest conditions are a strong contributor to IFB-related disorders, the influence of several pre-harvest orchard conditions, including fruit size, crop load, maturity at harvest, cultivar, climatic conditions, seasonal temperatures, growing degree days, and major mineral nutrients, such as nitrogen (N), phosphorus (P), potassium (K), and calcium (Ca) are reported. Although there are contradictory findings in the studies reported, in general, factors such as larger fruit size, light crop load and delayed harvesting, along with cool temperatures after bloom and warmer temperatures before harvest, increase the risk of IFB-related disorders. In relation to fruit mineral concentrations, high N and low Ca have been associated with increasing IFB, while there is conflicting evidence in relation to the impact of both P and K. This review also examines the effectiveness of commercial pre-harvest technologies such as 1-methylcyclopropene, aminoethoxyvinylglycine and diphenylamine in the prevention of IFB-related disorders, but none of these technologies were found promising due to varied and contradictory results.

Pumpkins being cheap and having higher medicinal value can act as a saviour to low-income families. Butbeing a minor crop, little attention has been paid to its improvement. The hybridization in pumpkins is economicallyfeasible due to the monoecious nature and higher number of seeds per fruit. Moreover, the development of superiorhybrids can enhance production and consumption through ease in cultivation, meeting consumers’ preferencesand suitability to different seasons. Hitherto, 34 F1 hybrids were evaluated during spring and rainy seasons forstandard heterosis. H9 (P-225 × GFR-6783) and H28 (VR-1365 × VR-13364) hybrids exhibited maximum standardheterosis for yield per plant and can be exploited for commercial cultivation. Resistance to PYVMD is a pre-requisitefor the successful cultivation of pumpkin in the rainy season. 11 hybrids (H24, H25, H26, H27, H28, H29, H30, H31,H32, H33 and H34) tolerant to PYVMD offered the advantage of cultivating pumpkin in both seasons.

The purpose of this study was to explore the relationship between foreign language enjoyment, grit, and English language performance. This study adopted a descriptive correlational research design involving 388 Chinese EFL university students. Self-reported questionnaires and the College English Test-Band 4 were utilised to collect the data. The findings reported a moderate to high level of language enjoyment and grit among the students. No significant differences were found between male and female students regarding their language enjoyment and grit. Furthermore, the path analysis showed that language enjoyment and grit could significantly predict English language performance. Keywords: foreign language enjoyment; grit; sustainable language learning; positive psychology eISSN: 2398-4287 © 2023. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI

Background: Despite large-scale investment in health service delivery outsourcing, few studies have examined human resources for health (HRH) in Afghanistan. Aims: To review the HRH situation of outsourced healthcare services in Afghanistan and evaluate nongovernment organization (NGO) investments in the health workforce. Methods: Two questionnaires were used for data collection. One gathered information about the characteristics of HRH in 2020 and the other collected budgetary data for 2017–2020 to analyse budget allocation and expenditure by NGOs on the health workforce. Results: A total of 25 262 (65% male, 35% female) individuals were employed by NGOs in 31 provinces of Afghanistan. There was a critical shortage of personnel and a prevalence of gender imbalance across all provinces. Healthcare workers were mostly aged 26 to 30 years. Services were mostly provided by local NGOs and their scopes were not limited to outsourced projects. More than 75% of the budget of NGOs was allocated to the health workforce in 2017–2020, and more than 70% of allocations was spent on staff salaries, followed by other health workforce expenditure. Less than 5% was spent on capacity building. Conclusion: There is a gross shortage and large gender imbalance in the Afghanistan health workforce. It is essential to maintain and increase current financial and technical investments to ensure sustainability and enhance the fragile health system in Afghanistan.

This article represents a Multiple Input Multiple Output (MIMO) hybrid fractal antenna with wider bandwidth. The hybrid fractal MIMO antenna is created by integrating Minkowski and Koch curves on a half octagonal radiating patch. A wider impedance bandwidth 20.4GHz (1.0 to 21.4GHz) and 6.10GHz (23.9 to 30GHz) along with fractional bandwidth of 182.14% and 22.63% has been achieved by using an amalgamated fractal configuration and a tapered microstrip line feed. The proposed antenna retains high isolation between -20 to -50dB in the entire frequency range along with the DG value greater than 9.99 dB and the ECC less than 0.02. The operating frequency increases from 1.5GHz to 8.5GHz with gain of 8dBi .The gain is almost flat and varies between 4dBi to 7dBi in the frequency range from 8.5GHz to 21.1GHz. Further, in the frequency range from 23.9 to 25.9GHz, the gain rises exponentially to 14dBi Hence, the proposed hybrid fractal MIMO antenna is a proficient candidate for 5G, 3.5GHz band (3.4 – 3.6GHz), 5G NR (New Radio) frequency bands (3.3 – 5.0GHz), LTE band 46 (5.15 – 5.925GHz), EU (European Union) 5G frequency band (5.9 – 6.4GHz), UWB applications (3.1 – 10.6GHz) and 5G 26GHz frequency band.

Dental fluorosis is a dental enamel development disturbance caused by repeated exposure to high fluoride concentrations during tooth development, resulting in enamel with a lower mineral content and more porosity. Dental fluorosis shows white opaque appearance of hypomineralized enamel subsurface, with pitting and subsequent loss of enamel surface leads to brown color. The lesions take place in these forms : hypoplasia of dental enamel, pitting, decalcified areas, mottling, brownin. Fluorides are always considered as double-edged sword. Fluorides are necessary for the healthy growth and development of the body, however excessive fluoride intake can be harmful and causes severe deformities by understanding the sources of fluoride, knowing to avoid over exposure, fluorosis can be prevented. They are also treated with bleaching, micro abrasion, resin infiltration, resin infiltration with bleaching, and microabrasion with bleaching.

Background: Aromatase inhibitors (AIs) are highly effective at reducing recurrences and mortality in postmenopausal patients with estrogen receptor positive breast cancer (ER+ BC). Poor anti-proliferative (Ki67) response or ER+ BCs to AIs after 2 weeks is associated with worse long-term outcomes. Factors that relate to the degree of the response may identify markers and/or mechansims of resistance. Methods: The PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial randomized 4,480 with ER+ BC to 2 weeks’ AI before surgery or no presurgical treatment. All patients within the bottom 15% of Ki67 responders to AI (poor responders [PRs]; n=177 with RNA extracted) were selected from and matched to good responders (GRs) within the 50% showing the best response (n=190). Matching was based on baseline Ki67 levels as measured by immunohistochemistry (IHC). Response to AI was measured by the percentage change in Ki67 after 2 weeks’ treatment. PRs were further divided into groups expressing high ESR1 (PRs ESR1HIGH; n=119) and low ESR1 (PRs ESR1LOW; n=58) levels since there were very few GRs with low ESR1. RNAseq, targeted exome DNA sequencing of 87 BC/resistance related genes and measurement of plasma estradiol levels by mass spectrometry were performed to understand mechanisms of de novo resistance. Intrinsic subtypes were estimated from RNAseq data. Results: More than 90% of PRs ESR1LOW were non-luminal subtypes with low expression of estrogen-responsive genes. In contrast, 11% of PRs ESR1HIGH were non-luminal compared to 4% of GRs but only HER2-enriched subtypes were significantly higher in PR ESR1HIGH (p=0.05, Fisher exact). While AI treatment had limited impact on Ki67 IHC values in PRs ESR1HIGH, PGR expression was more than 2-fold lower after 2 weeks of AI. Gene-set enrichment analysis showed significantly lower expression of estrogen-response genes in PRs ESR1HIGH compared to GRs (FDR< 10-9) at baseline despite similar percentage of Luminal subtypes in PRs ESR1HIGH and GRs. Plasma estradiol levels were correlated with expression of estrogen-response genes (FDR=0.01) and levels were significantly lower in PRs ESR1HIGH compared to GRs (p=0.003, Mann Whitney). PRs ESR1HIGH had significantly more mutations in RB1, TP53, ARID1B and DNAH11 genes (p< 0.05, Fisher exact). TP53 mutations were significantly enriched in Luminal-A PRs ESR1HIGH compared to GRs (22% and 3% respectively; p=0.003, Fisher exact), but not in Luminal-B tumors (23% and 15% mutated respectively). Discussion and conclusions: In approximately 33% of PRs, de novo AI resistance was associated with and most likely due to low expression of ER/ESR1 and estrogen-responsive genes in non-luminal tumors. In the remaining tumors, AI treatment still impacted some estrogen responsive genes but had limited downstream impact on suppressing proliferation. This might be due to mutations including in TP53 that limit suppression of proliferation downstream of estrogen signaling. The proportion of Luminal tumors in GRs and PRs ESR1HIGH was similar, suggesting better outcome of Luminal-A tumors on AI is likely due to their better intrinsic prognosis rather than better response to endocrine therapy. Citation Format: Eugene F. Schuster, Elena López-Knowles, Anastasia Alataki, Lila Zabaglo, Elizabeth Folkerd, David Evans, Kally Sidhu, Holly Tovey, Perry Maxwell, Nicholas Turner, Stephen Johnston, Manuel Salto-Tellez, Maggie Chon U Cheang, John Robertson, Ian Smith, Judith Bliss, Mitch Dowsett. PD10-07 Low plasma estradiol, low expression of estrogen responsive genes and TP53 mutations are associated with poor anti-proliferative response to aromatase inhibitors [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD10-07.

A substantial proportion of patients with heart failure and kidney disease have poorly controlled blood pressures. This study aimed to evaluate patterns of blood pressure after initiation of an angiotensin receptor neprilysin inhibitor (ARNI) or an angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) across the spectrum of kidney function.Between 2016 and 2020, we evaluated 26,091 patients admitted to a Veterans Affairs hospital for an acute heart failure exacerbation with reduced ejection fraction. We assessed patterns of systolic and diastolic blood pressure among those started on ARNI or ACEI/ARB over 6 months, overall and across estimated glomerular filtration rate (eGFR). To account for differential treatment factors, we applied 1:1 propensity score matching using 15 known baseline covariates.There were 13,781 individuals treated with an ACEI or ARB and 2589 individuals treated with an ARNI prescription. After propensity score matching, 839 patients were matched in each of the ARNI and ACEI/ARB groups. Mean baseline estimated glomerular filtration rate (eGFR) was 63.8 (standard deviation 21.6), and 10% had stage 4 or 5 chronic kidney disease. Patients in the ARNI group experienced greater systolic blood pressure reduction at month 3 (-5.2 mmHg vs -2.2 mmHg, ARNI vs ACEI/ARB; P0.001), and month 6 (-4.7 mmHg vs -1.85 mmHg, ARNI vs ACEI/ARB; P0.001). These differences in systolic blood pressure by 6 months did not vary by eGFR above and below 60 mL/min/1.73mThe use of ARNI was associated with significant reduction in blood pressure as compared to the ACEI/ARB group overall and across the eGFR spectrum, including in advanced chronic kidney disease.

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease from fatty accumulation (steatosis), necro-inflammation though to fibrosis. It is of increasing global prevalence as a hepatic manifestation of the metabolic syndrome. Although accurate histopathology and magnetic resonance imaging techniques for hepatic fat quantification exist, these are limited by invasiveness and availability, respectively. Ultrasonography is potentially ideal for assessing and monitoring hepatic steatosis given the examination is rapid and readily available. Traditional ultrasound methods include qualitative B-mode for imaging markers, such as increased hepatic parenchymal echogenicity compared to adjacent renal cortex are commonplace; however, there is acknowledged significant interobserver variability and they are suboptimal for detecting mild steatosis. Recently quantitative ultrasound metrics have been investigated as biomarkers for hepatic steatosis. These methods rely on changes in backscatter, attenuation, and speed of sound differences encountered in a steatotic liver. Prospective studies using quantitative ultrasound parameters show good diagnostic performance even at low steatosis grades and in NAFLD. This review aims to define the clinical need for ultrasound-based assessments of liver steatosis, to describe briefly the physics that underpins the various techniques available, and to assess the evidence base for the effectiveness of the techniques that are available commercially from various ultrasound vendors.

Background: Aromatase inhibitors (AIs) are one of the main treatment strategies for the clinical management of estrogen receptor-positive (ER+) breast cancer (BC). Despite prolonged time to recurrence and initial clinical responses, >20% of patients eventually relapse, and previous studies have shown an association of poor anti-proliferative response to AIs and worse outcome. High immune activity in ER+ tumors may be associated with worse outcome, in contrast to ER-negative BC where immune infiltration is a feature associated with better outcome. Our work focused on understanding the correlations between immune cell infiltration and response to AI. Methods: All patients with ER+ HER2- tumors within the bottom 15% of Ki67 anti-proliferative responders to AIs (poor responders [PRs]; n=177) were selected from the PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial and matched on baseline Ki67 levels to good responders (GRs) within the 50% showing the best response (n=190). Response to AI was measured by the Ki67 percentage change after 2 weeks of treatment. PRs were further divided into groups expressing high ESR1 (PRs ESR1HIGH; n=119) and low ESR1 (PRs ESR1LOW; n=58) levels to represent PR subgroups that showed partial or no response to AIs. The percentage of stromal tumor-infiltrating lymphocytes (TILs) was assessed. Multiple immunofluorescence was performed for ER, CD3, CD20, CD68, FOXP3, and CD3/FOXP3 in 15 baseline samples from each of the GR, PR ESR1HIGH, and PR ESR1LOW populations and immune cell density in stromal or tumor compartments was estimated. Spearman correlations of TILs with Consensus tumor microenvironment (TME) deconvolution and Molecular Signatures Database hallmark gene sets were conducted. The relationship between the immune markers’ density and genes, hallmark gene sets and Consensus TME was assessed. Results: The percentage of TILs was significantly higher in the PR ESR1HIGH and PR ESR1LOW compared to the GRs (adjusted p< 0.05). As expected, TILs were highly correlated with T cells (particularly T-regulatory cells) and immune hallmark gene sets. There was a tendency for higher density of each of the immune markers in PRs compared to GRs, with significant differences being observed in stromal B-cell marker CD20 density (p< 0.05). Analysis showed a significant correlation between TILs and stromal FOXP3 marker density (FDR< 0.05), and stromal biomarker density was highly correlated to the gene expression of the encoding genes of the same tumors (CD3/CD3D, FOXP3/FOXP3, and CD20/MS4A1) (FDRs< 0.05). There was also a strong and significant correlation between the stromal expression of CD20, CD3, FOXP3, and CD3/FOXP3 with the immune hallmark gene sets (FDRs< 0.05). Finally, the immune phenotyping showed the expected correlations with TME deconvolution, with particularly strong correlations of CD20 and CD3 with B- and T-cell gene signatures, respectively (FDRs< 0.05). Conclusions: Different immune features indicated a broad involvement of several immune cell types in PRs to AIs, suggesting that the immune system might be associated with resistance of ER+ breast tumors to AI treatment. Spatial gene expression profiling is ongoing to characterize these tumors further and investigate potential mechanisms of AI resistance. Citation Format: Anastasia Alataki, Gene Schuster, Lila Zabaglo, Perry Maxwell, Elena López-Knowles, Elizabeth Folkerd, David Evans, Kally Sidhu, Holly Tovey, Nicholas Turner, Stephen Johnston, Maggie Chon U Cheang, John Robertson, Manuel Salto-Tellez, Ian Smith, Judith Bliss, Mitch Dowsett. PD10-08 Immune cell infiltration associated with poor anti-proliferative response to aromatase inhibitors in postmenopausal women with primary ER-positive HER2-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD10-08.

Background: The Afghanistan Reconstruction Trust Fund, managed by the World Bank through a contracted-out instrument called Sehatmandi, financed health service delivery in Afghanistan, with substantial achievements in infant, child and maternal health. After the collapse of the Afghan Government on 15 August 2021, the health system has been on the brink of collapse. Aims: We assessed the use of basic health services and estimated excess mortality resulting from the interruption to healthcare funding. Methods: We conducted a cross-sectional study that compared health services utilization from June to September for 3 consecutive years, 2019, 2020 and 2021, using 11 output indicators reported by the health management and information system. We used the Lives Saved Tool, a linear mathematical model with input data from the Afghanistan Demographic Health Survey 2015, to calculate the additional maternal, neonatal and child mortality at 25%, 50%, 75% and 95% reduction in health coverage. Results: During August and September 2021, after the announced ban on financing, health service utilization decreased to a range of 7–59%. Family planning, major surgeries and postnatal care showed the greatest decreases. Uptake of child immunization showed one-third decrease. Sehatmandi provides around 75% of primary and secondary health services: pausing funds to this programme will result in additional 2862 maternal deaths, 15 741 neonatal deaths, 30 519 child deaths, and 4057 stillbirths. Conclusion: Sustaining the current level of health services delivery is crucial to avoid excess, preventable morbidity and mortality in Afghanistan.

Background: Adverse drug reactions are important causes of mortality and morbidity in the patients. Early detection, evaluation and monitoring of ADRs is essential to improve public health. Methods: This was an observational, non-interventional and retrospective study conducted at the ADR monitoring centre of a tertiary care hospital of North India. Suspected ADR forms reported over a period of 4 years involving at least one chemotherapeutic drug with at least one dose were analyzed. Results: A total of 261 chemotherapeutic drugs associated ADRs were analyzed. Out of these, maximum numbers of ADRs were reported by males (54%). Maximum reporting was done by Skin and VD department (37.93%). Causality assessment was probable in maximum number of cases (54%). Most common ADRs were skin rashes (21.46%), followed by jaundice, urticaria and fixed drug eruptions. Maximum ADRs were suspected to be caused by Anti tubercular drugs (31.42%) followed by anticancer drugs (14.56%). Conclusions: ADRs due to antibiotics and anticancer drugs is a significant health problem.