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In 2022, national health expenditures in the United States were estimated to have grown from 2.7% to 4.3% and increased further in 2023, reaching an estimated $5.2 trillion. Medicare alone, in 2021, accounted for 21% of national health care spending, amounting to $689 billion in total Medicare expenditures. The Mark Cuban Cost Plus Drug Company (MCCPDC) Model offers a solution by providing prescription medications at lower costs. The objective of this study was to assess the effectiveness of the MCCPDC model in reducing men’s health drug costs compared to Medicare Part D. A comprehensive analysis was conducted on the “Men’s Health” drugs available through the MCCPDC. Prices, including dispensing and shipping fees, were collected for the minimum quantity (30 count) and maximum quantity (90 count) from the MCCPDC. Unit costs and total savings were calculated, and unit prices for 30 count and 90 count prescriptions were compared between Medicare and the MCCPDC. Of the 15 medications in our sample, Medicare’s expenditure amounted to $1.8 billion, with the MCCPDC displaying lower prices overall compared to Medicare. Evaluating 30 count prescriptions, 11 of 15 (73.3%) men’s health drugs resulted in total cost savings of $1.1 billion. For 90 count prescriptions, all 15 drugs yielded savings totaling $1.3 billion. Our study findings highlight substantial potential for cost savings if Medicare were to adjust its contracted rates to those currently set by the MCCPDC. We recommend that healthcare providers include the MCCPDC in patient counseling sessions to educate patients about accessing medications at lower prices. Integrating the MCCPDC as a resource can contribute to significant savings and improve medication affordability.

Foodborne diseases are very easily transmitted from contaminated food and food handlers. Bacteria and fungi are the major factors for fruit spoilage. Food spoilage causes losses to producers, distributors, and consumers in the form of reduced quality and quantity and higher prices. The objective of this study was to isolate and evaluate the antifungal analysis of food-borne fungal pathogens. For the evaluation of pathogenic fungi Milk, Chutney, Apple, Spinach, Salad, Guava, Fish, and Peas were taken. All the other food samples were taken in polythene zip bags. The vegetables and fruits were cut into small pieces with a sterilized blade and then plated on Sabouraud dextrose agar (SDA) aseptically and then incubated for 5 days. To find foodborne pathogenic fungi in various food items, a total of 320 were collected for evaluation. Out of the total food samples (65), 20.31% were found positive for fungal pathogens in various foodstuffs while 255 (79.68%) food samples were found negative. Among the positive food samples, Fusarium spp was more predominant 28(43%) led by Aspergillus spp 25( 38.5%). In comparison, Mucor and Cladosporium were found in low frequency with percentages of 7(10.8%), 5(7.7%). For antifungal activity, a panel of selected drugs was used to assess the susceptibility of pathogens. Among the antifungals best activity was shown by Voriconazole and intermediate activity was shown by Fluconazole. While high resistance was observed in Nystatin as compared to other antifungals.

Background and Aims: One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine–dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries. Methods: This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (n = 30) (0.5 µg/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 µg/kg/h) and Group LKD (n = 30) (IV bolus of 0.5 µg/kg of dexmedetomidine and 0.2 mg/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 µg/kg/h and 0.2 mg/kg/h, respectively). Ramsay Sedation Scale score of 3–4 was maintained. The t-test or the Wilcoxon–Mann–Whitney U test was used to compare the parameters between groups. Results: The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((P = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (P = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (P > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (P = 0.003). Conclusion: The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD).

Malaria, anemia, and malnutrition are global health challenges with significant morbidity and mortality, and higher rates among children particularly in Africa. This study evaluated the prevalence and risk factors of malaria infection, anemia, and malnutrition among school-going children of Charsadda (a city of Khyber, Pakistan). A total of 400 children of aged 5-10 years were included in the study in 2023. Malaria infection was confirmed by rapid diagnostic tests. Hematocrit level was obtained using a centrifuge microhematocrit and converted to hemoglobin using standard conversion. Nutritional status was determined by the anthropometric measurements, and demographic characteristics were obtained by questionnaire. Anemia and malnutrition were defined according to the World Health Organization standards. Logistic regression analysis was used to determine association between the predictor variables and primary outcomes. In current research work 400 children were selected for the assessment of malaria and nutritional status, malaria infection was found more frequent among the students 120(12%). In addition, high prevalence of anemia 105(10.5%), malnutrition 90(9%), and stunting 70(7%) was observed, while wasting 2(0.2%) and underweight 20(2%0 had very low frequency. Malaria infection, anemia, and malnutrition were observed in12%, 10.5% and 9% of the children population, respectively. To the best of our knowledge, this is the first study showing the current health problems among the school-going children of district Charsadda the prevalence of malaria, anemia and malnutrition and their co-existence in children 5-10 years.

Herein, we report on the synthesis and characterization of p-type semiconductor indium phosphide/zinc sulphide (InP/ZnS) core/shell quantum dots (QDs) prepared via a simple solvothermal method and their potential application in bulk heterojunction (BHJ) flexible solar cell (SC). The BHJ SC composed of donor–acceptor (D-A) configuration at nanoscale provides larger interfacial junction area throughout the bulk volume of the photo-absorber D-A blend that facilitates excitons to efficiently dissociate within the bulk layer at D-A interface. Hence, InP/ZnS core–shell QDs and a fullerene derivative – phenyl C61 butyric acid methyl ester (PCBM) – are used as hybrid inorganic–organic D-A materials, respectively, to fabricate Ag/LiF/InP/ZnS-PCBM/P3HT/ITO/PET BHJ flexible SC. Indium tin oxide (ITO) coated on polyethylene terephthalate (PET), poly(3-hexylthiophene) (P3HT), lithium fluoride (LiF) and silver (Ag) are employed as a flexible substrate, hole transport layer (HTL), electron transport layer (ETL) and counter electrode, respectively. Photovoltaic (PV) properties of the fabricated BHJ flexible SC are studied under standard testing conditions (STC) i.e., 25 0C, 1.5 AM global and 100 mW/cm2 irradiation, which exhibit fill factor (FF) of 59 ± 0.02 % and power conversion efficiency (PCE) of 4.22 ± 0.05 %. Also, the heterojunction characteristics are investigated in dark condition (0 lx) to find series resistance (Rs), ideality factor (n), and reverse saturation current (I0). X-ray diffraction (XRD), atomic force microscopy (AFM), scanning electron microscopy (SEM) and ultraviolet–visible (UV–vis) spectroscopy are performed to further investigate the properties of InP/ZnS-PCBM thin films. Transmission electron microscopy (TEM) image of InP/ZnS core/shell QDs confirmed the successful synthesis of QDs having an average size of 5 ± 1 nm. The InP/ZnS-PCBM D-A photo-absorber layer reveals its potential as one of good candidates for high performance BHJ flexible SCs.

Single-phase induction motors (SIMs) are commonly used in industrial applications. The extensive industrial usage of SIMs requires proper maintenance and fault detection. Among various faults, the most common mechanical faults in SIMs are bearing faults. Thus, detecting these faults during motor operation is essential for preventing damage. Many fault diagnosis methods have been proposed to detect bearing faults based on contact sensors, but they have accessibility problems. This paper presents a novel Infrared Thermography (IRT) based fault diagnosis method, leveraging both conventional machine learning (CML) and deep learning (DL) techniques for motor condition classification. In CML, Statistical and Gray Level Co-occurrence Matrix (GLCM) features are extracted from thermal images. The support vector machine recursive feature elimination (SVM-RFE) method is used to select the most relevant and highest-score features from the extracted features. Support vector machine (SVM) with linear and radial basis function (RBF) kernel functions and K-nearest neighbours (KNN) classifiers are applied to the selected interpretable features to classify machines into five classes of healthy, inner race, outer race, missing ball with low lubrication, and no lubrication bearing faults. Furthermore, in DL, a convolutional neural network (CNN) of few simple convolutional layers with several filters is also used as a healthy and faulty bearings classifier. The proposed method achieves classification accuracy of 98.29 % using CML and 100 % using DL. Moreover, our IRT-based SIMs bearing fault diagnosis methods demonstrate a reduction in architectural complexity compared to prevailing state-of-the-art approaches.

Abstract Background The present study was conducted to explore the diversity pattern of spring vegetation under the influence of topographic and edaphic variables in sub-tropical zone, District Malakand. In the present vegetation study, 252 species of 80 families were recorded in the study area. It included 39 species of trees, 43 species of shrubs, 167 species of herbs and 3 climber species. As a whole, 12 communities were established on the basis of topographic and edaphic characteristics in 12 different stations. Results The results of the present study revealed that all diversity indices (species diversity, evenness index, species richness index, maturity index) during spring showed that the communities in plains lying at lower altitudes had higher diversity while the communities formed at high altitudes had lower diversity. The results of the similarity index showed that there was low similarity (below 50%) amongst the communities in different stations. Conclusions It can be concluded that variations in topographic and edaphic factors affect species diversity and communities pattern.

Abstract Objective This study aims to evaluate published clinical trials of ramucirumab to assess the risk/benefit profile and burden over time for patients. Background The burden of oncologic drug development on patients paired with increasing clinical trial failure rates emphasizes the need for reform of drug development. Identifying and addressing patterns of excess burden can guide policy, ensure evidence‐based protections for trial participants, and improve medical decision‐making. Methods On May 25, 2023 a literature search was performed on Pubmed/MEDLINE, Embase, Cochrane CENTRAL, and ClinicalTrials.gov for clinical trials using ramucirumab as monotherapy or in combination with other interventions for cancer treatment. Authors screened titles and abstracts for potential inclusion in a masked, duplicate fashion. Following data screening, data was extracted in a masked, duplicate fashion. Trials were classified as positive when meeting their primary endpoint and safety, negative or indeterminate. Results Ramucirumab was initially approved for gastric cancer but has since been tested in 20 cancers outside of its FDA approved indications. In our analysis of ramucirumab trials, there were a total of 10,936 participants and 10,303 adverse events reported. Gains in overall survival and progression‐free survival for patients were 1.5 and 1.2 months, respectively. FDA‐approved indications have reported more positive outcomes in comparison to off‐label indications. Conclusion We found that FDA‐approved indications for ramucirumab had better efficacy outcomes than non‐approved indications. However, a concerning number of adverse events were observed across all trials assessed. Participants in ramucirumab randomized controlled trials saw meager gains in overall survival when evaluated against a comparison group. Clinicians should carefully weigh the risks associated with ramucirumab therapy given its toxicity burden and poor survival gains.

Abstract Background Growth hormone deficiency (GHD) is the commonest endocrine cause of short stature and may occur in isolation (I-GHD) or combined with other pituitary hormone deficiencies. Around 500 children are diagnosed with GHD every year in the UK, of whom 75% have I-GHD. Growth hormone (GH) therapy improves growth in children with GHD, with the goal of achieving a normal final height (FH). GH therapy is given as daily injections until adult FH is reached. However, in many children with I-GHD their condition reverses, with a normal peak GH detected in 64–82% when re-tested at FH. Therefore, at some point between diagnosis and FH, I-GHD must have reversed, possibly due to increase in sex hormones during puberty. Despite increasing evidence for frequent I-GHD reversal, daily GH injections are traditionally continued until FH is achieved. Methods/design Evidence suggests that I-GHD children who re-test normal in early puberty reach a FH comparable to that of children without GHD. The GHD Reversal study will include 138 children from routine endocrine clinics in twelve UK and five Austrian centres with I-GHD (original peak GH

Forests play a significant role for maintaining the biodiversity. In order to manage sustainable forests, tree species history, distribution, and their future prospects are vital. Using standardized quantitative approaches, the age, radial growth, and size class distribution of Abies pindrow (Himalayan fir) were determined from three different altitudinal sites (i.e. high, middle, and lower). The results indicate that Himalayan fir growing in the high-altitude site (Ayubia, 2 917 m a.s.l.) of moist temperate forests of the Himalayan mountains showed lower radial growth (0.13 cm) than in the middle (Bara Gali, 2 617 m a.s.l.; radial growth = 0.13 cm) and lower (Kuldana, 2 455 m a.s.l.; radial growth = 0.22 cm) altitude sites. Correlation analysis demonstrated that age showed a significant positive correlation (P < 0.001) with diameter at breast height. The tree-ring width chronology (totally 80 core samples) of Himalayan fir was developed from moist temperate forests of Himalayan mountains of Pakistan. At Ayubia site it possesses a long time-span (1703-2020 C.E.), followed by Bara Gali (1862-2020 C.E.) and Kuldana (1864-2020 C.E.). Further, the tree-ring width (TRW) chronology of Ayubia showed a significant positive correlation (P < 0.05) with May and June temperature, and a significant negative correlation (P < 0.05) with June and October precipitation, indicating that summer temperatures are the key factor for the radial growth of Himalayan fir. For the Kuldana site, the response of TRW chronology to temperature and precipitation was the same, however, it was significant only for June temperature at Bara Gali. The size class distribution of the high-altitude region (Ayubia) showed a higher number of individuals than the lower altitude region, indicating the lowest disturbance conditions. The absence of individuals in the early size classes and the gap in middle and mature size classes indicate a lower regeneration potential and anthropogenic impact. The pointer year analysis indicated that the Bara Gali forest is more sensitive to abnormal climate events than the other sites. Based on the present study, we suggest that proper attention and conservation strategy should be provided to Himalayan fir growing in the moist temperate forests of Pakistan.

IntroductionAgricultural activities in the North China Plain are often challenged by inadequate irrigation and nutrient supply. Inadequate and improper resource utilization may impose negative impacts on agricultural sustainability. To counteract the negative impacts, a deeper understanding of the different resource management strategies is an essential prerequisite to assess the resource saving potential of crops.MethodsWe explored plausible adaptation strategies including drip irrigation lateral spacings of 40 and 80 cm (hereafter referred to as LS40 and LS80, respectively), irrigating winter wheat after soil water consumption of 20 and 35 mm (hereafter represented as IS20 and IS35, respectively), and nitrogen fertilization scheme of a) applying 50% nitrogen as a basal dose and 50% as a top-dressing dose (NS50:50), b) 25% nitrogen as a basal dose and 75% as a topdressing dose (NS25:75), and c) no nitrogen application as a basal dose and 100% application as a top-dressing dose (NS0:100).Results and discussionThe consecutive 2 years (2017–2018 and 2018–2019) of field study results show that growing winter wheat under LS40 enhanced the water use efficiency (WUE), grain yield, 1,000-grain weight, and number of grains per spike by 15.04%, 6.95%, 5.67%, and 21.59% during the 2017–2018 season, respectively. Additionally, the corresponding values during the 2018–2019 season were 12.70%, 7.17%, 2.66%, and 19.25%, respectively. Irrigation scheduling of IS35 treatment improved all the growth-related and yield parameters of winter wheat. Further, treating 25% nitrogen as a basal dose and application of 75% as a top-dressing dose positively influenced the winter wheat yield. While NS0:100 increased the plant height, leaf area index (LAI), and aboveground biomass as compared to the other application strategies, but high nitrogen was observed in deeper soil layers. Regarding soil environment, the lowest soil moisture and nitrate nitrogen contents were observed in LS80 during both growing seasons. Overall, coupling the IS35 with NS25:75 under 40-cm lateral spacing is a suitable choice for sustainable winter wheat production in theNorth China Plain. The results of our study may be helpful in advancing the knowledge of the farmer community for winter wheat production. The findings can also aid in advancing new insights among scientists working on soil water and nitrogen distribution in drip irrigation for better productivity.

In this paper, a study was carried out to investigate the surface roughness and material removal rate of low carbon NiTi shape memory alloy (SMA) machined by Wire Electro Spark Erosion (WESE) technique. Experiments are designed considering three parameters viz, spark ON time (SON), spark OFF time (SOFF), and voltage (V) at three levels each. The surface roughness increased from 2.1686 μm to 2.6869 μm with an increase in both SON time, SOFF time and a decrease in voltage. The material removal rate increased from 1.272 mm3/min to 1.616 mm3/min with an increase in SON time but a varying effect was observed the SOFF time and voltage were varied. The analysis revealed that the intensity and duration of the spark had an unswerving relation with the concentration of the microcracks and micropores. More microcracks and micropores were seen in the combination of SON = 120 µs, voltage = 30 V. The concentration of the microcracks and micropores could be minimised by using an appropriate parameter setting. Therefore, considering the surface analysis and material removal, the low carbon NiTi alloy is recommended to machine with 110 μs – 55 μs – 30 v (SON – SOFF – V respectively), to achieve better surface roughness with minimal surface damage.

Accurate differentiation of benign and malignant cervical lymph nodes is important for prognosis and treatment planning in patients with head and neck squamous cell carcinoma. We evaluated the diagnostic performance of magnetic resonance image (MRI) texture analysis and traditional 18F-deoxyglucose positron emission tomography (FDG-PET) features. This retrospective study included 21 patients with head and neck squamous cell carcinoma. We used texture analysis of MRI and FDG-PET features to evaluate 109 histologically confirmed cervical lymph nodes (41 metastatic, 68 benign). Predictive models were evaluated using area under the curve (AUC). Significant differences were observed between benign and malignant cervical lymph nodes for 36 of 41 texture features (p < 0.05). A combination of 22 MRI texture features discriminated benign and malignant nodal disease with AUC, sensitivity, and specificity of 0.952, 92.7%, and 86.7%, which was comparable to maximum short-axis diameter, lymph node morphology, and maximum standard uptake value (SUVmax). The addition of MRI texture features to traditional FDG-PET features differentiated these groups with the greatest AUC, sensitivity, and specificity (0.989, 97.5%, and 94.1%). The addition of the MRI texture feature to lymph node morphology improved nodal assessment specificity from 70.6% to 88.2% among FDG-PET indeterminate lymph nodes. Texture features are useful for differentiating benign and malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Lymph node morphology and SUVmax remain accurate tools. Specificity is improved by the addition of MRI texture features among FDG-PET indeterminate lymph nodes. This approach is useful for differentiating benign and malignant cervical lymph nodes.

OBJECTIVES The aim of this study was to assess the mental health status and quality of sleep among house officers in Peshawar and to determine the correlation between their mental health status and quality of sleep. METHODOLOGY This was a cross-sectional study, conducted on house officers of four tertiary care hospitals in Peshawar. Data was collected through a self-administered questionnaire using convenience sampling technique. Pittsburgh sleep quality index (PSQI) scale was used for assessing the sleep quality and Warwick Edinburgh mental wellbeing scale (WEMWBS) was used for assessing the mental health status of the respondents. RESULTS Among the 276 house officers, the mean mental health score was 48.13±9.17, and mean sleep quality score was 6.39±3.27. In comparison, female House officers had poor mental health status (female: 45.72±9.32, male: 49.83±8.70, p

This systematic review aims at offering a comparative analysis of the leading reasons for encounters (RFEs) of patients presenting to primary care facilities. A systemic search was carried out using MEDLINE/PUBMED, CINAHL, Google Scholar, LILACS, and PROQUEST to identify the studies relevant to RFEs in primary health care in June 2020. Fifteen studies met the eligibility criteria which included originality, published between 2015 and 2020, listed two to five RFEs at a primary health care facility, and included patients with acute and/or chronic conditions. The mean total RFEs recorded were 6753.07 (Standard deviation = 17446.38, 95% Confidence Interval 6,753.0667 ± 8,829.088 [± 130.74%]). The most common RFE chapters recorded were Respiratory and Digestive chapters. The patients recorded fever as the most frequently reported RFE while cough was ranked as most common. The physicians reported hypertension as the most frequently reported and most common RFE. The most frequently physician and patient reported RFEs to the primary health care are hypertension and fever. Respiratory and Digestive were the most frequently reported chapters. The findings are useful for the proper implementation of services, facilities, and equipment utilized in Trinidad and Tobago primary health care.

Objective: To study the relationship and impact of post traumatic growth and psychological distress on quality of life among renal failure patients seeking dialysis, and to see differences in these variables among different age group patients. Study Design: Cross sectional study. Place and Duration of Study: Lady Reading Hospital, Peshawar, Government Hospital Mardan Pakistan, from Jan to Jun 2019. Methodology: A sample of 300 renal failure Patients 18 years or older who had a diagnosis of end-stage renal disease receiving treatment within different dialysis units were approached through purposive sampling technique. Post traumatic growth inventory Quality of life scale and the Psychological distress scale were used to measure the study variables. Results: Results reveal that psychological distress has a negative correlation with post traumatic growth (r=- 0.77**, p

Dengue virus, transmitted by Aedes aegypti mosquitoes, is the most important emerging viral disease, infecting more than 50 million people annually. Currently used sticky traps are useful tools for monitoring and controlling Ae. aegypti. Therefore, this study was conducted to evaluate the attraction of Ae. aegypti mosquitoes using various colors, materials and insecticides. The laboratory and field assessed the four different colors of ovitraps (blue, green, black and transparent). Among the tested ovitraps, the black ovitraps showed the highest number of eggs (348.8) in the laboratory and maximum eggs (80.0) in field trials. In addition, six different materials (casein, urea, yeast, fish meal, chicken meal and water) were also used to evaluate mosquito’s attraction. In our results, the highest number of eggs were collected with fish meal having 0.5% concentration in both laboratory (195.17) and the field (100.7). In laboratory trials, the Deltamethrin treated ovitraps (treated with Deltamethrin) significantly trapped and killed the highest percent of female Ae. aegypti (91.5%) compared to untreated (not-treated with Deltamethrin) ovitraps (3.3%). In field trials, the lethality was determined by installing 10 lethal ovitraps in one block and 10 untreated ovitraps in another block. The results indicate a significant reduction in eggs collected from the treated block (727 eggs) as compared to the untreated block (1865 eggs). The data also reveal that the ovitrap positive index (50) and egg density index (24.3) were also low in treated areas than in untreated areas, 83.3 and 37.3, respectively. It is concluded that the lethal ovitraps significantly reduced the Ae. aegypti population and thus could be considered an integral part of the integrated vector management (IVM) program.

The current study was carried out to explore the phytochemical, antioxidant potential and antibacterial activities of the crude methanolic extract of A. santolinifolia Turcz. Ex Besser. The antioxidant activity was carried out by using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2’-azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS) assay, while methanolic extract displayed the highest scavenging activity (DPPH) was 61.31µg/ml on Artemisia santolinifolia root and the lowest (51.05µg/ml) was record for their leaves. Similarly, in (ABTS) the highest activity (89.16µg/ml) was recorded for roots of A. santolinifolia followed by leaves (68.14µg/ml). In low inhibitory concentration assay, the crude methanolic extracts showed significant inhibition against all tested microbes on different concentrations like 25 µg/ml, 50 µg/ml, and 100 µg/ml. The leaves extract of A. santolinifolia AsL showed MIC of 12.5µg/ml for B. subtilis, a gram-positive bacterium, 50µg/ml for gram positive bacteria S. aureus and 37.5 µg/ml for gram negative bacteria P. aeruginosa that is almost equal to the response of standard ciprofloxacin. Our current study revealed that Artemisia santolinifolia root (AsR) exhibited a significant antioxidant potential while AsL showed good antibacterial effect which is suggested to be used for treatment and management of different infectious diseases.

Carotid blowouts are a low-incidence complication of head and neck tumors. We present the case of a 56-year-old man with squamous cell carcinoma of the supraglottic larynx causing acute hemoptysis. Pseudoaneurysm was discovered on the left distal carotid artery and subsequently, a stent was placed. Despite treatment, re-hemorrhage occurred distal to the covered stent leading to irreversible brain damage and death. We provide striking images of active extravasation and propose liberal deployment of long stent constructs in treating this pathology. It may be beneficial for the interventionalist to place a stent covering the area affected by the tumor rather than the area of the pseudoaneurysm.

Background and Purpose: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. Prophylactic treatment of the unruptured intracranial aneurysm (UIA) is considered in a select group of patients thought to be at high for aneurysmal rupture. Hospital readmission rates can serve as a surrogate marker for the safety and cost-effectiveness of treatment options for UIAs; we present an analysis of the 30-day rehospitalization rates and predictors of readmission following UIA treatment with surgical and endovascular approaches.Methods: We retrospectively analyzed data from the National Readmission Database (NRD) derived from the Healthcare Cost and Utilization Project for the year 2014. The cohort included patients with a primary discharge diagnosis of a treated unruptured aneurysm. The primary outcome variable was the 30-day readmission rate in open surgical vs. endovascularly treated groups. The secondary outcomes included predictors of readmissions, and causes of 30-day readmissions in these two groups.Results: The 30-day readmission rate for the surgical group was 8.37% compared to 4.87% for the endovascular group. The index hospitalization duration was longer in the surgical group. A larger proportion of the patients readmitted following surgical treatment were hypertensive (76.35, vs. 63.43%), but the prevalence of other medical comorbidities was comparable in the two treatment groups.Conclusions: There is a higher likelihood for 30-day readmission, longer duration of initial hospitalization and a lower likelihood of discharge home following surgical treatment of UIAs when compared to endovascular treatment. These findings, however, do not demonstrate long-term superiority of one specific treatment modality.

Multivariate analysis was conducted to explore the moist temperate forests of the Shangla district, Khyber Pakhtunkhwa. The prime objective was to quantitatively describe and differentiate the vegetation groups and the factors that determine the boundaries and composition of plant communities in the Shangla district. This was achieved by sampling all common species in a complex vegetation mosaic coinciding with local gradients in topography and soil distribution. Ward’s clustering dendrogram demonstrated four significant vegetation clusters with respect to environmental effects. These four major groups of the tree vegetation were superimposed on the ordination plane: 1. Pinus wallichiana, the dominant group associated with Abies pindrow; 2. Abies pindrow and the Picea smithiana group; 3. Dominant Cedrus deodara associated with the Pinus wallichiana, Abies pindrow, Picea smithiana, and Quercus baloot group; 4. Pinus roxberghii pure group. The key controlling factors for each group were the environmental characteristics (i.e., edaphic factors, topographic factors, soil physical properties, and soil nutrients). The results revealed elevation (p p < 0.05) relationship with vegetation. The other environmental factor did not show a significant relationship with vegetation. Ward’s cluster dendrogram of understory species also demonstrated four groups. Group 1 comprises two subgroups, a and b, with the highest number of species, i.e., Digeteria sanguinalis, Fragaria nubicola, Verbascum Thapsus, Pinus wallichiana seedlings, and Polygonatum multiflorium, respectively. The second large group contains twenty-five species out of eight stands, and the dominant species was Tagetis minuta. Eighteen species out of six stands were found in group 3, which was considered the smallest group. Group 4 consisted of seven stands containing twenty-four species of ground flora, with Anaphalis scopulosa followed by Adiantum venustum as the dominant species. The environmental characteristics of the understory vegetation showed a resemblance with the tree communities. With the exception of elevation, the other factors did not show a significant correlation.

The high temperature oxidation and hot corrosion behavior of nickel–iron-based superalloy are studied at 900 ° and 1000 °C. The significant role of alloying elements with respect to the exposed medium is studied in detail. The mass change per unit area was catastrophic for the samples exposed at 1000 °C and gradual increase in mass change was observed at 900 °C for both the environments. The exposed samples were further investigated with SEM, EDS and XRD analysis to study the metallurgical characteristics. The surface morphology has expressed the in situ nature of the alloy and its affinity toward the environment. The EDS and XRD analysis has evidently proved the presence of protective oxides formation on prolonged exposure at elevated temperature. The predominant oxide formed during the exposure at high temperature has a major contribution toward the protection of the samples. The nickel–iron-based superalloy is less prone to oxidation and hot corrosion when compared to the existing alloy in gas turbine engine simulating marine environment.

In this paper, Daftardar–Jeffery Polynomials are introduced in the Optimal Homotopy Asymptotic Method for solution of a coupled system of nonlinear partial differential equations. The coupled nonlinear KdV system is taken as test example. The results obtained by the proposed method are compared with the multistage Optimal Homotopy Asymptotic Method. The results show the efficiency and consistency of the proposed method over the Optimal Homotopy Asymptotic Method. In addition, accuracy of the proposed method can be improved by taking higher order approximations.

OBJECTIVES: To evaluate the prevalence and severity of TMDs in house officers and postgraduate students belonging to public and private sector medical and dental colleges. METHODOLOGY: This was a cross sectional study carried out from July 2018 to September 2018 in Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College and Hospital, Peshawar. After approval from ethical committee Gandhara University, an informed consent was obtained and Fonseca questionnaire was used to evaluate TMDs from 320 subjects who voluntarily want to participate in the study; selected with equal genders from public and private sectors medical and dental hospitals, Peshawar. Those who have musculoskeletal, neurological, systemic problems and orthodontics treatment subjects were excluded from the study. RESULTS: The age range selected was 22-32 years and the mean age presentation was 26.5 ± 3.4 years. Results showed that female postgraduate residents of private sector consider themselves tenser (18.8%) than others. 70.17% female house officers of private sector have noticed TMJ clicking and 83.17% of male house officers clenched or grind their teeth than others. CONCLUSION: The study concluded that mild and moderate TMDs are more common in-house officers and postgraduate residents. KEYWORDS: Temporomandibular Disorders, Prevalence, Temporomandibular Joint, Fonseca’s Anamnestic Index, Cross-Sectional Study

Given the reported increasing trends in high Asian streamflow and rapidly increasing water demand in the Indian subcontinent, it is necessary to understand the long‐term changes and mechanisms of snow- and glacier-melt-driven streamflow in this area. Thus, we have developed a June–July streamflow reconstruction for the upper Indus River watershed located in northern Pakistan. This reconstruction used a temperature-sensitive tree-ring width chronology of Pinus wallichiana , and explained 40.9% of the actual June–July streamflow variance during the common period 1970–2008. The high level of streamflow (1990–2017) exceeds that of any other time and is concurrent with the impact of recent climate warming that has resulted in accelerated glacier retreats across high Asia. The streamflow reconstruction indicated a pronounced reduction in streamflow in the upper Indus River basin during solar minima (Maunder, Dalton, and Damon). Shorter periods (years) of low streamflow in the reconstruction corresponded to major volcanic eruptions. Extreme low and high streamflows were also linked with sea surface temperature. The streamflow reconstruction also provides a long-term context for recent high Asian streamflow variability resulting from seasonal snow and glaciers that is critically needed for water resources management and assessment.

Epoxy and its composites have shown remarkable properties to be used for outdoor high voltage insulation applications. However, outdoor environment that contains UV-A radiations deteriorates the organic structure of epoxy-based insulators. To analyze the surface degradation and chemical changes in structure due to UV radiations, neat epoxy (NEPOX), 15 wt.% epoxy microcomposite (EMC 15) and 5 wt.% epoxy nanocomposite (ENC 5) were prepared and subjected to a specially fabricated UV chamber under accelerated conditions. The samples were analyzed with visual inspection, STRI hydrophobicity classification, and Scanning Electron Microscopy (SEM) and Fourier Transform Infrared (FTIR) spectroscopy. The analyses confirmed the pattern of gradual degradation of surface structure due to the appearance of ester and carbonyl groups due to oxidation of hydrocarbon chains. FTIR peaks of C=O stretching at ∼1725.52 increased by 157.44%, 75.86% and 33.33% for NEPOX, EMC 15 and ENC, respectively. This shows that ENC-5 expressed better resistance against surface oxidation as compared to EMC 15 and NEPOX. Addition of fillers enhanced the chain intactness and nano filler performed even better due to greater surface area and surface energy.

In this paper, the Optimal Homotopy Asymptotic Method is extended to derive the approximate solutions of fractional order two-dimensional partial differential equations. The fractional order Zakharov–Kuznetsov equation is solved as a test example, while the time fractional derivatives are described in the Caputo sense. The solutions of the problem are computed in the form of rapidly convergent series with easily calculable components using Mathematica. Reliability of the proposed method is given by comparison with other methods in the literature. The obtained results showed that the method is powerful and efficient for determination of solution of higher-dimensional fractional order partial differential equations.

Epoxy decays its dielectric characteristics and exhibits degradation of main hydrocarbon on exposure to multiple environmental stresses. Inorganic oxides-based epoxy composites have been performingwell in many applications and short-term testing; therefore, evaluation of their dielectric and structural characteristics under extreme weathering conditions may also unleash enhancement in these characteristics. To explore dielectric properties and degradation of main hydrocarbon group, neat epoxy and silica-based epoxy microcomposite (15% micro-silica loading) and nanocomposites (5% nano-silica loading)have been prepared and subjected to acid rain, heat, ultra-violet radiation, salt fog, and humidity in a chamber that was specially fabricated in view ofservice conditions. Interesting results were obtained before and after aging. Enhanced intactness of methylene group was observed in nanocomposite followed by micro composite. Similarly, for epoxy nanocomposites not only higher dielectric constant, lower energy dissipation and conductivity was recorded before application of stresses, but also nanocomposite showed superior sustainability in these properties after aging. In all analyses, microcomposites performed better than neat epoxy but in conductivity the results of both samples were found comparable.

Modern organic electronic and power electronic devices gained attention due their superior performance and efficiency with reduced cost. While nanocomposites of these organic semiconductors have high potential to further enhance these properties. In this work, thin films of zinc oxide-polyaniline (ZnO-PANI) nanocomposite with different compositions of ZnO (50, 60 and 70 wt%) are deposited by spin coater onto the surface of p-Si. The phase identification of the samples is identified through x-ray diffraction analysis. Pure ZnO showed wurtzite crystalline while PANI and nanocomposites of ZnO-PANI showed amorphous structure. The optical absorption band gap was evaluated from Ultraviolet–visible spectroscopy absorption studies and band gaps were calculated from Tauc’s plots. The Ultraviolet–visible spectroscopy showed that by increasing ZnO content in the nanocomposite, the band gap increases from 3.25 eV to 3.3 eV and 3.4 eV for 50–50, 60–40 and 70–30 wt% respectively. The AC electrical properties of the nanocomposites were studied by using impedance spectroscopy. The parameters extracted from the impedance plots and conductivity values showed that 50–50 wt% is more conductive while that of 70%–30% wt is more resistive.