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Latin American dictator fiction has a long tradition and is widely acclaimed in critical studies, while Pakistani dictator fiction began to emerge in recent years. The study is analytical and comparative research based on the contents of two culturally, historically, and geographically diverse novels--Mario Vargas Llosa's The Feast of the Goat and Mohammad Hanif's A Case of Exploding Mangoes so as to locate their common and contrasting aspects. It is a qualitative study and through content analysis, it finds convergences and divergences between a Latin American and a Pakistani dictator novel. A special emphasis of the study is on power, dictator portrayal, torture, resistance, retelling/rewriting history, and representation. The study concludes that where Llosa presents the detailed description of events related to the atrocious regime of Trujillo, Hanif presents a partial and not the whole view of Zia's dictatorship. Llosa misses no opportunity to create the sentiments of detestation and wrath against the despotic rule and his language throbs with bitterness and becomes satiric while unveiling the dark aspects of the Trujillo regime. However, Hanif, instead of giving a detailed and direct portrayal of certain dark aspects and brutalities, gives just oblique references to them and even the events which he brings to the forefront are presented in a very light and humorous vein which fail to arouse the emotions of abhorrence and denouncement against the despotic rule. [ABSTRACT FROM AUTHOR]

Adding green elements in logistics functions have biggest impact in shaping the supply chains towards sustainability. Business strategies must promote environmentally conscious thinking through continuous integration of green and evaluation of resultant business and environment sustainability performance. The approach is illustrated and validated through the development and analysis of sustainability initiatives implemented in warehouses of frozen food supply chains in Saudi Arabia. Modelled on a case study basis, this three-phase study builds on theoretical concepts of contingency theory and triple bottom line approach. It incorporates identification and ranking of essential sustainable practices of warehousing using literature analysis, participation of practitioners in fuzzy Delphi and Best Worst Method. Further, study establishes its uniqueness by applying combined compromise solution to rank the resultant sustainability performance improvement in warehouses. The results draw attention to green operations for energy and resource conservations, promotes the role of sustainable work culture, sustainable strategies, and policies for their role in encouraging sustainability performance outcomes. [ABSTRACT FROM AUTHOR]

Societal emergence and sustainability are results of human actions and practices which can either imbalance it with maximum exploitation or retain it through responsible utilization of resources. Based on theories on institutional and resource-based views, the study explores the enablers of green sustainable practices of procurement, logistics, product and process design and regulatory frameworks for low carbon performance.The study employs a Hybrid approach of step-by-step empirical process to examine the impact of sustainable practices on low carbon performance which further affects the sustainable manufacturing and societies. A theoretical model developed based on hypothesis is tested first using modified Dillman's approach. Then it is tested in in the PLS-SEM package using 380 data responses collected from the various manufacturers. Further robustness of proposed model is validated using different ML (machine learning) followed by post hoc analysis using Item Response Theory to validate the scale and efficacy of the measurement model. The study validates the positive relationships of sustainable practices on the low carbon performance which eventually is responsible for sustainable societies. The area of sustainable manufacturing is found relatively lacking and requires further attention of leadership for better societal establishments. The study hopes to further enrich the literature with its unique Hybrid approach of SEM/PLS Machine Learning and IRT which is used to presents carbon performance as a central entity deriving from green practices and driving sustainable manufacturing and societies. [ABSTRACT FROM AUTHOR]

Latin American dictator fiction has a long tradition and is widely acclaimed in critical studies, while Pakistani dictator fiction began to emerge in recent years. The study is analytical and comparative research based on the contents of two culturally, historically, and geographically diverse novels--Mario Vargas Llosa's The Feast of the Goat and Mohammad Hanif's A Case of Exploding Mangoes so as to locate their common and contrasting aspects. It is a qualitative study and through content analysis, it finds convergences and divergences between a Latin American and a Pakistani dictator novel. A special emphasis of the study is on power, dictator portrayal, torture, resistance, retelling/rewriting history, and representation. The study concludes that where Llosa presents the detailed description of events related to the atrocious regime of Trujillo, Hanif presents a partial and not the whole view of Zia's dictatorship. Llosa misses no opportunity to create the sentiments of detestation and wrath against the despotic rule and his language throbs with bitterness and becomes satiric while unveiling the dark aspects of the Trujillo regime. However, Hanif, instead of giving a detailed and direct portrayal of certain dark aspects and brutalities, gives just oblique references to them and even the events which he brings to the forefront are presented in a very light and humorous vein which fail to arouse the emotions of abhorrence and denouncement against the despotic rule. [ABSTRACT FROM AUTHOR]

Stakeholder satisfaction is a significant aspect of component-based product development. Satisfaction level of stakeholder varies due to diverse reviews and perspective about components functionalities. The reviews and perspective create ambiguities and misunderstanding during management of components requirement from specification to linking requirements that lead to product failures. The improper components management increases efforts and errors when component's stakeholders and development team is located in a globally distributed environment. The major issues of distributed component-based systems, are control, communication, coordination, and semantical analysis of different reviews and perspectives. As requirements of components is elicited and developed at different locations which created ambiguities and irrelevancy during components integration. Therefore, in this study, we proposed a framework to improve the management process of components requirement in a distributed environment. To reduce ambiguities and incompleteness among requirements, aspect based sentiment analysis has been utilized for each stakeholders' reviews and perceptive individually. On the other hand, to reduce involvement of stakeholder and efforts in components prioritization and linking processes, we adapted cased based reasoning method and decision tree-based classification of requirements, respectively. The performance of the proposed framework has been evaluated through an experimental approach in order to compare it with current practices i.e. Random selection and expert based. The findings described that the accuracy of component management in global development increases with proposed framework. Further, results show that there is an increase in product quality with decrease in irrelevancy and redundancy in stakeholders' aspects and priority. [ABSTRACT FROM AUTHOR]

Developing a promising technology that copes with the industrial warehousing environment requires special preparation. It includes infrastructure, equipment, resources, knowledge, efficiencies, and strategies for dealing with failures. This study examines Technology 4.0 driven warehouse practices and performance based on a thorough literature review. The study presents a unique proposition as it considers a two-fold fuzzy Delphi analysis to rank the Technology 4.0 driven practices using best-worst method (BWM) based on experts' responses. Warehouse performance measures are evaluated by the Combined Compromise Solution (CoCoSo) method. The results indicate the contributions of a 'Man-machines or robots for facilitating human'; 'Planning system for management'; 'Storage systems' as as leading practices contributing to 'improved inventory management', 'effective storage and distribution', and 'improved distribution and shipping or delivery process'. Using this study, researchers and managers will better understand how to adopt technology in warehouse management system. [ABSTRACT FROM AUTHOR]

In the current era of technology and development, component‐based software development (CBSD) has been progressively implemented. Components are used in large products for multiple users with diverse viewpoints and are highly configurable to provide higher satisfaction. Components are reused because of their similar functionality to reduce complexity and ensure the correct interaction between interfaces during product development. However, implementation of component functionalities creates complications due to improper specification, prioritization of components requirements, encapsulated functionalities, and more human interaction. Furthermore, due to configurability and the involvement of multiple stakeholders, ambiguity and semantic issues arise in the behaviour of reusable components. To overcome semantic‐based specification and prioritization components' related issues, we propose a framework that uses text mining and case‐based reasoning (CBR) techniques. Results of our empirical evaluation demonstrate that the proposed framework significantly outperforms the conventional technique. [ABSTRACT FROM AUTHOR]

Unintended pregnancies due to low prevalence of contraceptive use in Pakistan leads to a huge burden of induced abortions. These abortions are a major cause of concern, as a majority of these abortions are performed in an unhygienic environment by untrained providers, leading to maternal morbidities and mortalities. Some of the contributing factors of unsafe abortions are lack of availability of quality services, financial barriers, stigma associated with abortion and lack of awareness about abortion law. Therefore, there is an urgent need to invest on family planning and post-abortion care services through health system strengthening approach. The proposed comprehensive strategy for actions at the individual, facility, community and policy levels can address the issue of unsafe abortion in the country. [ABSTRACT FROM AUTHOR]

The world is moving towards a environmental restricted scenario where excellence and growth in business is contingent upon good governance and excellent green sustainability related policies, strategies and long-term values to stay ahead in competition. Green supply chain management (GSCM) practices play an essential role in shaping the way of offering environmental sustainable products and services to customers. Existing research insists that multiple pressure push organizations to navigate towards 'eco design', 'green purchasing' and 'cooperation with customers' leading to green supply chain management. But how these factors exactly impact the organisational performance based on green supply chain management is being explored in this research. Hypothesis developed is tested by using multivariate canonical correlation analysis to model the regression relationship of 54 manufacturing organizations. Green purchasing and eco-design are the main contributors of GSCM's organisational performance. Cooperation with customer as major roadblock for organisational's performance and requires management, to ponder over for improved results. The findings coincide with published research articles that were conducted in developing countries, such as Brazil and Jordan, to ensure environmental sustainability with the integration of GSCM practices. [ABSTRACT FROM AUTHOR]

Magnified resource consumption and depletion of natural resources calls for non-flexible or strict regulations and penalties on industrial operations, increased rate of processing and reuse of waste material as a substitute for raw material and political and legal interventions at global scale. Product recovery involves reuse, repair, refurbishing, remanufacturing and materials recycling, requires an efficient network design known as reverse logistic network and offers economical benefits in terms of fewer procurement of raw material, inventory management and less disposal. In current study, a mixed integer linear programming model designed on a multi-stage reverse logistics network for product recovery is proposed which considers different recovery options-product remanufacturing, component reprocessing and material recycling for sustainable outcomes. The model is designed to find optimal solutions for fulfilling demand and revenue needs by focusing on strategic locations for collection centers, reprocessing centers, remanufacturing plants and transportation options and simultaneously achieving sustainability goals. The model is applied on an Indian based manufacturing unit of a Saudi Arabian Industrial Air conditioner manufacturing organization and the case is presented here. The model is converted into a multi-objective programming model in accordance with the importance of each objective suiting the business needs. All relevant objective functions are evaluated using BWM, AHP and FAHP methods to obtain weights for integration into a fuzzy linear programming model which eventually provides three separate results. The model applied has originality and uniqueness for applications to solve multi-objective problems under uncertain environment and tends to strike a balance between economic and environmental objectives. The study provides for a base for further scope covering uncertainty about the amount and quality of returned products and even can be implemented by practitioners and academics for making a significant contribution in improving the efficiency of supply chains. [ABSTRACT FROM AUTHOR]

Requirement prioritisation and selection is an essential activity in modern‐day large software development. Optimal prioritisation process is critical for successful implementation and release planning in a software development project. Requirement prioritisation becomes more challenging in projects having large sets of requirements and stakeholders, having diverse perspectives resulting in irrelevancy and ambiguity during features extraction. This study aims to improve requirement prioritisation process using text mining and clustering techniques for accurate extraction of features and requirement prioritisation in multi‐stakeholder context. The proposed framework developed to avoid incompleteness in requirements and disagreement among development teams and stakeholders. Thus, the proposed framework compared with other requirement prioritisation techniques (i.e. Analytical Heretical Process, Commutative Voting and Wiegers) to highlight the significance of the proposed framework while conducting an experimental study. The results show that the proposed framework outperformed the traditional techniques and enhanced the prioritisation process with complete semantic information of extracted features and taking into account the diverse perspective of stakeholders. [ABSTRACT FROM AUTHOR]

Pakistani English is considered to be a distinct variety of English on the basis of its comparison with British English and American English. However, this claim is partial as its distinction from other varieties of English particularly used in South Asia has not yet been established. Thus, there is a need to investigate the similarities and differences between Pakistani and South Asian Englishes, and to analyse how far Pakistani English is distinct from other South Asian Englishes. Therefore, the present study aims at analyzing the linguistic features of Pakistani English as a separate variety from other varieties of English used in India and Bangladesh. For this purpose, a corpus of Pakistani, Indian and Bangladeshi English newspaper reportage was developed and analyzed using Biber's (1988) multivariate/multidimensional approach. The findings indicated that Pakistani press reportage is different from Indian and Bangladeshi press reportage on all the five dimensions, especially on Dimension 2, in which Pakistani press reportage is narrative, while Bangladeshi press reportage is non-narrative in nature. On Dimension 3, the press reportage of Pakistan is highly explicit as compared to Indian and Bangladeshi press reportage. Further, the sub-categories of Pakistani press reportage also exhibit variation when compared to the sub-categories of Indian and Bangladeshi press reportage. The possible causes of linguistic variation among these countries are their culture and geographical origin. It is further suggested that South Asian Englishes are evolving rapidly and linguistic variation among them certainly be a worth researchable area. [ABSTRACT FROM AUTHOR]

Background: In January 2016, health authorities from Zambézia province, Mozambique reported the detection of some patients presenting with fever, arthralgia, and a positive result for chikungunya in an IgM-based Rapid Diagnostic Test (RDT). We initiated a study to investigate a potential chikungunya outbreak in the city of Quelimane. Methods/Principal findings: From February to June 2016, we conducted a cross-sectional study enrolling febrile patients attending five outpatient health units in Quelimane. Serum from each patient was tested for CHIKV and DENV, using IgM and IgG ELISA and qRT-PCR. Patients were also tested for malaria by RDT. Entomological surveys were performed around patients’ households, and we calculated the proportion of positive ovitraps and the egg density per trap. A total of 163 patients were recruited, of which 99 (60.7%) were female. The median age was 28 years. IgM and IgG anti-CHIKV antibodies were identified in 17 (10.4%) and 103 (63.2%) patients, respectively. Plaque reduction neutralization assay confirmed the presence of anti-CHIKV antibodies in a subset of 11 tested patients with positive IgG results. IgM anti-DENV antibodies were found in 1 (0.9%) of 104 tested patients. Malaria was diagnosed in 35 (21.5%) patients, 2 of whom were also IgM-positive for CHIKV. Older age and lower education level were independently associated with the prevalence of IgG anti-CHIKV antibodies. Immature forms of Aedes aegypti were collected in 16 (20.3%) of 79 surveyed households. We also found that 25.0% (16/64) of the traps were positive, with an average of 90.8 eggs per pallet. Conclusions: Our investigation demonstrated that no CHIKV outbreak was ongoing in Quelimane; rather, endemic transmission of the virus has been ongoing. Aedes aegypti mosquitoes are abundant, but dengue cases occurred only sporadically. Further population-based cohort studies are needed to improve our understanding of aspects related to the dynamics of arboviral transmission in Mozambique, as well as in other parts of Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective: To find out the effectiveness of oral nifedipine as a tocolytic agent in external cephalic version. Methodology: This was an observational study carried out in the private clinical setting of Peshawar Health Center from Nov 15, 2014 till Nov 15, 2015. It included patients presenting with uncomplicated singleton breech fetuses between 36 to 41 weeks of period of gestation. All the patients were given a 10mg oral tablet of nifedipine, 15 minutes prior to the procedure. A pre-procedure ultrasound was done for assessment of fetal parameters, following which gentle attempt of external cephalic version (ECV) was made. Success of the procedure in terms of persistent cephalic presentation was recorded as the primary outcome. Any feto-maternal complications were noted as the secondary outcomes. A post procedure ultrasound was carried out for fetal reassurance and confirmation of fetal position. Results: A total of 58 patients were recruited in this study. Success rate of oral nifedipine was 77.6%. It was significantly higher (71.1%) in multigravida (p value 0.03) and in patients with flexed breech (84.6%) (p value 0.0001). No significant association was found with gestational age of the fetus and successful outcome. Conclusion: Nifedipine is a good choice as tocolytic agent in ECV, with no maternal or fetal complications and with better outcome in terms of success of ECV. [ABSTRACT FROM AUTHOR]

Requirement elicitation stands as a pivotal activity within requirement engineering, gaining even greater significance in the context of global software development. Effective communication among stakeholders assumes paramount importance in this arena. Factors such as time zone disparities, cultural variations, and language differences exert a formidable impact on communication within the sphere of global software development. These dynamics inevitably impinge upon timely coordination, potentially compromising the software's quality. In response, researchers have proffered communication models tailored for requirement elicitation within the ambit of global software development. The purpose of this study is to conduct an in-depth critical review of existing communication models for demand elicitation in global software development. Through this comprehensive review, we aim to discern prevailing publication trends, provide an introductory overview, and illuminate the strengths and limitations inherent in the existing communication models. By identifying these limitations, we seek to advance a novel, low-cost communication approach designed primarily for demand elicitation in global software development. To culminate our endeavor, we will undertake a case study-based experiment, meticulously designed to assess the efficacy and practical utility of the proposed techniques. [ABSTRACT FROM AUTHOR]

Background: Although Chikungunya virus has rapidly expanded to several countries in sub-Saharan Africa, little attention has been paid to its control and management. Until recently, Chikungunya has been regarded as a benign and self-limiting disease. In this report we describe the first case of severe Chikungunya disease in an adult patient in Pemba, Mozambique. Case presentation: A previously healthy 40 year old male of Makonde ethnicity with no known past medical history and resident in Pemba for the past 11 years presented with a severe febrile illness. Despite administration of broad spectrum intravenous antibiotics the patient rapidly deteriorated and became comatose while developing anaemia, thrombocytopenia and later, melaena. Laboratory testing revealed IgM antibodies against Chikungunya virus. Malaria tests were consistently negative. Conclusions: This report suggests that Chikungunya might cause unsuspected severe disease in febrile patients in Mozambique and provides insights for the improvement of national protocols for management of febrile patients in Mozambique. We recommend that clinicians should consider Chikungunya in the differential diagnosis of febrile illness in locations where Aedes aegypti mosquitos are abundant. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of antenatal corticosteroids on maternal blood glucose levels. Methodology: This observational study was conducted in the Department of Obstetrics and Gynecology at Hayatabad Medical Complex, Peshawar, after obtaining ethical approval from the Institutional Ethical Review Board. All patients admitted to the labor suite for antenatal corticosteroids were included in the study, while patients with diabetes or any other medical disorder requiring corticosteroids were excluded. Patients were selected using a non-probability convenient sampling technique. They were given two doses of Betamethasone (12mg) intramuscularly, with a 24-hour interval between doses. Maternal blood sugar levels were checked before administering the first dose of Betamethasone. Subsequently, patients were placed on a sugar profile for five days. All the data were entered in a pre-designed proforma. Result: A total of 247 patients were included in the study. The majority of the patients were multigravida (50.20%) and belonged to the age group of 21-30 (50.20%). The mean age of the patients was 26.4 ± 2.3 years. The majority of the patients (72.46%) had deranged blood sugar levels, either falling within the range of impaired glucose levels or full-blown diabetes. Antenatal corticosteroids mainly affected fasting blood sugar (FBS) and post-prandial blood sugar levels. Conclusion: Antenatal corticosteroids administered to normoglycemic patients result in significant but transient hyperglycemia. However, in the majority of patients, blood sugar levels normalize within five days following the administration of corticosteroid doses. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission. A total of 271 patients were included (enoxaparin prophylaxis, n = 45; no enoxaparin prophylaxis, n = 225). The median time until enoxaparin initiation was 11 ± 1 days. There was no significant difference in the proportion of patients who developed a VTE when using enoxaparin prophylaxis compared with no enoxaparin prophylaxis (2 vs 4%; P = 0.65). Rates of deep vein thrombosis (2 vs 3%; P = 0.87) and pulmonary embolism (0 vs 1%; P = 0.99) were similar between treatment groups, respectively. Late enoxaparin prophylaxis did not demonstrate a protective effect for VTE. Given the overall low event rate, the administration of pharmacologic prophylaxis against VTE late in the treatment course may not be routinely warranted after craniotomy for acute TBI. Further investigation with early administration of enoxaparin is needed. [ABSTRACT FROM AUTHOR]

No equipment (system) can be perfectly reliable in spite of the utmost care and best efforts on the part of the designer, decision-maker and manufacturer. The two sides of maintenance arecorrectiveandpreventivemaintenance. It is generally assumed that a preventive maintenance action is less costly than a repair maintenance action. We examine this proposition in detail on the basis of a failure-time model that relates conformance quality to reliability. Illustratively, we present reliability in the context of contracts with asymmetric information. The model shows how to overcome information rents through price distortions and quantity rationing. The paper ends with a conclusion and an outlook to future studies. [ABSTRACT FROM PUBLISHER]

The field of sustainable supply chain management has been abundantly explored from environmental perspective, however the growing focus on holistic sustainable development demands critical perspective on social dimensions also. Consequently, organizations under national and global pressures tend to implement social sustainability measures in their supply chains. While existing research suggests that social sustainability measures are prevalent in developed countries, the developing nations nonetheless require elaborate efforts. This study aims to explore the initiatives and practices adopted by logistics, specifically warehousing operations organizations. Social sustainability practices identified and finalized using Best Worst Method (BWM) are ranked for their impact on improving social sustainability footprint of organizations. The effectiveness of corporate social responsibility (CSR) is evaluated based on the implementation of the social sustainability practices in the warehousing organizations of the developing countries. Taking a survey-based approach data collected from 217 organizations is statistically analysed using binary logistic regression. The hybrid approach results indicate the importance of 'responsible work environment' as strong contender for reflecting effectiveness of corporate social responsibility. Contrary to theoretical predictions and expectations, 'training education and development' is found lacking for improving social footprints of organizations indicating deeper and rigorous approaches. Additionally, social sustainability practices 'corporate ethical responsibility commitment' towards social reforms and 'Philanthropy' are considerably lacking the seriousness of corporates and require further exploring. [Display omitted] • Explored issues of social sustainability in warehousing of developing countries. • Evaluated sustainability initiatives undertaken by Corporate Social Responsibility departments. • Identified strong and weak social sustainability areas for further improvement. • Employed BWM and Logistic Regressions for social sustainability practices evaluation. [ABSTRACT FROM AUTHOR]

Inpatient falls lead to an injury in 30 per cent of cases and serious injury in 5 per cent. Increasing staffing and implementing fall prevention programs can be expensive and require a significant use of resources. We hypothesized that trauma patients have unique risk factors to sustain a fall while hospitalized. This is a retrospective cohort study from 2005 to 2010 of all trauma patients admitted to an urban Level I trauma center. Patients who fell while hospitalized were compared with patients who did not fall to identify risk factors for sustaining an inpatient fall. There were 16,540 trauma patients admitted during the study period and 128 (0.8%) fell while hospitalized. Independent risk factors for a trauma patient to fall while hospitalized included older age (odds ratio [OR], 1.02 [1.01 to 1.03], P < 0.001), male gender (OR, 1.6 [1.0 to 2.4], P = 0.03), blunt mechanism (OR, 5.1 [1.6 to 16.3], P = 0.006), Glasgow Coma Score at admission (OR, 0.59 [0.35 to 0.97], P = 0.04), intensive care unit admission (OR, 2.3 [1.4 to 3.7], P = 0.001), and need for mechanical ventilation (OR, 2.2 [1.2 to 3.9], P = 0.01). Trauma patients who fell while hospitalized sustained an injury in 17 per cent of cases and a serious injury in 5 per cent. Inpatient falls in hospitalized trauma patients are uncommon. Risk factors include older age, male gender, blunt mechanism, lower Glasgow Coma Score, and the need for intensive care unit admission or mechanical ventilation. Trauma patients with these risk factors may require higher staffing ratios and should be enrolled in a formal fall prevention program. [ABSTRACT FROM AUTHOR]

This study reports the characterization of the seeds and seed oils of five locally grown canola cultivars: Zafar-2002, Bulbul (Frontier), Dunkeld, Oscar and Con-11. The oil contents from canola seeds ranged from 34.3 to 39.3%. The levels of protein, fiber, ash and moisture were found to be 22.1-41.0, 12.0-14.0, 3.0-3.5 and 4.0-7.5%, respectively. The glucosinolate (GSL) contents in the canola seeds examined ranged from 49.7 to 78.1 mmol g-1. The extracted canola seed oils revealed an iodine value of 118.2-124.6 g of l/100g of oil; refractive index (40 °C), 1.460-1.464: density (24 °C), 0.914-0.919 mg mL-1; saponification value, 187-195; unsaponifiable matter, 0.51-1.10%; acidity (% as oleic acid), 0.40-1.40, and color (1-in. cell), 1.35-1.73 R + 21.0-38.0 Y. Peroxide value (meq/kg of oil) and specific extinctions at 232 and 270 nm were determined to be 2.00-7.08, 2.17-3.16 and 0.44-0.91, respectively. The seed oils of the five canola cultivars mainly consisted of oleic (C18:1), linoleic (C18:2) and linolenic (C18:3) acids at levels of 49.16-62.14, 14.61-23.45 and 6.97-9.10%, respectively The concentrations of palmitic (C16:0), stearic (C18:0), erucic (C22:1) and gadoleic (C20:1) acids ranged from 3.47 to 6.00, 1.51 to 2.10, traces to 13.03 and 1.30 to 10.63%, respectively, A small amount of arachidic acid (20:0) with a contribution below 1% was also detected. The contents of tocopherols (α, γ and δ) in the canola oils accounted for 77.1-270.3, 191-500, 3.5-15.6 mg kg-1, respectively. The presence of rather high levels of erucic acid and GSL in the present analysis of canola emphasized the need to further reduce the contents of these two anti-nutritional constituents in the investigated cultivars. [ABSTRACT FROM AUTHOR]

The perishable milk products industry has to deal with multiple pressures such as demand forecasting, price fluctuations, lead time, order batching, and inflated orders along with difficulties of climatic and traffic conditions, storage areas and shipment in unfavorable circumstances. The Indian dairy industry faces immense wattage issue due to improper infrastructure for the cold chain storage facilities, resulting in unsatisfied customers. A study is undertaken to comprehend the supply chain framework that handles perishability issues in production and distribution. Researchers propose a multi-objective mixed-integer non-linear supply chain coordination model under uncertain environments to minimize the cost of transportation, offset wastage of products and neutralize the losses due to insufficiencies of transit and storage amenities. The proposed model is meant for managing the delivery with lesser deterioration losses for producers, warehouses, and retailers. The model considers various costs for holding, halting, discounts on purchased cost, transportation cost for truckload policy under regular and unforeseen circumstances of curfew, and identify the rate of deterioration to know the impact on the cost for all players involved in the SCM framework. To handle uncertainty of objective functions, fuzzy set concepts and the defuzzification method are imposed, and fuzzy non-linear programming algorithms are used to get the single objective function from the defuzzified multi-objective functions. Data analysis is done on Lingo 18.0 software. Rate of deterioration is highest for the warehouse, which indicates that efforts should be made to augment warehouse facilities for less spoilage to reduce losses in cost. Finally, the study ends with main findings, conclusions, limitations and future scopes. [ABSTRACT FROM AUTHOR]

The article reports on the inducible ischemia and the risks of recurring cardiovascular consequences with outpatients. It discusses that readmission after HF hospitalization is the increasing focus for physicians and policy makers, and that the statistical models are needed to assess patient risk and to compare hospital performance. It infers that more systematic recognition and integration of visit companions in health care processes may benefit the quality of care for a vulnerable patient population.

The predictive value of left atrial (LA) dilatation in ambulatory adults with coronary artery disease is not known. It was hypothesized that echocardiographic LA volume index (LAVI) predicts heart failure (HF) hospitalization and mortality with similar statistical power as left ventricular ejection fraction (LVEF) in ambulatory adults with coronary artery disease. We measured LAVI in 935 adults without atrial fibrillation, atrial flutter, or significant mitral valve disease in the Heart and Soul Study. LAVI was calculated using the biplane method of disks. Outcomes included HF hospitalization and mortality. Logistic regression odds ratios (ORs) were calculated and adjusted for age, demographics, medical history, left ventricular mass, diastolic function, and LVEF. Mean LAVI was 32 ± 11 ml/m2, and mean LVEF was 62 ± 10%. Sixty-six patients (7%) had LAVI >50 ml/m2. There were 108 HF hospitalizations and 180 deaths at 4.3 years of follow-up. C statistics calculated as the area under the receiver-operator characteristic curve were the same (0.60) for LAVI and LVEF in predicting mortality. The unadjusted OR for HF hospitalization was 4.4 for LAVI >50 ml/m2 and 5.3 for LVEF <45% (p <0.001). In those with normal LVEF, the ORs for LAVI >50 ml/m2 were 5.2 for HF hospitalization (p <0.0001) and 2.5 for mortality (p = 0.006). After multivariate adjustment, LAVI >50 ml/m2 was predictive of HF hospitalization (OR 2.4, p = 0.02), and LAVI >40 ml/m2 was predictive of mortality (OR 1.9, p = 0.005). In conclusion, LAVI had similar predictability as LVEF for HF hospitalization and mortality in ambulatory adults with coronary artery disease. [Copyright &y& Elsevier]

The article reports on a study that examined the risk of cardiovascular events which are related to self-reported failure to comply with medication in 1015 outpatients with coronary heart disease from the Heart and Soul Study. Cardiovascular events, namely, myocardial infarction, coronary heart disease death and stroke, were determined by reviewing the patients' medical records during 3.9 years of follow-up. The findings revealed that self-reported failure to comply to medication in outpatients with stable coronary heart disease is related to a more than two-fold increase in the rate of subsequent cardiovascular events.

Health profession students work in close proximity to patients and could be a source of nosocomial influenza. We studied the proportion of health profession students presenting for immunization at an influenza immunization campaign. This assessment is useful to guide future campaigns as we prepare for pandemic influenza. [ABSTRACT FROM AUTHOR]

Objectives: We compared the predictive ability of tricuspid regurgitation (TR) and end-diastolic pulmonary regurgitation (EDPR) gradients in outpatients with coronary artery disease. Background: The TR and EDPR gradients, in conjunction with right atrial pressure, provide Doppler estimates of pulmonary artery systolic and diastolic pressures. We hypothesized that increases in TR or EDPR gradients in stable coronary artery disease would predict heart failure (HF) hospitalization or cardiovascular (CV) death. Methods: We measured TR and EDPR gradients in 717 adults with completed outcome adjudications who were recruited for the Heart and Soul Study. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for HF hospitalization, CV death, all-cause death, and the combined end point. Multivariate adjustments were made for age, gender, race, history of CV or pulmonary disease, functional class, and left ventricular ejection fraction. Results: There were 63 HF hospitalizations, 19 CV deaths, and 86 all-cause deaths at the 3-year follow-up. There were 466 measurable EDPR gradients and 573 measurable TR gradients. Age-adjusted ORs for EDPR >5 mm Hg predicted HF hospitalization (2.7, 95% CI 1.3 to 5.5, p = 0.006), all-cause death (2.5, 95% CI 1.4 to 4.4, p = 0.002), and HF hospitalization or CV death (2.7, 95% CI 1.4 to 5.2, p = 0.004). Age-adjusted OR for TR >30 mm Hg predicted HF hospitalization (3.4, 95% CI 1.9 to 6.2, p < 0.0001) and HF hospitalization or CV death (3.0, 95% CI 1.7 to 5.3, p = 0.0001). Multivariate adjusted OR per 5-mm Hg incremental increases in EDPR predicted HF hospitalization or CV death (1.9, 95% CI 1.01 to 3.6, p = 0.046) and all-cause death (1.7, 95% CI 1.05 to 2.8, p = 0.03). Multivariate adjusted OR per 10-mm Hg incremental increases in TR predicted HF hospitalization or CV death (1.6, 95% CI 1.1 to 2.4, p = 0.008). Conclusions: Increases in EDPR or TR gradients predict HF hospitalization or CV death among ambulatory adults with coronary artery disease. [Copyright &y& Elsevier]

Background: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global emergency, causing significant damage to the global economy and health care. Knowledge and awareness are crucial elements in stimulating self-imposed preventive measures. Objectives:We evaluated the knowledge and awareness about COVID-19 and the practice of hygiene measures to prevent the spread of coronavirus disease. Methods: A prospective observational study was conducted in Karachi, Pakistan, between March 01 and March 25, 2020, using a non-probability consecutive sampling technique. All individuals aged 18 years or above were included in the study. The individuals who had no formal education were excluded from the study. A self-reported questionnaire assessing knowledge, awareness, and practices was distributed among the participants. Results: The mean age ± SD of the study population was 29.11 ± 7.8 years. In our study, 424 (98.6%) participants knew that a virus causes COVID-19, and most were knowledgeable about the disease's transmission mode. Higher education status and the medical profession were associated with the better practice of preventive measures. Conclusions:We recommend that knowledge about COVID-19 and preventive measures be spread across the country via electronic media. [ABSTRACT FROM AUTHOR]

Anorexia Nervosa (AN) is an eating and behavioral disorder characterized with anxiety/depression, hyperactivity, behavioral impulsivity and psychosis. Most of the associated symptoms are related to the deficiency of serotonin (5-hydroxytryptamine: 5-HT) stores. A deficiency of 5-HT can modulate dopamine neurotransmission in the striatum to elicit hyperactivity and psychosis in AN patients. Also, the release and availability of 5-HT are modulated by serotonin-1A (5-HT1A) auto-receptor. The present study investigates the role of striatal metabolism of 5-HT and dopamine in precipitating hyperactivity in the rat model of diet restriction (DR) induced AN. The role of tryptophan (Trp) in influencing the 5-HT metabolism and the mRNA expression of 5-HT1A auto-receptor is also investigated. We find that long-term DR for 38 days reduces body-weight in rats and produces hyperactivity, similar to AN. This hyperactivity is characterized by declined striatal metabolism of both, dopamine and 5-HT. The mRNA expression of 5-HT1A auto-receptor in the raphe nuclei is also decreased. Trp co-treatment improves these deficiencies in monoamine metabolism and alleviates hyperactivity. Interestingly, DR-induced changes in body-weights are not effected by Trp co-treatment. The study suggests that the striatal metabolism of 5-HT and dopamine and mRNA expression of 5-HT1A auto-receptor has an important role in the pathogenesis of AN. The finding suggests that co-use of Trp can prevent precipitation of AN by normalizing 5-HT metabolism. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the standard of care for the treatment of blunt thoracic aortic injury (BTAI) requiring intervention. Data suggest that low-grade BTAI (grade I [intimal tears] or grade II [intramural hematoma]) will resolve spontaneously if treated with nonoperative management (NOM) alone. There has been no comparison specifically between the use of NOM vs TEVAR for low-grade BTAI. We hypothesize that these low-grade injuries can be safely managed with NOM alone. STUDY DESIGN: Retrospective analysis of all patients with a low-grade BTAI in the Aortic Trauma Foundation Registry from 2016 to 2021 was performed. The study population was 1 primary outcome was mortality. Secondary outcomes included complications, ICU length of stay, and ventilator days. RESULTS: A total of 880 patients with BTAI were enrolled. Of the 269 patients with low-grade BTAI, 218 (81%) were treated with NOM alone (81% grade I, 19% grade II), whereas 51 (19%) underwent a TEVAR (20% grade I, 80% grade II). There was no difference in demographic or mechanism of injury in patients with low-grade BTAI who underwent NOM vs TEVAR. There was a difference in mortality between NOM alone and TEVAR (8% vs 18%, p = 0.009). Aortic-related mortality was 0.5% in the NOM group and 4% in the TEVAR group (p = 0.06). Hospital and ICU length of stay and ventilator days were not different between the 2 groups. CONCLUSIONS: NOM alone is safe and appropriate management for low-grade BTAI, with lower mortality and decreased rates of complication when compared with routine initial TEVAR. [ABSTRACT FROM AUTHOR]

The world is moving towards carbon restricted scenario where excellence and growth in business is contingent upon good governance and excellent low carbon emission related policies, strategies, and long-term values to stay ahead in competition. Existing research insists that multiple external pressures push organizations to navigate towards sustainable internal practices leading to low carbon performance. Rooted in the theoretical concepts of institutional and contingency theory, this study explores the impact of uncertainties of external business environment on complexities of business internal environment. Hypothesis developed is tested by taking data from 134 manufacturing organizations based on their size and sector, and sustainability practices. The data is analyzed using correlation and multiple linear regression analysis (MLR). Chi-square, Cramer's V and MLR is used for regression analysis and correlation whereas ANN is applied for validating the robustness of the MLR model. Comparison of results of MLR and ANN provide similar outcomes. Results rule out the impact of size of organizations on carbon performance. 'Environmental regulations activities' and 'political and legal regulations' along with efficient implementation of Corporate Social Responsibility (CSR)/Sustainability activities backed by top management are the main contributors of low carbon performance. The study identified the 'interest of foreign investors' in the region as one of areas requiring further exploration for improved carbon performance. Mode of technology came as major roadblock for low carbon performance and requires top management to ponder over for improved results. Also, found wanting for improvement are-modes of transport, employee motivation and external stakeholders. Image 1 [ABSTRACT FROM AUTHOR]

Loiasis, caused by the filarial nematode Loa loa, is often asymptomatic but frequently manifests as episodic angioedema and periocular migration of adult worms. Hence also known as the eye worm. 1 It is rarely encountered in the United States among travelers and immigrants. This report describes a case of loiasis in a Cameroonian student seen at a US university clinic. [ABSTRACT FROM AUTHOR]

Aim: Using lean six sigma QI tools, Define-Measure-Analyze-Improve-Control (DMAIC), design and implement best practices to reduce percentage of patients with hgbA1c >9.0% from baseline of 26% in May 2018 to 21% by July 2019 in our endocrinology clinic. Methods: We used institution's diabetes registry to capture hgbA1c values and patient visits to endocrinology clinic. DMAIC data driven improvement cycle was used for identifying care gaps, problem solving and interventions to improve workflow processes. At the end of the DMAIC implementation, Plan-Do-Study-Act (PDSA) cycles were implemented for 6 months for control of the new processes. During Analyze phase, main care gaps identified were missing hgbA1c values, appointment cancellations and low participation in self-management diabetes education. We implemented pre visit planning, standardization of hgbA1c ordering process, standing medical orders for both hgbA1c testing and self-management diabetes education classes. DMAIC phases were completed over five months, and the process was monitored for next six months. Results: 3016 persons were seen for diabetes management during the measurement period. Percent in poor control improved from 26% in May 2018 to 18% by July 2019. Conclusion: Quality improvement tools can be successfully applied to improve and sustain clinical outcomes such as hgbA1c control in persons with diabetes. Disclosure: S. Ali: None. U. Kollipara: None. [ABSTRACT FROM AUTHOR]

Blockchain Technology (BT) has the potential to revolutionize supply chain management by providing transparency, but it also poses significant environmental and security challenges. BT consumes energy and emits carbon gases, affecting its adoption in Supply Chains (SCs). The substantial energy demand of blockchain networks contributes to carbon emissions and sustainability risks. Moreover, for secure and reliable transactions, mutual authentication needs to be established to address security concerns raised by SC managers. This paper proposes a tri-objective optimization model for the simultaneous design of the SC-BT network, considering a two-step authentication process. The model considers transparency caused by BT members, emissions of BT, and costs related to BT and SC design. It also takes into account uncertainty conditions for participating BT members in the SC and the range of transparency, cost, and emission targets. To solve the model, a Branch and Efficiency (B&E) algorithm equipped with BT-related criteria is developed. The algorithm is implemented in a three-level SC and produces cost-effective and environmentally friendly outcomes. However, the adoption of BT in the SC can be costly and harmful to the environment under uncertain conditions. It is worth mentioning that implementing the proposed algorithm from our article in a three-level SC case study can result in a significant cost reduction of over 16% and an emission reduction of over 13%. The iterative nature of this algorithm plays a vital role in achieving these positive outcomes. [ABSTRACT FROM AUTHOR]

To determine the effect of long-term restricted feeding schedules on behavior, serotonergic responses, and neuro-endocrine functions, metabolism of serotonin (5-HT) in the striatum, expression of serotonin-1A (5-HT1A) auto-receptor in the raphe nuclei and circulating levels of leptin and corticosterone were determined in female Wistar rats kept on excessive food restriction schedule. Due to a role of dietary deficiency of tryptophan (Trp) in influencing serotonergic neurotransmission, circulating levels of Trp were also determined. Estimations were done in 2 different restricted feeding models: time-restricted feeding (TRF) and diet restricted (DR). TRF animals were given access to food ad libitum only for 2 hours/day. The DR animals were given a small calculated amount of food each day. We found that chronic food restriction for 5 weeks cause a significant decrease in the body weight and produced hyperactivity in both, TRF and DR animals. Levels of Trp were declined in circulation and in the striatum. Similarly, the levels of 5-HT and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) were decreased in the striatum. Also, the expression of 5-HT1A auto-receptor was declined in the raphe nuclei. These changes in 5-HT metabolism and 5-HT1A auto-receptor expression were more profound in DR animals as compare to TRF animals. Similarly, hypoleptinemia and increased corticosterone found in both models was higher in DR animals. Effect of dietary deficiency of Trp in the modulation of striatal 5-HT metabolism and its consequences on circulating leptin and corticosterone are discussed. [ABSTRACT FROM AUTHOR]

Objective: Zika virus (ZIKV) has emerged as an important health problem worldwide. The aim of this study was to investigate the occurrence, geographical distribution and trend of immunoglobulin M (IgM) antibodies against ZIKV between 2009 and 2015 in Mozambique. Results: The median age of participants was 3 years [interquartile range (IQR): 1.0–6.0 years)] and 56.5% (480/850) of them were male. Of the 850 samples, 42 (4.9%) were positive for IgM antibodies against ZIKV. Positive samples were found in 9 provinces of the country. Frequency of IgM antibodies against ZIKV was slightly higher in patients aged 5–9 years old, and in the north region of the country. [ABSTRACT FROM AUTHOR]

Sarcopenia is a clinically relevant loss of muscle mass with implications of increased morbidity and mortality in adult trauma populations. Our study aimed to evaluate loss of muscle mass change in adult trauma patients with prolonged hospital stays. Retrospective analysis using institutional trauma registry to identify all adult trauma patients with hospital length of stay >14 days admitted to our Level 1 center between 2010 and 2017. All CT images were reviewed, and cross-sectional area (cm2) of the left psoas muscle was measured at the level of the third lumbar vertebral body to determine total psoas area (TPA) and Total Psoas Index (TPI) normalized for patient stature. Sarcopenia was defined as a TPI on admission below gender specific thresholds of 5.45(cm2/m2) in men and 3.85(cm2/m2) in women. TPA, TPI, and rates of change in TPI were then evaluated and compared between sarcopenic and non-sarcopenic adult trauma patients. There were 81 adult trauma patients who met inclusion criteria. The average change in TPA was -3.8 cm2 and TPI was -1.3 cm2. On admission, 23% (n = 19) of patients were sarcopenic while 77% (n = 62) were not. Non-sarcopenic patients had a significantly greater change in TPA (-4.9 vs. -0.31, p <0.0001), TPI (-1.7 vs. -0.13, p <0.0001), and rate of decrease in muscle mass (p = 0.0002). 37% of patients who were admitted with normal muscle mass developed sarcopenia during admission. Older age was the only risk factor independently associated with developing sarcopenia (OR: 1.04, 95%CI 1.00–1.08, p = 0.045). Over a third of patients with normal muscle mass at admission subsequently developed sarcopenia with older age as the primary risk factor. Patients with normal muscle mass at admission had greater decreases in TPA and TPI, and accelerated rates of muscle mass loss compared to sarcopenic patients. [ABSTRACT FROM AUTHOR]

Agitation on arrival in trauma patients is known as a sign of impending demise. The aim of this study is to determine outcomes for trauma patients who present in an agitated state. We hypothesized that agitation in the trauma bay is an early indicator for hemorrhage in trauma patients. We performed a single-institution prospective observational study from September 2018 to December 2020 that included any trauma patient who arrived agitated, defined as a Richmond Agitation-Sedation Scale of +1 to +4. Variables collected included demographics, mechanism of injury, admission physiology, blood alcohol level, toxicity screen, and injury severity. The primary outcomes were need for massive transfusion (≥ 10 units) and need for emergent therapeutic intervention for hemorrhage control (laparotomy, preperitoneal pelvic packing, sternotomy, thoracotomy, or angioembolization). Of 4657 trauma admissions, 77 (2%) patients arrived agitated. Agitated patients were younger (40 versus 46, P = 0.03), predominantly male (94% versus 66%, P < 0.0001) sustained more penetrating trauma (31% versus 12%, P < 0.0001), had a lower systolic blood pressure (127 versus 137, P < 0.0001), and a higher Injury Severity Score (17 versus 9, P < 0.0001). On multivariable logistic regression, agitation was independently associated with massive transfusion (odds ratio: 2.63 [1.20-5.77], P = 0.02) and emergent therapeutic intervention for hemorrhage control (odds ratio: 2.60 [1.35-5.03], P = 0.005). Agitation in trauma patients may serve as an early indicator of hemorrhagic shock, as agitation is independently associated with a two-fold increase in the need for massive transfusion and emergent therapeutic intervention for hemorrhage control. [ABSTRACT FROM AUTHOR]

Failed extubation in critically ill patients is associated with poor outcomes. In critically ill trauma patients who have failed extubation, providers must decide whether to proceed with tracheostomy or attempt extubation again. The aim of this study was to describe the natural history of failed extubation in trauma patients and determine whether tracheostomy or a second attempt at extubation is more appropriate. Trauma patients admitted to our level I trauma center from 2013 to 2019 were identified. Patients who failed extubation, defined as an unplanned reintubation within 48 h of extubation, were included. Patients who immediately underwent tracheostomy were compared with those who had subsequent attempts at extubation. The primary outcome was mortality, and the secondary outcomes were intensive care unit (ICU) length of stay (LOS), ventilator days, and hospital LOS. The population included 93 patients who failed extubation and met inclusion criteria. A total of 53 patients were ultimately successfully extubated, whereas 40 patients underwent a tracheostomy. There was no statistically significant difference in demographics or injury patterns. Patients who underwent tracheostomy had a longer ICU LOS and more ventilator days. There was no difference in mortality or hospital LOS between the two groups. In trauma patients, those who underwent subsequent attempts at extubation did not experience higher rates of mortality than those who received a tracheostomy. Tracheostomy was associated with longer ICU LOS and ventilator days. In certain situations, it is appropriate to consider subsequent attempts at extubation in trauma patients who fail extubation rather than proceeding directly to tracheostomy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although evidence suggests that racial and ethnic minority (REM) patients receive inadequate pain management in the acute care setting, it remains unclear whether these disparities also occur during the prehospital period. The aim of this study is to assess the impact of race and ethnicity on prehospital analgesic use by emergency medical services (EMS) in trauma patients. STUDY DESIGN: Retrospective chart review of adult trauma patients aged 18 to 89 years old transported by EMS to our American College of Surgeons-verified level 1 trauma center from 2014 to 2020. Patients who identified as Black, Asian, Native American, or Other for race and/or Hispanic or Latino or Unknown for ethnicity were considered REM. Patients who identified as White, non-Hispanic were considered White. Groups were compared in univariate and multivariate analysis. The primary outcome was prehospital analgesic administration. RESULTS: A total of 2,476 patients were transported by EMS (47% White and 53% REM). White patients were older on average (46 years vs 38 years; p < 0.001) and had higher rates of blunt trauma (76% vs 60%; p < 0.001). There were no differences in Injury Severity Score (21 vs 20; p = 0.22). Although REM patients reported higher subjective pain rating (7.2 vs 6.6; p = 0.002), they were less likely to get prehospital pain medication (24% vs 35%; p < 0.001), and that difference remained significant after controlling for baseline characteristics, transport method, pain rating, prehospital hypotension, and payor status (adjusted odds ratio [95% CI], 0.67 [0.47 to 0.96]; p = 0.03). CONCLUSIONS: Patients from racial and ethnic minority groups were less likely to receive prehospital pain medication after traumatic injury than White patients. Forms of conscious and unconscious bias contributing to this inequity need to be identified and addressed. (J Am Coll Surg 2023;236:461-467. © 2022 by the American College of Surgeons. [ABSTRACT FROM AUTHOR]

The article focuses on the increasing Zika Virus activity in Mozambique and threats posed by it. Topics discussed include past and recent outbreaks of dengue in the country and the abundance of mosquito Aedes, design of effective prevention strategies to eradicate Zika, and taking into consideration the specificities and difference of the ecology of Anopheles and Aedes mosquitoes.

Regular physical activity reduces the progression of several cancers and offers physical and mental health benefits for cancer survivors. However, many cancer survivors are not sufficiently active to achieve these health benefits. Possible biological mechanisms through which physical activity could affect cancer progression include reduced systemic inflammation and positive changes in metabolic markers. Chronic and acute hyperglycemia could have downstream effects on cell proliferation and tumorigenesis. One novel strategy to motivate cancer survivors to be more active is to provide personalized biological-based feedback that demonstrates the immediate positive impact of physical activity. Continuous glucose monitors (CGMs) have been used to demonstrate the acute beneficial effects of physical activity on insulin sensitivity and glucose metabolisms in controlled lab settings. Using personal data from CGMs to illustrate the immediate impact of physical activity on glucose patterns could be particularly relevant for cancer survivors because they are at a higher risk for developing type 2 diabetes (T2D). As a pilot project, this study aims to (1) test the preliminary effect of a remotely delivered physical activity intervention that incorporates personalized biological-based feedback on daily physical activity levels, and (2) explore the association between daily glucose patterns and cancer-related insulin pathway and inflammatory biomarkers in cancer survivors who are at high risk for T2D. We will recruit 50 insufficiently active, post-treatment cancer survivors who are at elevated risk for T2D. Participants will be randomly assigned into (1) a group that receives personalized biological feedback related to physical activity behaviors; and (2) a control group that receives standard educational material. The feasibility and preliminary efficacy of this wearable sensor-based, biofeedback-enhanced 12-week physical activity intervention will be evaluated. Data from this study will support the further refinement and enhancement of a more comprehensive remotely delivered physical activity intervention that targets cancer survivors. Trial registration: ClinicalTrials.gov Identifier: NCT05490641. [ABSTRACT FROM AUTHOR]

Background: Thyroid dysfunction is among the most common autoimmune diseases and immune checkpoint inhibitor (ICI)-induced immune-related adverse events (irAE). We determined the association between longitudinal thyroid function and clinical outcomes in patients treated with ICI. Methods: We identified all patients treated with ICI at UT Southwestern Medical Center from January 1, 2011, through December 31, 2020. We defined normal thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels according to institutional reference range. We defined clinical thyroid dysfunction using established criteria incorporating labs and treatment. We determined the association between thyroid function and overall survival (OS) using Kaplan–Meier curves, log-rank tests, and multivariate Cox proportional hazards model. Results: A total of 1781 patients were included in analyses, of whom 381 (21%) had abnormal baseline TSH. Patients with abnormal baseline TSH were more likely to be female, have kidney cancer, and initiate levothyroxine after ICI initiation (all P < 0.001). Patients with abnormal baseline TSH had inferior OS (median 16 vs 27 months; P < 0.001). Among patients with normal baseline TSH, those who had abnormal TSH after ICI initiation had improved OS (median 41 vs 22 months; P < 0.001). In a multivariate Cox model, abnormal baseline TSH was associated with worse OS (HR 1.62; 95% CI, 1.30–2.02; P < 0.001), while initiation of levothyroxine after ICI initiation was associated with improved OS (HR 0.62; 95% CI, 0.44–0.88; P = 0.008). Conclusions: ICI-induced thyroid dysfunction is associated with improved survival, although abnormal TSH prior to ICI initiation is associated with inferior survival. Precis: Thyroid abnormalities occur commonly in the general population and as immunotherapy toxicities. We found that immunotherapy-induced thyroid dysfunction is associated with better survival, but pre-existing thyroid abnormalities convey worse outcomes. [ABSTRACT FROM AUTHOR]

This research suggests a novel Robust, Resilient machine learning that focuses on the Risk approach (3R) in a hard situation for the first time. A robust stochastic LASSO regression is proposed for predicting gas consumption. This model tries to optimize a new form of LASSO regression by minimizing the expected value of mean and maximum and EVaR of MAD with the penalty of the regression coefficient. The 3R requirements include robustness and resiliency in the mathematical model approach by paying attention to disaster and flexibility and the risk-averse method by considering risk criteria like max function and EVaR determined. The results show that the value of Robust and Resiliency Mean Absolute Deviation with Risk approach (RRMADR) and R-squared of the hybrid natural logarithm function is 26.81% less than the polynomial LASSO model (base model). In addition, the polynomial regression without LASSO performs better than the base model. This subject is because of the penalty of LASSO regression. The conservatism coefficient, confidence level, penalty of LASSO, resiliency coefficient, and scenario probability are analyzed. Decreasing conservatism and resiliency coefficient, increasing confidence level and penalty of LASSO increase RRMADR and decrease R-squared of the model. [ABSTRACT FROM AUTHOR]

The article focuses on improving communication between nursing staff and surgery residents in the age of electronic medical records (EMRs). Topics include the challenges of collaboration between nurses and physicians, the communication issues identified at Dell Seton Medical Center, and the effectiveness of a quality improvement initiative to address the problem by reducing the number of pages and improving interprofessional communication.

Background: This study evaluates the utility of chest (CXR) and pelvis (PXR) X-ray, as adjuncts to the primary survey, in screening geriatric blunt trauma (GBT) patients for abdominal injury or need for laparotomy.Methods: We performed a retrospective analysis of patients 65-89 years in the 2014 National Trauma Data Bank. X-ray injuries were identified by ICD9 codes and defined as any injury felt to be readily detectable by a non-radiologist. X-ray findings were dichotomized as "both negative" (no injury presumptively apparent on CXR or PXR) or "either positive" (any injury presumptively apparent on CXR or PXR). Rates of abdominal injuries and laparotomy were compared and used to calculate sensitivity and specificity. The primary outcomes were abdominal injury and laparotomy. The secondary outcomes included mortality, ventilator days, and hospital days.Results: A total of 202 553 patients met criteria. Overall, 9% of patients with either positive X-rays had abdominal injury and 2% laparotomy vs. 1.1% and .3% with both negative (P < .001). The specificity for any positive X-ray was 79% for abdominal injury and 78% for laparotomy. The sensitivity was 69% for abdominal injury and laparotomy. The either positive group had fewer ventilator days (.3 vs. .8, P < .0001), longer length of stay (7 vs. 5, P < .0001), and higher mortality (6% vs. 4%, P < .0001) vs both negative.Conclusion: CXR and PXR can be used to assess for intra-abdominal injury and need for laparotomy. GBT patients with either positive X-rays should continue workup regardless of mechanism due to the high specificity of this tool for abdominal injury and need for laparotomy. [ABSTRACT FROM AUTHOR]

Objective: To compare the platelet indices in pregnant and non-pregnant females at a tertiary care diagnostic laboratory. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: 166 healthy pregnant females were included in group-1, and 166 non-pregnant healthy females were recruited in group-2. 5 ml of fresh venous blood from the antecubital vein was collected under aseptic conditions in EDTA anticoagulant tubes. This sample was analyzed to determine complete blood counts (TLC, RBC, HB, and Platelet Count) and platelet parameters, namely Platelet distribution width (PDW), Mean platelet volume (MPV) and Plateletcrit (PCT), using an automated haematology analyzer Sysmex XN-3000. Results: A total of 332 patients with a mean age of 26.5 ± 5.12 years were included in the study. Platelet count, PCT and PDW values were higher among group-2 than the pregnant females (p=0.001). MPV was higher among the group-1 females than the group-2 females (p=0.001). The distribution of platelet parameters across the trimesters showed that platelet count and PDW among the trimesters showed a statistically significant difference (p=0.001). Conclusion: Pregnancy brings along many physiological changes in the female body. Various haematological and biochemical changes accompany these changes. MPV, PDW and PCT values were decreased in the pregnancy group. However, MPV was found to be increased as compared to group-2. [ABSTRACT FROM AUTHOR]