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Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region heightens the susceptibility to the impact of global warming. In addition to affecting agriculture, water resources, and livelihood, environmental changes interfere with endocrine functioning. Resulting lifestyle changes increase the risk of metabolic and endocrine disorders. Individuals with diabetes face heightened vulnerability to extreme weather due to impaired thermoregulation. A high ambient temperature predisposes to heat-related illnesses, infertility, and nephropathy. Additionally, essential endocrine drugs and medical devices are susceptible to temperature fluctuations. The South Asian Federation of Endocrine Societies (SAFES) calls for collaboration among stakeholders to combat climate change and promote healthy living. Comprehensive approaches, including the establishment of sustainable food systems, promotion of physical activity, and raising awareness about environmental impacts, are imperative. SAFES recommends strategies such as prioritizing plant-based diets, reducing meat consumption, optimizing medical device usage, and enhancing accessibility to endocrine care. Raising awareness and educating caregivers and people living with diabetes on necessary precautions during extreme weather conditions are paramount. The heat sensitivity of insulin, blood glucose monitoring devices, and insulin pumps necessitates proper storage and consideration of environmental conditions for optimal efficacy. The inter-connectedness of global warming and endocrine disorders underscores the necessity of international collaboration guided by national endocrine societies. SAFES urges all stakeholders to actively implement sustainable practices to improve endocrine health in the face of climate change.

OBJECTIVES: To determine the seroprevalence of SARS-CoV-2 antibodies (IgM, IgG) in school-age children and identify the predominant symptoms in seropositive children in the Swabi district of Khyber Pakhtunkhwa, Pakistan. METHODS: This descriptive cross-sectional study was conducted from November 2020 to May 2021. Blood samples from 246 randomly selected children (aged 5-16 years) in Swabi district of Pakistan were analyzed using ELISA. The study focused on the general pediatric population, excluding those over 16 years, with chronic illnesses, or whose parents declined participation. Data was collected through a structured questionnaire. RESULTS: Among 246 participants, 5 (2.03%) individuals tested positive for IgM and 58 (23.6%) for IgG antibodies, totaling 63 (25.6%) participants with both IgM & IgG antibodies. Mean age of seropositive and seronegative children was 11.2±3.0 and 10.3±2.98 years respectively (p=0.030). Out of 63 seropositive children, 51 (80.96%) were symptomatic, and 12 (19.04%) were asymptomatic. Common symptoms among seropositive individuals included fever (98.0%, n=50/51), cough (88.02%, n=45/51), sore throat (78.4%, n=40/51), coryza (66.7%, n=34/51), myalgia (60.8%, n=31/51), and loss of smell and taste (49.0%, n=25/51). The mean antibody titer was 20.9±10.41 IU/ml and 13.35±5.6 IU/ml for symptomatic and asymptomatic individuals respectively (p=0.013). CONCLUSION: In our study, approximately one fourth of the participants tested positive for SARS-CoV-2 antibodies, predominantly IgG. Females exhibited higher seropositivity than males, with a significant association between seropositivity and exposure to confirmed COVID-19 cases. Symptomatic cases comprised 80.95% of seropositive individuals, with predominant symptoms of fever, cough, and sore throat. Symptomatic individuals had a higher mean antibody titer.

Currently 1.3 billion individuals globally engage in smoking, leading to significant morbidity and mortality, particularly among diabetic patients. There is urgent need for a better understanding of how smoking influences antidiabetic treatment efficacy. The review underscores the role of cigarette smoke, particularly polycyclic aromatic hydrocarbons (PAHs), in modulating the metabolic pathways of antidiabetic drugs, primarily through the induction of cytochrome P450 (CYP450) enzymes and uridine diphosphate (UDP)-glucuronosyltransferases (UGTs), thus impacting drug pharmacokinetics and therapeutic outcomes. Furthermore, the review addresses the relatively uncharted territory of how smoking cessation influences diabetes treatment, noting that cessation can lead to significant changes in drug metabolism, necessitating dosage adjustments. Special attention is given to the interaction between smoking cessation aids and antidiabetic medications, a critical area for patient safety and effective diabetes management. This scoping review aims to provide healthcare professionals with the knowledge to better support diabetic patients who smoke or are attempting to quit, ensuring tailored and effective treatment strategies. It also identifies gaps in current research, advocating for more studies to fill these voids, thereby enhancing patient care and treatment outcomes for this at-risk population.

The control and state estimation of Unmanned Aerial Vehicles (UAVs) provide significant challenges due to their complex and nonlinear dynamics, as well as uncertainties arising from factors such as sensor noise, wind gusts, and parameter fluctuations. Neural network-based methods tackle these problems by accurately approximating unknown nonlinearities through training on input-output data. This paper proposes an adaptive Multi-layer Neural Network (MLNN) Luenberger observer-based control for altitude and attitude tracking of a quadrotor UAV. The MLNN observer, employing a modified back-propagation algorithm, is used for the quadrotor’s state estimation. The adaptive nature of the proposed observer helps mitigate the effects of parameters such as wind gusts, measurement noise, and parameter variations. Subsequently, a sliding mode controller is designed based on the observed states to track the reference trajectories. Lyapunov stability is ensured by using the modified back-propagation weight update rule for the proposed MLNN observer. Simulation results demonstrate superior tracking performance of the proposed observer compared to the Sliding Mode Observer (SMO) and a Single Hidden Layer Neural Network (SHLNN) observer, even in the presence of the aforementioned parameters.

This study considers the numerical design and practical implementation of a new multi-layer neural network observer-based control design technique for unmanned aerial vehicles systems. Initially, an adaptive multi-layer neural network-based Luenberger observer is designed for state estimation by employing a modified back-propagation algorithm. The proposed observer’s adaptive nature aids in mitigating the impact of noise, disturbance, and parameter variations, which are usually not considered by conventional observers. Based on the observed states, a nonlinear dynamic inversion-based fast terminal sliding mode controller is designed to attain the desired attitude and position tracking control. This is done by employing a two-loop control structure. Numerical simulations are conducted to demonstrate the effectiveness of the proposed scheme in the presence of disturbance, parameter uncertainty, and noise. The numerical results are compared with current approaches, demonstrating the superiority of the proposed method. In order to assess the practical effectiveness of the proposed method, hardware-in-loop simulations are conducted by utilizing a Pixhawk 6X flight controller that interfaces with the mission planner software. Finally, experiments are conducted on a real F450 quadrotor in a secured laboratory environment, demonstrating stability and good tracking performance of the proposed MLNN observer-based SMC control scheme.

Background: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation. Objective: To identify research on behavioral interventions for smoking cessation in diabetes. Methods: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included. Results: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes. Conclusions: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy.

Although most patients with cardiac amyloidosis are diagnosed with either light chain (AL) or transthyretin (ATTR) disease, coexisting amyloid subtypes can occur. We present three cases of coexisting AL and ATTR cardiac amyloidosis and demonstrate the importance of clinical history and endomyocardial biopsy in diagnosis of this rare entity.

Abstract Network security has developed as a critical research subject as a result of the Rapid advancements in the development of Internet and communication technologies over the previous decades. The expansion of networks and data has caused cyber-attacks on the systems, making it difficult for network security to detect breaches effectively. Current Intrusion Detection Systems (IDS) have several flaws, including their inability to prevent attacks on their own, the requirement for a professional engineer to administer them, and the occurrence of false alerts. As a result, a plethora of new attacks are being created, making it harder for network security to properly detect breaches. Despite the best efforts, IDS continues to struggle with increasing detection accuracy while lowering false alarm rates and detecting new intrusions. Therefore, network intrusion detection enhancement by preprocessing and generation of highly reliable algorithms is the main focus nowadays. Machine learning (ML) based IDS systems have recently been implemented as viable solutions for quickly detecting intrusions across the network. In this study, we use a combined data analysis technique with four Robust Machine learning ensemble algorithms, including the Voting Classifier, Bagging Classifier, Gradient Boosting Classifier, and Random Forest-based Bagging algorithm along with the proposed Robust genetic ensemble classifier. For each algorithm, a model is created and tested using a Network Dataset. To assess the performance of both algorithms in terms of their ability to anticipate the anomaly occurrence, graphs of performance rates have been evaluated. The suggested algorithm outperformed other methods as it shows the lowest values of mean square error (MSE) and mean absolute error (MAE). The experiments were conducted on the Network traffic dataset available on Kaggle, on the Python platform, which has limited samples. The proposed method can be applied in the future with more machine learning ensemble classifiers and deep learning techniques.

We study the problem of optimal switching on a treatment-vaccination model with four switches. These switches provide a more realistic approach when dealing with the control of an epidemic. We have used a relatively new approach to investigate optimal switching. The main idea behind this approach is to convert the switched system, a nonlinear, nonconvex optimal control problem, into an equivalent optimal control problem with a linear and convex structure. This allows us to obtain an equivalent convex formulation better suited to being solved by high-performance numerical computing. Toward the end, we perform some numerical simulations and draw the conclusion that the presence of treatment is essential, whereas vaccination control can be used at intervals with progressively larger gaps between the intervals.

Vaccination programs are crucial for reducing the prevalence of infectious diseases and ultimately eradicating them. A new age-structured SEIRV (S-Susceptible, E-Exposed, I-Infected, R-Recovered, V-Vaccinated) model with imperfect vaccination is proposed. After formulating our model, we show the existence and uniqueness of the solution using semigroup of operators. For stability analysis, we obtain a threshold parameter $ R_0 $. Through rigorous analysis, we show that if $ R_0 < 1 $, then the disease-free equilibrium point is stable. The optimal control strategy is also discussed, with the vaccination rate as the control variable. We derive the optimality conditions, and the form of the optimal control is obtained using the adjoint system and sensitivity equations. We also prove the uniqueness of the optimal controller. To visually illustrate our theoretical results, we also solve the model numerically.

IN939 is a modern class of nickel-based superalloys designed for continuous operational sustenance at elevated temperatures owing to their excellent combination of fatigue, creep, and corrosion resistance. This unique performance of IN939 is associated with the composition of this alloy, along with specific post-processing treatments such as solution treatment and aging, giving rise to features such as the presence of γ’ residues, as well as the presence of MC and M23C6 carbides. This also includes the absence of the eutectic and incipient melting phases. For this alloy, the primary part development is by the powder bed fusion process using a laser powder bed fusion machine. At the same time, a solo study highlights the use of an EB-PBF machine for the synthesis. The AM development process of these alloys is hindered by machine parameters, which have been found ineffective in isolation to obtain a fully dense structure with desired properties. The purpose of these parameters is to improve their core properties while minimizing defects associated with powder metallurgy routes, such as porosity, detrimental precipitates, grain anisotropy, etc. This study aims to provide an overview of the advancements in research related to IN939, explicitly focusing on the benchmarks achieved through additive manufacturing techniques. We have discussed the work performed in this area, compared the results of different studies, and identified the gaps in current research. By doing so, we aim to provide a comprehensive understanding of the potential of IN939 and its applications in extreme environments.

Both clonal plasma cell and myeloid disorders occur more frequently with age. Patients with concurrent clonal plasma cell and myeloid disorders (CPCMD) can present clinical and therapeutic challenges. In this single-institution cohort of patients with CPCMD (n = 18), we abstracted clinically relevant themes. A majority of patients (12/18) were treated with clone-directed therapies and three received treatment targeting both clones. Treatment of clones with targetable genetic lesions or those causing end-organ complications should be prioritized. Simultaneous treatment of both clones can be safe but is best done in a stepwise manner. Further study of patients with dual clonal processes is warranted.

Background: South Asian countries face the colossal challenge of tackling the massive burden of diabetes and other endocrine disorders. These patients grossly outnumber the specialists trained to deal with these conditions. A trained cadre of diabetes specialist nurses (DSN) and endocrine specialist nurses (ESN) might help bridge this gap. Exploring the perception of DSN/ESN among South Asian doctors will help to understand their role, responsibilities and future prospects. Methods: One hundred and seventy-four endocrinologists from South Asia participated in an online survey on their perception of DSNs and ESNs. Results: Out of the 174 respondents, 61 (35%) were currently working with DSN/ESN, 79 (45.4%) had worked in the past and 131 (75.2%) were willing to start recruiting or employ additional DSN/ESN in the future. The majority considered that the primary function of DSN and ESN is to educate on diabetes (n = 86, 96.6%) and endocrine disorders (n = 34, 57.6%), respectively, followed by anthropometry and initial work-up. Only a small minority felt they could write independent follow-up prescriptions (nurse-led clinics) [DSN - 16 (18%) and ESN – 3 (5.1%)]. Graduation with a certificate course in diabetes and basic endocrinology was considered a sufficient qualification by 68 (39.1%) respondents. Endocrinologists from countries other than India were more willing to recruit ESN/DSN in the future (89.7% vs 72.4%; P < 0.03) and approve a nurse-led clinic (62.1% vs 29.7%; P < 0.03). Upon multiple logistic regression, working in countries other than India was an independent predictor of future willingness to work with DSN/ESN (odds ratio (OR): 4.48, 95% confidence interval (CI) 1.09–18.43, P = 0.03). Conclusion: DSN and ESN could facilitate the management of healthcare-seekers with diabetes and endocrine disorders. A certification course to train nurses on diabetes and basic endocrine disorders following graduation could be helpful. Major hindrances in creating a regular cadre of DSN/ESN were limited opportunities for career progression and lack of additional remuneration for services.

Abstract Background Sodium-Glucose-Co-Transporter 2 (SGLT2) inhibitor (Empagliflozin) is an effective drug in controlling blood glucose through predominantly glycosuria. Glycosuria increases the risk of genitourinary infections in diabetes. This study was aimed to establish the safety and efficacy of Empagliflozin (Group-A) versus standard care (Group-B) in Pakistani Muslim individuals with type 2 diabetes. Methods A multicenter, randomized clinical trial was conducted in five cities across Pakistan from July 2019 to August 2020. Patients of both genders aged 18–75 years, body mass index (BMI) ≤ 45 kg/m2, glycosylated hemoglobin (HbA1c) 7–10% (53 mmol/mol to 86 mmol/mol) and treatment-naive to Empagliflozin were included. Treatment was given for 24 weeks, and allocation was done through randomization. Results Out of 745 screened patients, 333 met the eligibility criteria, and a total of 244 (73.3%) patients were enrolled. More hypoglycemic events were reported in the standard care group, whereas positive urine culture, fungal infection, dehydration, and hypotension occurrence were comparable between the two groups. The 6 months mean HbA1c reduction was significant in both groups; (Group-A: 0.91 ± 0.15; p

Background: The South Asian Region shoulders more than its fair share of health-related challenges. While we continue to tackle acute and communicable illness, newer challenges and concerns have emerged. These include the rapidly increasing metabolic and endocrine syndromes such as diabetes, dyslipidemia and obesity. Methods: In the past, SAFES has released the Dhaka Declaration (2015) on gestational diabetes mellitus, and the Colombo Declaration (2019) on prevention of diabetes. The authors from 8 countries have together drafted and agreed this declaration to improve healthcare delivery for the recognition and management of obesity in the region. Results: In this Kathmandu declaration we highlight the urgent need for recognition, evaluation and prevention of obesity in this region. It has described not only the need but also the methods to improve obesity outcomes in the region through advocacy, awareness and addressal. Conclusion: Through its member associations, South Asian Federation of Endocrine Societies (SAFES) works to ensure optimal endocrine health care delivery in South Asia and has worked on the Kathmandu Declaration to improve the obesity pandemic in the region.

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes non-pharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.

Supercapacitors are the cutting-edge, high performing, and emerging energy storage devices in the future of energy storage technology. It delivers high energy and produces higher specific capacitances. This research study provides insights into supercapacitor materials and their potential applications by examining different battery technologies compared with supercapacitors’ advantages and disadvantages. Transition metal hydroxides (cobalt hydroxides) have been studied to develop electrodes for supercapacitors and their use in various fields of energy and conversion devices. Cobalt-based metal oxides and hydroxides provide high-capacitance electrodes for supercapacitors. Metal hydroxides combine high electrical conductivity and excellent stability over time. The metal oxides used to prepare the electrodes for supercapacitors are cobalt-based metal oxides and hydroxides. It is stronger than most of the other oxides and has tremendous electrical conductivity. Cobalt hydroxides are also used in supercapacitors instead of other metal hydroxides, such as aluminum hydroxide, copper hydroxide, and nickel hydroxide. This study gives a complete overview of the preparation, synthesis, analysis, and characterization of cobalt hydroxide thin film electrodes by using the electrochemical deposition technique, parameters measurements, important characteristics, material properties, various applications, and future enhancement in supercapacitors.

Using the techniques of Darbo’s fixed-point theorem associated with measures of noncompactness, we investigate the existence results for functional stochastic integral equations in Banach Algebra, which are useful in many real-life problems, such as applied mathematics, physics, and economics problems. Our existence results treat numerous existence results achieved by different authors as special cases. An example is also provided to show the effectiveness of our main results.

Abstract Background One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. Methods This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients. Results A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value

In this work, the thermal performance characteristics and emissions of VCR, one cylinder compression ignition (CI) engine fuelled with a mixture of two biodiesel in a blend with diesel has been assessed by using artificial neural network (ANN). Further, the two biodiesel considered are Pongamia and Jatropha mixed in different volume ratio, i.e. 25:75, 50:50, 75:25 these mixtures are called M1, M2, and M3. The mixtures are used to prepare the various blends operated with diesel fuel, which are utilized in the experimentation. The engine experimental data required for the training and validation of ANN model are obtained through the VCR engine operated with pure diesel and blends of two biodiesel mixture as a fuel at different load and compression ratio. To train the ANN model, mixture ratio, blend ratio, load and compression ratio (CR), are selected as the inputs and output variables are brake specific fuel consumption (BSFC), exhaust gas temperature (EGT), brake thermal efficiency (BTE), carbon monoxide (CO), hydrocarbons (HC), nitrogen oxides (NOx), smoke density. Different architectures of ANN are trained by varying the number of hidden neurons in the hidden layer and corresponds to the minimum mean square error (MSE) for validation data for selecting the optimum architecture to estimate the parameters. The thermal performance and emissions of VCR engine estimated by using proposed ANN model are found to be quite close to experimental values with reasonable accuracy as the correlation coefficient is ranging from 0.97 to 0.99.

I In recent years, there has been a serious need to understand the effects of emerging information technologies with a focus on artificial intelligence and the Internet in organizations. Therefore, the aim of this research is to identify and rank the various components of these emerging information technologies in the defense-military field. The research method is qualitative and based on Delphi. Initially, with the exploratory study of the new literature of the world's information technology in the military field, 23 emerging information technologies were provided to 9 members of the Delphi panel of AJA experts as the primary questionnaire. At this stage, 4 new technologies were introduced and one technology was eliminated. In the second phase of Delphi and Consensus of Experts, 26 effective emerging information technologies in the defense sector were identified and ranked through the Kendall test. In the third stage, experts were asked to determine the future ownership of these technologies by the Iranian defense sector in three periods: imitation of technology, adaptation to technology, and mastery of technology. According to the research findings, it takes 4, 7, and 13 years to imitate, adapt, and master technology, respectively. In the final stage, according to experts, these technologies were classified in terms of application in three categories: technical, tactical and strategic. Theoretical assistance of the article is the identification and classification of 26 emerging information technologies in two dimensions of technology acquisition and the type of application of technology in the defense sector.

It is imperative in a medical domain that protection of information does not allow an individual to be overlooked. In medical domain, research community encourages use of real-time datasets for research purposes. These real-time datasets contain structured and unstructured (natural language free text) information that can be useful to researchers in various disciplines including computational linguistics. On the other hand, these real-time datasets cannot be distributed without anonymization of Protected Health Information (PHI). The information of PHI (such as Name, age, address, etc.) that can identify an individual is unethical. Therefore, we present a rule-based Natural Language Processing (NLP) anonymization system using a challenging corpus containing medical narratives and ICD-10 codes (medical codes). This anonymization module can be used for pre-processing the corpus containing identifiable information. The corpus used in this research contains '2534' PHIs in '1984' medical records in total. 15% of the labelled corpus was used for improvement of guidelines in the identification and classification of PHI groups and 85% was held for the evaluation. Our anonymization system follows two step process: (1) Identification and cataloging PHIs with four PHI categories ('Patients Name', 'Doctors Name', 'Other Name [Names other than patients and doctors]', 'Place Name'), (2) Anonymization of PHIs by replacing identified PHIs with their respective PHI categories. Our method uses basic language processing, dictionaries, rules and heuristics to identify, classify and anonymize PHIs with PHI categories. We use standard metrics for evaluation and our system outperforms against human annotated gold standard with 100% of F-measure by increasing 39% from baseline results, which proves the reliability of data usage for research.

Inorganic arsenic causes carcinogenesis in a large part of the world. Its potential is elicited by the generation of ROS, which leads to damages to DNA, lipid and protein. Black tea, an antioxidant, can mitigate such deleterious effects by quenching ROS. We study Arsenic-toxicity and its amelioration by black tea in a colony of albino mice: a homology exists between the protein coding regions of mice and human. We observe that black tea has salutary effects on tumor-growth: it arrests damaged cell growth and produces early saturation of the damage. The experimental data obtained by us are modelled with dynamical equations. This is followed by a search for steady states and their stability analysis.

Abstract This article mainly explores and applies a modified form of the analytical method, namely the homotopy analysis transform method (HATM) for solving time-fractional Cauchy reaction–diffusion equations (TFCRDEs). Then mainly we address the error norms L2 $L_{2}$ and L∞ $L_{\infty }$ for a convergence study of the proposed method. We also find existence, uniqueness and convergence in the analysis for TFCRDEs. The projected method is illustrated by solving some numerical examples. The obtained numerical solutions by the HATM method show that it is simple to employ. An excellent conformity obtained between the solution got by the HATM method and the various well-known results available in the current literature. Also the existence and uniqueness of the solution have been demonstrated.

Objective Advancement in healthcare provision has led to increasing octogenarian ST elevation myocardial infarction (STEMI) presentation to hospital for early revascularisation therapies. Limited literature to date exists to suggest octogenarian STEMI population; with majority of trials excluding these age group patients. Due to an ageing population, we expect increasing rates of STEMI in the octogenarian and nonagenarian population in the future. This study seeks to identify the outcomes of patients over the age of 80 presenting with STEMI and determine the factors associated with better or worse outcome.Patients and methods This study is a single-centre retrospective observational study involving patients’ age 80 or older presenting with STEMI between January 2014 and December 2019. Patient data were collected by chart review and analysis of the local STEMI database. Standard Bayesian statistics were employed for analysis.Results 1301 patients presented with STEMI during this period. 159/1301 (12.2%) were 80 years or older that fulfilled STEMI criteria, 35/159 (22.1%) were medically managed. 107/124 (86.29%) had angiographic evidence of acute total or partial thrombotic occlusion, and 97/107 were treated with primary percutaneous coronary intervention (PPCI). The activation ECG most commonly exhibited an anterior STEMI, while inferior STEMI ECGs had the strongest positive predictive value. PPCI group had a 30-day mortality rate of 20% (p=0.07) and 1-year mortality was 22.4%. Highest mortality was observed with cardiogenic shock, low ejection fraction, higher high sensitivity cardiac troponin T and creatinine at presentation. Conservatively managed patients had significant higher mortality rate (48% vs 22.4%, p=0.005) at 1 year.Conclusion Patients over the age of 80 who present with STEMI and undergo PPCI have a significantly lower mortality rate at 1 year. These patients have a 77.6% survival at 1 year, with 92.4% likelihood of discharge to home (without need for long-term nursing home care). Cardiogenic shock in this group was associated with a 1-year mortality of 87.5%. Despite the advanced age, we suggest favourable outcomes described in the absence of patients presenting with cardiogenic shock.

We describe a rare case of intramammary lymphadenopathy due to Kikuchi-Fujimoto disease. A 15-year old female presented to the Breast Clinic with complaints of a tender, palpable right breast lump. An ultrasound of the area of concern demonstrated an enlarged 2.9 cm intramammary lymph node with preservation of the fatty hilum. An ultrasound guided core biopsy of the lymph node confirmed the diagnosis of Kikuchi-Fujimoto disease.

Abstract: Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P = .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.

Compared to motherhood, the molecular changes associated with fatherhood are less understood. Here, the authors investigate gene expression changes associated with paternal care in male stickleback fish, and compare them with patterns in territorial aggression.

In this manuscript, a new class of non-instantaneous impulsive stochastic neutral integro-differential equation driven by fractional Brownian motion (fBm, in short) with state-dependent delay and their stochastic optimal control problem is studied. We utilize the theory of the resolvent operator and a fixed point technique to present the solvability of the stochastic system. Then, the existence of optimal controls is discussed for the proposed stochastic system. Finally, an example is offered to demonstrate the obtained theoretical results.

Abstract We study almost periodic solutions for a class of nonlinear second-order differential equations involving reflection of the argument. We establish existence results of almost periodic solutions as critical points by a variational approach. We also prove structure results on the set of strong almost periodic solutions, existence results of weak almost periodic solutions, and a density result on the almost periodic forcing term for which the equation possesses usual almost periodic solutions.

Background: Bethesda category III and IV thyroid nodules fall in the indeterminate risk of malignancy category. These nodules have been a relatively elusive entity to manage as previous studies have shown a wide variation in malignancy rates in different regions and institutions across the world. However, data from the subcontinent with regards to this is scarce. Aim and objective: This study aimed to determine the characteristics and malignancy rates of cytology proven Bethesda Category III and IV thyroid nodules and its association with clinical, histopathological and laboratory variables, in the regional population. Method: A retrospective search was performed on all patients with thyroid nodules who presented to this hospital, from January 2011 to September 2018. Patients who had cytology proven Bethesda category III and IV thyroid nodules that underwent surgery were included in the study. Results: Malignancy in Bethesda Category III and Bethesda Category IV thyroid nodules was 29.6% and 47.1%, respectively. There was no significant association determined between malignancy rate and various clinical, histopathological, and radiological characteristics. Conclusion: The malignancy rates in Bethesda category III and IV thyroid nodules in this study are significantly higher than that initially suggested by the Bethesda consensus publication but is comparable to international data present.

Localizing small damages often requires sensors be mounted in the proximity of damage to obtain high Signal-to-Noise Ratio in system frequency response to input excitation. The proximity requirement limits the applicability of existing schemes for low-severity damage detection as an estimate of damage location may not be known a priori . In this work it is shown that spatial locality is not a fundamental impediment; multiple small damages can still be detected with high accuracy provided that the frequency range beyond the first five natural frequencies is utilized in the Frequency response functions (FRF) curvature method. The proposed method presented in this paper applies sensitivity analysis to systematically unearth frequency ranges capable of elevating damage index peak at correct damage locations. It is a baseline-free method that employs a smoothing polynomial to emulate reference curvatures for the undamaged structure. Numerical simulation of steel-beam shows that small multiple damages of severity as low as 5% can be reliably detected by including frequency range covering 5–10 th natural frequencies. The efficacy of the scheme is also experimentally validated for the same beam. It is also found that a simple noise filtration scheme such as a Gaussian moving average filter can adequately remove false peaks from the damage index profile.

IoT (Internet of Things) is the next generation of the Internet. The main goal of IoT is to connect each and every physical object to the Internet Cloud. This concept is introduced by bringing IoT technology to the laboratories, making expensive laboratory equipment available on-cloud for real-time experimentation. In this paper, an on CLP (Cloud Laboratory Platform) is presented by employing the concept of IoT to the academic experimentation environment. The CLP allows a rapid deployment of an online laboratory system enabling students and researchers to perform actual experiments on the on-Cloud laboratory equipment using a web interface. A web interface for end users to access front end of the system. This interface was developed for login purposes so that any user can perform experiments from anywhere. The interface also provides options for comments and feedback. Moreover, this research contribution also facilitate users to test their designs and record observations in real-time on the equipment. For demonstration purposes, a remote lab has been developed for high-tech Xilinx FPGA (Field Programmable Gate Array) development boards, namely Spartan-II and Spartan-III. This project aims to provide students a new tool to enhance their learning experience and encourage them to test their theoretical knowledge in practical applications.

In this article, we establish the Picard-Lindelof theorem and approximating results for dynamic equations on time scale. We present a simple proof for the existence and uniqueness of the solution. The proof is produced by using convergence and Weierstrass M-test. Furthermore, we show that the Lispchitz condition is not necessary for uniqueness. The existence of epsilon-approximate solution is established under suitable assumptions. Moreover, we study the approximate solution of the dynamic equation with delay by studying the solution of the corresponding dynamic equation with piecewise constant argument. We show that the exponential stability is preserved in such approximations.

The Surghar Range western extension of the Trans-Indus ranges constitutes the southeastern anterior foldand-thrust belt of the Kohat Plateau. This structural territory is comprised of various local to regional scale anticlines right from Serkia-Mitha Khattak to Kutki areas. The existing range-front anticlinal trend is well-built along the eastwest trending segment of the Surghar Range. These anticlinal features reveal infantile tendency from east to west and unearthing the platform rock sequences ranging from Permian to Eocene which is unconformably overlain by the Mitha Khattak Formation, equivalent facies to the Rawalpindi Group. This formation in turn has been overlain by the fluvial sediments of Siwalik Group. Overall three major anticlinal structures have been mapped from west to east as the Mitha Khattak, Makarwal and Malla Khel anticline. Different stratigraphic levels are exposed in cores of these anticlines and illustrate probable prospect that could be potential hydrocarbon reservoir horizons. The Eocene Sakesar limestone has been chosen for detailed studies. This horizon exposes along the range front which making fraction of the frontal limbs of different anticlines. Various fractures network and joints pattern has been observed in the Sakesar Limestone at different localities along the range and reveal high secondary porosity and permeability. Most of the secondary features induced and primary diagenetic opening and ruptures planes are interconnected and tenders proficient conduit lattice for munificent circulation of fluids in the Sakesar horizon. Origin of fractures and joints growth is mainly associated to force folding in response to the compressional, transpressional and trans-tensional deformation being observed in the region. The studied anticlines reveal that they are the product of fault-bend and fault-propagation folding tender excellent structural fluid trapping philosophy. The range frontal flanks reveal that different level of strata thrust over the foredeep showing variation in the subsurface level of basal detachment horizon which is too hopeful for the construction of structural traps at various levels. Blending of the structural style of the area with the sedimentary structural features of the Sakesar Limestone of Surghar Range urges that this structural province is significantly associated to make hydrocarbon reservoir potential at the stratigraphic level of Sakesar Limestone. The mapped fractured rocks assist the fluid storage aptitude and transmissivity along the medium to enhance the reservoir eminence of the Sakesar Limestone. That’s why one of the most important preconditions for the hydrocarbon accrual is in hand in the Surghar Range, Trans-Indus Ranges of the outer Himalayan Orogenic province of north Pakistan.

The present study deals with geochemical and petrographic analysis of the Kirana Hill shield rocks of Punjab plains from Buland, Hachi, Shaheen Abad, Shaikh and Machh hills. On basis of the current studies certain modifications have been made in the classification and nomenclature of rocks exposed in the study areas. Chemical analyses have also been carried out in order to calculate Cross Iddings, Pirsson, and Washington (CIPW) norms”, to strengthen nomenclature scheme and finally rocks are classified by using “MAGMA SOFTWARE”. Rhyolites predominate over the basalts/dolerites, andesites, and phyllite/ slate. Rhyolitic rocks are light grey, greenish grey and light brown in color, aphanitic in nature. The observed microscopic textures are aphyric, phyric or porphyritic and micropoikilitc. Moreover, some rhyolitic rocks also show flow texture. They are either cryptocrystalline to microcrystalline or microcrystalline to cryptocrystalline. No glassy material has been observed in any thin section. Mafic rocks are characterized by the presence of ferromagnesian minerals with plagioclase. Andesites exhibit mainly porphyritic texture, but aphyric texture has also been observed in few samples. Hydrothermal alterations are also very common in these rocks. Other rock assemblages identified during laboratory studies from Kirana area include: tuffs i.e. (Lithic Crystal Tuff and Lithic Tuff), basaltic andesite, rhyodacite/ dacite, slate/ phyllite, ankeritic rocks/ veins and quartzofeldspathic veins. Our studies also reveal that no evidence of quartzite has been found in the samples collected from above mentioned areas of Kirana, although it has been reported in previous literature. Iron (Fe) has been observed in rhyolite as well as other volcanic rocks of Kirana hills, its presence suggests magma from deep mantle instead of crustal melting / anatexis. In the present analysis some primary and secondary copper minerals including chalcopyrite, atacamite and malachite have been identified. Some anomalous values of the Rare Earth Elements are also observed. Inclusive geological investigations are recommended for better studies to appraise the potential of Iron (Fe), Copper (Cu) and trace/Rare Earth Elements (REE) in the area.

Butterflies of the Inani Reserve Forest were studied between May 2014 and May 2015. One hundred twenty five species of butterflies belonging to 84 genera and six families (Hesperiidae, Papilionidae, Pieridae, Lycaenidae, Riodinidae and Nymphalidae) were recorded during this study. The highest number of species comprised Family Nymphalidae (38 species, 30.4%) followed by Lycaenidae (35 species, 20.8%), Hesperiidae (26 species, 20.16%), Pieridae (16 species, 12.8%), Papilionidae (9 species, 7.2%) and the Family Riodinidae comprised the lowest (one species, 0.8%). The abundance of recorded butterflies was calculated in term of Very Common (20 species), Common (29 species), Uncommon (32 species), Rare (23 species) and Very Rare (21 species). The butterflies preferred different types of habitat (viz., Grass Land, Crop Land, Open Forest, Scrub Forest, Dense Forest and Bamboo Patches). Thirty species of butterflies were regularly observed in all kind of habitats, 69 species preferred multiple habitats (8 in 4 types, 24 in 3 types and 38 in 2 types of habitat) and 25 species were recorded only in a single type of habitats. Mud-puddling of 36 species were also observed. During this study, Zinaspa todara (Family: Lycaenidae) was the first time record in Bangladesh and Euploea doubledayi (Family: Danaidae) was recorded after 150 year later.

BackgroundMyotomy length in type 3 achalasia is generally tailored based on segment of spasticity on high-resolution manometry (HRM). Potential of length of tertiary contractions on barium esophagram (BE) or length of thickened circular muscle on endoscopic ultrasound (EUS) to guide tailored myotomy is less understood. This study aimed to assess agreement between spastic segments lengths on HRM, BE, and EUS among patients with type 3 achalasia.MethodsThis retrospective study included adults with type 3 achalasia on HRM between November 2019 and August 2022 who underwent evaluation with EUS and/or BE. Spastic segments were defined as HRM-distance between proximal borders of lower esophageal sphincter and high-pressure area (isobaric contour ≥70 mmHg); EUS-length of thickened circular muscle (≥1.2 mm) from proximal border of esophagogastric junction (EGJ) to the transition to a non-thickened circular muscle; BE-distance between EGJ to proximal border of tertiary contractions. Pairwise comparisons assessed for correlation (Pearson's) and intraclass correlation classification (ICC) agreement.Key resultsTwenty-six patients were included: mean age 66.9 years (SD 13.8), 15 (57.7%) male. Spastic segments were positively correlated on HRM and BE with good agreement (ICC 0.751, [95% CI 0.51, 0.88]). Spastic segments were negatively correlated with poor agreement on HRM and EUS (ICC -0.04, [-0.45, 0.39]) as well as BE and EUS (ICC -0.03, [-0.47, 0.42]).Conclusions & inferencesLength of spastic segment was positively correlated on HRM and BE while negatively correlated when compared to EUS, supporting the common use of HRM and highlighting the uncertain role for EUS in tailoring myotomy length for type 3 achalasia.

Introduction: Along with the transition from the digital era to the era of cyber-technology, medical professionals have been forced to use different conceptual systems to meet their informational and communicational needs. These emerging scientific concepts each have specific meaning which should be redefined in their own context so that they could be utilized in the conceptual systems of specialized sciences including medical education. The aim of this study was to examine critically the conceptual system emerged from the changes of technology-based learning in the medical education system and to propose the concept of cyber medical education in the medical learning system. Methods: This semi-systematic review study was conducted in 2015 with a critical approach. The databases of PubMed Central and Google Scholar were searched for publications from 1980-2015 using the keywords “information and communication technology, medical education, educational technology, technology-based learning, cyber learning, medical informatics”. Results: Integration of the concepts and terms of informatics and learning sciences has introduced a wide range of terminology into the scientific cycle. The extent and diversity of concepts in field of technology-based medical education have made it difficult to manage scientific contents. This paper suggested the institutionalization of the concept “cyber” at different levels of the medical education system for the purpose of medical knowledge management in the contemporary era and development of a specialized conceptual system for the next generation of physicians and other health professionals. Conclusion: Critical thinking and adoption of smart approaches are essential for reviewing and even redefining some of the technology-based concepts in the field of medical education ranging from basic concepts to designing, shaping and developing future scientific centers such as virtual medical universities.

The limestone of Eocene age Laki Formation of Matyaro Jabal area, Lakhi Range SindhPakistan has been studied to see different sedimentary features and diagenetic overprinting. The most diagnostic diagenetic feature of the Laki Formation is the formation of strata bound dolostone over extensive area. The dolostone beds which are separated by non-dolomitic limestone have developed at three different stratigraphic levels whose thickness vary from few centimeters to about 5 meters. Interbedded non dolomitic limestone is characterized by highly fossiliferous to less fossiliferous white chalky limestone with significant secondary porosity. The dolostone beds make lower erosional contact with chalky limestone while upper contact is sharp as well as transitional. The dolostone beds are very hard to soft with well developed dissolution cavities and karstification horizons. As a result of dolostone formation, the primary sedimentary features of rock fabrics and bioclasts are poorly preserved. However, few bioclastic grains show partial preservation with enhanced dissolution and biomoldic porosity. Dolomitization and different porosity types such as; intragranular, vuggy, molidic, intercrystalline, fracture and fenestral have made the limestone of Laki Formation as potential hydrocarbon reservoir rock. The mechanism of stratabound dolostone formation within Laki Formation is due to the mixing of seawater and fresh water with optimum Mg:Ca ratio. The Mg rich sea-water circulated through highly porous and permeable strata which was responsible for stratabound dolostone formation in the Laki Formation. The extrinsic factors such as sea level fluctuations and tectonics also played a vital role for dissolution along with porosity and permeability enhancement followed by dolomitization.

The vanadium oxide-zirconium oxide nanocomposite (V _2 O _5 /ZrO _2 NC) was synthesized by green method using Daphne alpine ( D. alpine ) leaves extract. The pore size and surface area was studied by N _2 adsorption-desorption process using Brunaure-Emmett-Teller (BET) methods and S _BET was found to be 214 m ^2 g ^−1 . The crystalline nature and other crystal properties was investigated by x-ray diffraction (XRD) and the calculated average crystallite size is 41.74 nm. The morphology of the V _2 O _5 /ZrO _2 NC was examined by scanning electron scanning microscopy (SEM) and transmission electron microscopy (TEM). The thermal stability was examine by thermogravimetric analysis and a total of 11.73% weight loss was observed. The optical property was studied by diffuse reflectance spectroscopy (DRS) and band gap was found to be 3.93 eV. The surface function group was studied the Fourier transform infrared (FTIR) spectroscopy. The photocatalytic performance of V _2 O _5 /ZrO _2 NC was examined against methyl orange and picloram and 76.94% and 86% were degraded in 75 min respectively.

Introduction: Knowing and understanding the views of educational program stakeholders, especially faculty members about the concept of value-based curriculum are requirements of appropriate planning in this field. Given multiple conceptualizations of value-based curriculum in different contexts, this research developed the conceptual components model of the value-based curriculum with respect to indigenous values from the viewpoints of experts in education of ethics and values. Methods: This qualitative study with thematic content analysis approach was performed in 2014. Six experts in education of ethics and values in Shahid Beheshti University of Medical Sciences were selected through purposive sampling method and then participated in semi-structured in-depth interviews. MAXQDA 11 software was used for content analysis. Guba and Lincoln’s standards of rigor and trustworthiness were respected in this study. Results: The main theme “value-based curriculum features” was identified and associated categories were extracted including: general and targeted value needs assessment, value-based mission statement, classification of values expected from graduates, concrete achievable outcomes and objectives of value-based learning and education, value rich contents, organization of value content, proper teaching-learning methods for internalization of values, value-oriented evaluation methods, conducive educational environment for value transfer. Conclusion: Indigenous conceptual model of value-based curriculum suggests a process with a precise sequence for the concrete implementation of values education in accordance with the situation in Iran.

Animals exhibit dramatic immediate behavioral plasticity in response to social interactions, and brief social interactions can shape the future social landscape. However, the molecular mechanisms contributing to behavioral plasticity are unclear. Here, we show that the genome dynamically responds to social interactions with multiple waves of transcription associated with distinct molecular functions in the brain of male threespined sticklebacks, a species famous for its behavioral repertoire and evolution. Some biological functions (e.g., hormone activity) peaked soon after a brief territorial challenge and then declined, while others (e.g., immune response) peaked hours afterwards. We identify transcription factors that are predicted to coordinate waves of transcription associated with different components of behavioral plasticity. Next, using H3K27Ac as a marker of chromatin accessibility, we show that a brief territorial intrusion was sufficient to cause rapid and dramatic changes in the epigenome. Finally, we integrate the time course brain gene expression data with a transcriptional regulatory network, and link gene expression to changes in chromatin accessibility. This study reveals rapid and dramatic epigenomic plasticity in response to a brief, highly consequential social interaction.

Japanese Encephalitis (JE) has caused repeated outbreaks in endemic pockets of India. This study was conducted in Kushinagar, a highly endemic district, to understand the human-animal-ecosystem interactions, and the drivers that influence disease transmission. Utilizing the ecosystems approach, a cross-sectional, descriptive study, employing mixed methods design was employed. Four villages (two with pig-rearing and two without) were randomly selected from a high, a medium and a low burden (based on case counts) block of Kushinagar. Children, pigs and vectors were sampled from these villages. A qualitative arm was incorporated to explain the findings from the quantitative surveys. All human serum samples were screened for JE-specific IgM using MAC ELISA and negative samples for JE RNA by rRT-PCR in peripheral blood mononuclear cells. In pigs, IgG ELISA and rRT-PCR for viral RNA were used. Of the 242 children tested, 24 tested positive by either rRT-PCR or MAC ELISA; in pigs, 38 out of the 51 pigs were positive. Of the known vectors, Culex vishnui was most commonly isolated across all biotopes. Analysis of 15 blood meals revealed human blood in 10 samples. Univariable analysis showed that gender, religion, lack of indoor residual spraying of insecticides in the past year, indoor vector density (all species), and not being vaccinated against JE in children were significantly associated with JE positivity. In multivariate analysis, only male gender remained as a significant risk factor. Based on previous estimates of symptomatic: asymptomatic cases of JE, we estimate that there should have been 618 cases from Kushinagar, although only 139 were reported. Vaccination of children and vector control measures emerged as major control activities; they had very poor coverage in the studied villages. In addition, lack of awareness about the cause of JE, lack of faith in the conventional medical healthcare system and multiple referral levels causing delay in diagnosis and treatment emerged as factors likely to result in adverse clinical outcomes.