Search

Using proposed system psychologists can use technology to make decisions which can provide ease for both patients and psychologists. Psychologists can check the progress of patients by analysing emotions reports of patient over time. Using historical data and emotion detection technology psychologists can make more accurate decisions. Using proposed system patient and psychologists don’t have to go to anywhere they only need a device and internet. Based on the characteristics of patient emotion psychologist only need report generated by system and prescribe medicine in emergency situation. Proposed system improves consultancy method by using machine learning emotion detection algorithm. Proposed system detects facial emotion of patient by using CNN with HAAR cascade classifier. We use FER 2013 dataset to train our model. We use VGG 19 architecture to train our model for optimization function to enhance the accuracy of model. We use RELU. We use DJANGO framework for integration with frontend. Result of our model on dataset 82.3% after find tuning the accuracy goes to 82.3% to 92%. We use recall and F1 method to check the performance of model. We trained model on the testing dataset which have gray scale images and 48*48pixel images to achieve his performance. To achieve our accuracy goal, we split dataset into trainee validation and testing dataset. We use CNN and achieve 93% accuracy in our system which help patient to get feedback only selected question and psychologist. Patients select psychologist to answer questions of psychologist system stores emotions of patient against every question to generate emotion report. Psychologist can analyze emotion report to provide better prescription to patient.

AbstractDrawing upon dynamic capability theory, this article tested high performance organization (HPO) framework with relation to organizations’ performance and explore causes of tested results in public sector of Pakistan. An explanatory sequential mix method was applied whereby the partial least square structural equation modeling method was used to test the direct effect of the HPO framework on organizations’ performance while qualitative method was used to explore causes of poor factors resulted from HPO framework. The results show that the HPO Framework is valid for PSOs. However, this study found weak predictive relevance and small effect size of HPO framework in public organizations. The overwhelming and compelling causes identified are mechanistic structure, lack of commitment and resources, and lack of ethical and visionary leadership in qualitative strand of the study. This study has several contributions; firstly, it explains whether HPO framework is valid to be applied in public organizations, secondly, this study answer question: how five factors criteria of HPO framework influence public organization performance? Thirdly, this study explains HPO framework application to improve organization status from low performance to high performance through ethical and visionary leadership under the lens of dynamic capability theory. This study provides a clue for public managers of developing countries to produce models of high performance and to generate new ideas and information to realize the power of high performance. High performance factors and models will promote sustainable performance of organizations which will benefit employees, organizations and society overall.

Abstract Background Empathy is described as one’s ability to perceive and apprehend another person’s feelings, situation, emotions, and problems as their own. Empathetic behavior increases patients’ satisfaction, reduces discomfort, and helps with patient’s satisfaction. Objective To evaluate the psychometric properties of the Jefferson Empathy Scale and compare the measure of invariance within genders and amongst the public and private sector dental students. Method This cross-sectional study utilized JSE-HPS version for research purpose. An exploratory factor analysis was performed to detect underlying factors. Reliability of the study tool was evaluated using Cronbach alpha test. Mann Whitney U test was used to compare the differences in scores between genders and among public and private university students while Student’s t analysis compared the scores according to different domains. The level of significance was ≤ 0.05. Results Females demonstrated higher empathy levels (88.52 ± 14.19) along with private institute students (88.46 ± 13.98). Perspective taking and compassionate care domain was also scored highest by the females (31.73 ± 6.49 & 29.31 ± 6.22) and among second year students (33.30 ± 7.11 & 30.50 ± 7.16). PCA analysis extracted 4 factors namely (i) Health-care-provider’s sense of humor contributed to improved outcome (ii) Health-care provider’s understanding of patients’ feelings and of their families influences treatment outcomes (iii) Understanding body language is as important as verbal communication and (iv) Patients feel better when their feelings are understood, which accounted for the 59.51% of the total variance. Conclusion The findings revealed that students from private institute and females demonstrated higher empathy score. Moreover, the Jefferson Scale of Empathy (JSE) was found to be a reliable and validated tool for assessment of empathy in our sample population.

BACKGROUND: Hemodialysis is the treatment of choice for end-stage renal disease but there is increasing evidence that dialysis patients have a high burden of problems including pain which may affect their quality of life. OBJECTIVES: The objective of this study was to find out the frequency of pain, its severity, and interference in patients receiving hemodialysis. METHODOLOGY: Data was collected from 218 patients from dialysis units of the Institute of Kidney Disease, Rehman Medical Institute, and Northwest General Hospital, Hayatabad Peshawar. A brief pain inventory questionnaire (BPI) was used to find out the frequency, severity, and interference of pain. RESULTS: The frequency of pain was 70.2%. The mean time period of treatment was 22.42 months (standard deviation (SD) 28.56). The pain was most commonly present in the lower limb. The calculated mean severity was 4.3 (SD 1.70) which showed most of the patients had mild pain. The mean interference of pain in general performance was calculated to be 5.6 (SD 2.10) which presented moderate interference. There was a significant correlation between mean pain severity and mean pain interference (P=0.000). Out of those 153 patients who reported pain, 119(77.78%) were taking medications for pain relief. CONCLUSION: Pain is a frequent problem reported by these patients. Out of those who had pain, greater than two third were taking medications for pain. Pain in these patients is the main cause of interference in the performance of general activities. So, it is important to manage the pain, and strategies other than medications should also be considered. KEYWORDS: Dialysis, End Stage Renal Disease, Hemodialysis, Interference, Pain

Self-powered photodetectors which operate without external power sources hold immense promise in future photodetection systems. To achieve high-performance self-powered optoelectronic devices, efficient electron-hole pair separation is critical to generate high photocurrents. In this work, we successfully synthesized semiconducting graphene nanoribbons (GNRs) with a direct bandgap of 1.80 eV and employed them to construct a high-performance GNR/Al2O3/IGZO heterostructure photodetector. The built-in electric field in the heterojunctions enables this photodetector to exhibit remarkable performance, showing a responsivity of up to 68 mA/W, a detectivity of 8.34 × 1010 Jones, and rapid response times of 21/20 ms at zero bias. Furthermore, the photodetector features a wide spectral detection range of 405 to 1550 nm. These results highlight the promising potential of GNR/IGZO p-n heterojunction-based self-powered photodetectors in optoelectronic applications.

Background Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders.Aims This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions.Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis.Results The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country’s economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries.Conclusions The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses.PROSPERO registration number CRD42023416096.

Abstract Background The popularity of e-cigarettes has risen dramatically over the last few years, particularly among the younger population. Although the use of combustible cigarettes has established evidence to be associated with the development of several adverse cardiopulmonary diseases, the investigations regarding the prospective long-term effects of e-cigarette use on the cardiovascular system have just begun. We set to investigate if there is an association between the history of MI and e-cigarette use among smokers and non-smokers? Methods The current review aims to assess the association of myocardial infarction with e-cigarette consumption. PubMed, Google Scholar, and Cochrane Central Register of Controlled Trials (CENTRAL) were queried up to October 2022 to identify articles assessing the incidence of myocardial infarction among e-cigarette users. Data were meta-analyzed using a random-effects model to derive odds ratios (OR) and 95% confidence intervals. Results Nine studies involving 984,764 patients were included. The mean age of e-cigarette smokers was less than the controls, and female participants dominated the sample size. E-cigarette users were associated with increased odds of MI than non-users [OR = 1.44; 95% CI (1.22, 1.74); P

Abstract Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-being. Strict fasting protocol has been used prior to OGDS with the concern of reduced visibility or suboptimal endoscopic assessment. Maltodextrin beverages were also commonly used as the pre-operative carbohydrate loading in enhanced recovery after surgery (ERAS) protocol. Our study aimed to look for the effects of maltodextrin beverage 2 h before OGDS on gastric residual volume and patient’s well-being scores. This was a single-blinded, stratified randomised controlled trial, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie). The primary objectives were to measure the gastric residual volume (GRV) and patient’s well-being scores using visual analogue scale (VAS) scores for hunger, thirst, anxiety, tiredness and general discomfort. Of 80 randomised patients, 78 completed the study (38 received plain water and 40 Carborie). The median (IQR) GRV was not significantly different between group A and B (5.0 ml (20) vs 4.0 ml (19), p = 0.777). Both groups showed significant reduction in VAS scores in all five parameters (p ≤ 0.001). There were no complications attributed to endoscopy in either group. Pre-endoscopy maltodextrin beverage is as safe as clear water with improved patient’s well-being in both groups. Clinical Trial Registration: NCT05106933.

Urine amylase levels are usually used to diagnose acute pancreatitis. However, there are reported cases where urine amylase levels are slightly increased in individuals without pancreatitis. Herein, we report the case of a young lady who presented with acute abdominal pain for 3 days. Her urine amylase level was 1717 U/L upon admission, and her condition was initially treated as acute pancreatitis. Unfortunately, the patient demonstrated abdominal guarding after 24 h; thus, urgent computed tomography (CT) was performed. CT revealed the presence of a dilated small bowel. She underwent emergency laparotomy, wherein a gangrenous small bowel with no evidence of saponification at the lesser sac was noted. Due to the non-specific nature of hyperamylasaemia, an alternative diagnosis other than acute pancreatitis should be considered if the clinical symptoms are not suggestive of pancreatitis or the condition worsens despite conservative management.

Pain is a common complaint, and the consumption of analgesics is prevalent. Community pharmacists, as primary contact points for patients, can play a crucial role in guiding patients toward rational pharmacotherapy or alternative pain management strategies. However, there are no specific educational curricula or standard guidelines to support this role, and the perception of this potential role is not well known. We conducted an anonymous online questionnaire among community pharmacists in Norway to assess their knowledge, perspectives, and willingness to engage in pain care. The survey also explored potential facilitators and barriers, and the use of any current guidelines. Seventy-one community pharmacists participated from various regions in Norway. Findings revealed that community pharmacists felt knowledgeable and willing to engage in pain management but anticipated barriers such as time constraints and a lack of standard guidelines. Participants also highlighted the need for better collaboration with other healthcare professionals and continuous professional development to enhance their role. To optimize the role of community pharmacists in pain management, therefore, integrating them into multidisciplinary healthcare teams, minimizing barriers, and providing continuous education and standard guidelines seem essential. This approach can empower community pharmacists and improve pain management outcomes.

This case describes a 60-year-old man with a history of diabetes and hypertension who underwent a kidney transplant in September 2023. The patient presented with fever, cough for 5 days, empirical antibiotics were started but complaints were not resolved so fungal markers were sent, which showed elevated galactomannan levels, necessitating the initiation of voriconazole therapy. X Ray chest showed patch along with cavitatory lesion which was further confirmed by CT Scan Chest which confirmed a cavitatory lesion. This case report emphasizes the importance of considering fungal infection as a differential diagnosis in immunocompromised patients and achieving good results with appropriate treatment.

Quince (Cydonia oblonga) is a medicinal plant and a member of family Rosaceae. It is native plant of Asia Minor and Europe. It is used in production of jam and jellies and also as a remedy of several ailments. The present study was conducted to evaluate the genetic polymorphism based on morphological and molecular traits. Different varieties of Quince were collected from different ecological zones of Khyber Pakhtunkhwa Pakistan and a total of 26 different morphological traits were recorded among studied genotypes. Based on qualitative morphological trait study, the variety collected from Tindodag was unique one with highest fruit weight (328.82 g). The lowest fruit weight (68.38 g) was recorded for Talash genotype. The Charbagh and Tindodag genotypes showed highest seed length (10.6 mm) while genotypes of Chitral was recorded as lowest (8.4 mm). Statistically, significant level of variation was noted with coefficient of variance ranged from 2.23% to 30.38%. Based on correlation analysis, fruit length had strongly correlation with fruit weight (r = 0.89**), Average Fruit width was found significant with fruit weight (r = 0.90**). Similarly, the Core Width was found strongly significant with Core Length (r = 0.95**). ANOVA analysis indicated 10 quantitative characters to be highly significant, 2 significant and 1 insignificant. Principal component analysis was also computed for the 13 quantitative traits with Eigen value of 0.48 and a total variance of 97.78%. The first principal component shows total variation of 52.52%. In PC2 the total variation was 80.15%, PC3 94.06% while in PC4 it was 97.78%. The NCBI BLAST results shows that all the genotypes have similar origin except Tindodag genotype, which shows differences in its origin. Accession number for all other genotypes is MN216014.1, while accession number of Tindodag genotype is KF861967.1. Based on this study, it can be concluded that Tindodag genotype is unique out of the studied localities. NCBI BLAST have provided further support for the drawn conclusion.

BackgroundAntimicrobial resistance (AMR) is a major global public health crisis and around the last decade, newspapers were one of the main sources of public dissemination of information for so. This study highlights how Bangladeshi mainstream newspapers represented AMR-related news and how they created the narrative of AMR in Bangladesh.MethodsWe conducted both quantitative and qualitative content analysis on 275 AMR-related news articles published in the twelve highest circulated dailies (January 2010 to September 2021). We divided the articles into report, opinion, and editorials and analyzed how their contents built the narrative of AMR in Bangladesh.ResultsBangladeshi newspapers reported misuse of antibiotics by the consumers the most (32.2%), followed by selling without prescriptions (29%), and over-prescription by the health providers (26.1%). There were hardly any news reports describing the impact of pharmaceutical companies in prescribing and selling antibiotics. Around 45% of the news articles were event-oriented. Moreover, they suggested inadequate recommendations to battle AMR.ConclusionValid, consistent, and reliable AMR news coverage can play a crucial role in creating mass awareness, making providers accountable, and supporting national action plan in mitigating AMR threat. The Bangladeshi journalists interested in reporting AMR-issues should focus on disseminating more Bangla articles with scientific information, and reporting causes and recommendations responsibly.

Manuscripts serve as a wealth of knowledge for future generations and are a useful source of information for locating material from the Middle Ages. Ancient manuscripts can be found in handwritten form, thus they must be translated into digital form so that computing equipment can access them and additional indexing and search operations can be performed with ease. Manuscript recognition is already possible using a variety of methods. Regional languages like Devanagari, Gurmukhi, Sanskrit, etc., however, have very few methods available. In this study, the Devanagari characters from the manuscripts is recognised using a CapsNet-based method. 33 fundamental characters, 3 conjuncts, and 12 modifiers make up the Devanagari alphabet. The complete dataset is divided into 399 classes for the recognition of basic, modifiers, and conjunct characters. Due to spatial relationship, CapsNet is used to recognize the handwritten characters. The proposed model was run using 10:70, 20:80, and 30:70 as test: train ratio of characters. Also, the number of epochs was varied for better recognition accuracy. The authors observed the best recognition accuracy of 94.6% was achieved to recognize the Devanagari characters using CapsNet.

Objective: To determine the diagnostic accuracy of hypocalcaemia and hypomagnesaemia in paediatric patients suffering from febrile seizures. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Pediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, Jul 2021 to Feb 2022. Methodology: We included 87 patients between the ages of 1-6 years with ongoing febrile illness who had a history of febrile seizures. Those with a history of febrile seizures within the last month, suffered from organic brain disease or were on drugs that altered serum calcium and magnesium levels were excluded. Patients were tested for serum magnesium and calcium on admission and remained admitted throughout the febrile period for observation of the development of seizures. Results: The mean age ± standard deviation of our sample was 3.23±1.50 years, with 46(52.9%) males. The serum magnesium levels demonstrated that 46(52.9%) had hypomagnesaemia at a cut-off of 1.4 mEq/L, which had a sensitivity of 70.3%, a specificity of 55.0% and diagnostic accuracy of 59.8% in predicting the development of febrile seizures. Serum calcium levels at a cut-off of 8.8 mg/dL showed that 36(41.4%) had hypocalcaemia, which carried a sensitivity of 48.2%, a specificity of 61.7% and a diagnostic accuracy of 57.5%. Conclusion: Both serum magnesium and calcium levels had comparable diagnostic accuracy in predicting whether a patient with a history of febrile seizures would go on to develop febrile seizures during the current illness. However, the individual diagnostic accuracy for this prediction could have been higher.

Objective: To determine the diagnostic value of red blood cell distribution width and red cell distribution width index in differentiating iron deficiency anaemia and beta-thalassemia trait. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2021 to Feb 2022. Methodology: A study population of 110 children with an age limit of 1.5-7 years who reported low haemoglobin was subjected to serum iron and ferritin levels with further evaluation of red cell count, blood morphology, and comparison of mean corpuscular volume. Red cell distribution width was taken from the lab report, whereas Red blood cell distribution width index value was computed for the samples. Results: A total of 110 patients were enrolled in the study. Seventy-five (68.18%) participants were diagnosed with IDA, 26(23.63%) participants were the candidate of βTT. Nine participants were suffering from anaemia of variable etiologies such as chronic ailment and sideroblastic, etc. βTT patients presented with higher RBC counts with a mean of 5.71±1.2 x1012 /l (6.8- 8.5 x1012 /l) when compared to IDA participants who deciphered values of 3.5±0.5 (2.6-4.3 x1012 /l). Mean MCV in βTT was 52.2±2.7(50.1-56.8) whereas for IDA were 72.5±1.2(61.2–78.3). In IDA low serum ferritin was recorded 4.02±1.1(2.2-9.2) as compared to mean values of βTT patients. Conclusion: Red cell distribution width index and Red blood cell distribution width are authentic variables and inexpensive modalities in differentiating between iron deficiency anaemia and beta-thalassemia trait with reliability.

Abstract Multiferroic materials, showing simultaneous ferroelectric and ferromagnetic orders, are considered to be promising candidates for future data storage technology however, the multiferroic phenomenon in two-dimensional (2D) materials is rarely observed. We report a simple approach to observe frequency-dependent ferroelectricity and multiferroicity in 2D Ti3C2T x MXene film at room-temperature. To study the frequency and poling effect on ferroelectricity, we performed electric polarization vs. electric field (P-E) measurement at different frequencies, measured under zero and non-zero static magnetic fields. The results not only indicate a clear frequency dependence of electric domains owing to varying time relaxation during reversal dynamic but also showed magnetic field control of electric polarization thus, confirmed the presence of strong magneto-electric (ME) coupling at room-temperature. The existence of ME coupling was attributed to the coupling between disordered electric dipoles with local spin moments as well reduced dielectric loss after heat-treatment. Moreover, the ferroelectric Ti3C2T x MXene film was employed as an active layer within the resistive data storage device that showed a stable switching behavior along with improved on/off ratio in comparison to non-ferroelectric Ti3C2T x active layer. The unique multiferroic behavior along with ferroelectric-tuned data storage devices reported here, will help understand the intrinsic nature of 2D materials and will advance the 2D ferroelectric data storage industry.

Purpose Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. Methods A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. Results Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P

Owing to the climatic dryness and shortage of surface water, Pakistani farmers have been forced to rely on groundwater resources to meet the irrigation demand for crops. Pumping an excessive amount of water from the aquifers is turning it brackish. Our study aims to select a suitable depth of freshwater for installing tube wells in a study area, Tehsil Nankana Sahib. Sixteen vertical electrical soundings (VES) were arrayed in this study area, and water samples were also collected to record their electrical conductivity. The interpolation maps for different parameters were generated by using the inverse distance weighted interpolation method. The obtained results depict that the central and southeastern region has good groundwater at depths from 60 to 90 m, the northeastern region has marginally fit water, while the northwestern region is marked as having an unfit groundwater zone. This research article is not only a case study but also can be used for other areas of Punjab, Pakistan, facing similar groundwater problems. However, the comparison of VES results with borehole data is critical to achieve better accuracy. An extensive exploratory borehole study of the area is recommended to further characterize the subsurface lithology.

Abstract Clinical benefits and safety of carbohydrate loading pre-gastroscopy remain unclear. We aimed to determine the effects of a commercial carbohydrate-rich whey protein beverage versus plain water given pre-gastroscopy on gastric residual volume and well-being, and to determine adverse events. This was a single centre, single-blinded, parallel-group, sex-stratified randomized controlled trial. Participants were randomized either to carbohydrate-rich whey protein beverage group (Resource®, Nestle Health Science) or control group (250 ml plain water) given pre-gastroscopy. Gastric contents were aspirated into a suction reservoir bottle to determine the gastric residual volume (GRV). Visual analogue scale (VAS) of well-being (anxiety, hunger, thirst, tiredness, and weakness) was compared before and after the intervention. Adverse events were also evaluated post-intervention. Of 369 screened, 78 participants (36 males, mean age 49 ± 14.3 years) were randomized. Compared with the control group, carbohydrate beverage was associated with significantly higher GRV (p

Abstract There is a prevalent notion regarding divergence in the extent of ethnocentrism and the intercultural willingness to communicate across cultures. Given this cultural divergence, research is replete with comparative studies of ethnocentrism and the intercultural willingness to communicate between individualistic and collectivistic cultures. However, to our knowledge, a comparison of these crucial cultural tendencies within and their consequences for collectivistic cultures has been overlooked. Thus, this study provides a cross-cultural comparison of ethnocentrism and the intercultural willingness to communicate among university students from two collectivist cultures, i.e., Pakistan and China. The researchers employed a cross-sectional design. A sample of 775 students was collected using a survey technique. The findings show that Pakistani students are more ethnocentric and have a lower intercultural willingness to communicate than Chinese students. Moreover, males were found to be more ethnocentric and less willing to communicate in intercultural settings than females in both countries. These findings validate the notion of ethnocentrism divergence across collectivistic countries and its influence on the intercultural willingness to communicate. Additionally, they demonstrate the role of demographic attributes in evolving ethnocentrism and the intercultural willingness to communicate. Accordingly, these findings also confirm the ecological assumption that contextual factors, such as demographic attributes (e.g., past interactions with foreigners), influence communication schemas. Therefore, concerning its management, these findings suggest that increased people-to-people interactions between the two focal countries can better foster their mutual understanding to reap an increased harvest of the fruits of the Belt and Road Initiative.

BackgroundWe investigated the biological predisposition to site of metastasis in patients with NSCLC based on their molecular profiling and program death ligand PD-L1 status. We sought to identify any association between metastatic site and molecular profile in NSCLC patients.MethodsThis was a retrospective analysis of patients with stage IV NSCLC who were newly diagnosed from January 2014 to June 2022. Clinical characteristics, pathology, molecular reports, and imaging were retrieved and analyzed.ResultsA total of 143 patients were included in the study. Median age was 65 years, with an equal number of men (n=71) and women (n=72). The most common histology was adenocarcinoma (81.8%). At least one genetic mutation was discovered in 100 patients. Mutations with a targetable drug were found in 86 patients. The most common mutations were TP53 (25.2%), EGFR (24.5%), KRAS/NRAS (20.3%), and CDKN2A/2B (7.7%). Patients with any mutation were significantly more likely to have metastatic disease to the brain (57% vs. 37%, p=0.03), but there was no difference in metastatic disease to bone (34% vs. 26%, p=0.32). Patients without a discoverable mutation were significantly more likely to have metastatic disease to other sites (e.g., adrenal gland 91% vs. liver 66%, p=0.002). There was no difference in progression-free survival (PFS) or overall survival (OS) between those with versus without mutations. Median PFS and OS were significantly longer in patients with an EGFR mutation than those with KRAS/NRAS or TP53 mutations. Patients with PD-L1 >1% or TP53 were significantly more likely to have metastatic disease to organs other than bone or brain (p=0.047 and p=0.023, respectively). We identified four prognostic groups in metastatic NSCLC. Patients with PD-L1

BackgroundThe World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine–related infodemics as a significant risk perception factor hindering mass vaccination campaigns. ObjectiveGiven the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication–laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. MethodsThis study used a cross-sectional research design vis-à-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. ResultsThe results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. ConclusionsThese pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one’s knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response.

Climatic conditions intricately influence agriculture, impacting optimal crop growth and reproduction through environmental factors. This study introduces a technological solution leveraging the Internet of Things (IoT), with Raspberry Pi 3 as the central controller. The system systematically collects crucial data on temperature, humidity, and soil moisture, ensuring the quality of crops. Subsequently, this information is used to formulate systematic crop watering plans. By efficiently using Raspberry Pi, the system regulates and monitors crops, contributing to water conservation by directing it precisely to the crops. This technology offers a practical and efficient approach to crop management, especially during challenging agricultural periods.

The ubiquity of Internet of Things (IoT) devices has prompted security concerns, particularly in the face of evolving botnet attacks. This paper investigates the impact of botnet attacks on IoT devices and proposes a network-based detection and prevention system employing signature and anomaly-based mechanisms. Notably, our methodology extends beyond traditional detection, focusing on proactively impeding bot creation. Leveraging a Linux-based distributed system, Security Information and Event Management (SIEM) tools, and custom rules, our approach encompasses distinct phases Preprocessing, Network Security Monitoring, Rule-based IDS System, and Analysis. Experimental results with diverse PCAP files demonstrate the efficacy of custom rules, significantly enhancing alert counts for various security aspects, including network trojan detection and privacy violations. The significant finding is the substantial increase in alert counts after the integration of custom rules, exemplified in the 1.1 GB PCAP file scenario. Network trojan detection surged from 585 to 988, emphasizing the heightened efficacy of rule-based measures. Privacy breaches and bad traffic alerts also experienced significant increments, showcasing the system’s improved sensitivity and responsiveness. This finding reinforces the pivotal role of custom rules in fortifying IoT network security comprehensively.

Abstract In Smart Cities’ applications, Multi-node cooperative spectrum sensing (CSS) can boost spectrum sensing efficiency in cognitive wireless networks (CWN), although there is a non-linear interaction among number of nodes and sensing efficiency. Cooperative sensing by nodes with low computational cost is not favorable to improving sensing reliability and diminishes spectrum sensing energy efficiency, which poses obstacles to the regular operation of CWN. To enhance the evaluation and interpretation of nodes and resolves the difficulty of sensor selection in cognitive sensor networks for energy-efficient spectrum sensing. We examined reducing energy usage in smart cities while substantially boosting spectrum detecting accuracy. In optimizing energy effectiveness in spectrum sensing while minimizing complexity, we use the energy detection for spectrum sensing and describe the challenge of sensor selection. This article proposed the algorithm for choosing the sensing nodes while reducing the energy utilization and improving the sensing efficiency. All the information regarding nodes is saved in the fusion center (FC) through which blockchain encrypts the information of nodes ensuring that a node’s trust value conforms to its own without any ambiguity, CWN-FC pick high-performance nodes to engage in CSS. The performance evaluation and computation results shows the comparison between various algorithms with the proposed approach which achieves 10% sensing efficiency in finding the solution for identification and triggering possibilities with the value of $$\alpha = 1.5$$ α = 1.5 and $$\gamma = 2.5$$ γ = 2.5 with the varying number of nodes.

Abstract We studied the effects of birth order and socioeconomic factors on educational attainment in Pakistan. We examined this relationship by using PSLM/HIES 2018–19 which is nationally representative household survey data. We found striking evidence that being born first as a male child is positively and significantly associated with educational attainment. Whereas in our girls' sample we found that being born first is significantly and negatively associated with educational attainment, and this effect does not persist for second-born female children if the firstborn is a male child. Such a difference in our estimates led us to investigate further the cohort and rural–urban dimensions. We concluded that urban areas in Pakistan are primarily responsible for resource rationing in favor of male children for younger cohorts. Therefore, the study recommends the targeted policy intervention to remove such differentials based on gender when it comes to the educational attainment of a child.

Objective: To establish the frequency of thyroid disorders among Rheumatoid Arthritis patients and its association with disease severity measured by DAS28-ESR. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Rheumatology, Federal Government Policlinic Hospital, Islamabad Pakistan, from Jan to Jun 2021. Methodology: The study included 87 consecutive patients either gender with Rheumatoid Arthritis visiting Rheumatology OPD. Thyroid profile and DAS28-ESR were performed in all the patients. Results: Out of 87 patients, 73(83.9%) were females, and 14(16.1%) were males. The mean age was 45.54±13.50 years. The mean DAS28-ESR was 4.45±0.68, with a minimum DAS28-ESR of 1.25 and a maximum of 8.40. The Disease severity calculated by DAS28-ESR was mild in 19(21.8%), moderate in 44(50.6%) and severe in 24(27.6 %) patients. The thyroid gland was abnormal in 23(26.1%) patients. 18(78.2%) of 23 patients with thyroid disorders belonged to the moderate to severe Rheumatoid arthritis disease activity group. Conclusion: Thyroid disorders are very common in Rheumatoid Arthritis patients. Thyroid workup should be part of investigations of Rheumatoid Arthritis for early detection of thyroid disorder and better disease control.

Abstract Introduction Sydenham's chorea (SC), prevalent in developing countries and occasionally affecting developed ones, poses a clinical challenge due to the lack of systematic guidelines for diagnosis and treatment. Resulting from Group A Beta‐Hemolytic Streptococcus infection, SC presents various symptoms. This review aims to collect and evaluate available data on SC management to propose a cohesive treatment plan. Methods We searched PubMed, the Cochrane Library, Google Scholar, and ClinicalTrials.gov for literature on SC management from inception until 24th July 2022. Studies were screened by titles and abstracts. Cochrane Collaboration's Risk of Bias tool (RoB‐1) assessed Randomized Controlled Trials, while the Risk of Bias In Non‐randomized Studies of Interventions (ROBINS‐I) tool evaluated nonrandomized studies. Results The review includes 11 articles assessing 579 patients. Excluding one study with 229 patients, of the remaining 550 patients, 338 (61.5%) were females. Treatments used were dopamine antagonists in 118 patients, antiepileptics in 198, corticosteroids in 134, IVIG in 7, and PE in 8 patients. Dopamine antagonists, particularly haloperidol, were the primary treatment choice, while valproic acid (VPA) was favored among antiepileptics. Prednisolone, a corticosteroid, showed promising results with weight gain as the only side‐effect. Our review emphasizes the importance of immunomodulators in SC, contrasting previous literature. Conclusion Despite limitations, dopamine antagonists can serve as first‐line agents in SC management, followed by antiepileptics. The role of immunomodulators warrants further investigation for conclusive recommendations.

Current research aims to unpack the issues faced by the telecom sector of Pakistan to sustain its supply chain management. While using the qualitative case study method, this research has analyzed the available framework to achieve sustainability in the supply chain. The study used data triangulation and extracted data from Telecom company’s documentation, on-site observation & semi-structured interviews. Based on primary and secondary data, we have proposed a strategic framework for developing sustainability in the supply chain of telecom companies. The framework provides the step-by-step implementation of all dimensions of sustainability upstream of a supply chain. The developed framework can be used as a roadmap by the Telecom sector to make their supply chain more sustainable. The research focuses on the upstream supply chain, and the findings argue that telecom supply chains can only use the proposed framework upstream to achieve sustainability.

This paper introduces a facile solution route to fabricate MoTe2 grain nano-domains for hybrid polymer heterojunction solar cells and photodetectors. Fabricated MoTe2 structures were investigated using Raman and XRD, and surface morphologies characterized using FE-SEM and TEM. We subsequently assembled a non-fullerene polymer heterojunction device using the PBDB-T:ITIC active layer for ITO/HTL/active-layer/LiF/Al architype solar cells and photodetectors. We also investigated effects from different MoTe2 nanostructure proportions embedded in the PBDB-T:ITIC polymer matrix as active layers to assemble solar cell and photodetector devices. Maximum power conversion efficiency ≈8.94% with improved carrier mobility ≈9.23 × 10−4 cm2 V−1 s−1 was achieved for 10 vol% MoTe2 nanostructure inclusion with PBDB-T:ITIC active layer. A fabricated photodetector using 10 vol%-MoTe2@PBDB-T:ITIC film achieved maximum detectivity ≈2.62 × 1010 Jones with 0.706 A W−1 responsivity at 755 μW cm−2 light density under 656 nm laser source. The proposed facile approach to fabricate 2D MoTe2 atomic layer infusion with polymer heterojunction offers a credible mechanism to progress interfacial characteristics for future organic semiconducting devices.

A 3-terminal device with a tunable Schottky barrier controls the charge transport across a vertically stacked structure named “barristor”- one composed of a graphene/rhenium diselenide (ReSe2) p-n heterojunction to exploit the advantages of the high mobility of graphene with tunable ReSe2 for digital applications is reported herein. The CVD-graphene used to fabricate p-n heterojunction with ReSe2 is p-type doped by DUV irradiation in O2 atmosphere for 30 min. Density functional theory (DFT) calculations reveals highly anisotropic behavior of ReSe2, possessing bandgap of 1.17 eV. We demonstrate that the gate-controlled Schottky barrier can be utilized to modify carrier transport in graphene, resulting in tuning of the Schottky barrier height. Thus, by modulating the work function of the monolayered graphene via the back-gate voltages, the Schottky barrier height at the interface between the graphene and ReSe2 could be varied by up to 300 meV. A diode showed good rectification behavior with an ON/OFF current ratio of 102. Furthermore, the barristor exhibits good optoelectronic characteristics with a sensing range from visible (455 nm) to near IR (850 nm) and is capable of detecting low incident power density. The diode attained photoresponsivity and detectivity values of 42 AW-1 and 2.2 × 1012 Jones, respectively, and a rise time of 33.94 ms under 656 nm laser illumination. Our approach could aid the improved development of high-performance graphene-based heterojunction devices.

Abstract Background: the context and purpose of the study Unhealthy food consumption has raised an alarming situation of obesity among Asian nations and posing serious threats to human health. Recent studies have acknowledged that organic food consumption has been contrariwise associated with obesity. The consumption of healthy food has received research attention in social marketing and several antecedents and consequences have been identified. However, to date, there is a void in literature that how social, individual, and marketing elements together tradeoff in predicting a healthy lifestyle. Thus, the current investigation unfolds the antecedents of healthy foods’ adoption in Asia by integrating the brand signaling and theory of planned behavior. Methods The data of 241 respondents were collected from selected social media Facebook communities through a survey using assessed 42 questions. For this purpose, participants’ Facebook accounts were selected from the online healthy communities such as ‘Diet Suku Suku Separuh’ (469,000 followers), ‘Hiking, and Camping around Malaysia’ (351,200 followers), and ‘Healthy Malaysia’ (332 followers). The enumerator also engaged with the online community by liking posts and following health accounts. Results The data was analyzed using PLS (SEM) approach, the outcomes of hypotheses revealed interesting information that health consciousness not significantly predicts the purchase intention of healthy food. All antecedents were significant contributors to the prediction of foods’ purchase intentions in this study. However, the findings indicated that no positive relationship exists between brand image identifications and brand credibility identifications, and healthy foods’ purchase intentions identifications. The findings also indicated that no positive relationship exists between health consciousness identifications and healthy foods’ purchase intentions identifications. Conclusions: (summary and potential implications) Owing to the perilous increase in obesity among the general public in Asia. This study reinforced the factor that can help in the adoption of a healthy lifestyle. The study validated that a healthy lifestyle is reliant on the consumers’ health consciousness, environmental concern, and innovativeness through motivating the consumers’ healthy foods’ purchase intentions. Surprisingly, the results highlighted that respondents have not identified brand image and credibility as an antecedent of purchase intention. Given that organic food brands are somewhat new in Asian markets and therefore, brands must endure crisis marketing practices to improve their brand recognition. Therefore, policymakers must facilitate the food promotional activities that are critical to enhancing the perceived benefits of organic food to combat issues like obesity. This paper offers a foundation for future empirical investigations in Asia and various stakeholders on how to promote a healthy lifestyle in Asia. Specifically, the results will help policymakers to offer positive policies and procedures for the improvement of a healthy lifestyle through the understanding of the antecedents and consequences of health-conscious consumers’ healthy foods’ purchase intentions.

Abstract Background Iodine deficiency poses a significant public health challenge worldwide, particularly in preschool children and pregnant women. Assessing the iodine intake at a population level is essential, as both deficient and excessive iodine status can have adverse health consequences. The main objective of this survey is to understand the iodine deficiency status in schoolchildren aged 6–12 years in the State of Qatar. Methods A cross‐sectional survey was conducted from March to June 2014 among school‐aged children using a two‐stage cluster sampling technique. Anthropometric, biochemical, clinical, and dietary parameters for seafood were collected. Spot urine samples were collected from 967 participants, and a repeat random subsample urine was collected from 288 participants. Overall median urinary iodine concentration (UIC) was calculated. Iodine content in household salt samples was estimated by qualitative and quantitative methods. Mann–Whitney U test was used for comparison. Results The median UIC was 333.2 μg/L (IQR = 228.6). UIC prevalence rates between 300–999 and >1000 μg/L were 56.7% and 2.8%, respectively. The goiter prevalence was 0.4%. A significant difference was noted in overall median UIC levels between boys and girls (p = 0.003). Adequate iodized salt consumption was reported by 74.9% of households, and weekly seafood consumption was reported by one third of the respondents. Conclusion The results indicate an excess intake of iodine among the studied population in the State of Qatar, and national efforts are needed to bring iodine intake and concentration levels within the cutoff value for the concerned survey population's age group. In addition, a surveillance system needs to be set up for continuous monitoring of iodine content and salt intake at the population level in the State of Qatar.

Abstract Transition‐metal dichalcogenides exhibit strong light–matter interactions and unique multifunctional logic behavior. Here, the strong interlayer transition and excellent broadband photodetection of GeSe/MoTe2 van der Waals (vdW) heterojunction are demonstrated. Differential charge density and photoluminescence quenching analyses reveal a strong interlayer transition between GeSe and MoTe2. In addition, density functional theory analysis predicts the formation of staggered band alignment, which contributed to the spatial segregation of photogenerated electron–hole pairs. The diode exhibited excellent optoelectronic characteristics in the visible and near‐infrared region. A high responsivity of ~1.0 × 104 A/W, an excellent detectivity of ~8.4 × 1012 jones, and a fast rise and fall time of 458 and 498 μs, respectively. Finally, a two‐dimensional complementary inverter consisting of p‐channel GeSe and n‐channel MoTe2 is examined to analyze its application for a logic inverter. The findings of this study will play a crucial role in the stimulation and fabrication of multifunctional vdW heterostructure devices.

Objective: To determine drug compliance among patients with rheumatological and musculoskeletal diseases and to identify the reasons behind poor compliance. Study Design: Cross-sectional study. Place and Duration of Study: Department of Rheumatology Lady Reading Hospital, Peshawar Pakistan, from Aug 2020 to Feb 2021. Methodology: All patients aged 16 to 70, of either gender with inflammatory rheumatic diseases who were prescribed conventional DMARDs for at least six months were included in the study. Results: Two hundred and eighteen patients were included in the study. There were 59(27.1%) males and 159(72.9%) females with a mean age of 38.56±4.75years. There were 156 SPRA patients (71.5%), while SLE and SNIA accounted for 22(10.1%) and 17(7.8%) cases, respectively. Methotrexate was the most commonly prescribed medicine, 158(72.5%) while 90(41.3%) patients were prescribed Hydroxychloroquine and 43(19.7%) patients were prescribed Sulfasalazine. Regarding compliance, 112 (51.4%) patients were found to have good drug adherence. On the other hand, side effects and lack of awareness were found to be the most common cause of poor medication adherence. Conclusion: We concluded that adherence to medication among patients with inflammatory rheumatic and musculoskeletal diseases is poor

Abstract Van der Waals (vdW) heterostructures composed of atomically thin two‐dimensional (2D) materials have more potential than conventional metal‐oxide semiconductors because of their tunable bandgaps, and sensitivities. The remarkable features of these amazing vdW heterostructures are leading to multi‐functional logic devices, atomically thin photodetectors, and negative differential resistance (NDR) Esaki diodes. Here, an atomically thin vdW stacking composed of p‐type black arsenic (b‐As) and n‐type tin disulfide (n‐SnS2) to build a type‐III (broken gap) heterojunction is introduced, leading to a negative differential resistance device. Charge transport through the NDR device is investigated under electrostatic gating to achieve a high peak‐to‐valley current ratio (PVCR), which improved from 2.8 to 4.6 when the temperature is lowered from 300 to 100 K. At various applied‐biasing voltages, all conceivable tunneling mechanisms that regulate charge transport are elucidated. Furthermore, the real‐time response of the NDR device is investigated at various streptavidin concentrations down to 1 pm, operating at a low biasing voltage. Such applications of NDR devices may lead to the development of cutting‐edge electrical devices operating at low power that may be employed as biosensors to detect a variety of target DNA (e.g., ct‐DNA) and protein (e.g., the spike protein associated with COVID‐19).

Abstract Infectious Disease Surveillance (IDS) in the community is essential to prevent, control, and detect outbreaks. A strong surveillance system is a need of time for low to middle-income countries like Pakistan where around half of the reported deaths are due to infections that can be easily prevented in the presence of a surveillance system. Although Pakistan has IDS which monitors and collects the data on several infectious diseases, the system is unreliable, inadequate, and substandard. As a result, dengue, tuberculosis, malaria, hepatitis B and C, and many other infectious diseases are still prevalent in Pakistan and unfortunately, the numbers are still rising. In this commentary, we have tried to highlight the problems the country is facing to establish a proper and self-sustainable surveillance system and have recommended some steps the relevant stakeholders should consider taking to make healthcare better in Pakistan.

Abstract Background Leaf senescence occurs in an age-dependent manner, but the rate and timing of leaf senescence may be influenced by various biotic and abiotic factors. In the course of stress, the function, composition, and different components of photosynthetic apparatus occur to be synthesized homogeneously or degraded paradoxically due to different senescence-related processes. Nitrogen (N) deficiency is one of the critical environmental factors that induce leaf senescence, and its incidence may curtail leaf photosynthetic function and markedly alter the genetic information of plants that might result in low grain yield. However, the physiological and genetic mechanism underlying N deficiency regulates premature senescence, and flag leaf function, ROS homeostasis, and intercellular sugar concentration in rice during grain filling are not well understood. In this paper, Zhehui7954 an excellent indica restorer line (wildtype) and its corresponding mutant (psf) with the premature senescence of flag leaves were used to study the effect of different N supplies in the alteration of physiological and biochemical components of flag leaf organ and its functions during grain filling. Results The results showed that the psf mutant appeared to be more susceptible to the varying N supply levels than WT. For instance, the psf mutant showed considerably lower Pn, Chl a, Chl b, and Car contents than its WT. N deficiency (LN) decreased leaves photosynthetic activities, N metabolites, but significantly burst O2 •−, H2O2, and relative conductivity (R1/R2) concentrations, which was consistent with the expression levels of senescence-associated genes. Sucrose, glucose, and C/N ratio concentrations increased with a decrease in N level, which was closely associated with N and non-structural carbohydrate translocation rates. Increases in POD activity were positively linked with the senescence-related enhancement of ROS generation under LN conditions, whereas, SOD, CAT, and APX activities showed opposite trends. High N (HN) supply significantly inhibits the transcripts of carbohydrate biosynthesis genes, while N assimilation gene transcripts gradually increased along with leaf senescence. The psf mutant had a relatively higher grain yield under HN treatment than LN, while WT had a higher grain yield under MN than HN and LN. Conclusions This work revealed that the C/N ratio and ROS undergo a gradual increase driven by interlinking positive feedback, providing a physiological framework connecting the participation of sugars and N assimilation in the regulation of leaf senescence. These results could be useful for achieving a higher yield of rice production by appropriate N supply and plant senescence regulation.

Background and Purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China in December 2019. Symptoms range from mild flu-like symptoms to more severe presentations, including pneumonia, acute respiratory distress syndrome (ARDS), and even death. In response to the COVID-19 pandemic, the Emergency Use Authorization (EUA) approved the use of several vaccines. Because vaccines have been fast-tracked for emergency use, the short and long-term safety profile has been an area of concern. The aim of this paper is to extensively review published literature regarding post-COVID-19 vaccination neurological complications and characterize neuroimaging findings from three case presentations for early diagnosis and treatment. Methods: The analysis includes data from PubMed and Google Scholar. Articles included were retrieved from database inception beginning December 2020 with no language restrictions. Terms used include “SARS-CoV-2”, “post Covid vaccination”, “neurological complications”, “Guillain-barre Syndrome”, “Transverse-myelitis”, “Cerebral Venous Sinus thrombosis”, and “Cerebral hemorrhage”. Results: The literature review yielded several neurological complications post vaccination, including cerebral sinus venous thrombosis, transverse myelitis, Guillain-Barré Syndrome and optic neuritis, to name a few. Patient case presentation findings were consistent with documented results in published literature. Conclusions: We present a case series with a thorough literature review documenting adverse neurological affects following COVID-19 vaccination. Our case presentations and literature review highlight the importance of neuroimaging when diagnosing post-COVID-19 vaccination adverse effects. MRI imaging study is an important tool to be considered in patients presenting with post-COVID-19 vaccination-related unexplained neurological symptoms for accurate diagnosis.

Background: Healthcare professionals experience stressful working conditions that can lead to burnout. This study investigates the association between psychosocial working conditions and burnout among healthcare professionals in a tertiary care hospital in Karachi, Pakistan. Methodology: This cross-sectional study was conducted at three different facilities of Dr. Ziauddin Hospital, Karachi, from July 2021 to December 2021. Two standardized surveys were used to assess the psychosocial working conditions and burnout. The selected participants were associated with the institutional healthcare facility and were working as house officers, residents, nurses, dentists, and allied health professionals. Results: out of 384 distributed questionnaires, only 172 participants completed and returned the questionnaire. The mean score of burnouts was 46.24 with an SD value of 16.1 when assessed with the different levels of burnout (i.e., no burnout, stressed out, mild burnout, burned out, server burnout), it was found that the majority of the participants' n=56 (32.6%) had mild burnout and n=55 (32%) had burnout while severe burnout was found in n=22 (12.8%). Conclusion: Our study results indicate that there is a significant increase in healthcare professionals' level of burnout in a tertiary care system.

In this study, we aim to provide an efficient load prediction system projected for different local feeders to predict the Medium- and Long-term Load Forecasting. This model improves future requirements for expansions, equipment retailing or staff recruiting to the electric utility company. We aimed to improve ahead forecasting by using hybrid approach and optimizing the parameters of our models. We used Long Short-Term Memory (LSTM), Convolutional Neural Network (CNN), Multilayer perceptron (MLP) and hybrid methods. We used Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), Mean Absolute Error (MAE) and squared error for comparison. To predict the 3 months ahead load forecasting, the lowermost prediction error was acquired using LSTM MAPE (2.70). For 6 months ahead forecasting prediction, MLP gives highest predictions with MAPE (2.36). Moreover, to predict the 9 months ahead load forecasting, the highest prediction has been attained using LSTM in terms of MAPE (2.37). Likewise, ahead 1 years MAPE (2.25) was yielded using LSTM and ahead six years MAPE (2.49) was provided using MLP. The proposed methods attain stable and better performance for prediction of load forecasting. The finding indicates that this model can be better instigated for future expansion requirements.

Objectives: To see the effects of Intra-Vitreal Diclofenac injection (IVD) in refractory Diabetic Macular Edema (DME). Study Design: Quasi-experimental study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020. Methodology: Patients included in the study having Clinically Significant Macular Edema (CSME) with Central Macular Thickness (CMT) of more than 300 microns not responding to three consecutive Intravitreal injections of Bevacizumab (IVB).Intravitreal Diclofenac injection (500μg/0.1 ml) was given by the same retina fellow with the same protocol across all patients.Each patient was evaluated based on Central Macular Thickness (CMT) before intravitreal Diclofenac injection and on followup visits one week and one month after injection. Results: A total of 30 patients (30 eyes) were included in the study. Out of these, 11 were females, and 19 were males. The mean age of the patients was 57.87±4.424 years. Mean Central Macular Thickness (CMT) before injection was 439.67±110.45µm, after one week 398.47±110.55µm and 384.87±119.11µm after one month of intra-vitreal Diclofenac injection. Pre and post-injection central macular thickness (µm), which was clinically significant (p-value

The coronavirus pandemic has caused massive damage to global health care and the economy. COVID-19 vaccination and following the government protocols is the only way to tackle this situation. The vaccination program has been paced around the globe to return as soon as possible to pre-COVID time. Although all the vaccines have been approved after the rigorous clinical and safety trials, some adverse effects have surfaced and are being reported from different parts of the world. One such side effect is chilblain-like lesions following the COVID vaccination. Chilblain lesions, also known as pernio, are an inflammatory condition usually affecting the acral regions of the body. It is mostly reported from cold and damp areas and has multiple causes associated with it. Reporting of such similar lesions has raised concern amongst the scientific community and has led to vaccine hesitancy amongst the general population. The exact mechanism behind these lesions is still unknown. Although the incidence of this condition is low, it still requires attention from the authorities. This study aims to review the publicly available data and to provide concise and comprehensive information on chilblain-like lesions post-COVID-vaccination.

Introduction: Cholesterol efflux capacity (CEC) is impaired following acute myocardial infarction (AMI). CSL112 is an intravenous preparation of human plasma-derived apoA-I formulated with phosphatidylcholine (PC). CSL112 is intended to improve CEC and thereby prevent early recurrent cardiovascular events following AMI. AEGIS-I (ApoA-I Event Reducing in Ischemic Syndromes I) was a multicenter, randomized, double-blind, placebo-controlled, dose-ranging phase 2b study, designed to evaluate the hepatic and renal safety of CSL112. Here, we report an analysis of a pharmacokinetic (PK) and pharmacodynamic (PD) substudy of AEGIS-I. Methods: AMI patients were stratified by renal function and randomized 3:3:2 to 4, weekly, 2-hour infusions of low- and high-dose (2 g and 6 g) CSL112, or placebo. PK/PD assessments included plasma concentrations of apoA-I and PC, and measures of total and ABCA1-dependent CEC, as well as lipids/lipoproteins including high density lipoprotein cholesterol (HDL-C), non-HDL-C, low density lipoprotein cholesterol (LDL-C), ApoB, and triglycerides. Inflammatory and cardio-metabolic biomarkers were also evaluated. Results: The substudy included 63 subjects from AEGIS-I. CSL112 infusions resulted in rapid, dose-dependent increases in baseline corrected apoA-I and PC, which peaked at the end of the infusion (T max ≈ 2 hours). Similarly, there was a dose-dependent elevation in both total CEC and ABCA1-mediated CEC. Mild renal impairment did not affect the PK or PD of CSL112. CSL112 administration was also associated with an increase in plasma levels of HDL-C but not non-HDL-C, LDL-C, apoB, or triglycerides. No dose-effects on inflammatory or cardio-metabolic biomarkers were observed. Conclusion: Among patients with AMI, impaired CEC was rapidly elevated by CSL112 infusions in a dose-dependent fashion, along with an increase in apoA-I plasma concentrations. Findings from the current sub-study of the AEGIS-I support a potential atheroprotective benefit of CSL112 for AMI patients.

Optimizing nitrogen (N) fertilization without sacrificing grain yield is a major concern of rice production system because most of the applied N has been depleted from the soil and creating environmental consequences. Hence, limited information is available about nutrient management (NM) performance at a specific site under alternate wetting and drying (AWD) irrigation compared to conventional permanent flooding (PF). We aimed to inquire about the performance of NM practices compared to the farmer’s fertilizer practice (FFP) under PF and AWD on rhizospheric nitrifier and denitrifier abundance, rice yield, plant growth, and photosynthetic parameters. Two improved NM practices; nutrient management by pig manure (NMPM); 40% chemical N replaced by pig manure (organic N), and nutrient management by organic slow-release fertilizer (NMSR); 40% chemical N replaced by organic slow-release N were compared. The results showed an increased total grain yield (16.06%) during AWD compared to PF. Compared to conventional FFP, NMPM, and NMSR significantly increased the yields by 53.84 and 29.67%, respectively, during AWD. Meanwhile, PF prompted a yield increase of 45.07 and 28.75% for NMPM and NMSR, respectively, (p < 0.05) compared to FFP. Besides, a significant correlation was observed between grain yield and nitrogen content during AWD (R2 = 0.58, p < 0.01), but no significant correlation was observed during PF. The NMPM contributed to photosynthetic attributes and the relative chlorophyll content under both watering events. Moreover, relatively higher abundances of ammonia-oxidizing bacteria (AOB) and ammonia-oxidizing archaea (AOA) were observed during AWD, and the highest value was found after the late panicle stage. Our results suggest that the AWD–NMPM model is the best option to stimulate nitrifier and denitrifier gene abundance and promote rice production.

Background & Aims: Population-level trends and factors associated with HBV-related decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality are crucial to evaluate the impacts of therapeutic interventions. Methods: Trends in HBV-DC and -HCC diagnoses and liver-related mortality in New South Wales, Australia, were determined through linkage of HBV notifications (1993-2017) to hospital admissions (2001-2018), mortality (1993-2018), and cancer registry (1994-2014) databases. Late HBV notification was defined as notification at or within 2 years of a DC or HCC diagnosis. Cox proportional-hazards regression and multivariable logistic regression analyses were performed to evaluate associated factors. Results: Among 60,660 people with a HBV notification, 1,276 (2.0%) DC and 1,087 (1.8%) HCC diagnoses, and 1,219 (2.0%) liver-related deaths were documented. Since the early 2000s, the number of DC and HCC diagnoses increased; however, age-standardised incidence decreased from 2.64 and 1.95 in 2003 to 1.14 and 1.09 per 1,000 person-years in 2017, respectively. Similarly, age-standardised liver mortality decreased from 2.60 in 2003 to 1.14 per 1,000 person-years in 2017. Among people with DC and HCC diagnoses, late HBV notification declined from 41% and 40% between 2001-2009 to 29% and 25% in 2010-2018, respectively. Predictors of DC diagnosis included older age (birth

Media exposure to health communication contents related to the COVID-19 pandemic alone is inadequate to measure the influence of media on individuals in adopting precautionary behaviors against COVID-19, such as vaccine uptake. Certain individuals may pay attention to and be influenced by communication content. However, literature has suggested other instrumental determinants in developing and adopting health precautionary measures, such as culture or religion, especially regarding vaccination. In times of crisis, such as the COVID-19 pandemic, it is valuable to examine the interrelationships among psychological, sociocultural, and informational factors. This can provide valuable insights for policymakers in developing effective communication strategies. Drawing an analogy between the Media dependency theory (MDT) and the Theory of Planned Behavior (TPB) model, this study unravels the factors underpinning the COVID-19 vaccine uptake intention among Pakistanis. The study utilized a cross-sectional research design and employed a survey method to gather data from a sample of 993 participants. The findings obtained from the PLS-SEM analysis confirmed that individuals relied on both traditional and social media to cope with the COVID-19 pandemic. The findings show that individuals rely more on the informational content disseminated through conventional media channels. The findings also suggest that individuals from Asian countries, such as Pakistan, tend to be more inclined toward collectivism. The findings about the moderating role of religiosity suggest that religious beliefs significantly shape individuals’ reliance on traditional media. Hence, this study has uniquely contributed to public health and media management by providing a strategy for managers to address disseminating misinformation related to religion and its impact on vaccination-related health issues. The study has theoretically confirmed the principles of media dependency theory. As a result, it is recommended that various information sources be utilized to cultivate resilience among individuals to manage health crises effectively.

OBJECTIVE: To find the relationship between quality of life of mothers of cerebral palsy children and child's motor functioning after at least 3 months of rehabilitation. METHODS: This cross-sectional study was conducted at Liaquat National Hospital, Karachi, Pakistan from August to November 2019. Total 35 cerebral palsy (CP) children and their mothers were involved. Assessment of mother’s health done through Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) and children's motor functioning through Gross Motor Function Measure (GMFM-88). RESULTS: While comparing the results of SF-36 in GMFM-88, we found that children’s mothers with low GMFM score had a general health deterioration compared to children with higher GMFM score. Mothers who are having a child with cerebral palsy, with GMFM between 1-80 had to cut down the amount of time spend on work while mothers whose child’s GMFM was between 1-20 were limited in kind of work and other activities as well as they accomplished less than she would like, and they didn’t do their work as carefully as usual. Due to low GMFM (1-20) of kids’ mothers even suffered from moderate level of body ache. Likewise, in children’s mothers with lower GMFM ratings (1-20 & 21-40) have disturbed work intervention due to affected physical and emotional health. Similarly, social interaction has also been affected. CONCLUSION: This study illustrates that mother of cerebral palsy patient deal with severe physical and mental fatigue. While paying attention only to children’s issues, the health of caregiver mothers also needs special considerations.