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Objectives: This study examined the effectivity of subsystem components in community which could accept the acceleration of Covid-19 vaccine in Polman Region, therefore it becomes information for decision makers to create better health service management which is equal for everyone. Methods: this study applied mix method exploratory design which was conducted in two respective phases: qualitative and quantitative study. Qualitative study was conducted through focus group discussion on 3 target groups (primary, secondary and tertiary) to identify themes, ideas, perspectives, and believes, which became part of quantitative study to be explored. In quantitative study, 133 respondents were recruited from two boarding schools in the target area. Indepth interview and Focus group Discussion were used to collect data in the qualitative method. Quantitative study used descriptive statistics to describe information with frequency distribution. Results: The main results prove that there were relations between the variables found in the two methods which were significant and there was no internal conflict between the qualitative and quantitative findings. The result of the analysis found that the vaccine acceleration model which can be carried out namely involving local organizations and social groups in the COVID-19 information education system as well as taking preventive measures such as vaccination, and it will also be very effective if there were social relationships between individuals who were able to disseminate information about the importance of maintaining health protocols and also to conduct vaccinations in every level of society that could increase trust and follow-up for those who were still doubt about COVID-19 or about government's recommendation for vaccination. Conclusions: We conclude that each dimension of the social ecology and Health Belief Model was found to be consistent in both qualitative and quantitative research findings. [ABSTRACT FROM AUTHOR]

Objectives: Rheumatic heart disease remains a significant problem in developing countries, with mitral stenosis (MS) being a frequent manifestation. The objective of this study was to compare transthoracic echocardiographic (TTE) findings of mitral valve calcification with fluoroscopy. Methodology: This cross-sectional study was conducted at the department of adult cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi. All patients were candidates for percutaneous mitral balloon valvuloplasty (PMBV), aged between 15 to 65 years of either gender. Patients who underwent TTE were subjected to fluoroscopy before PMBV. The Kappa coefficient was calculated to assess the agreement between the two modalities. An appropr iate t-test or Mann-Whitney U test was applied, and a p-value = 0.05 was taken as the criterion for statistical significance. Results: A total of 160 patients were included in this study with a mean age of 34.01± 12.32 years, 119 (74.4%) were between 18 to 40 years of age, and 108 (67.5%) were female. Calcification was observed in 40.6% (65) on echocardiography and 50.6% (81) of the patients on fluoroscopy. A substantial agreement was observed between the two modalities with a Kappa coefficient of 0.75 for the detection of calcification. Conclusion: No significant difference was observed in the detection of calcification on echocardiography and fluoroscopy, along with a substantial agreement between the two modalities for the detection of calcification. Echocardiography can be a less invasive alternative to fluoroscopy for the detection of calcification before PMBV. [ABSTRACT FROM AUTHOR]

Nias Island is presently being confronted with a substantial and imminent threat of a tsunami. However, the level of knowledge of the communities on Nias Island regarding earthquake and tsunami hazards is limited. This study aims to evaluate the level of knowledge, attitudes, and practices (KAP) among the communities residing on Nias Island with respect to the hazard of tsunami. This study adopted a community participation method derived from a social inductive study. Data were collected from field observations and in-depth interviews with 210 communities. Data were analysed using a descriptive table form for comprehensive examination. The results showed that the majority of communities lacked comprehensive knowledge regarding both the sources of tsunamis and estimated times of arrival (ETAs) for tsunamis. The findings also indicated a lack of regular disaster evacuation drills or simulations conducted by the government in the area. Moreover, there is a prevailing belief among the communities that God will prevent loss of life in the event of a tsunami. This belief is concerning because of its potential contribution to a fatalistic attitude towards disasters, potentially resulting in inadequate preparedness. The findings of this research confirm previous research that found that people living on small islands in Indonesia have very limited knowledge of the tsunami hazard., Contribution: These findings highlight the important role of the government to carry out substantial efforts aimed at enhancing the resilience of communities residing in small islands. Currently, small islands receive less attention in efforts to reduce disaster risk., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Advanced Encryption Standard (AES) is the most secured ciphertext algorithm that is unbreakable in a software platform's reasonable time. AES has been proved to be the most robust symmetric encryption algorithm declared by the USA Government. Its hardware implementation offers much higher speed and physical security than that of its software implementation. The testability and hardware Trojans are two significant concerns that make the AES chip complex and vulnerable. The problem of testability in the complex AES chip is not addressed yet, and also, the hardware Trojan insertion into the chip may be a significant security threat by leaking information to the intruder. The proposed method is a dual-mode self-test architecture that can detect the hardware Trojans at the manufacturing test and perform an online parametric test to identify parametric chip defects. This work contributes to partitioning the AES circuit into small blocks and comparing adjacent blocks to ensure self-referencing. The detection accuracy is sharpened by a comparative power ratio threshold, determined by process variations and the accuracy of the built-in current sensors. This architecture can reduce the delay, power consumption, and area overhead compared to other works., Competing Interests: NO authors have competing interests Enter: The authors have declared that no competing interests exist.

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan's four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans., Aims: In this paper, we estimate financial hardship of OPHE in Pakistan., Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE., Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (-1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (-2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE., Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

This study investigated the physicochemical surface changes of various plastics caused by indigenous communities. The first invading microbes on plastics in 4 different aquatic communities including seawater, freshwater, marine sediments and lake sediments were developed in microcosm incubation experiments. A mixture of weathered plastics (PE, PS, PET) was incubated with different indigenous communities under their respective habitat simulations. All microbial communities were able to form populations on all plastic surfaces with time-dependent development. Biofilm also affected floatation of plastics and the communities on PE foam (PF) were dominated by genera affiliated with plastic and hydrocarbon degraders. The results showed that indigenous populations were able to degrade plastic pieces and utilize them as carbon sources where the weight of PF was reduced more effectively than PS and PET. Besides, carbonyl groups that were seen with FTIR on initial PF disappeared after microbial treatment along with signs of bioerosion on the plastic surface., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Rivers are important routes for sea-bound microplastics. Thus, this study investigated the occurrences and distributions of microplastics and polychlorinated biphenyls (PCBs) in sediment samples from the Qiantang River (QR) and Hangzhou Bay (HZ) and analyzed the correlation between microplastics and PCBs. A total of 15 sampling sites were selected, including eight from the QR (i.e., four in the Tonglu area and four in the Fuyang area), two from the Andong salt marsh (ASM; located in a hydrodynamic turning point of the HZ), and five from HZ. The mean microplastic abundance was highest in the QR, followed by HZ and ASM, with 0.23 ± 0.06, 0.18 ± 0.05, and 0.15 ± 0.03 particles/g sediment, respectively. Cluster analysis demonstrated that fragments and fibers may have originated from domestic sewage inputs to the QR. Spatially, mean PCB concentrations from Tonglu, Fuyang, and HZ were 1.47 ± 0.10, 1.65 ± 0.10, and 1.65 ± 0.09 ng/g sediment, respectively, which were higher than that from the ASM (1.13 ± 0.09 ng/g sediment). The vertical distributions (0-5 cm, 5-10 cm, and 10-15 cm) of microplastics in the sediments at Tonglu and Fuyang decreased with increasing depth, which was opposite to the depth trend of PCB concentrations. Micro-Fourier transform infrared spectroscopy analysis suggested that polyethylene was typically the dominant polymer, accounting for 60 ± 0.08% of the total suspected plastic particles. Microbeads and films showed considerable correlations with both highly and lesser chlorinated PCBs. Overall, our findings highlight the need for routine monitoring of microplastics in China in addition to measures for controlling plastic pollution on a national scale. Further study should ascertain specific sources of microplastics and analyze their adsorption capacity to organic pollutants., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Systemic sclerosis is a rare and progressive multisystem autoimmune disorder that is characterized pathologically by vascular abnormalities, connective tissue sclerosis and atrophy of skin and various internal organs (e.g., alimentary tract, lungs, heart, kidney, CNS), and autoantibodies. With an unknown etiology, Scleroderma is a complex polygenetic disease. A recent Genome Wide Association Study (GWAS) confirmed a strong association with the Major Histocompatibility Complex (MHC) and autoimmunity. We provide a case scenario along with a review of the systems involved and challenges physicians can face in dealing with this rare disease., Case Presentation: Our patient, a known case of systemic sclerosis, was admitted with a history of right femur fracture following a fall. We highlight the medical, anesthetic and surgical challenges faced by our team in the management of this patient. We will explain the stages patient faced in treatment process till her death. We combined the case report with detailed literature review of this rare disease., Discussion: Systemic sclerosis is a complex disease process with many different levels of system involvement. Patient needs to be reviewed thoroughly in preoperative period by multidisciplinary team and counseled in detail about the difficulties in procedure, risks and complications., Conclusion: Patient with scleroderma presents a challenge to the surgical team and anesthetist and a multidisciplinary approach should be followed with all of these patients to avoid catastrophic results., (Copyright © 2017. Published by Elsevier Ltd.)