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OBJECTIVE: To evaluate the therapeutic effectiveness of fluoroscopy-guided genicular nerve radiofrequency ablation for treating refractory knee osteoarthritis. METHODOLOGY: This quasi-experimental study was conducted in Peoples Medical College Hospital from July 2020 to June 2022 on patients suffering from refractive knee osteoarthritis treated by fluoroscopy-guided genicular nerve radiofrequency ablation (FGGNRA). Eighty-six patients enrolled using a convenient sampling technique. The outcome measures included a reduction in pain scores assessed by the Visual Analog Scale (VAS) at 1, 2, 4, 6, and 12 weeks, though follow-up at six and nine months intervals. Data was collected on a predesigned proforma and analyzed using SPSS version 26, and a P value of less than 0.05 was considered significant. RESULTS: A total of 86 patients were treated, with the highest number of patients in the age group of 41-50 years (n=30, 34.9%, Mean. 54.3, Min. 35, Max. 85) having ASA Status-I (n=81, 94.2%). VAS score before the therapeutics block was at an average of 6.6 (±0.8); however, after the procedure, the average score was 2.0 (±0.8). The consequent observation after 1, 2, 4, 6, 12 weeks, six, and nine months showed an average VAS score of 1.9 (±0.8), 1.9 (±0.8), 1.8 (±0.8), 1.8 (±0.8), and 1.9 (±0.9), 2.5 (±0.8) and 2.5 (±0.9) respectively. Major complications after the procedure were numbness (43.0%, n=37), weakness (37.2%, n=32), vascular injury (12.8%, n=11), and paresthesia (7.0%, n=6). CONCLUSION: The FGGNRA technique for refractory knee osteoarthritis can be a promising option for treating knee pain with minor complications and long-term effects.

Abstract In this article, we have proposed memory-type exponential and non-exponential estimators for population variance based on exponentially weighted moving average (EWMA) statistic in stratified sampling. We drive mathematical expressions for mean square errors of the proposed estimators using Taylor and exponential expansions. Our analysis demonstrates that the proposed memory-type estimators outperform the conventional estimators under stratification, particularly, when the information of previous sample is utilized. The performances of the proposed estimators are evaluated mathematically by deriving the conditions in which the memory-type estimators would perform better than their corresponding conventional estimators under stratification. Through an extensive simulation, we evaluated the performance of the proposed estimators across various population parameters, revealing their enhanced efficiency in time-scaled survey. Additionally, a real data application is also used to support the mathematical findings, confirming the practical utility of the proposed estimators. The results of numerical study underscore the importance of the use of previous sampled information which significantly improves the accuracy and reliability of the proposed estimator for variance estimation for time-scaled surveys.

Abstract Wheat (Triticum aestivum L.) is a staple crop of immense economic importance, especially in the agronomic context of Dera Ismail Khan, Khyber Pakhtunkhwa (KPK), Pakistan. Understanding the effects of various agronomic practices, such as priming techniques, sowing methods, and seed rates, on wheat yield and growth is crucial for optimizing production and ensuring regional food security. To study the effects of priming and sowing techniques in combination with seed rates on short (Israr Shaheed) and long (Gomal) duration, three experiments were conducted at the agronomic research site of Gomal University, Dera Ismail Khan, Pakistan, wheat varieties. In the first experiment, various priming techniques were used. Among different techniques used Farmyard manure priming produced the tallest plants at 111.3 and 125.3 cm, the maximum number of tillers (335.7 and 345.0 m-2), longest spikes (8.6 and 7.6 cm), maximum spikelets (27.2 and 31.0 spike-1), maximum number of grains (45.5 and 48.7 spike-1), maximum grain yield (4.4 and 4.6 t ha-1) and maximum harvest index (38.7 and 41.5%) respectively for Israr Shaheed and Gomal. Conversely, compost manure produced heavier grains than other interactions (49.2 and 42.3 g) while sodium chloride showed the maximum biological yield (12.4 and 11.8 t ha-1) for Israr Shaheed and Gomal correspondingly. In 2nd experiment, different sowing methods were tested on two wheat varieties Israr Shaheed and Gomal. Dry sowing followed by flooding produced tallest plants measuring (105.5 and 101.7 cm), maximum number of tillers (398.2 and 406.7 m-2), longest spikes (8.3 and 7.2 cm), maximum spikelets (29.8 and 35.5 spike-1), maximum number of grains (54.3 and 51.6 spike-1) and maximum grain yield (4.3 and 4.6 t ha-1) respectively for Israr Shaheed and Gomal. Israr Shaheed and Gomal showed maximum 1000-grain weights (45.3 and 45.0 g) in sprouted seeding in flooded fields respectively. The highest biological yield (13.6 t ha-1) was in dry seed in the flooded field while the maximum harvest index (33.5 and 33.9%) was recorded in soaked seed followed by flooding for Israr Shaheed and Gomal. In the last experiment, different seed rates were studied. The results showed that plants grown with seed rate 150 kg ha-1 showed the tallest plants at 111.0 and 111.7 cm, maximum number of tillers (411.6 and 408.2 m-2), longest spikes (7.8 and 7.7 cm), maximum spikelets (34.3 and 34.3 spike-1), maximum number of grains (50.8 and 47.2 spike-1), maximum grain yield (4.6 and 4.5 t ha-1) and maximum harvest index (38.4 and 36.7%) respectively for Israr Shaheed and Gomal. The maximum number of 1000-grains weight (g) was found on 200 and 250 kg ha-1 for Israr Shaheed and Goma-8, respectively giving 45.2 g while biological yield was the highest in 175 kg ha-1 respectively. Conclusively, the results indicated that yield and yield attributes in wheat were enhanced up to 150 kg ha-1 seed rate when interacted with farmyard manure priming along with dry sowing of seed followed by flooding. Future research should explore the integration of advanced irrigation techniques and nutrient management practices to further enhance wheat productivity in the Dera Ismail Khan region.

Pakistan has significant geothermal potential but due to poor energy management and low utilization of rich geothermal energy, the country is ranked among the energy deficient nations in the world. In this study, integrated geophysical techniques were used to assess the geothermal energy potential of various hot springs in the Sindh province. The study revealed that Naing Shareef and Gaji Shah hot springs have remarkable potential for geothermal energy having pool water temperature of 43 °C and 45 °C, respectively. Geophysical resistivity survey was carried out at both Naing Shareef and Gaji Shah hot spring to determine depth, thickness and quality of thermal water. At Naing Shareef hot spring, only a single thermal aquifer zone has been pinpointed within the shale composition of the Oligocene Nari Formation, and it is on average 55.07 m depth and 29.8 m thick. At an average depth of 100.66 m and an aquifer thickness of 77.03 m, the Gaji Shah hot springs exclusively possess a thermal aquifer region established within the sandstone composition of the Oligocene Nari Formation.

A reduction in river flows is a major cause of the shrinking of river deltas. The Ramsar protected Indus Delta is one such example. Due to a consistent reduction in the flows of the Indus River, 15 out of 17 allied creeks facing back flows from the sea, while the remaining two are flowing during flooding years only. The connected wetlands and lagoons of these creeks have turned brackish, resulting in the devastation of associated habitats and ecosystems. This situation also increased seawater intrusion and coastal erosion. This study spatially detect the devastated lagoons, employing the Arc-Hydro tools in ArcGIS, conduct community meetings and draft evidence-based recommendations to revive the abandoned wetlands. The study identified 130 waterbodies using maximum likelihood and supervised classification methods on Landsat imagery. Through ground trothing 20 abandoned waterbodies have been visited and verified with community engagement. The revival of wetlands will improve biodiversity and coastal habitat, along with the re-plantation of mangrove, which provides a shield against tsunamis and cyclones and is also home to hundreds of species of shrimp. The sustainable wetlands may also provide immediate drinking and agricultural needs for the local population, as well as repel seawater from intruding inland.

Abstract Cadmium (Cd) toxicity significantly threatens agricultural productivity and food safety. Developing effective strategies to enhance plant tolerance to Cd stress is essential. This study investigates the synergistic effects of biochar (BC) and gibberellic acid (GA3) on mitigating Cd toxicity in maize (Zea mays), focusing on their impact on oxidative stress markers and antioxidant enzyme activities. Soil samples were collected from the Cholistan Institute of Desert Studies (CIDS) and analyzed for trace metal ions and other properties. Biochar was produced from fruit and vegetable waste, washed, washed, deashed, and mixed with 10 ppm GA3. FH-1036 hybrid maize seeds were sterilized and planted in pots containing soil with varying Cd levels (0, 8, and 16 mg Cd/kg soil). Twelve treatments were established, including control, GA3, BC, and their combinations under different Cd stress levels. Plants were irrigated to maintain 60% field capacity and harvested at the V10 growth stage. Hydrogen peroxide (H2O2) contents and activities of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) were measured in roots, stems, and leaves. Statistical analysis was performed using OriginPro 2021, with ANOVA and Fisher’s LSD test used to determine significant differences. GA3 and BC treatments significantly reduced H2O2 levels in maize roots, stems and leaves under Cd stress. The combined treatment of GA3 + BC showed the most significant reduction in H2O2 levels across all plant parts, reducing root H2O2 by 50%, stem H2O2 by 55%, and leaf H2O2 by 53% under severe Cd stress (16 mg Cd/kg). SOD activity increased under non-stress conditions but decreased under Cd stress, with the highest activity observed in the combined treatment. POD activity followed a similar pattern, with GA3 + BC treatment resulting in the most significant increases under non-stress conditions and the least reductions under Cd stress. CAT activity showed substantial increases with GA3 + BC treatment, particularly under severe Cd stress, with a notable rise over the control. APX activity also exhibited enhancements with GA3 and BC treatments, especially in the combined treatment under various Cd stress levels. This study highlights the potential of combined BC and GA3 treatments in improving Cd stress tolerance in maize. Future research should focus on field trials and the long-term impacts of these treatments on crop productivity and soil health.

Background: Esophageal cancer (EC) remains a significant health challenge in South Asia, with poor prognosis despite advancements in diagnostics and treatment. Identifying and validating prognostic factors is essential for improving patient outcomes. Methods: A prospective study was conducted with 146 biopsy-confirmed EC patients at the Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan. Clinical and laboratory data were collected and analyzed using descriptive statistics, receiver operating characteristic (ROC) analysis, and the Chi-square test. Survival outcomes were assessed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazard models for univariate and multivariate regression analyses, with statistical significance set at p ≤ 0.05. Results: Bivariate analysis showed significant associations of the neutrophil lymphocyte ratio (NLR) (p = 0.017), C-reactive protein to albumin ratio (CAR) (p = 0.033), red cell distribution width to platelet ratio (RPR) (p = 0.020), and systemic immune-Inflammation index (SII) (p = 0.009) with patient survival. Univariate analysis identified tumor length >10 cm (p = 0.016), T4 stage (p = 0.015), metastasis (p < 0.001), surgery not performed (p < 0.001), and SII (p = 0.022) as significant factors for survival, with higher SII linked to poorer overall survival (p = 0.020). Interestingly, in the multivariate model, only metastasis (p < 0.001) and surgery not performed (p = 0.011) remained significant. Conclusions: Immuno-inflammatory markers may be less pertinent prognostic factors for EC in the South Asian population.

This paper presents a novel artificial intelligence (AI) based approach to predict crucial meteorological parameters such as temperature, pressure, and wind speed, typically calculated from computationally intensive weather research and forecasting (WRF) model. Accurate meteorological data is indispensable for simulating the release of radioactive effluents, especially in dispersion modeling for nuclear emergency decision support systems. Simulation of meteorological conditions during nuclear emergencies using the conventional WRF model is very complex and time-consuming. Therefore, a new artificial neural network (ANN) based technique was proposed as a viable alternative for meteorological prediction. A multi-input multi-output neural network was trained using historical site-specific meteorological data to forecast the meteorological parameters. Comprehensive evaluation of this technique was conducted to test its performance in forecasting various parameters including atmospheric pressure, temperature, and wind speed components in both East-West and North-South directions. The performance of developed network was evaluated on an unknown dataset, and acquired results are within the acceptable range for all meteorological parameters. Results show that ANNs possess the capability to forecast meteorological parameters, such as temperature and pressure, at multiple spatial locations within a grid with high accuracy, utilizing input data from a single station. However, accuracy is slightly compromised when predicting wind speed components. Root mean square error (RMSE) was utilized to report the accuracy of predicted results, with values of 1.453 ℃ for temperature, 77 Pa for predicted pressure, 1.058 m/s for the wind speed of U-component and 0.959 m/s for the wind speed of V-component. In conclusion, this approach offers a precise, efficient, and well-informed method for administrative decision-making during nuclear emergencies.

Abstract Background Pakistan faces profound mental health challenges, which necessitate the urgent need for a comprehensive assessment of its mental healthcare system. A holistic understanding of the mental health landscape is essential to identify strengths, weaknesses, and existing gaps within the system, which can inform targeted interventions and policy enhancements to improve mental healthcare accessibility. Objective The primary objective of this desk research is to conduct an in-depth analysis of Pakistan’s mental healthcare system across various dimensions, guided by the World Health Organization’s Assessment Tool for Mental Health Systems (WHO-AIMS). Methods Data for this desk research and scoping was obtained through desk research, including an examination of existing policies and legislation and consultations with various health facilities across Pakistan. This comprehensive analysis focused on six critical domains within the WHO-AIMS framework: policy and legislation, mental health services, integration of mental health into primary care, public awareness and collaboration with other sectors, human resources, and monitoring and research initiatives. Results The findings provides a snapshot of strength and opportunities for improvement in Pakistan’s mental healthcare system that can serve as the foundation for revising and updating national priorities. Key areas of focus include enhancing policy and legislation, expanding access to mental health services, improving existing initiatives for better integration of mental health into primary care, improving public awareness and sector collaboration, addressing human resource challenges, and strengthening monitoring and research initiatives. Conclusion This desk research provides a roadmap for refining and enhancing Pakistan’s mental health ecosystem and informs the prioritization of mental health campaigning efforts.

Abstract Our study describes the reported rate of the Institutional Review Board (IRB) approval, declaration of Helsinki (DoH), and informed consent in the case reports and case series and investigates factors associated with the ethical approval report. We searched PubMed for case reports and case series from 2006 to 2017. Annually, we obtained the first 20 articles of a case report cluster from 20 distinct publications. This analysis initially contained at least 2400 papers, with 100 papers each study design and year. Only 26 (5.4%) of 480 included studies reported IRB approval, DoH approval, and participant informed consent; 58 (12.1%) reported two out of three ethical statements (DoH, informed consent, IRB); and 151 (31.5%) reported only one, leading to nearly 245 studies (51.0%) did not report any ethical approval item. Both clusters mentioned the DoH the least. Only years, ages, ethical item types, and cluster types were associated with ethical reporting practices. This study found the serious under‐reporting of ethical practices in both case reports and case series.

Abstract Hemp (Cannabis sativa L.) is an annual, and dioecious herb belonging to the Cannabaceae family. This plant is native to Central and Southeast Asia. The wild races of this species are commonly growing in Khyber Pakhtunkhwa and Punjab provinces, as well as in Islamabad, Pakistan. This study provides crucial insights into how environmental variables influence the wild hemp populations, which can be utilized in for conservation and breeding. The present study was aimed at evaluating the effects of key environmental factors such as altitude, geographical location, precipitation, relative humidity, maximum, minimum, and average temperature on 16 morpho-agronomic traits of a wild population of hemp growing in the Potohar Plateau and Lesser Himalayas. Our findings indicated that high relative humidity (> 64%), low average temperature ( 22 °C) played significant roles in determining the distribution pattern of the wild hemp. Correlation analysis demonstrated that average annual temperature contributed a higher percentage of variation in phenotypic diversity than geographic variables. Additionally, cluster analysis indicated three groups for the selected 35 populations. Clustering and Principal Component Analysis (PCA) of the morpho-agronomic traits indicated that group 1 from the Lesser Himalayas showed high relative humidity (> 64%) and low average temperature ( 22 °C) compared to Group 1 and Group 2. Our examination highlights the complex interplay between ecological factors, and morphological attributes in native landraces of Cannabis sativa, giving significant insight into knowledge for preservation and breeding initiatives. A study of genetic diversity could complement morpho-agronomic traits in future research to learn more about how genetic variation affects environmental adaptation.

Abstract The major challenge for the construction industry is to design and produce sustainable construction materials that are efficient in their performance and can be affordable for construction projects. The objective of this study is to determine the viability of incorporating waste products such as sugarcane bagasse ash (SCBA) to produce concrete with polypropylene (PP) fibers. SCBA is an industry waste that has certain pozzolanic properties, however, it shows limited mechanical properties when used as a cement replacement. To improve the mechanical and durability performance, metakaolin (15%) and PP fiber (0.5%, 1%, and 1.5%) were incorporated in the SCBA blend as a ternary additive. Some of the important characteristics explored include compressive strength, tensile strength, density, water absorption, acid resistance, and sorptivity. The study reveals that the incorporation of 15% metakaolin in the composite enhanced the compressive strength by 7%, 8.2%, and 9.1% for PP fiber additions of 0.5%, 1%, 1.5%, while the acid resistance enhanced by 4%, 6% and 8% relative to the control mix for the same value of pp fiber. Furthermore, cost evaluation confirms that the overall costs of concrete with 15% metakaolin and 5% SCBA were 12.2% less than the control concrete, thus making this option economically feasible. This research proves that the inclusion of SCBA, metakaolin, and PP fibers into the concrete mixture brings a sustainable approach that enhances mechanical properties and durability while assisting sugar manufacturing plants in the proper disposal of wastes.

As carbon-based nanomaterials have such remarkable physical, chemical, and electrical capabilities, they have become a major focus of materials science study. A thorough examination of several carbon nanomaterial varieties, such as carbon nanotubes, graphene, fullerenes, and carbon nanodiamonds, is given in this review work. These materials all have distinctive qualities that qualify them for particular uses. This work starts by examining the synthesis processes of these nanomaterials, outlining the ways by which they are made and the variables affecting their ultimate characteristics. The specific features of each kind of carbon nanomaterial will then be briefly discussed in this study, along with their size, structure, and special physical and chemical properties. These materials have a wide range of possible uses in several fields. They are employed in the electronics industry to fabricate sensors, high-speed transistors, and other devices. Their high surface area and electrical conductivity make them useful in energy storage devices like supercapacitors and batteries. They are applied to environmental remediation and water purification in environmental science. They are employed in biomedicine for biosensing, bioimaging, and medication delivery. Notwithstanding the encouraging uses, the large-scale synthesis and functionalization of carbon nanomaterials present several difficulties. This review discusses the importance of carbon nanomaterials by studying their multifaceted properties and potential applications in industries. The novelty of this work lies in its detailed examination of the degradation and toxicity of these materials, which is essential for their safe integration into various technological and biomedical applications. By thoroughly analysing recent experimental results, this review aims to bridge the gap between fundamental research and practical applications.

Abstract Background Dental students face the rigorous demands of coursework, which can lead to feelings of inadequacy and stress. These pressures can negatively influence self-efficacy and cause neglect in practicing healthy behaviors that encompass oral health. Identifying the associations of these variables with oral hygiene practices can help in the formulation of interventions tailored toward supporting young students. Therefore, this study aimed to investigate the impact of health behaviors, perceived stress and self-efficacy on oral hygiene practices among undergraduate dental students in Pakistan. Methods A national online survey was carried out among 904 students across the dental colleges of Pakistan. The survey assessed general health behaviors such as tobacco use, sleep, and exercise, among other demographic variables. Perceived stress was evaluated via the Perceived Stress Scale (PSS-10), and self-efficacy was evaluated via the General Self-Efficacy Scale (GSES). Twice daily brushing, brushing for 2 min, and changing toothbrushes after 3 months informed oral hygiene practice of the participants. Results The students experienced moderate perceived stress (20.82 ± 5.92) and high self-efficacy (29.19 ± 5.43). The majority of participants were in their third year (31.9%), were female (65.9%), and resided in home during their studies (64.4%). Perceived stress was observed to have no significant effect on the oral practice of participants. Female gender, non tobacco user, regular exercise, frequent dental visits and higher self-efficacy were associated with good oral hygiene practices. Conclusions The results highlight the importance of addressing stress, enhancing self-efficacy and encouraging healthy behaviors among dental students to improve their oral health, which could be reflected in their professional practice and personal well-being. This study contributes to the understanding of behavioral determinants and emphasizes the need for supportive measures to foster better health behaviors in future dental professionals.

This research endeavors to conduct an examination of the thermal characteristics within the duct filled with the copper nanoparticles and water as base fluid. In exhaust systems, like car exhausts, chimneys, and kitchen hoods, duct flows are crucial. These systems safely discharge odors, smoke, and contaminants into the atmosphere after removing them from enclosed places. The study focuses on a laminar flow regime that is both hydrodynamically and thermally developed, with a specified constraints at any cross-sectional plane. To address this, we employ the finite volume method as it stands as a judicious choice, offering a balance between computational efficiency and solution accuracy. Notably, we have observed that the deceleration of flow induced by elevated Rayleigh numbers can be effectively regulated by the application of an appropriately calibrated external magnetic field. The prime parameters of the problem with ranges are: pressure gradient (1≤p0≤100)(1\le {p}_{0}\le 100), Hartmann number (0≤Ha≤50)(0\le \text{Ha}\le 50), Rayleigh number (1,000≤Ra≤40,000)(1,000\le \text{Ra}\le 40,000), and magnetic parameter (0≤M≤50)(0\le M\le 50). Furthermore, our analysis reveals that the Nusselt number exhibits a nearly linear correlation with the nanoparticle volume fraction parameter, a trend observed across a range of Rayleigh numbers and magnetic parameter values. We have noted that a mere 20% nanoparticle volume fraction can result in up to 62% rise in the Nusselt number while causing an almost 50% decrease in the factor f Re. This research framework serves as a robust foundation for understanding the intricate interplay between magnetic influences and thermal-hydraulic behavior within the delineated system.

Abstract Accurate consumption forecasting is of great importance to grasp the energy consumption habits of consumers and promote the stable and efficient operation of integrated energy system (IES). To this end, this paper proposes an interactive multi-scale convolutional module-based short-term multi-energy consumption forecasting method for IES. Firstly, based on multi-scale feature fusion and multi-energy interactive learning, a novel interactive multi-scale convolutional module is proposed to extract and share the coupling information between energy consumption from different scales without increasing network parameters. Then, a short-term multi-energy consumption forecasting method is proposed, where different forecasting network structures are selected in different seasons to make full use of seasonal and coupling characteristics of the energy consumption, thus enhancing prediction performance. Furthermore, a Laplace distribution-based loss function weight optimization method is proposed to dynamically balance the loss magnitude and training speed of joint forecast tasks more robustly. Finally, the effectiveness and superiority of the proposed method are verified by comparative simulation experiments.

In this work, the Marangoni convective flow of magnetohydrodynamic tangent hyperbolic (Fe3O4−Cu/{{\rm{F}}{{\rm{e}}}_{3}{\rm{O}}}_{4}-{\rm{Cu}}/ethylene glycol) hybrid nanofluids over a plate dipped in a permeable material with heat absorption/generation, heat radiation, elastic deformation and viscous dissipation is discussed. The impact of activation energy is also examined. Hybrid nanofluids are regarded as advanced nanofluids due to the thermal characteristics and emerging advantages that support the desire to augment the rate of heat transmission. The generalized Cattaneo–Christov theory, which takes into account the significance of relaxation times, is modified for the phenomena of mass and heat transfer. The fundamental governing partial differential equations are converted to ordinary differential equations (ODEs) by adopting similarity variables. The Runge–Kutta–Fehlberg-45 technique is utilized to solve nonlinear ODEs. Regarding the non-dimensional embedded parameters, a graphic investigation of the thermal field, concentration distribution, and velocity profile is performed. The results show that the increasing Marangoni ratio parameter enhances velocity and concentration distributions while decreases the temperature distribution. The velocity profile is decreased and the efficiency of heat transfer is improved as the porosity parameter is increased. Nusselt number is diminished with the rising values of the porosity variable.

India is facing a new wave of Lumpy skin disease outbreaks since May 2022, spreading in more than 22 states and causing morbidity to more than 29 lakh animals and mortality to more than 2 lakh animals. Lack of specific antiviral treatment restores symptomatic therapeutic interventions. However, in the advent of large no. of cases and severity of disease, investigations on specific antiviral drugs are imperative. This scientific study was conducted on a group of LSD-affected cattle (n = 40) from the trans-Himalayan region of Kashmir (Jammu and Kashmir). The affected cattle were subjected to different treatments, including acyclovir (n = 27), symptomatic treatment (n = 7), and ivermectin (n = 6), along with supportive drugs. The animals were carefully monitored and compared both within and between groups at various intervals (0-96 hr) using a two-way analysis of variance (ANOVA). Significant (P ≤ 0.05) improvement in regaining rectal temperature, respiration rate, and heart rate was noted 48 hours after treatment in a group of LSD-affected animals (n = 27) treated with acyclovir at a dose rate of 1 mg/kg body weight (small cattle) to 1.5 mg/kg (large cattle) intravenously in 500 ml normal saline along with supportive drugs including enrofloxacin (2.5 mg/kg), combination of meloxicam (0.25 mg/kg) and paracetamol (7.5 mg/kg) and pheniramine maleate (0.5 mg/kg) all intramuscularly, compared to group of LSD affected cattle (n = 6) treated with ivermectin (0.2 mg/kg subcutaneously) and supportive drugs and another group of LSD affected cattle (n = 7) treated symptomatically with only supportive drugs. Acyclovir treated group showed a significant (P ≤ 0.05) decrease in total leucocyte count, lymphocyte, and basophil count from 0 hour to 96 hour of treatment (23.00 ± 0.534 to 5.59 ± 0.208; 13.97 ± 0.310 to 3.43 ± 0.126; 0.11 ± 0.003 to 0.03 ± 0.001 respectively). Significant (P ≤ 0.05) decrease in total oxidative status (TOS: 73.31%) and increase in total antioxidant status (TAS: 59.9%) was observed in acyclovir treated group followed by ivermectin treated group (TOS: 68.05% and TAS: 27.16%) compared to symptomatically treated group (TOS: 42.41% and TAS: 18.75%). Acyclovir being comparatively more specific antiviral agent than ivermectin may have helped in amelioration of clinical severity and regaining of normal physiological, hematological, and oxidative indices in LSD-affected animals. The current study demonstrates expedited recovery, diminished clinical severity, and re-establishment of physiological, hematological and oxidative markers in animals subjected to acyclovir treatment, followed by animals administered with ivermectin, when compared to animals receiving symptomatic treatment. However, further studies are required to investigate safety or adverse effects, if any.

Introduction: Multifocal primary neuroblastoma in the non-infantile age group is rare, posing challenges in risk stratification and surgery. Case report: A 3-year-old girl presented with an abdominal mass and elevated urinary vanillylmandelic acid (218 mg/l). Positron emission tomography - computed tomography showed fluorodeoxyglucose-avid masses in the left suprarenal and posterior mediastinum with regional paraortic nodes. A biopsy of the suprarenal and thoracic masses was suggestive of ganglioneuroblastoma and ganglioneuroma. She was stratified as an intermediate risk, with the bone marrow being uninvolved and non-amplified MYCN. Gross tumor resection was achieved at all the sites after 2 cycles of neoadjuvant chemotherapy. She received 2 more cycles of adjuvant chemotherapy and has been disease-free for 3 years. Conclusion: Multifocal primaries in the non-infantile age group have favorable biological features and a good outcome.

Abstract Women-led entrepreneurial startups play a crucial role in fostering a sustainable future. These startups have the potential to provide innovative solutions. However, women entrepreneurs in Pakistan face socio-economic challenges like unemployment, gender inequality, and environmental deterioration. Even though women are underrepresented in the workforce, entrepreneurship is essential for developing sustainable practices. This research explores the contributions that women entrepreneurs can make to sustainability, the obstacles and possibilities that exist, as well as the requirements for changes in policies and regulations to accomplish sustainable development goals. This study utilizes a qualitative approach and focuses on conducting semi-structured interviews with 20 Pakistani women entrepreneurs in the service sector industry. Subsequently, thematic analysis was employed. The study provides recommendations for Pakistani policymakers and stakeholders to enhance the efficiency of entrepreneurship to promote sustainable development.

Abstract The plant extract-mediated method is eco-friendly, simple, safe, and low-cost, using biomolecules as a reducing agent to separate nanoparticles. Lanthanum (La) is a rare earth metal that positively affects plant growth and agriculture. Citrus limon is a leading citrus fruit with many varieties. Conventional vegetative propagation methods depend on season, availability of plant material and are time-consuming. It is the main reason for limiting the acceptance of new varieties. So, In-vitro propagation of the lemon method is practiced overcoming all these problems. Lanthanum oxide nanoparticles (La2O3-NPs) were synthesized using plant extract of C. aurantium. Ultraviolet (UV)-Visible Spectroscopy, Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Fourier Transform Infrared (FTIR) spectroscopy, and Thermal Gravimetric Analysis (TGA) were used to characterize the synthesized La2O3-NPs. Fabricated La2O3-NPs were oval and spherical, with an average size of 51.1 nm. UV-visible absorption spectra of La2O3-NPs were shown at a sharp single peak at 342 nm and FTIR showed stretching frequency at 455 cm−1-516 cm−1. In the TGA outcome, mass loss was 9.1%. In vitro experiments demonstrated that La2O3-NPs significantly enhanced the germination and growth of C. limon seeds, achieving an 83% germination rate at 5 mg/L concentration, with uncoated seeds showing root initiation at 10 days and shoot formation at 15 days. Furthermore, La2O3-NPs effectively stimulated callus induction and maturation, with optimal responses observed in media containing MS and 2 mg/L 2,4-D, resulting in a maximum callus frequency of 100% from leaves and 87.5% from shoots at 5 mg/L concentration. These findings underscore the potential of La2O3-NPs to improve seed germination rates, seedling vigor, and callogenesis efficiency, suggesting their promising integration into agricultural practices for sustainable crop production, especially in suboptimal growing conditions. Future research is recommended to explore the mechanisms and broader applications of La2O3-NPs across various plant species and environments.

Abstract This study focused on sustainable and novel development of concrete through treated and untreated plastic waste aggregates. In this study, the surface of Elec-waste coarse aggregates was treated with sulfuric acid, marble dust coating, silica fume coating, and alkaline bleach. Elec-waste aggregates were used in concrete by replacing natural coarse aggregates in amounts of 10%, 20%, and 30%. The 10%, 20%, and 30% Elec-waste replacement ratios resulted in the compressive strength reduction of 8.97%, 27.99%, and 42.01%, respectively. The same percentage of Elec-waste aggregates reduced the splitting tensile strength by 21.77%, 35.89%, and 47.89%, respectively. However, the slump was observed to increase by 41.4%, 52.1%, and 68.8%, respectively. All the considered treatments enhanced the performance of Elec-waste aggregate concrete (E-WAC). Overall, the best improvement in the performance of E-WAC was imparted by silica fume coating, irrespective of the quantity of Elec-waste aggregates. The present study proposed an expression to estimate the reduction of the compressive strength of E-WAC. It was demonstrated that the equation by JCI-08 predicted splitting tensile strength of E-WAC close to experimental results.

The transformation of business and the economy is a key business problem, and its importance was further heightened during the COVID-19 pandemic, with the increased pressure on enterprises. Hence, the digital readiness of their business will likely determine its future competitiveness in the field. Objectives: The paper addresses the issue of digital readiness for business, with the aim of examining similarities and differences in the digital readiness of European Union countries. The main focus is on identifying the changes during the first two years of the pandemic. Methods/Approach: We conducted a factor analysis and hierarchical cluster analysis based on selected indicators. The results revealed some significant differences. Results: While the countries that lead in digital readiness remained the same, there were relatively large differences in the classification of other EU countries. Some countries, such as Latvia or Slovenia, significantly improved in many aspects of digital readiness during the pandemic. On the other hand, Bulgaria and Romania are still included in the same cluster, representing an overall low digital readiness. Conclusion: Enterprises in more developed countries also have a higher level of digital readiness. Although COVID-19 had a positive impact on digital readiness in some less developed countries, the impact is only partial, indicating a need for stronger actions to bridge the digital divide at the EU level. These findings provide a hopeful outlook, suggesting that with the right actions, the digital divide in the EU can be effectively bridged.

Muhammad B Qureshi,1 Jose O Garcia,1 Jaxon Quillen,2 Carolyn Mead-Harvey,2 Christina Wentz,3 Cherie B Nau,4 Muriel Schornack,4 Keith Baratz,4 Sanjay V Patel,4 Joanne Shen5 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 3Illinois College of Optometry, Chicago, IL, USA; 4Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 5Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USACorrespondence: Joanne Shen, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, 85259, Tel +1 480-301-8085, Fax +1 480-301-7326, Email shen.joanne@mayo.eduPurpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.Patients and Methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson’s Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (− 17.26, p < 0.001), CFS OD (− 0.50, p < 0.001), and CFS OS (− 0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.Keywords: graft-versus-host disease, GVHD, chronic GVHD, dry eye disease, ocular GVHD, keratoconjunctivitis sicca, KCS

Abstract Background Elevated mammographic density (MD) for a woman’s age and body mass index (BMI) is an established breast cancer risk factor. The relationship of parity, age at first birth, and breastfeeding with MD is less clear. We examined the associations of these factors with MD within the International Consortium of Mammographic Density (ICMD). Methods ICMD is a consortium of 27 studies with pooled individual-level epidemiological and MD data from 11,755 women without breast cancer aged 35–85 years from 22 countries, capturing 40 country-& ethnicity-specific population groups. MD was measured using the area-based tool Cumulus. Meta-analyses across population groups and pooled analyses were used to examine linear regression associations of square-root (√) transformed MD measures (percent MD (PMD), dense area (DA), and non-dense area (NDA)) with parity, age at first birth, ever/never breastfed and lifetime breastfeeding duration. Models were adjusted for age at mammogram, age at menarche, BMI, menopausal status, use of hormone replacement therapy, calibration method, mammogram view and reader, and parity and age at first birth when not the association of interest. Results Among 10,988 women included in these analyses, 90.1% (n = 9,895) were parous, of whom 13% (n = 1,286) had ≥ five births. The mean age at first birth was 24.3 years (Standard deviation = 5.1). Increasing parity (per birth) was inversely associated with √PMD (β: − 0.05, 95% confidence interval (CI): − 0.07, − 0.03) and √DA (β: − 0.08, 95% CI: − 0.12, − 0.05) with this trend evident until at least nine births. Women who were older at first birth (per five-year increase) had higher √PMD (β:0.06, 95% CI:0.03, 0.10) and √DA (β:0.06, 95% CI:0.02, 0.10), and lower √NDA (β: − 0.06, 95% CI: − 0.11, − 0.01). In stratified analyses, this association was only evident in women who were post-menopausal at MD assessment. Among parous women, no associations were found between ever/never breastfed or lifetime breastfeeding duration (per six-month increase) and √MD. Conclusions Associations with higher parity and older age at first birth with √MD were consistent with the direction of their respective associations with breast cancer risk. Further research is needed to understand reproductive factor-related differences in the composition of breast tissue and their associations with breast cancer risk.

OBJECTIVE: To identify outcomes of wound healing after using Plasma rich platelet therapy METHODOLOGY: A prospective cross-sectional study was conducted at ISRA University Hospital, Hyderabad, from July to December 2022, with a sample size of 50 and a non-probability sampling technique. Both genders aged 45 to 75 years, Diabetes mellitus type II, Chronic or Non-healing wounds/ulcers for 3 to 6 months, and Wound size 2cm to 6cm were included. Participants who were not willing to study, Patients on steroid and Anticoagulant therapy and Immunosuppressive drugs, Pregnant females, those with Cardiovascular Disorders, and Associated Lymphoedema were excluded. Data was analyzed by SPSS version 21. RESULTS: Fifty patients were enrolled after matching the inclusion and exclusion criteria. The age range was 40 years to 70 years. Thirty-one were males, and 19 were females. Co-morbid conditions included were diabetes mellitus type II and hypertension. The most common cause of lower limb ulcers was diabetic foot, and the most common site was the dorsum of the foot. 52% of patients had

The issue of grade inflation has been studied in many countries across the globe, yet it remains under-researched in Pakistan. This study aims to understand grade inflation in Pakistani universities by examining the contributing factors and its consequences. The data for this study was collected through in-depth interviews of 20 professors from four (two public and two private sector) universities in the federal capital of Islamabad, Pakistan. The data reveals that the major cause for grade inflation in the selected universities was the competition between public and private universities to recruit students without giving due consideration to merit. Additionally, the culture of hiring untrained candidates as visiting faculty who aspire to be hired in permanent positions was a key contributing factor that led to grade inflation. Other factors include the limitations of the semester system and individualised directed studies. This study recommends the need to monitor and revisit the examination and grading system in Pakistani universities to enhance imparting quality education and to compete at the international level.

Abstract Background This study’s purposes were to evaluate the impact of biological therapies on outcomes in patients with severe asthma (SA) and chronic rhinosinusitis (CRS) and to compare these effects among those with NP (CRSwNP) versus those without NP (CRSsNP) in the “real-world” setting in Saudi Arabian patients. Methods From March to September 2022, a retrospective observational cohort study was undertaken at the severe asthma clinics of the Armed Forces Hospital—Southern Region (AFHSR) and King Khalid University Hospital, Abha, Saudi Arabia, to delineate the effects of dupilumab therapy. Outcomes were assessed, including clinical outcomes, FEV1, and laboratory findings before and one year after dupilumab. Post-therapy effects were compared between CRSwNP and CRSsNP. Results Fifty subjects were enrolled, with a mean age of 46.56. There were 27 (54%) females and 23(46%) males. Significant improvements in clinical parameters (frequency of asthma exacerbations and hospitalizations, the use of OCs, anosmia, SNOTT-22, and the ACT), FEV1, and laboratory ones (serum IgE and eosinophilic count) were observed 6 and 12 months after using dupilumab (p

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10−8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels.

The removal of balloon fragments from the pulmonary artery without damaging the pulmonary and tricuspid valves can be difficult. Four cases during transcatheter pulmonary valve replacement are described in which a novel retrieval system was used to facilitate safe removal. (Level of Difficulty: Advanced.).

BackgroundPharmacist-led programs and clinics have been integrated into primary and specialty care clinics in a variety of ways, for example, to improve diabetes outcomes via patient education and counseling. However, factors important to the implementation of different outpatient pharmacy models have not been well elucidated.ObjectiveTo identify provider- and health system-level drivers of implementation and sustainability of pharmacy-led programs in the outpatient setting.DesignQualitative study of key informants using semi-structured interviews of individuals working in various roles throughout a large health system, including ambulatory clinical pharmacists, pharmacy managers, medical directors and physician leaders, and operations and quality managers.ParticipantsKey informants (n=19) with leadership roles in pharmacy programs and front-line experience providing integrated pharmacy care were selected purposively and with snowball sampling.ApproachWe coded the interviews using a codebook derived from the 2022 Consolidated Framework for Implementation Research (CFIR), which details various internal and external factors important for implementation.Key resultsWe identified the following themes related to implementing ambulatory care pharmacy programs: (1) pharmacy programs varied in their level of embeddedness in the outpatient clinic, (2) establishing pharmacy program required leadership advocacy and coordination among stakeholders, (3) continued operations required integrated workflows and demonstrated value to the health system and clinicians, and (4) established revenue streams or added indirect value and continued improvement of integration sustained programs over time.ConclusionsExternal policies and incentives such as new reimbursement codes and quality measurement programs that rely on pharmacy input play a significant role in shaping the design, implementation, and sustainability of health system outpatient pharmacy programs. Ensuring that quality metrics used in value-based contracts or programs demonstrate pharmacy benefits will be critical to supporting and growing pharmacy programs.

An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbais population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery.