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Tuberculosis remains a formidable global health challenge, with drug-resistant strains posing significant hurdles in its eradication efforts. Addressing the challenge of drug-resistant and multidrug-resistant tuberculosis requires a multifaceted approach encompassing enhanced diagnostics, novel therapeutics, and patient-centered care models. This study aims to find the treatment outcomes of DR-TB patients registered at tertiary care settings along estimation of impact of associated adverse events. This retrospective study was undertaken at a tertiary care setting of Lahore Punjab Pakistan during the year 2023. Using a predefined scheme of variables data was collected Regression analysis was applied by taking death and treatment failure as adverse outcomes excluding the treatment defaulter patients as their final fate was not known. A total of 1438 drug resistant TB patients comprising of 49.4% males and 50.6 females with mean age of patients at the time of registration as 35.08±15.91 years were included in final analysis. A high number of 17.4% patients were died, 56.2% patients were cured and 10.4% successfully completed their treatment. Rate of loss to follow up was noted to be 11.1% and treatment failure were 4.9% in this study. Regression model showed that patients aged =34 years, patients having previous history of treatment and treatment strategy other than LTR are at greater risk of adverse events. Overall success rate of treatment remained to be 66.6% remained far below of the target laid down by the WHO. A high mortality rate was found to be associated with drug resistant tuberculosis patients. Age =34 years, prior history of TB treatment and treatment strategy are risk factors for death of DR TB patients. [ABSTRACT FROM AUTHOR]

In the current article, a defective interface is characterized by "Dc," representing the smallest diameter of nanosheets crucial for effective conduction transfer from the conductive filler to the medium, and by "ψ" as interfacial conduction. These parameters define the effective aspect ratio and operational volume fraction of graphene in the samples. The resistances of the graphene and polymer layer in contact zones are also considered to determine the contact resistance between adjacent nanosheets. Subsequently, a model for the tunneling conductivity of composites is proposed based on these concepts. This innovative model is validated by experimental data. Additionally, the effects of various factors on the conductivity of the composites and contact resistance are analyzed. Certain parameters such as filler concentration, graphene conductivity, interfacial conduction, and "Dc" do not affect the contact resistance due to the superconductivity of the nanosheets. However, factors like thin and large nanosheets, short tunneling distance (d), high interfacial conduction (ψ), low "Dc," and low tunnel resistivity (ρ) contribute to increased conductivity in nanocomposites. The maximum conductivity of 0.09 is obtained at d = 2 nm and ψ = 900 S/m, but d > 6 nm and ψ < 200 S/m produce an insulated sample. Additionally, the highest conductivity of 0.11 S/m is achieved with Dc = 100 nm and ρ = 100 Ω m, whereas the conductivity approaches 0 at Dc = 500 nm and ρ = 600 Ω m. [ABSTRACT FROM AUTHOR]

Practice fragmentation in surgery may be associated with poor quality of care. We sought to define the association between fragmented practice and outcomes in hepatopancreatic surgery relative to surgeon volume and sex. Medicare beneficiaries who underwent hepatopancreatic surgery between 2016 and 2021 were identified. Multivariable analysis was performed to determine provider sex-based differences in the rate of fragmented practice relative to the achievement of a textbook outcome and health care expenditures after adjusting for procedure-specific case volume. Among 37,416 patients, almost one-half were female (n = 18,333, 49.0%) with the majority treated by male surgeons (n = 33,697, 90.8%). Female surgeons were more likely to have a greater rate of fragmented practice (females: n = 242, 84.9% vs males: n = 1,487, 78.4%, P =.003; odds ratio 2.66, 95% confidence interval 2.33–3.03, P <.001). Patients treated by high rate of fragmented practice surgeons had increased odds of postoperative complications (odds ratio 1.40, 95% confidence interval 1.28–1.54), extended length-of-stay (odds ratio 1.52, 95% confidence interval 1.38–1.68), 90-day-mortality (odds ratio 1.49, 95% confidence interval 1.28–1.72), and lower odds of achieving a textbook outcome (odds ratio 0.76, 95% confidence interval 0.71–0.83). This association persisted independent of surgeon-specific volume (textbook outcome, high vs low rate of fragmented practice: high-volume surgeon, odds ratio 0.53, 95% confidence interval 0.31–0.91, P =.021 vs. low-volume surgeon, odds ratio 0.76, 95% confidence interval 0.69–0.82, P <.001). Among patients treated by male surgeons, a high rate of fragmented practice was associated with reduced odds of achieving a textbook outcome (male surgeons: odds ratio 0.76, 95% confidence interval 0.70–0.82, P <.001; female surgeons: odds ratio 0.81, 95% confidence interval 0.63–1.05, P =.110). Treatment by surgeons with higher fragmented practice was associated with higher expenditures (index expenditure: percentage difference 9.87, 95% confidence interval, 7.42–12.36; P <.05). A high rate of fragmented practice adversely affected postoperative outcomes and healthcare expenditures even among high-volume surgeons with the impact varying based on surgeon sex. [ABSTRACT FROM AUTHOR]

This document presents a study that examined the outcomes of patients with hypertrophic cardiomyopathy (HCM) who underwent a procedure called percutaneous left atrial appendage occlusion (LAAO). HCM is an inherited heart condition that can lead to atrial fibrillation and an increased risk of blood clots. The study analyzed data from a national database and found that patients with HCM had a higher risk of in-hospital mortality and peripheral vascular complications compared to those without HCM. However, there was no difference in other complications or readmissions between the two groups. More research is needed to fully understand the outcomes of LAAO in patients with HCM. [Extracted from the article]

The rise in greenhouse gases, particularly carbon dioxide (CO2) emissions, in the atmosphere is one of the major causes of global warming and climate change. The production of ordinary Portland cement (OPC) emits harmful CO2 gases, which contribute to sporadic heatwaves, rapid melting of glaciers, flash flooding, and food shortages. To address global warming and climate change challenges, this research study explores the use of a cement-less recycled aggregate concrete, a sustainable approach for future constructions. This study uses fly ash, an industrial waste of coal power plants, as a 100% substitute for OPC. Moreover, this research study also uses recycled coarse aggregates (RCAs) as a partial to complete replacement for natural coarse aggregates (NCAs) to preserve natural resources for future generations. In this research investigation, a total of 60 pull-out specimens were prepared to investigate the influence of steel bar diameter (9.5 mm, 12.7 mm, and 19.1 mm), bar embedment length, d b (4 d b and 6 d b ), and percentage replacements of NCA with RCA (25%, 50%, 75%, and 100%) on the bond stress behavior of cement-less RA concrete. The test results exhibited that the bond stress of cement-less RCA concrete decreased by 6% with increasing steel bar diameter. Moreover, the bond stress decreased by 5.5% with increasing bar embedment length. Furthermore, the bond stress decreased by 7.6%, 7%, 8.8%, and 20.4%, respectively, with increasing percentage replacements (25%, 50%, 75%, and 100%) of NCA with RCA. An empirical model was developed correlating the bond strength to the mean compressive strength of cement-less RCA concrete, which matched well with the experimental test results and predictions of the CEB-FIP model for OPC. The CRAC mixes exhibited higher costs but significantly lower embodied CO2 emissions than OPC concrete. [ABSTRACT FROM AUTHOR]

The emergence of new virulent genotypes and the continued genetic drift of Newcastle disease virus (NDV) implies that distinct genotypes of NDV are simultaneously evolving in different geographic locations across the globe, including throughout Africa, where NDV is an important veterinary pathogen. Expanding the genomic diversity of NDV increases the possibility of diagnostic and vaccine failures. In this review, we systematically analyzed the genetic diversity of NDV genotypes in Africa using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Information published between 1999 and 2022 were used to obtain the genetic background of different genotypes of NDV and their geographic distributions in Africa. The following genotypes were reported in Africa: I, II, III, IV, V, VI, VII, VIII, XI, XIII, XIV, XVII, XVIII, XX, and XXI. A new putative genotype has been detected in the Democratic Republic of the Congo. However, of 54 African countries, only 26 countries regularly report information on NDV outbreaks, suggesting that this number may be vastly underestimated. With eight different genotypes, Nigeria is the country with the greatest genotypic diversity of NDV among African countries. Genotype VII is the most prevalent group of NDV in Africa, which was reported in 15 countries. A phylogeographic analysis of NDV sequences revealed transboundary transmission of the virus in Eastern Africa, Western and Central Africa, and in Southern Africa. A regional and continental collaboration is recommended for improved NDV risk management in Africa. [ABSTRACT FROM AUTHOR]

In this study, a poor/imperfect interphase is assumed to express the effective interphase thickness, operative filler concentration, percolation onset and volume share of network in graphene–polymer systems. Additionally, a conventional model is advanced by the mentioned terms for conductivity of samples by the extent of conduction transference between graphene and polymer medium. The model predictions are linked to the experimented data. Likewise, the mentioned terms as well as the conductivity of nanocomposites are expressed at dissimilar ranges of various factors. The novel equations successfully predict the percolation onset and conductivity in the samples containing a poor/imperfect interphase. Thin and long nanosheets with high conduction transportation desirably govern the percolation onset and nanocomposite conductivity, but a bigger tunneling distance causes a lower conductivity. [ABSTRACT FROM AUTHOR]

Social determinants of health can play an important role in patient health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all social determinants of health. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on postoperative surgical outcomes. Medicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of postoperative complications, extended length of stay, 90-day mortality, and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO. Among 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95), and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all P < 0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95% CI 0.94-0.94) (both P < 0.001). Privilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an "optimal" TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care. [ABSTRACT FROM AUTHOR]

Objective: Coronary artery angiography plays a pivotal role in cardiovascular disease diagnosis and treatment, but concerns regarding patient safety due to ionizing radiation necessitate innovative approaches. The article explores the integration of adaptive learning algorithms to optimize low-dose imaging in coronary artery angiography. Method: Articles are selected on the basis of inclusion criteria that mentions studies in between the time span of 2018 to 2022 emphasizing the detailed algorithmic studies of Low dose optimization of coronary arteries angiography and techniques used in it, mentioned total 175 studies were included in initial studies that were reduced to ten final selected studies. Results: The extracted data shows a comprehensive data on various techniques that are used for low dose CAA, advancements in image segmentation, noise reduction, and operator dose reduction highlight the potential of machine learning techniques. Innovative methods such as Model-Based Deep Learning (MBDL) and Self-Attention Generative Adversarial Networks (SAGAN) demonstrate efficient reconstruction capabilities. Application of such algorithms include automate segmentation, lesion detection, and real-time image analysis, optimizing dose parameters based on patient-specific factors, thus prioritizing patient safety and treatment effectiveness while revolutionizing medical imaging. Then there are possible limitations of the Algorithmic approach to reduce radiation dose for patient that include concerns include data heterogeneity, lack of diversity, and challenges in data collection and privacy protection. Addressing these limitations is crucial for enhancing the reliability of AI-driven dose optimization methods. Conclusion: This comprehensive review provides valuable insights into the potential of adaptive learning algorithms for low-dose optimization in coronary artery angiography. It underscores the importance of safer imaging practices without compromising diagnostic efficacy. And the future lies in exploring adaptive learning algorithms, integrating patient-specific data, and real-time adaptability during procedures. Validation studies and collaboration with healthcare institutions are essential for successful integration into clinical practice. [ABSTRACT FROM AUTHOR]

This quantitative study assessed infographics' perceptions, preferences, and effectiveness as a learning tool among Pakistani undergraduate medical students. The research focused on understanding the impact of infographics on knowledge acquisition, comprehension of complex medical concepts, and bridging the gap between theoretical learning and clinical practice. The study utilised a self-evaluated questionnaire developed through a meticulous literature review, self-evaluation, and expert input. The questionnaire covered demographics, perceptions, preferences, effectiveness in knowledge acquisition, impact on understanding complex medical concepts, and linking theoretical learning to clinical practice. The research was conducted at Shahida Islam Medical College, Lodhran, Punjab, Pakistan, and involved undergraduate medical students across various academic years. Data collection occurred between November 10 and November 30, 2023, with 229 participants. Quantitative analysis was conducted using SPSS, involving one-sample t-test, paired samples t-test, independent samples t-test, Pearson correlation, and multiple regression analysis to address specific hypotheses. Findings indicate a strong positive perception and preference for infographics among undergraduate medical students. Infographics were perceived as effective in enhancing knowledge acquisition, positively impacting the understanding of complex medical concepts, and bridging the gap between theoretical learning and clinical practice. Statistical analyses supported these perceptions, demonstrating significant relationships and explaining variance in students' perceptions and knowledge acquisition. This study highlights the substantial role of infographics as valuable tools in medical education, emphasising their positive impact on undergraduate medical students' learning experiences. The findings support the integration of infographics into medical curricula to enhance knowledge acquisition, comprehension, and application in real-life clinical settings. [ABSTRACT FROM AUTHOR]

The construction industry strongly relies on concrete and clay bricks for various applications. The escalating demand for these materials, driven by rapid population growth, has led to resource depletion and increased construction and demolition waste (CDW). Recycling CDW into construction materials, particularly in the form of recycled concrete aggregates (RCAs) and recycled brick aggregates (RBAs), has emerged as a promising solution. This study deals with the structural performance of concrete incorporating RCAs and RBAs. The experimental program encompasses material characterization, concrete mix design, and several tests to assess density, compressive strength, bond behavior, and flexural properties. The results indicate that the replacement of fine natural aggregate (NA) with fine RCAs or RBAs has a negligible impact on density, while the partial replacement of coarse NAs with RAs yields modest reductions in compressive strength. Notably, the bond strength between steel rebar and concrete is influenced by the type and content of RA, with specimens containing RCAs exhibiting a higher bond strength than those with RBAs. Empirical models used to predict bond strength generally align with experimental results, with conservative predictions by some models, such as ACI 318, and overestimation by others, such as models proposed by AS-3600 and CEB-FIB. The flexural tests of beams highlight the variation in stiffness and load-bearing capacity with the proportion of NAs replaced by RAs. While beams with 50% NA replacement demonstrate comparable performance to control beams, those with 100% RA replacement exhibit lower cracking and yielding stiffness. Cracking patterns in beams with RAs differ from control beams, with RA-containing beams showing more cracks and an altered crack distribution. The findings underscore the feasibility of using recycled aggregates in construction, with partial NA replacement offering a balance between sustainable material usage and desired structural properties. [ABSTRACT FROM AUTHOR]

Ostrich farming serves as a source for meat, feathers, skin, eggs, and oil. In general, ostriches are hardy birds that can resist a wide range of climatic harshness and some diseases. However, musculoskeletal and digestive complications, including the gastric impaction, remain the major cause of mortality. The gastrointestinal impaction alone is responsible for 30 – 46% of spontaneous deaths in growing ostriches. The literature review of 21 publications on this subject has shown that 90% of these incidents happen during first six months of life. The aetiology of this problem is mostly stress and behaviour-related gorging of feed and picking on non-feeding materials such as stone, sand, wood pieces, plastic, glass, and metallic objects. Conservative therapy or surgical approaches show good results with almost 70 to 100% recovery depending upon the clinical presentation and timely diagnosis. Overall, this literature review describes impaction in farmed ostriches, along with diagnosis, treatment, and control and preventive measures. This information will help stakeholders understand the gastrointestinal impaction in ratites to better manage this issue, reduce economic losses, and improve welfare of the birds.