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Abstract Electrochemical water splitting is a promising approach towards a sustainable and renewable energy source. However, the demand for high anodic potential and sluggish kinetics of oxygen evolution reaction (OER) restrict the efficiency and feasibility of the water-splitting process. In this quest, transition metal oxides and alloys are considered potential candidates owing to their natural occurrence and high redox potential for OER. However, many associated challenges in their use are still there to be addressed. Here, we designed a new class of bismuth-doped iron oxide on exfoliated graphene oxide by optimizing the metal loading on the conductive support to facilitate the flow of charge during catalysis. The catalytic ability of the synthesized Bi-doped nanocomposites was evaluated in activating the OER under extreme alkaline conditions (1 MKOH). On screening different combinations, 20Bi–Fe2O3@GO was identified as the most efficient and sustainable electrocatalyst even under harsh operating conditions, with an onset potential of 1.48 V and a Tafel slope of 65 mV/dec. The current study offers a new class of Bi-doped electrocatalysts, where the precise doping of Bi and the optimized loading of metal was found the key to achieving low onset potential and high current density to initiate OER. Graphical abstract

Highlights A novel optoelectronic synapse compatible with existing chip technology is demonstrated. This device excels in mimicking memory and learning functions using light, making it ideal for future neuromorphic computing in biomedicine. Our design surpasses previous models with its ability to switch between short-term and long-term memory states using light pulses. Experiments on real-world biomedical data (electroencephalogram, electromyography, electrocardiogram) showed significant improvement in classification accuracy. This highlights the device's potential for advanced physiological signal processing and wearable health monitoring systems.

Background A digital decision support system in healthcare is a digital health intervention that assists healthcare professionals in decision-making by providing treatment recommendations and enhancing diagnostic accuracy and quality of care. This will be the first study in Pakistan to assess the system’s usability, acceptability and effectiveness in improving healthcare outcomes while also evaluating the perceived quality of care. This comprehensive assessment will inform policy development in areas such as the scale-up of digital health interventions, data privacy and technology interoperability. Measures of effectiveness will include changes in clinical outcomes through a patient exit feedback survey. This study aims to evaluate the role of digital decision support systems in healthcare decision-making, which may be integrated into Pakistan’s tele-primary healthcare system.Methods The study will employ a multimethod approach. The data collection tools are adapted from the WHO’s digital health intervention monitoring and evaluation framework and include a technology assessment, healthcare provider surveys, patient exit interviews and focus group discussions with healthcare providers. Purposive sampling will be used for qualitative interviews with providers (doctors) and patients. Government stakeholders, private sectors, multilateral, academia and policymakers will be engaged through a consultative meeting. We will also conduct a literature review, as well as a comprehensive analysis of existing studies, documents and data relevant to digital decision support systems and digital health interventions implemented globally, and assess the performance, challenges and opportunities.Ethics and dissemination The study has been approved by the Ethics Review Committee at The Aga Khan University (2023-8514-26533). The dissemination of study findings through scientific publications and seminars will enable programme managers and policymakers to design tools to improve the quality of care provided through telemedicine platforms. This will contribute to efficient decision-making, access and quality of care for primary healthcare in low-income and middle-income countries. This study will also inform policy regarding the scale-up of decision support systems in primary care settings, data privacy and technology interoperability.

Abstract Background Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. Methods A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants’ parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. Results In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. Conclusion This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust.

Abstract Background While the COVID-19 pandemic has exposed the vulnerabilities of immunization delivery systems globally, the devastating impact of the pandemic on immunization delivery is most pronounced in low and middle-income countries like Pakistan. We conducted a qualitative study to capture the views and experiences of parents and healthcare workers (HWs) and assess the impact of the COVID-19 pandemic on childhood routine immunization (CRI) and COVID-19 vaccination in Pakistan. Methods We used a qualitative research design with a purposive sampling approach. Semi-structured interviews (via telephone) and focus group discussions (via Zoom) were conducted with parents/child caregivers and HWs, respectively. All qualitative interviews were conducted between February and July 2021 from three sites (two urban and one rural) in Sindh, Pakistan. Interviews were audio-recorded, transcribed, and coded for a team-based thematic analysis. Results Overall, most parents and HWs indicated a strong trust in the benefits of CRI; nonetheless, a substantial disruption in the delivery and uptake of these services was also reported. The barriers towards CRI included closed vaccination centers, drastic reduction in outreach programs, lack of information for parents/child caregivers on vaccine availability, fear in the community regarding vaccine safety, limited vaccine supply, and a lack of healthcare staff. For COVID-19 vaccines, challenges cited included skepticism about the reality of the pandemic and confusion over COVID-19 vaccines due to conflicting (or mis-or-dis) information. Both participant groups showed a willingness to integrate COVID-19 vaccination into Pakistan’s Expanded Program for Immunization if required in the future. Conclusion During the COVID-19 pandemic, disruptions of regular immunization delivery in Pakistan were not due to parental unwillingness to vaccinate, but rather to social and logistical challenges caused by a rapidly changing context and difficulties in providing vaccination services safely. Barriers to vaccine access and concerns about COVID-19 exposure during clinic visits also contributed to uncertainty regarding immunization services early in the pandemic. For catchup campaigns and future pandemics, more than focusing interventions on persuading people, strategic approaches to building resilience through system-based interventions, such as investing in surge capacity in the immunization workforce to bounce back quickly after the first shock are required.

Among the most common and serious tomato plant pests, leafminer flies (Liriomyza sativae) are considered one of the major tomato-plant-damaging pests worldwide. Detecting the infestation and quantifying the severity of these pests are essential for reducing their outbreaks through effective management and ensuring successful tomato production. Traditionally, detection and quantification are performed manually in the field. This is time-consuming and leads to inaccurate plant protection management practices owing to the subjectivity of the evaluation process. Therefore, the objective of this study was to develop a machine learning model for the detection and automatic estimation of the severity of tomato leaf symptoms of leafminer fly attacks. The dataset used in the present study comprised images of pest symptoms on tomato leaves acquired under field conditions. Manual annotation was performed to classify the acquired images into three groups: background, tomato leaf, and leaf symptoms from leafminer flies. Three models and four different backbones were compared for a multiclass semantic segmentation task using accuracy, precision, recall, and intersection over union metrics. A comparison of the segmentation results revealed that the U-Net model with the Inceptionv3 backbone achieved the best results. For estimation of symptom severity, the best model was FPN with the ResNet34 and DenseNet121 backbones, which exhibited lower root mean square error values. The computational models used proved promising mainly because of their capacity to automatically segment small objects in images captured in the field under challenging lighting conditions and with complex backgrounds.

The Internet of Things (IoT) is a transformative technology that is reshaping industries and daily life, leading us towards a connected future that is full of possibilities and innovations. In this paper, we present a robust framework for the application of Internet of Things (IoT) technology in the agricultural sector in Bangladesh. The framework encompasses the integration of IoT, data mining techniques, and cloud monitoring systems to enhance productivity, improve water management, and provide real-time crop forecasting. We conducted rigorous experimentation on the framework. We achieve an accuracy of 87.38% for the proposed model in predicting data harvest. Our findings highlight the effectiveness and transparency of the framework, underscoring the significant potential of the IoT in transforming agriculture and empowering farmers with data-driven decision-making capabilities. The proposed framework might be very impactful in real-life agriculture, especially for monsoon agriculture-based countries like Bangladesh.

Penyakit kardiovaskuler merupakan penyebab kematian nomor satu di dunia. Oleh karena itu, diperlukan alat untuk memonitoring kesehatan jantung berupa Elektrokardiograf (EKG). Penelitian ini bertujuan merancang bangun elektrokardiograf berbasis Internet of Things (IoT). Elektrokardiograf dibentuk dari rangkaian penguat amplifier IC AD620, band pass filter, notch filter, dan penguat non inverting. Modul EKG dihubungkan dengan perangkat ESP 8266 untuk mentransmisikannya melalui jaringan internet. Pengujian dilakukan dengan membandingkannya terhadap EKG terkalibrasi. Data yang dibandingkan adalah beat per minute (BPM) jantung dan grafik keluaran EKG. Pengujian BPM dilakukan terhadap tiga objek. Objek pertama menghasilkan BPM 62,57 dan error 1,47%. Objek kedua menghasilkan BPM sebesar 68,96 dan error 4,49%. Objek ketiga menghasilkan BPM sebesar 79,42 dan error 0,53%. Rata-rata error dari ketiga objek adalah 2,16 % atau lebih kecil dari ambang batas sebesar 5%. Data EKG ditampilkan dalam bentuk grafik dan nilai BPM dalam bentuk paket data selama enam detik. Berdasarkan hasil pengujian, EKG berbasis IoT memiliki nilai error dibawah ambang batas.

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value < 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 μg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 μg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

Currently, optical imaging techniques are extensively employed to automatically sort agricultural products based on various quality parameters such as size, shape, color, ripeness, sugar content, and acidity. This methodological review article examined different machine vision techniques, with a specific focus on exploring the potential of fluorescence imaging for non-destructive assessment of agricultural product quality attributes. The article discussed the concepts and methodology of fluorescence, providing a comprehensive understanding of fluorescence spectroscopy and offering a logical approach to determine the optimal wavelength for constructing an optimized fluorescence imaging system. Furthermore, the article showcased the application of fluorescence imaging in detecting peel defects in a diverse range of citrus as an example of this imaging modality. Additionally, the article outlined potential areas for future investigation into fluorescence imaging applications for the quality assessment of agricultural products.

The relationship between visual attention and stress is a long-standing question in cognitive science. There are few studies which indicate improvement in visual attention under stress while few other studies suggest that stress affect visual attention negatively. Even though the mental stress is a critical issue in the modern age, only a few studies investigate the impact of mental stress on visual attention. Several studies on stress suggest that stress response could differ based on gender difference. However, none of the investigations compared the male vs female visual attention under mental stress. Additionally, although there are two broad class of visual attention, namely focused and selective attention, most of the studies investigated either the focused or selective visual attention. Moreover, the stress inducer used in most of the studies could generate pain and discomfort as well. The generated pain and discomfort may affect visual attention differently than just mental stress. This incompleteness and contradiction in previous research motivated us to carry out a full spectrum analysis of visual attention (focused and selective) under mental stress. To the best of our knowledge, we are the first time investigating the gender-wise visual attention (both focused and selective) performance under mental stress. We have used Rapid Serial Visual Processing (RSVP) to study the focused visual attention and Stroop task to study selective attention. We induced mental stress using the Montreal Imaging Stress Test (MIST). We also have used Electrodermal Activity Signal (EDA) and photoplethysmogram (PPG), a more robust method to study emotion, to study the participants' mental stress condition. We observed that focused attention gets better after mental stress induction (Median = 82.94 and std = 13.19) than before the stress (Median = 71.26 and std = 16.72), t (30) = 3.02889 and $\rho =$ .00183. Selective visual attention too improves significantly after stress induction (Median = 1682.54 and std = 286.91) than before stress (Median = 2100.58 and std = 397.40), t(30) = 4.67151 and $\rho $ =

Published in August 2021.

In this paper, we have measured Electrodermal Activity (also known as Galvanic Skin Response or EDA) signal of young adult human subjects, during tasks associated with Visual attention, in order to investigate whether these signals carry any information regarding human visual attentiveness. We find that the phasic component of the EDA signal carries more information about visual attentiveness compared to the tonic component. Specifically, zero crossing rate is a feature that is found to be useful in differentiating between periods of low and high mental activity during visual attention related tasks. This paper proposes two new features namely the number of Gaussian peaks in the histograms of zero crossing rate and the overlapping area between two Gaussians which have been used to predict the visual attentiveness of the subject during tasks associated with visual attentiveness. A total of thirty human subjects have volunteered for the current experiment where they have been asked to complete three tasks (each task twice). These tasks are standard tests for visual attentiveness measurement. The proposed model has been tested on the collected dataset. In 91.3% cases, the result aligned with manual visual attentiveness test results. We have tried to investigate the EDA signal during good, average, and poor stages of visual attentiveness. Furthermore, the method gives better performance compared to the methods carried out using Electroencephalogram signals by other research groups.

Recent developments in electrical power systems are concerned not only with static power flow control but also with their control during dynamic processes. Smart Grids came into being when it was noticed that the traditional electrical power system structure was lacking in reliability, power flow control, and consistency in the monitoring of phasor quantities. The Phasor Measurement Unit (PMU) is one of the main critical factors for Smart Grid (SG) operation. It has the ability to provide real-time synchronized measurement of phasor quantities with the help of a Global Positioning System (GPS). However, when considering the installation costs of a PMU device, it is far too expensive to equip on every busbar in all grid stations. Therefore, this paper proposes a new approach for the Optimum Placement of the PMU problem (OPP problem) to minimize the installed number of PMUs and maximize the measurement redundancy of the network. Exclusion of the unwanted nodes technique is used in the proposed approach, in which only the most desirable buses consisting of generator bus and load bus are selected, without considering Pure Transit Nodes (PTNs) in the optimum PMU placement sets. The focal point of the proposed work considers, most importantly, the case factor of the exclusion technique of PTNs from the optimum PMU locations, as prior approaches concerning almost every algorithm have taken PTNs as their optimal PMU placement sets. Furthermore, other case factors of the proposed approach, namely, PMU channel limits, radial bus, and single PMU outage, are also considered for the OPP problem. The proposed work is tested on standard Institute of Electrical and Electronics Engineering (IEEE)-case studies from MATPOWER on the MATLAB software. To show the success of the proposed work, the outputs are compared with the existing techniques.

Breast milk contains anti-rotavirus IgA antibodies and other innate immune factors that inhibit rotavirus replication in vitro. These factors could diminish the immunogenicity of oral rotavirus vaccines, particularly if breastfeeding occurs close to the time of vaccine administration.Between April 2011 and November 2012, we conducted an open label, randomized trial to compare the immunogenicity of Rotarix (RV1) in infants whose breastfeeding was withheld one hour before through one hour after vaccination with that in infants breastfed at the time of vaccination. The trial was conducted in the peri-urban area of Ibrahim Hyderi in Karachi, Pakistan. Both groups received three doses of RV1 at 6, 10 and 14 weeks of age. Seroconversion (anti-rotavirus IgA antibodies ≥ 20 U/mL in subjects seronegative at 6 weeks of age) following three vaccine doses (6, 10 and 14 weeks) was determined at 18 weeks of age (primary objective) and seroconversion following two doses (6 and 10 weeks) was determined at 14 weeks of age (secondary objective).Four hundred eligible infants were randomly assigned in a 1:1 ratio between the withholding breastfeeding and immediate breastfeeding arms. Overall, 353 (88.3%) infants completed the study according to protocol; 181 in the withholding breastfeeding group and 172 in the immediate breastfeeding group. After three RV1 doses, anti-rotavirus IgA antibody seroconversion was 28.2% (95% CI: 22.1; 35.1) in the withholding arm and 37.8% (95% CI: 30.9; 45.2) in the immediate breastfeeding arm (difference: -9.6% [95% CI: -19.2; 0.2] p = 0.07). After two doses of RV1, seroconversion was 16.6% (95% CI: 11.9; 22.7) in the withholding arm and 29.1% (95% CI: 22.8, 36.3) in the immediate breastfeeding arm (difference: -12.5% [95% CI: -21.2,-3.8] p = 0.005).Withholding breastfeeding around the time of RV1 vaccine administration did not lead to increased anti-rotavirus IgA seroconversion compared with that seen with a breastfeed at the time of vaccination. On the contrary, IgA seroconversion in infants immediately breastfed tended to be higher than in those withheld from a feeding. Our findings suggest that breastfeeding should be continued adlib around the time of rotavirus vaccination and withholding breastfeeding at that time is unlikely to improve the vaccine immunogenicity.ClinicalTrials.gov NCT01199874.

To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine.A cross-sectional study was carried out over a period of two years from 2006 - 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping.6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593).Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.

Background Hydroxychloroquine (HCQ) has proved ineffective in treating patients hospitalised with Coronavirus Disease 2019 (COVID-19), but uncertainty remains over its safety and efficacy in chemoprevention. Previous chemoprevention randomised controlled trials (RCTs) did not individually show benefit of HCQ against COVID-19 and, although meta-analysis did suggest clinical benefit, guidelines recommend against its use. Methods and findings Healthy adult participants from the healthcare setting, and later from the community, were enrolled in 26 centres in 11 countries to a double-blind, placebo-controlled, randomised trial of COVID-19 chemoprevention. HCQ was evaluated in Europe and Africa, and chloroquine (CQ) was evaluated in Asia, (both base equivalent of 155 mg once daily). The primary endpoint was symptomatic COVID-19, confirmed by PCR or seroconversion during the 3-month follow-up period. The secondary and tertiary endpoints were: asymptomatic laboratory-confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection; severity of COVID-19 symptoms; all-cause PCR-confirmed symptomatic acute respiratory illness (including SARS-CoV-2 infection); participant reported number of workdays lost; genetic and baseline biochemical markers associated with symptomatic COVID-19, respiratory illness and disease severity (not reported here); and health economic analyses of HCQ and CQ prophylaxis on costs and quality of life measures (not reported here). The primary and safety analyses were conducted in the intention-to-treat (ITT) population. Recruitment of 40,000 (20,000 HCQ arm, 20,000 CQ arm) participants was planned but was not possible because of protracted delays resulting from controversies over efficacy and adverse events with HCQ use, vaccine rollout in some countries, and other factors. Between 29 April 2020 and 10 March 2022, 4,652 participants (46% females) were enrolled (HCQ/CQ n = 2,320; placebo n = 2,332). The median (IQR) age was 29 (23 to 39) years. SARS-CoV-2 infections (symptomatic and asymptomatic) occurred in 1,071 (23%) participants. For the primary endpoint the incidence of symptomatic COVID-19 was 240/2,320 in the HCQ/CQ versus 284/2,332 in the placebo arms (risk ratio (RR) 0.85 [95% confidence interval, 0.72 to 1.00; p = 0.05]). For the secondary and tertiary outcomes asymptomatic SARS-CoV-2 infections occurred in 11.5% of HCQ/CQ recipients and 12.0% of placebo recipients: RR: 0.96 (95% CI, 0.82 to 1.12; p = 0.6). There were no differences in the severity of symptoms between the groups and no severe illnesses. HCQ/CQ chemoprevention was associated with fewer PCR-confirmed all-cause respiratory infections (predominantly SARS-CoV-2): RR 0.61 (95% CI, 0.42 to 0.88; p = 0.009) and fewer days lost to work because of illness: 104 days per 1,000 participants over 90 days (95% CI, 12 to 199 days; p < 0.001). The prespecified meta-analysis of all published pre-exposure RCTs indicates that HCQ/CQ prophylaxis provided a moderate protective benefit against symptomatic COVID-19: RR 0.80 (95% CI, 0.71 to 0.91). Both drugs were well tolerated with no drug-related serious adverse events (SAEs). Study limitations include the smaller than planned study size, the relatively low number of PCR-confirmed infections, and the lower comparative accuracy of serology endpoints (in particular, the adapted dried blood spot method) compared to the PCR endpoint. The COPCOV trial was registered with ClinicalTrials.gov; number NCT04303507. Interpretation In this large placebo-controlled, double-blind randomised trial, HCQ and CQ were safe and well tolerated in COVID-19 chemoprevention, and there was evidence of moderate protective benefit in a meta-analysis including this trial and similar RCTs. Trial registration ClinicalTrials.gov NCT04303507; ISRCTN Registry ISRCTN10207947., Author(s): William H. K. Schilling 1,2,*, Mavuto Mukaka 1,2, James J. Callery 1,2, Martin J. Llewelyn 3,4, Cintia V. Cruz 1,2, Mehul Dhorda 1,2, Thatsanun Ngernseng 1, Naomi Waithira 1,2, [...]