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ObjectiveThe study's primary aim was to compare the utilization rates of services by minors with depression/anxiety in a county mental health clinic before (from December 1, 2019, to March 15, 2020) and during the COVID-19 pandemic (from March 16 to June 30, 2020). The secondary aim was to study demographics and psychiatric symptomatology.MethodsService utilization rates were estimated. Univariate and multivariate logistic regression was used to identify significant predictors of worsening psychiatric symptoms, anxiety, and change in the frequency of therapy between the pre-COVID-19 period and the COVID-19 period.ResultsService utilization rates increased during the pandemic period. During the pandemic, the presence of mood symptoms, suicidal ideation, and relationship conflicts predicted worsening psychiatric symptoms. In addition, the presence of preexisting sleep problems and physical health issues that continued during COVID-19 exhibited correlations with worsening psychiatric symptoms during COVID-19. COVID-related stressors and physical health issues were associated with anxiety; suicidal ideation predicted a change in the frequency of therapy.Conclusions Prospective studies to recognize risk factors for worsening mental health in minors with psychiatric illness during a crisis are warranted to identify and allocate services to the high-risk groups.

Technostress is defined as any unhealthy condition caused by dealing with modern technology in various harmful ways; examples of technostress include addiction and stress. Even though technostress has been extensively studied in the literature, little attention has been paid to investigating technostress among academics who work in exceptional circumstances, such as crises, and who might be experiencing different psychological states due to those circumstances. To fill the gap, this study aims to explore the factors influencing technostress among school teachers. The study examined technostress's level and factor graphics structure among 692 academics from different Arab countries during COVID-19. The technostress factors and their stories were explored and measured using sequential mixed methods and confirmatory and exploratory factor analysis. The study discusses various factors' direct and indirect effects on mobile technology integration in education and the theoretical and practical implications of managing technostress in online classes. A model of techno-stressors among Arab academics was found to include: schedule overload, complexity, uncertainty, uselessness, invasion, and compulsion. The direct effect of various factors on mobile technology integration in education is mainly positive, while indirect effects are more varied. The theoretical and practical implications of managing technostress in online classes include: considering the psychological and physiological impact of technostress on students' learning performance, decreasing overall satisfaction with the learning experience, and improving the overall quality of online courses. As a result of this study's findings, a new perspective is provided on how academics in particular circumstances (in this study, the occupation of Palestine) may behave and feel toward technology in teaching.

Subclavian artery thrombosis is a relatively rare and unheard complication postmodified radical mastectomy (MRM) surgery and it is still not reported in the literature. We report a case of a 55-year-old female who underwent MRM for Stage II left ductal carcinoma of breast with level 2 lymph node involvement in a private hospital. She developed ischemic pain in the left upper limb on postoperative day 3. She came to JNMCH and was referred to us and initial imaging with computed tomography angiography revealed occlusion from the origin of the subclavian to axillary artery. We discuss the management of the aforementioned condition in our setup and would also discuss the steps needed to avoid the same in the future.

Background: There are missed opportunities to discuss goals and preferences for care with seriously ill patients in the acute care setting. It is unknown which factors most influence clinician decision-making about communication at the point of care. Objective: This study utilized a cognitive-interviewing technique to better understand what leads clinicians to decide to have a goals of care (GOC) discussion in the acute care setting. Methods: A convenience sample of 15 oncologists, intensivists and hospitalists were recruited from a single academic medical center in a large urban area. Participants completed a cognitive interview describing their thought process when deciding whether to engage in GOC discussions in clinical vignettes. Results: 6 interconnected factors emerged as important in determining how likely the physician was to consider engaging in GOC at that time; (1) the participants' mental model of GOC, (2) timing of GOC related to stability, acuity and reversibility of the patient's condition, (3) clinical factors such as uncertainty, prognosis and recency of diagnosis, (4) patient factors including age and emotional state, (5) participants' role on the care team, and (6) clinician factors such as emotion and communication skill level. Conclusion: Participants were hesitant to commit to the present moment as the right time for GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of intra-articular PRP injections in patients with knee osteoarthritis. Study Design: Cross Sectional. Setting: Orthopedic Department of Mardan Medical Complex. Period: 13th August to 14th December 2023. Methods: Involving 50 diagnosed osteoarthritis patients at demographic data, grades of osteoarthritis, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded pre-treatment. Patients received PRP injections at three intervals, and post-treatment WOMAC scores were assessed. Statistical analysis included mean, standard deviations, and a paired t-test. Results: The study comprised 66% female patients, with a mean age of 50.08±5.82 and mean BMI of 27.16±3.53. Regarding grades of osteoarthritis, grade 1, grade 2 and grade 3 comprised of n=14(28%), 19(38%), 17(34%) respectively PRP treatment significantly reduced WOMAC scores from a pre-treatment mean of 56.62±5.70 to 27.54±4.79 (p < 0.001). Conclusion: The significant reduction in WOMAC scores post-treatment suggests that intra-articular PRP injections may serve as a valuable intervention in the short term management of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstract Background This study was conducted to investigate the optimum dietary level of tryptophan (Trp) supplementation at which broiler chickens have better growth with efficient immune system and anti‐oxidant status. Method One hundred and twenty (n = 120) 1‐day‐old broiler chicks were fed a common commercial diet from days 1 to 7. On day 7, the chicks were randomly divided in three treatment groups, that is, Trp 0.2 [national research council (NRC) recommended level of tryptophan], Trp 0.3 (tryptophan supplemented at 0.3%) and Trp 0.5 (tryptophan supplemented at 0.5%). All the experimental diets were iso‐caloric (ME; 3,000 kcal/kg) and iso‐proteic (CP; 18.5%). Weekly data on feed intake and body weight gain (BWG) were recorded to calculate feed conversion ratio (FCR). On day 19, avian tuberculin was injected to note the cellular immunity. On day 21, two birds per replicate were killed to determine carcass and visceral organ weights. Blood serum samples were collected for analysis of humoral immune response against sheep red blood cells, total oxidant and anti‐oxidants by spectrophotometric method. Results Feed intake, carcass and visceral organ weights remained unaffected by dietary treatments while BWG and FCR tended to improve (p

OBJECTIVES: To compare the outcome of laparoscopic total extra peritoneal (TEP) repair versus Lichtenstein repair (LR) of inguinal hernia in terms of post-operative pain, hematoma, seroma, wound infection and early recurrence. METHODOLOGY: This randomized control trial was conducted at Surgical Unit III, General Hospital Lahore, Pakistan during the period June 2017 to May 2018. Male patients aged up to 50 years diagnosed with unilateral, reducible primary inguinal hernia were randomized into two groups, Group A (TEP) and Group B (LR), with 38 patients each. Data was collected prospectively on structured proforma. Patients were regularly followed up for one year for early postoperative complications. Statistical analysis was done using SPSS version 26. RESULTS: Out of 76 patients, mean age for TEP was 36.72±4.50 years and LR was 34.42±6.8 years. No significant difference was found in both the groups in terms of short-term postoperative complications. LR group had comparatively high rate of postoperative complications; hematoma formation (n=3/38; 7.9%), wound infection (n=3/38; 7.9%) and seroma formation (n=1/38; 2.6%). Postoperative pain with Visual Analogue Score in TEP group on the 1st day, 3rd day, 7th day and 1 month follow up was less as compared to LR group. CONCLUSION: The present study concludes that TEP is better than LR in inguinal hernia in terms of less postoperative pain after 1 month. However, no statistical difference was found in seroma and hematoma formation and wound infection.

Cellular solids' acoustic properties, such as dispersion, direction dependence, and phase velocities, are inherently coupled to the dominant deformation modes in their ligaments. Understanding and exploiting this coupling can improve the design process of applications utilizing cellular solids' acoustic properties. This work aims to provide insights into this coupling using finite element simulations. In particular, this work investigates the effect of the two main deformation mechanisms observed in cellular materials, i.e. bending and stretching, on the dispersive and direction dependent characteristics of 2D elastic waves traversing them. Two related honeycomb-based lattices are used in this work, namely a bending dominated lattice and a stretching dominated lattice. Results show that asymmetric waves in the bending dominated lattice are more direction dependent and less dispersive than in the stretching dominated lattice, whereas symmetric waves are generally independent of direction and dispersive in both bending and stretching dominated lattices. In addition, results show that phase velocities of symmetric and asymmetric waves scale linearly with relative density in the bending dominated lattice and nonlinearly with relative density in the stretching dominated lattice. Moreover, maximum phase velocities in the stretching dominated lattice are observed to be higher than in the bending dominated lattice. [ABSTRACT FROM AUTHOR]

Empirically based lumped hydrologic models have an extensive track record of use for various watershed managements and flood related studies. This study focuses on the impacts of land use land cover change for a 10 year period (2000–2010) on the stream discharge in a sub-watershed of Indus River using lumped model HEC-HMS. The input variables for model building in HEC-HMS were calculated based on the DEM, LULC, soil and precipitation data which was collected and pre-processed in HEC-GeoHMS. The model was calibrated for the year 2000 and validation was done for 2010. The statistics shows correlation coefficient = 0.96, relative Bias = −9% and Nash-Sutcliffe coefficient of efficiency (NSCE) = 0.87. The validation statistics are Correlation Coefficient = 0.95, Bias = −14% and NSCE = 0.91. The model results shows that LULC change analysis using Landsat images in 10 years the overall concussion of change on discharge has been negligible in the study area. Due to decrease in forest the percent of bare soil and built up area increases. This conclusion was further supported by the LULC change analysis conducted on a local scale metropolitan district of Mansehra (16 km2). Soil and built up area in this sub-watershed increased from 69%, 8.2% in 2000 to 78%, 13.76% in 2010 respectively, whereas the corresponding river discharge increased by 33.61% from year 2000–2010, proving strong positive correlation on a local scale between the LULC and the river discharge. Keywords: HEC-HMS, Indus above Tarbela, LULC change, LandSat, TRMM

This article, titled "Let's Dive in Ultrasound-Guided Renal Biopsy Complications in the Last Decade: A Single-Institute Study," aims to assess the complications associated with ultrasound-guided renal biopsies at a specific institution over the past 10 years. The study found that percutaneous renal biopsy, while important for diagnosing renal pathologies, can lead to various complications such as hematuria, drop in hemoglobin, pain, infection, and hematoma formation. However, the study also noted that ultrasound-guided biopsy has fewer complications and better adequacy. The researchers recommend close monitoring of patients post-procedure for 24 hours to reduce morbidity and mortality rates. [Extracted from the article]

Background: The global burden of patients affected by chronic liver disease (CLD) has shown a steady rise over the last few decades and is now considered the 11th most frequent cause of death globally. In addition, as the world population is facing increased obesity rates coupled with alcohol consumption, these rates are predicted to continue to rise. The Objective was to assess the appearance of Lipiodol retention upon different MRI sequences with a special focus on non-contrast sequences. Lipiodol Transarterial chemoembolization (TACE) has become the standard treatment for unresectable hepatocellular carcinoma (HCC) without vascular invasion. However, data regarding Lipiodol TACE imaging via MRI is limited and results are not familiar to radiologists for regular assessment of treatment response. Methods: After IRB and EC approval, we included all those patients who underwent TACE treatment with Lipiodol and chemotherapeutic agent; having both 4-6-week post-treatment CT and MRI imaging. This criterion was fulfilled by a total of 25 patients. Only lipiodol-containing areas within the lesion were noted for signal intensities on all MRI sequences and labelled as hyperintense, isointense, hypointense and mixed intensity. Data was entered and analyzed by SPSS v27. Frequencies and percentages were calculated for qualitative data. Results: The most sensitive sequence in detecting Lipiodol retention was Fat suppressed T1 imaging sequence, with low signal intensity seen on T1 weighted fat-suppressed sequences in up to 76% of lesions. While on non-fat suppressed T1 weighted images, 60% of Lipiodol retention areas appeared hyperintense. 52% of lesions showed a hypointense appearance on the T2 weighted sequence. A much more variable appearance was seen in Diffusion-weighted imaging sequences demanding cautious interpretation. MR patterns were clearer in patients having more than 50% lipiodol retention on CT and lesion size more than 2 cm. Conclusion: While MRI is deemed as a reliable and most useful imaging modality for assessing HCC's following lipiodol TACE it requires cautious interpretation with knowledge of variable signal appearance seen on different imaging sequences. [ABSTRACT FROM AUTHOR]

In this study, ALOS-2 PALSAR L-band dual-pol (HH and HV) synthetic aperture radar (SAR) images were used for above ground biomass (AGB) estimation of Shisham (Dalbergia sissoo) tree species in the managed forest of Chichawatni Irrigated Plantation, Sahiwal District, Punjab, Pakistan. A total of 15 plots were surveyed during the field campaign and locally developed tree species-specific allometric equation was used for AGB calculation. The SAR images were pre-processed and calibrated to sigma nought (dB) for statistical AGB modeling. Nonlinear regression models between field-based AGB (ton/ha) and SAR backscatter sigma nought (dB) values give R2 (0.47 and 0.55) and RMSE (1.18 and 1.87) values for HH and HV-pol data, respectively. AGB maps generated through these regression models from both HH and HV-pol data show similar AGB values and spatial patterns. Due to a small number of sample plots, the Leave-One-Out Cross-Validation (LOOCV) proxy validation method was used for model validation, between estimated and predicted backscatter sigma nought (dB) values. The validation R2 values are small; however, outliers are identifiable in the validation scatterplots. The AGB maps from this study are useful as a first estimate of AGB values from remote sensing in the study region, especially in the context of the REDD+ program.

Management of renal emergencies has revolutionized over the past years and in that domain intervention radiology has gained an emerging role as the minimally invasive procedures aid at salvaging renal function and minimizing morbidity and mortality. Aim of this study is to highlight emerging importance of newer transcatheter therapies available to intervention radiologists in managing renal emergencies,attending in detail the techniques and clinical outcomes of interventional procedures. METHOD: We compiled few of the procedures performed at Shifa international hospital, Islamabad from January 2017- January 2023. These include: Management of fibromuscular dysplasia. Renal angiomyolipoma embolization. Renal artery giant aneurysm coiling/ embolization. Management of post renal biopsy bleed. Post partial nephrectomy bleed management. Embolization of renal cell carcinoma metastasis to stomach and small bowel. Renal cyst alcohol ablation. CONCLUSION: Knowledge about the disease, procedures of intervention developed for their management and their clinico-therapeutic outcomes can help efficiently treat the patients with renal illnesses. [ABSTRACT FROM AUTHOR]