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AbstractMore than one billion people around the globe are suffering from severe to moderate vitamin D deficiency. In Pakistan, 53.5% people suffer from vitamin D deficiency. The purpose of this study is to develop vitamin D fortified yogurt with two varying concentrations of vitamin D3, aiming to observe how these concentrations impact the physicochemical and sensory characteristics of the fortified products. A total of 750 mL of pasteurized milk was divided into three equal batches. For T1 and T2, 50 µL and 66.67 µL of emulsified vitamin D3 were added at 50 °C, respectively. Yogurt samples were prepared in triplicates and underwent storage tests, including proximate analysis, pH, viscosity, and vitamin D3 stability at 4 ± 1 °C. During the first week of storage, the viscosity of yogurt increased but later it started decreasing because of syneresis. T1 (8.1) and T2 (8.2) obtained a better overall sensory score using a 9-point hedonic scale as compared to T1 (7.9) During the 28-day storage period, the vitamin D3 content significantly decreased (P

Introduction: Malignancy-related hypercalcemia is commonly observed in patients with advanced stages of cancer. It is intricately linked with an unfavourable prognosis among oncology patients. This study aimed to evaluate survival outcomes among individuals diagnosed with hypercalcemia associated with malignancy. Materials and Methods: This retrospective analysis of 173 cancer patients with hypercalcemia who sought treatment at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, between July 2019 and June 2020. This cohort of patients underwent a longitudinal follow-up for 2.5 years. To assess survival outcomes, the Kaplan-Meier tool was used to construct survival curves and estimate the survival probability over time. The significance of potential survival factors was evaluated using the log-rank test. Results: All patients exhibited elevated levels of calcium. At admission, the cohort demonstrated varying degrees of hypercalcemia severity attributable to malignancy: mild hypercalcemia was observed in approximately 61.3% of patients, moderate hypercalcemia in 23.7%, and severe hypercalcemia in 15% of cases. Among the total sample, most patients were female (54.9%), with a median age of 54. The primary tumour site most frequently observed was in cases of breast cancer (35.3%), wherein the prevalent histological subtype was lobular/ductal invasive carcinoma (34.1%). Most of the patients (93.6%) had an Eastern Cooperative Oncology Group (ECOG) performance status (ECOG) > 1. Additionally, the median overall survival for patients diagnosed with hypercalcemia was 51 days. Notably, there was a significant association between survival factors, including the primary site of malignancy (P=0.001), bone metastasis (P=0.04), severity and symptoms of hypercalcemia (P=0.001), altered mental state (P=0.001), albumin levels (P=0.001), and ECOG (P=0.001). Conclusion: Malignancy-related hypercalcemia in patients with cancer is a significant predictor of an unfavourable prognosis. The aforementioned survival factors may have the potential to influence patient survival outcomes. Further studies on larger cohorts are warranted.

We are presenting a rare case of sino-nasal teratocarcinosarcoma. A 43-year-old male patient presented with repeated episodes of epistaxis and headache for 3 months. On examination, the ENT consultant noticed a mass in the right nasal cavity for which biopsy was performed and CT scan advised. Sinonasal teratocarcinosarcoma was diagnosed on biopsy and immunohistochemistry. CT Face followed by PET/CT showed a FDG-avid soft tissue density mass in the right nasal cavity extending locally with a standardised uptake value of 7.4 with no distant metastasis. Surgical debulking is the first line of treatment as per the literature; however, in this case, the multidisciplinary tumour board initiated induction chemotherapy of 02 cycles of CISP/DOC owing to marked local extension of the tumour. Subsequent CT scan of the face shows a good treatment response with shrinkage of the sinonasal mass. After successful chemotherapy, the patient is now scheduled for radiotherapy and subsequently follow-up to assess the response.

This editorial concerns the Special Issue of Axioms entitled “Advances in Difference Equations” [...]

The purpose of this work is to develop a semi-analytical numerical scheme for solving fractional order non-linear partial differential equations (FOPDEs), particularly inhomogeneous FOPDEs, expressed in terms of the Caputo-Fabrizio fractional order derivative operator. To achieve this goal, we examine several fractional versions of nonlinear model equations from the literature. We then present the proposed scheme, discussing its stability and convergence properties. We show that the proposed scheme is efficient and accurate, and we provide numerical examples to illustrate its performance. Our findings demonstrate that the scheme has significant potential for solving a wide range of complex FOPDEs. Overall, this work contributes to the advancement of numerical techniques for solving fractional order non-linear partial differential equations and lays a foundation for further research in this area.

The heat and mass transfer phenomenon in the presence of a moving magnetic field has a wide range of applications, spanning from industrial processes to environmental engineering and energy conversion technologies. Understanding these interactions enables the optimization of various processes and the development of innovative technologies. This manuscript is about a non-integer-order heat-mass transfer model for Maxwell fluid over an inclined plate in a porous medium. The MHD flow of non-Newtonian fluid over the plate due to the natural convection of the symmetric temperature field and general motion of the inclined plate is investigated. A magnetic field is applied with a certain angle to the plate, and it can either be fixed in place or move along with the plate as it moves. Our model equations are linear in time, and Laplace transforms form a powerful tool for analyzing and solving linear DEs and systems, while the Stehfest algorithm enables the recovery of original time domain functions from their Laplace transform. Moreover, it offers a powerful framework for handling fractional differential equations and capturing the intricate dynamics of non-Newtonian fluids under the influence of magnetic fields over inclined plates in porous media. So, the Laplace transform method and Stehfest’s numerical inversion algorithm are employed as the analytical approaches in our study for the solution to the model. Several cases for the general motion of the plate and generalized boundary conditions are discussed. A thorough parametric analysis is performed using graphical analysis, and useful conclusions are recorded that help to optimize various processes and the developments of innovative technologies.

Ground deformation associated with natural and anthropogenic activities can be damaging for infrastructure and can cause enormous economic loss, particularly in developing countries which lack measuring instruments. Remote sensing techniques like interferometric synthetic aperture radar (InSAR) can thus play an important role in investigating deformation and mitigating geohazards. Rawalpindi and Islamabad are twin cities in Pakistan with a population of approximately 5.4 million, along with important government and private entities of national and international interest. In this study, we evaluate rapid paced subsidence in this area using a modified small baseline subset technique with Sentinel-1A imagery acquired between 2015 and 2022. Our results show that approximately 50 mm/year subsidence occurs in the older city of Rawalpindi, the most populated zone. We observed that subsidence in the area is controlled by the buried splays of the Main Boundary Thrust, one of the most destructive active faults in the recent past. We suggest that such rapid subsidence is most probably due to aggressive subsurface water extraction. It has been found that, despite provision of alternate water supplies by the district government, a very alarming number of tube wells are being operated in the area to extract ground water. Over 2017–2021, field data showed that near-surface aquifers up to 50–60 m deep are exhausted, and most of the tube wells are currently extracting water from depths of approximately 150–160 m. The dropping water level is proportional to the increasing number of tube wells. Lying downstream of tributaries originating from the Margalla and Murree hills, this area has a good monsoon season, and its topography supports recharge of the aquifers. However, rapid subsidence indicates a deficit between water extraction and recharge, partly due to the limitations inherent in shale and the low porosity near the surface lithology exposed in the area. Other factors amplifying the impacts are fast urbanization, uncontrolled population growth, and non-cultivation of precipitation in the area.

With rising worldwide concerns about climate change and environmental sustainability, it is crucial to understand the link between energy usage, technological innovation, and CO2 emissions. Therefore, this study examines the complex link between energy consumption, technological innovation, and CO2 emissions in the BRICS economies over the time period from 1990 to 2022. To understand the BRICS dynamics and environmental sustainability, the Panel Mean Group Autoregressive Distributed Lag (PMG-ARDL) model is used. The results indicate a significant positive relationship between energy consumption and CO2 emissions, implying that BRICS economies experience a rise in CO2 output due to increased energy usage. Simultaneously, the research reveals an inverse connection between technological innovation and CO2 emissions. In this regard, technological advances are crucial for sustainable growth and environmental protection in the region. This research provides useful insights into the intricate interaction of factors that influence CO2 emissions in developing nations.

Background Targeted mental health interventions are increasingly described as individualised, personalised or person-centred approaches. However, the definitions for these terms vary significantly. Their interchangeable use prevents operationalisations and measures.Objective This scoping review provides a synthesis of key concepts, definitions and the language used in the context of these terms in an effort to delineate their use for future research.Study selection and analysis Our search on PubMed, EBSCO and Cochrane provided 2835 relevant titles. A total of 176 titles were found eligible for extracting data. A thematic analysis was conducted to synthesise the underlying aspects of individualisation, personalisation and person-centredness. Network visualisations of co-occurring words in 2625 abstracts were performed using VOSViewer.Findings Overall, 106 out of 176 (60.2%) articles provided concepts for individualisation, personalisation and person-centredness. Studies using person-centredness provided a conceptualisation more often than the others. A thematic analysis revealed medical, psychological, sociocultural, biological, behavioural, economic and environmental dimensions of the concepts. Practical frameworks were mostly found related to person-centredness, while theoretical frameworks emerged in studies on personalisation. Word co-occurrences showed common psychiatric words in all three network visualisations, but differences in further contexts.Conclusions and clinical implications The use of individualisation, personalisation and person-centredness in mental healthcare is multifaceted. While individualisation was the most generic term, personalisation was often used in biomedical or technological studies. Person-centredness emerged as the most well-defined concept, with many frameworks often related to dementia care. We recommend that the use of these terms follows a clear definition within the context of their respective disorders, treatments or medical settings.Scoping review registration Open Science Framework: osf.io/uatsc.

BackgroundThe COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. ObjectiveThis study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. MethodsA cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. ResultsT1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. ConclusionsThere is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises.

As an exponentially growing sensitivity to modest perturbations, chaos is pervasive in nature. Chaos is expected to provide a variety of functional purposes in both technological and biological systems. This work applies the time-fractional Caputo and Caputo-Fabrizio fractional derivatives to the Chua type nonlinear chaotic systems. A numerical analysis of the mathematical models is used to compare the chaotic behavior of systems with differential operators of integer order versus systems with fractional differential operators. Even though the chaotic behavior of the classical Chua's circuit has been extensively investigated, our generalization can highlight new aspects of system behavior and the effects of memory on the evolution of the chaotic generalized circuit.

Abstract Background The Chinese healthcare system is affected by frequent disputes between physicians and patients. Although recent reforms have contributed towards improving the patient-physician relationship, distrust in physicians is still high. Communication skills (CS) training of physicians holds the key to improving patient confidence and diffusing stressful situations. This survey reports on the status of CS training in medical education in China, and the experiences and attitudes of physicians towards CS training. Methods A cross-sectional survey was conducted at medical institutions across China. A questionnaire developed for this study included the status of CS training, current aspects of patient-physician relationships, perceived own CS and patient-centeredness with Likert-scaled items from 1 (most negative) to 6 (most positive). Physicians’ attitude towards CS training was measured with the Communication Skills Attitude Scale (CSAS) and its subscales PAS (Positive Attitude Scale) and NAS (Negative Attitude Scale). Data were analyzed descriptively and for group differences between the hospital level and operating vs. non-operating physicians. Binary logistic regression analysis was done to find associations explaining the occurrence of verbal and physical attacks and the role of CS attitudes. Results Out of 1080 questionnaires, 772 physicians met inclusion criteria. A total of 466/772 participants (60.4%) had received at least one CS training during their career. The participants rated the current situation related to patient-physician relationship in China as highly stressful (mean = 4.52, SD = 1.26, 95% CI: 4.43–4.60), experiencing verbal attacks in the past three years once a year in 372/772 cases (48.2%) and physical attacks 111/772 times (14.4%). The mean PAS was 62.96 (SD = 7.63, 95% CI: 62.41–63.47). Being female was associated with increased risk of verbal attacks (OR = 1.51, 95% CI: 1.01–2.25) while working in a tertiary hospital and showing high levels of PAS decreased this risk (OR = 0.62, 95% CI: 0.43–0.89, and OR = 0.95, 95% CI: 0.93–0.98). Having received a previous CS training decreased the odds of physical attacks (OR = 0.54, 95% CI: 0.35–0.83). Conclusions A majority of Chinese physicians showed a high positive attitude towards CS training, were trained in CS and would value further training. Our results highlight that CS training is likely to promote patient-centered communication and reduce attacks against physicians. Both of these effects are to improve the patient-physician-relationship in the long run. More CS training should be offered to Chinese physicians, especially at secondary- and primary-care hospitals, where such practices remain infrequent.

Abstract Introduction Cancer screening programs are routinely available in high‐income countries, but participation rates are low, especially among men. This narrative review aims to identify male‐specific access barriers to cancer‐related healthcare in high‐income countries that offer statutory insurance/subsidized health care. Methods We searched PubMed, Science Direct, and Web of Science for peer‐reviewed journal articles published within the past 10 years on cancer healthcare access, help‐seeking behavior, and men. Step‐wise screening of title, abstract, and full text resulted in 23 studies that fit the selection criteria for findings in high‐income countries. The results were analyzed descriptively using qualitative thematic synthesis. Results In the reviewed studies, barriers for men in accessing cancer‐related healthcare offers could be broadly categorized under sociocultural norms, personal behaviors, and structural problems. The most common barriers were related to sociocultural influences and included notions of masculinity, distrust in the medical system, and personnel/social commitments. Major personal barriers included fear of getting cancer or screening methods, lack of awareness about cancer, and problems in communication with healthcare professionals. Accessibility and lack of insurance were reported as common structural barriers. Conclusions The reluctance of men in approaching medical help was rooted in sociocultural norms of traditional masculinity with direct and indirect consequences such as fear, lack of awareness, distrust of medical personnel, and problems in communicating with healthcare professionals. Gender‐specific, male‐oriented information via digital, anonymous interventions may be helpful for increasing participation of men in cancer care.

The Kalabagh strike–slip fault, which is characterized by right-lateral movement, is part of the northwestern Himalayan foreland fold and thrust belt in Pakistan. This structure marks the western and eastern terminations of the Salt Range and Surghar Ranges, respectively. No significant (>M6) earthquakes have been reported along the Kalabagh Fault in recent decades. Here, we take advantage of space-borne Sentinel-1A SAR interferometry to gain insight into the mechanics of faulting, aseismic creeping, and stress loading of the seismic cycle on the Kalabagh Fault spanning over approximately 7 years. In this study, we also removed the tropospheric effects using the Generic Atmospheric Correction Online Service data from the rate map. We further resolved the LOS deformation into both horizontal and vertical deformations. Our Bayesian inversion indicates that the fault experiences significant horizontal and vertical displacements. The fault’s southern and northern segments exhibit a creeping rate of approximately ∼4.2 ± 1.3 to 4.8 ± 1.6 mm/year, respectively, while the central section does not display any horizontal creeping. We found that the creeping is confined between 0 and ∼2.7 ± 1.1 km depth at the northern section and 0 and ∼3.9 ± 1.1 km on the southern section of the faults. Nevertheless, we found that the vertical creeping of ∼10 mm/year is confined between 0.5 and 6 km depth in the central segment of the fault. Moreover, our model does not resolve the interseismic slip at depth on the Kalabagh Fault. Our results affirm that Kalabagh Fault is creeping, and the internal deformation due to the presence of a thick salt layer over the decollement facilitates the creeping on this fault. In addition, Coulomb stress modeling depicts that the creeping on the Kalabagh Fault increases the Coulomb stress changes in the northern section of the KBF.