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Introduction/Objective: The KidneyIntelX is a multiplex, bioprognostic, immunoassay consisting of 3 plasma biomarkers and clinical variables that uses machine learning to predict a patient’s risk for a progressive decline in kidney function over 5 years. We report the 1-year pre- and post-test clinical impact on care management, eGFR slope, and A1C along with engagement of population health clinical pharmacists and patient coordinators to promote a program of sustainable kidney, metabolic, and cardiac health. Methods: The KidneyIntelX in vitro prognostic test was previously validated for patients with type 2 diabetes and diabetic kidney disease (DKD) to predict kidney function decline within 5 years was introduced into the RWE study (NCT04802395) across the Health System as part of a population health chronic disease management program from [November 2020 to April 2023]. Pre- and post-test patients with a minimum of 12 months of follow-up post KidneyIntelX were assessed across all aspects of the program. Results: A total of 5348 patients with DKD had a KidneyIntelX assay. The median age was 68 years old, 52% were female, 27% self-identified as Black, and 89% had hypertension. The median baseline eGFR was 62 ml/min/1.73 m 2 , urine albumin-creatinine ratio was 54 mg/g, and A1C was 7.3%. The KidneyIntelX risk level was low in 49%, intermediate in 40%, and high in 11% of cases. New prescriptions for SGLT2i, GLP-1 RA, or referral to a specialist were noted in 19%, 33%, and 43% among low-, intermediate-, and high-risk patients, respectively. The median A1C decreased from 8.2% pre-test to 7.5% post-test in the high-risk group ( P

# Background Until recently, Pakistan had achieved significant milestones in polio eradication, and was close to becoming polio-free. The country has an Expanded Program on Immunization (EPI) since 1978 and a Polio Eradication Initiative (PEI) since 1994. PEI and EPI need to carry out synergized activities during the last leg of polio eradication; EPI taking over the responsibility for a polio-free Pakistan. Knowing the understanding and implementation of the synergy between the two programs is important at this critical juncture. # Methods We carried out a national-level exploration, comprised of 30 individual interviews and eight focus groups. The objectives were: (i) to explore the current understanding of the PEI-EPI synergy and its operationalization, especially for the zero-dose children at various levels, and (ii) to explore the context of the two programs, the synergy-related enablers and barriers, and suggestions to enhance synergy in the future. The participants included officials from various tiers along with health workers and vaccinators. # Results Four themes emerged. First, "synergy" has different meanings for different stakeholders; hence variable implementation models. Second, some synergies (e.g., sharing of surveillance data by PEI) are in place while additional (e.g., transferring human resources and enhancing community engagement) can be created. Third, the EPI and the PEI have become two unequal programs because of political factors, visibility, and funding. Fourth, the situation can be helped through clear policy and operational guidelines including roles and responsibilities. # Conclusions All stakeholders understand the importance of synergy. The willingness for the adoption of the interventions instituted by the PEI exists on both sides. The EPI, however, needs to enhance its capacity to absorb these interventions and improve service delivery. Given the context in which one partner has gained more political ownership, funding, and visibility than the other, the realization of the international donors, and the guidance from the Ministry of National Health Services, Regulations, and Coordination are essential for ensuring the polio legacy and achieving and maintaining the status of a polio-free Pakistan.

In 1997, during the 41st session of the WHO Regional Committee for the Eastern Mediterranean, the 21 countries in the Region (1) passed a resolution to eliminate (2) measles. (3) [...]

One major difficulty facing the healthcare industry is the early and precise detection of melanoma. With its capacity to record a broad spectrum of electromagnetic wavelengths, hyperspectral imaging (HSI) is a promising technique for accurate melanoma diagnosis. However, the limited accessibility of HSI technology prevents it from being widely used. This article introduces a novel method for converting readily available red green blue (RGB) images to their hyperspectral counterparts using convolutional neural networks (CNNs). Through this conversion process, spectral information is improved, enabling a more thorough examination to detect melanoma. Principal component analysis (PCA) aids the machine learning algorithm in differentiating between melanoma and healthy moles in the classification model. Accuracy is significantly increased when spot detection and PCA are combined; Naïve Bayes achieves 76% accuracy in this way. These models are used in the developed web-based program SkinScan for real-time melanoma analysis, providing a useful and accessible solution. This work emphasizes how CNN-driven RGB-to-HSI conversion might improve melanoma detection accuracy and accessibility.

This study examines the generation of irreversibility and the behavior of stagnation point hybrid nanofluid flow on a Riga plate. The effects of nonlinear thermally convective and solar radiation are incorporated in the modeled equations. The nanoparticles of (Cu) and (Al2O3) are mixed with Glycol (C3H8O2) to hybridized it. The leading equations have been changed to dimension-free form by using the set of appropriate variables and then have been evaluated by Artificial Neural Network (ANN) approach. It is revealed in this work that, the velocity panels are amplified with expansion in Grashof number and electromagnetic factor while declined with escalation in magnet/electrode factor and nanoparticles concentration. Upsurge, in Eckert number for both the scenarios (Ec < 0) and (Ec > 0), the radiation factor and nanoparticles concentration cause augmentation in thermal characteristics. Radiation factor has positive impacts on Bejan number and generation of Entropy. Moreover, Bejan number is retarded while entropy is augmented with growth in Brinkman number. It is also established in this work that the principle of entropy generation for hybrid nanoparticles supports the efficient delivery of drug in cancer treatment.

The bispidinone and bispidinol derivatives were synthesized using green synthetic methodologies and isolated in high yield without column chromatographic purification. The chemical structures of newly synthesized compounds were elucidated using spectroscopic techniques like IR, 1D & 2D NMR, and HRMS. The pivotal step, the reduction of the carbonyl group to alcohol, was developed by utilizing silica chloride and sodium borohydride. Their unique chemical structures offer versatility for functionalization, allowing for the introduction of specific moieties tailored to desired applications. Furthermore, the investigation into their anti-bacterial, anti-fungal, anti-oxidant, and cytotoxicity properties underscores their therapeutic potential. The compound 5n emerged as the best antimicrobial agent with low cytotoxicity. Subsequently, the green synthesis of bispidinones and bispidinols are valuable precursors to developing novel biomedical tools with diverse applications in imaging and cancer therapy, leveraging the unique properties of bispidine-derived compounds.

The goal of this research is to investigate fractional Maxwell hybrid nanofluids utilizing partial differential equations in terms of Caputo time fractional derivatives. Specifically, the effect of Newtonian heating on the thermal performance of a fractional Maxwell hybrid nanofluid moving over a permeable cone in the presence of thermal radiation and heat generation is considered. The Crank–Nicolson method and L1 algorithmt of Caputo derivative are used to find numerical solutions to the considered nonlinear problem. The effects of significant flow factors on fluid properties are examined and illustrated in various graphs. According to the results, the thermal performance of the fluid raised by 0.4%, 6.1%, and 3.1% on adding 4% volume fraction of [Formula: see text], [Formula: see text], and [Formula: see text], respectively, in the base fluid.

When applied to a rotating disk, Maxwell nanofluids have a wide range of applications in various fields. They provide increased heat transfer efficiency in cooling systems, which is essential for preserving the ideal operating temperatures of spinning gears like disk brakes and turbines. Furthermore, Maxwell nanofluids in microfluidic devices provide improved fluid manipulation and control, improving performance in applications such as microscale pumps and lab-on-a-chip systems. This article has numerically examined the magneto-bio-convection flow of Maxwell, which includes nanofluid, past a disk surface based on these applications. We present the model equations in PDE format, then shift them to ODEs using the appropriate variables. We utilize the bvp4c approach to obtain numerical solutions to the modeled equations. We also take into account the effects of thermal radiation, heat sources, Brownian motion, thermophoresis, chemical reactivity, and activation energy. We find that a higher stretching/shrinking variable has enhanced the radial velocity profile, while simultaneously diminishing the axial and angular velocity field. While the velocity profiles in the axial direction and redial direction have reduced with larger magnitude of Maxwell fluid variable. The thermal distributions have risen due to higher magnetic, Brownian motion, thermophoresis, heat sources, and thermal radiation components. Thermophoresis, magnetic and thermal radiation, heat sources, and Brownian motion all contribute to an increase in heat transfer rates.

Sensitivity and uncertainty analysis serves as a tool for modeling physical phenomenon and evaluating the model validity. It finds applications in simulating the dynamical behavior of aerosols in different contexts. Hygroscopic growth of aerosol particles is one such domain where it can optimize the accuracy of model output greatly. Accurate prediction of hygroscopic growth characteristics depends on the intrinsic parameters and the size-dependent evolution of growth factors. In reactor accident scenarios, growth characteristics of fission/activation product aerosols play a significant role in determining the airborne or deposited fraction. Köhler theory is fundamentally used to predict the growth behavior of aerosols with a detailed physical explanation of critical size and supersaturation characteristics. Alternative approaches including modified Köhler theories and semi-empirical models rely on the linkage of physical and chemical composition-based parameters. The variation of involved parameters and the choice of working range influence the outcome of the theory greatly. This study is focused on sensitivity analysis of the modified Köhler theory given by Brechtel and Kreidenweis and the evaluation of sensitivity and associated uncertainty in the parameters. Monte Carlo approach has been employed, and sensitivity indices were obtained. Identified sensitive parameters were dry particle diameter, solute density, molecular weight, and chemical composition dependent factor (b0). These parameters require careful attention while designing experimental measurements and/or preprocessing model inputs. All sensitive parameters were subjected to uncertainty analysis and the overall output of the aerosol growth code thus obtained has been observed to follow log-normal law with median size at 335.2 nm with a geometric standard deviation of 1.54. This finds applications in the case of studies aiming to predict the growth of aerosols in the reactor component systems during accident conditions. In such conditions, there lies no choice of selection of input parameters and one cannot be sure about their variation range. This provides a conservative estimate for such a random scenario as uncertainty analysis performed in this study covers all the random combinations of input parameters and the overall most probable grown droplet size is estimated.

Wolcott-Rallison syndrome (WRS) is a rare autosomal recessive, neonatal or infancy onset disease that is non-autoimmune insulin-dependent diabetes and is associated with skeletal dysplasia and liver failure. It results in the death of the patient, mainly due to multi-organ failure. Less than 60 cases have been described in the literature so far. Here, we present a very rare case of WRS, which was diagnosed by genetic testing for EIF2AK3 mutations with typical findings of the disease, except skeletal dysplasia, which eventually died due to multi-organ failure. To the best of our knowledge, this is the first case report of WRS in Pakistan.

Histoplasmosis is a rare airborne fungal infection that is soil-based and is mostly documented in Human Immunodeficiency Virus (HIV)-positive patients. It is common in people living near valley regions. Hereby, authors report three cases of Asian women from different regions of Southern Rajasthan who died due to delayed diagnosis of histoplasmosis within a few days of admission. They all had complaints of fatigue and fever for one month. One presented with decreased urine output and pancytopenia, while the others had complaints of prolonged fever with pancytopenia and fatigue. In all three cases, bone marrow examination was done, and they shared the same diagnosis - disseminated histoplasmosis. It was further confirmed by special stains and microbiological investigations. Authors also reviewed recent articles based on South Asian region histoplasmosis case reports and found three case presentations with the same clinical presentation and outcomes. Treatment was started, but patients deteriorated and died within 10 days of admission. Delay in the diagnosis of histoplasmosis leads to the death of patients. Therefore, histoplasmosis should be considered as a differential diagnosis for prolonged fever with pancytopenia and chronic infections.

In the past, the existence and uniqueness of the solutions of fractional differential equations have been investigated by many researchers theoretically in various approaches in the literature. In this paper, there is no discussion of the existence of solutions for the nonlinear differential equations with fractal fractional operators. The objective of this work is to present novel contraction approaches, notably the $ \varpropto $-$ \psi $-contraction $ \varpropto $-type of the $ \tilde{\texttt{F}} $-contraction, within the context of $ \hat{F} $-metric and orbital metric spaces. The aim of this study is to illustrate certain fixed point theorems that offer a new and direct approach to establish the existence and uniqueness of the solution to the general partial differential equations by employing the fractal fractional operators.

Abstract This manuscript aims to present new results about the generalized F-contraction of Hardy–Rogers-type mappings in a complete vector-valued metric space, and to demonstrate the fixed-point theorems for single and pairs of generalized F-contractions of Hardy–Rogers-type mappings. The established results represent a significant development of numerous previously published findings and results in the existing body of literature. Furthermore, to ensure the practicality and effectiveness of our findings across other fields, we provide an application that demonstrates a unique solution for the semilinear operator system within the Banach space.

In this research study, a metamaterial (MTM) based $1\times4$ linear antenna array is designed with an integrated butler matrix (BM) beamforming network (BFN) to execute the switched-beam antenna array (SAA) operation, which can be employed for sub-6 GHz 5G applications. The proposed SAA is designed and simulated using CST microwave studio and then fabricated using FR4 epoxy glass substrate with the thickness ( $h$ ) = 1.6mm and dielectric constant ( $\varepsilon _{r}$ ) = 4.3. The MTM-BM BFN has shown excellent performance in both simulated and measured results, having return-loss of below 14 dB and insertion-loss at ports 5–8 to be 7 ± 2dB between the frequency range of 3.2-3.75GHz, respectively. Moreover, the phase difference between the output ports of the BM is simulated and measured. The $0.5\lambda $ spaced complementary split-ring resonator (CSRR) based antenna array integrated with MTM-BM BFN achieved a measured gain of 4.8-6.1 dB when each input port of BM was excited. The SAA analysis has been performed to identify the variation of gain and grating lobes; the distance between MTM antennas was altered by $0.3\lambda $ , $0.5\lambda $ , and $0.7\lambda $ , respectively. Depending on the BM input ports excitation, the main beam of the SAA is steered in four different directions −40°, −15°, +15°, and +45°, respectively. These radiation pattern studies have shown that the MTM-BM connected with four linear MTM antennas has successfully generated four beams in four different directions, which can be utilized for 5G applications to improve the channel capacity and enhance the transmission quality.

We investigate the crumpling of an elastoplastic sheet as it is repeatedly crushed onto itself by rolling it into a cylinder and twisting it axially while allowing the end-to-end length to evolve freely. The sheet buckles and folds into structures that repeat but sharpen over hundreds of cycles to a remarkable degree before forming different configurations. Below a critical amplitude, reconfigurations decrease with applied cycles but continue to occur for large enough loading amplitude as the topology of the sheet changes as it tears. The sheet structure as measured by the mean curvature and the total crease length evolves logarithmically with cycle number with a rate that increases with compaction. We explain the progress of creasing using a flat folding model, and we show the logarithmic growth as being a consequence of individual creases becoming sharper with the number of folding cycles, leading to bifurcations in the folding pathway.

In the recent past, a number of ground motions with large velocity pulses have been recorded in the near-field regions of earthquakes. A ground motion recorded in the near-field region of a strike-slip earthquake (i.e., near the fault rupture of the earthquake) exhibits distinctive long-period velocity pulses that are characteristic of near-field earthquakes and are not found in far-field ground motion records. The present study is based on analytical evaluation of the effect of distribution of masonry infill panels over the elevation of planar masonry-infilled RC frames on the seismic response of the frame subjected to near-field earthquakes implementing rational seismic analysis methods within the performance-based framework such as nonlinear dynamic time-history analysis and nonlinear static force-displacement (push-over) analysis using realistic and efficient computational models. Despite intense worldwide research in the area of masonry infilled frame structures during the past few decades, displacement-based nonlinear analyses of masonry infilled frames with explicit consideration of infill panels as structural elements is far from common practice, mostly due to the analytical complexity in modeling the infill panel realistically. The displacements are of particular interest from the viewpoint of performance-based design (PBD), the emerging model for the next generation of standard codes of practice for earthquake-resistant design. One of the objectives of the study is to demonstrate rational displacement-based analysis methodologies within the performance-based framework for accurately and efficiently predicting the global and local seismic demands and related intensity of seismic damage in practical masonry infilled multistory RC framed construction with seismically undesirable vertical layouts of masonry panels under the influence of near-field earthquakes. DOI: 10.1061/(ASCE)0733-9445(2008)134:9(1569) CE Database subject headings: Analytical techniques; Brick masonry; Earthquakes; Predictions; Seismic analysis; Reinforced concrete; Frames.

Tuberculosis (TB) remains a significant global health challenge, with approximately 1.5 million deaths per year. The Bacillus Calmette-Guérin (BCG) vaccine against TB is used in infants but shows variable protection. Here, we introduce a novel approach using a double gene knockout mutant (DKO) from wild-type Mycobacterium tuberculosis (Mtb) targeting fbpA and sapM genes. DKO exhibited enhanced anti-TB gene expression in mouse antigen-presenting cells, activating autophagy and inflammasomes. This heightened immune response improved ex vivo antigen presentation to T cells. Subcutaneous vaccination with DKO led to increased protection against TB in wild-type C57Bl/6 mice, surpassing the protection observed in caspase 1/11-deficient C57Bl/6 mice and highlighting the critical role of inflammasomes in TB protection. The DKO vaccine also generated stronger and longer-lasting protection than the BCG vaccine in C57Bl/6 mice, expanding both CD62L-CCR7-CD44+/-CD127+ effector T cells and CD62L+CCR7+/-CD44+CD127+ central memory T cells. These immune responses correlated with a substantial ≥ 1.7-log10 reduction in Mtb lung burden. The DKO vaccine represents a promising new approach for TB immunization that mediates protection through autophagy and inflammasome pathways.

Piezoelectricity or piezoelectric effect is a phenomenon by which mechanical energy is converted into electrical energy and vice versa. Piezoelectric effect has been observed in several organic materials. Therefore, in past few years organic piezoelectric materials have received significant research interests in biomedical applications and specifically for fabrication of implantable biomedical devices because of their high piezoelectric performance, excellent biocompatibility and biodegradability, superior mechanical properties, and cheap fabrication process. This article provides a comprehensive review of the recent research progress on organic piezoelectric materials. It extensively covers the piezoelectric properties and preparation methods of different organic piezoelectric materials including amino acids, peptides, proteins, polysaccharides, and polymers (such as PVDF, PLLA, PHB), as well as their representative implantable biomedical device applications namely biosensing, tissue regeneration, and drug delivery. Finally, the article discusses the challenges and future directions of this research field.

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p:

This work inspects the thermal transportation of the magnetohydrodynamic Casson trihybrid nanofluid flow over a convectively heated bidirectional elongating sheet. The flow is considered as three dimensional passing over the sheet, which is placed in a porous medium. The effects of thermal radiations and space- and thermal-dependent heat sources are used in energy equations, while magnetic effects are used in momentum equations. Appropriate variables have been used to convert the modeled equations into a dimensionless form, which have then been solved using the homotopy analysis method. In this work, it is uncovered that both the primary and secondary velocities are weakened with an upsurge in porosity and magnetic factors. The thermal transportation is augmented with growth in thermal- and space-dependent heat source factors and the thermal Biot number. The convergence of the method used in this work is ensured through ℏ-curves. The results of this investigation have also been compared with the existing literature with a fine agreement among all the results that ensured the validation of the model and method used in this work.