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International trade is considered the central link in the complex system of contemporary international economic relations. It links all countries of the world in a unified economic system whose goal is to address economic problems at the international level through developing productive capacity, expanding employment opportunities, and enhancing the flow of production factors between countries to achieve economic growth. Our study aimed to clarify the considerable impact of some macroeconomic variables (exchange rate, gross domestic product, public spending, foreign direct investment) on foreign trade in Iraq and to determine the degree of relative importance of the macroeconomic variables affecting foreign trade in Iraq. The study followed the descriptive analytical approach by collecting data related to the study for the period from 2003 to 2020 and then analyzing the data obtained through artificial neural networks.

The integration of artificial intelligence in industry and the adoption of green finance emphasizing environmental sustainability through technology has become increasingly prominent. This article scrutinizes the asymmetric nexus between industrial artificial intelligence and green finance in the top ten countries leading in industrial artificial intelligence (China, USA, South Korea, Germany, Japan, Canada, UK, Australia, France, and Italy). Preceding studies applied panel data approaches to examine the industrial artificial intelligence-green finance nexus without considering that not all countries had established such a connection autonomously. Conversely, this paper implements a distinctive approach, ‘Quantile-on-Quantile’, which offers both worldwide and nation-specific foresight into the correlation of the variables. The results demonstrate that industrial artificial intelligence increases green finance at specific segments of the data distribution across diverse economies. These outcomes underscore policymakers’ need to approach the development and enactment of policies regarding industrial artificial intelligence and green finance with careful attention and thoughtful deliberation.

Abstract The present study evaluates the amelioration of fat clay by blending it with cohesive non-swelling soil (CNS) and cohesionless silty sandy soil (Kassu). The fat clay sample with a liquid limit (LL) of 50 and a plasticity index (PI) of 26 was collected from Narowal, while CNS and Kassu samples were procured from Lahore's outskirts. Geotechnical tests on the virgin soil indicated its unsuitability for construction. Laboratory tests, including modified Proctor compaction, unconfined compression, California bearing ratio (CBR), and one-dimensional consolidation, were performed on samples blended with 0–35% CNS or Kassu in 5% intervals. The LL and PI of fat clay decreased significantly with the addition of 35% CNS (LL: 50–32%, PI: 24 to 13) and Kassu (LL: 50–29%, PI: 24–12). The CBR value increased from 4 to 7%, making the blended soil suitable for subgrade use. Unconfined compression tests showed a strength increase from 102 to 185 kPa with 35% CNS and up to 140 kPa with 25% Kassu. Compaction tests revealed improved maximum dry unit weight and reduced optimum moisture content. Swell potential decreased from 4 to 1.2 and 0.26% with CNS and Kassu additions. Regression models predict swell pressure and ultimate swell potential. The study concludes that blending fat clay with CNS and Kassu significantly improves its geotechnical properties, with CNS being more effective in controlling swell characteristics.

Abstract This study delves into the complex prioritization process for Autism Spectrum Disorder (ASD), focusing on triaged patients at three urgency levels. Establishing a dynamic prioritization solution is challenging for resolving conflicts or trade-offs among ASD criteria. This research employs fuzzy multi-criteria decision making (MCDM) theory across four methodological phases. In the first phase, the study identifies a triaged ASD dataset, considering 19 critical medical and sociodemographic criteria for the three ASD levels. The second phase introduces a new Decision Matrix (DM) designed to manage the prioritization process effectively. The third phase focuses on the new extension of Fuzzy-Weighted Zero-Inconsistency (FWZIC) to construct the criteria weights using Single-Valued Neutrosophic 2-tuple Linguistic (SVN2TL). The fourth phase formulates the Multi-Attributive Border Approximation Area Comparison (MABAC) method to rank patients within each urgency level. Results from the SVN2TL-FWZIC weights offer significant insights, including the higher criteria values "C12 = Laughing for no reason" and "C16 = Notice the sound of the bell" with 0.097358 and 0.083832, indicating their significance in identifying potential ASD symptoms. The SVN2TL-FWZIC weights offer the base for prioritizing the three triage levels using MABAC, encompassing medical and behavioral dimensions. The methodology undergoes rigorous evaluation through sensitivity analysis scenarios, confirming the consistency of the prioritization results with critical analysis points. The methodology compares with three benchmark studies, using four distinct points, and achieves a remarkable 100% congruence with these prior investigations. The implications of this study are far-reaching, offering a valuable guide for clinical psychologists in prioritizing complex cases of ASD patients.

Abstract Hypereosinophilia is a rare presentation in all age groups, particularly when it is severe, persistent, and progressive. We describe the clinical characteristics and course of severe hypereosinophilia in a full-term Saudi female neonate. A febrile respiratory illness evolved with a progressive increase in peripheral blood leukocyte and eosinophil counts, reaching 44.9% of leukocytes and an absolute value of 57,000 cells/µl. Different etiological examinations (for viral, bacterial, immunodeficiency, hyper IgE syndrome, gene mutations) revealed extremely high CMV antigenemia and a homozygous mutation in the STAT1 gene. Anhelation was relieved by oxygen and anti-viral treatment. Steroids brought a dramatic response in peripheral blood counts within 24 h. After a 6-week course of antiviral and steroid treatment at home, she had an excellent general condition. Conclusion: Although a rare pathology, it is important to consider genetic disorders when there is an atypical immune response to viral infections.

Abstract BackgroundAlthough at the base of the pyramid-shaped organization of the Rwandan health system, community health workers (CHWs) are central to the community-based management of disease outbreaks. ObjectiveThis mixed methods study aimed to explore the feasibility, acceptability, satisfaction, and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. MethodsTwo urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed methods approach was used to inform the feasibility (awareness and expectation), acceptability (use and perceived benefits), satisfaction, and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organized with CHWs. A content analysis was performed on the transcripts. ResultsOverall, 383 CHWs were recruited and trained; 378 CHWs participated in the study. The mean age of CHWs was 36.7 (SD 6.6) to 45.3 (SD 9.9) years and most were women (237/378, 62.7%). More than 7000 people were registered with the use of the app and 20% were referred to a local COVID-19 testing facility. According to CHW reporting, the median number of people screened by each CHW ranged from 152 (IQR 70-276) for Nyarugenge to 24 (IQR 16-90) for Rusizi. COVID-19 positivity rates were higher in urban than rural districts: more than half of the CHWs in Gasabo reported a confirmed positive case versus only 2.4% for Kirehe and 15.4% for Rusizi. Despite the app being a novel tool, CHWs were well aware of the use of such a tool and had appropriate expectations. Acceptability and satisfaction were very high, with differences between urban and rural districts. Satisfaction was higher in Nyarugenge (72.8/100) and Gasabo (80.7/100) than in Kirehe (61.6/100) and Rusizi (64.5/100). More than 80% of the CHWs were willing to continue using the e-ASCov app, with the exception of CHWs in Kirehe (56.7%). The app was perceived as a tool to generate information on COVID-19, inform on the status of the pandemic, and help curb the spread of the pandemic in Rwanda. CHWs were satisfied with the app at all stages of its implementation in their districts. ConclusionsIn this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with the potential to increase health system efficiency in an epidemic context. The context should be analyzed for generalization on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalization and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system.

Objective To evaluate the use of antigen-based rapid diagnostic tests (Ag-RDTs) alongside a digital tool to deliver household-level COVID-19 testing by community health workers (CHWs), in line with Rwanda’s ambition to decentralise COVID-19 testing.Design This was an operational pilot study to evaluate the impact and operational characteristics of using the digital e-ASCov tool combined with Ag-RDTs to support COVID-19 symptom screening and rapid testing by CHWs across eight districts in Rwanda. A total of 800 CHWs selected from both rural and urban areas were trained in delivering Ag-RDTs for COVID-19 testing and using the e-ASCOV application for data capture on a smartphone. Laboratory technicians repeated a subset of Ag-RDTs to assess the concordance of results obtained by CHWs. The study also assessed CHWs’ experience of the intervention using a mixed-methods approach.Setting Eight rural, urban and semiurban districts in Rwanda.Participants A total of 19 544 individuals were enrolled and screened for signs and symptoms of COVID-19.Interventions Community-based screening for COVID-19 by CHWs using the digital tool e-ASCov combined with rapid testing using Ag-RDTs.Main outcome measures Number of participants screened and tested; concordance of Ag-RDT results between CHWs and laboratory technicians; feasibility of study procedures by CHWs and CHWs perceptions of the digital tool and Ag-RDT testing.Results From February to May 2022, CHWs screened 19 544 participants, of whom 4575 (23.4%) had COVID-19-related symptoms or a history of exposure to the infection. Among them, 86 (1.9%) were positive on Ag-RDTs. Concordance of Ag-RDT results between CHWs and laboratory technicians was 100%. Of the 800 trained CHWs, 746 (93.3%) were independently able to conduct household-based COVID-19 screening, perform the Ag-RDTs and send data to the central server. Most CHWs (>80%) found Ag-RDTs and e-ASCOV easy to use.Conclusions This study demonstrated the feasibility of deploying a digital tool and Ag-RDTs for household-level SARS-CoV-2 detection in Rwanda. The findings support a broader roll-out of digitally supported rapid testing by CHWs to broaden access to testing for priority diseases.

This comprehensive review paper examines the most updated state of research on glioblastoma, an aggressive brain tumor with limited treatment options. By analyzing 76 recent studies, from translational and basic sciences, to clinical trials, we highlight various aspects of glioblastoma and shed light on potential therapeutic strategies. The interplay between tumor cells, neural progenitor cells, and the tumor microenvironment is explored. Targeting the PI3K-Akt-mTOR pathway through extracellular-vesicle (EV)-mediated signaling emerges as a potential therapeutic strategy. Personalized modeling approaches utilizing patient-specific MRI data offer promise for optimizing treatment strategies. The response of glioblastoma stem cells (GSCs) to different treatment modalities is examined, emphasizing the need to inhibit the transformation of proneural (PN) GSCs into resistant mesenchymal (MES) GSCs. Metabolic therapy and combination therapies show potential in reversing treatment resistance and inhibiting both PN and MES GSCs. Immunotherapy, targeted approaches, and molecular dynamics in gliomas are discussed, providing insights into early-stage diagnosis and treatment. Additionally, the potential use of Zika virus as an oncolytic agent is explored. Analysis of phase 0 to 3 clinical trials reveal promising outcomes for various experimental treatments, highlighting the importance of combination therapies, predictive signatures, and patient selection strategies. Specific compounds demonstrate potential therapeutic benefits and tolerability. Phase 3 trials indicate the efficacy of DCVax-L in improving survival rates and depatux-m in prolonging progression-free survival. These findings emphasize the importance of personalized treatment approaches and continued exploration of targeted therapies, immunotherapies, and tumor biology understanding in shaping the future of glioblastoma treatment.

This systematic review paper provides a comprehensive analysis of the recent advances in deep learning techniques for rice disease recognition. Rice is one of the most important crops in the world, providing food for more than half of the global population. However, rice diseases pose a major threat to rice production and can cause significant yield losses. In recent years, deep learning techniques have shown great potential in automating the process of rice disease recognition, which can help in early disease detection and management. This paper reviews the current trends in deep learning techniques for rice disease recognition, including various pre-processing and augmentation techniques, as well as popular deep learning models such as convolutional neural networks (CNNs) and their variants. The paper also provides an in-depth analysis of the different datasets used in the studies, along with their limitations and challenges. Furthermore, the paper discusses the future directions for research in this field, such as the need for larger and more diverse datasets, the development of novel deep learning architectures, and the integration of other data sources such as weather data and satellite imagery. The paper concludes by summarizing the key findings of the systematic review and highlighting the potential impact of deep learning techniques in rice disease recognition. In addition, the review provides a useful resource for researchers and practitioners in the field of agricultural technology and can help in the development of more accurate and efficient automated systems for rice disease detection and management.

Abstract Background During the COVID-19 pandemic, many intensive care units (ICUs) halted research to focus on COVID-19-specific studies. Objective To describe the conduct of an international randomized trial of stress ulcer prophylaxis (Re-Evaluating the Inhibition of Stress Erosions in the ICU [REVISE]) during the pandemic, addressing enrolment patterns, center engagement, informed consent processes, data collection, a COVID-specific substudy, patient transfers, and data monitoring. Methods REVISE is a randomized trial among mechanically ventilated patients, comparing pantoprazole 40 mg IV to placebo on the primary efficacy outcome of clinically important upper gastrointestinal bleeding and the primary safety outcome of 90-day mortality. We documented protocol implementation status from March 11th 2020-August 30th 2022. Results The Steering Committee did not change the scientific protocol. From the first enrolment on July 9th 2019 to March 10th 2020 (8 months preceding the pandemic), 267 patients were enrolled in 18 centers. From March 11th 2020-August 30th 2022 (30 months thereafter), 41 new centers joined; 59 were participating by August 30th 2022 which enrolled 2961 patients. During a total of 1235 enrolment-months in the pandemic phase, enrolment paused for 106 (8.6%) months in aggregate (median 3 months, interquartile range 2;6). Protocol implementation involved a shift from the a priori consent model pre-pandemic (188, 58.8%) to the consent to continue model (1615, 54.1%, p

Railway projects are incredibly costly due to their complex nature. This study performs risk analysis and management of Pakistan railways ML-1 project expansion and upgradation that will be undertaken at US$6.8 billion under the China-Pakistan Economic Corridor (CPEC). The risks were identified based on an extensive literature review and their relevance to the CPEC. We employed fuzzy set theory (integrated with the risk severity index) to obtain the most severe risks. The novelty of this study is the technique employed to analyse and rank the risk, also there are no previous studies conducted that emphasized the construction risk of railway projects in Pakistan. The study is useful for all stakeholders of the project, as it can plan for them to tackle these risks and implement ML-1 successfully.

Variable-order derivatives are the natural extension of ordinary as well as of fractional-order differentiations and integration, respectively. Numerous suggestions for fractional variable-order operators have been made in the literature over time. Therefore, this is the moment to shine a light on the variable-order fractional calculus, due to the fact that it accurately describes the mathematical underpinnings and emphasizing the modeling utility via using contemporary numerical techniques. This study focuses on investigating a fractional variable-order model of lymphatic filariasis infection using with Atangana–Beleanue–Caputo derivative. Our investigations have led to the development of newly refined results, focusing on both qualitative and numerical aspects of analysis. To achieve our research objectives, we employ the fixed point theorems of Banach and Krasnoselskii. These theorems serve as powerful tools, allowing us to establish results regarding the existence of solutions to the model. Additionally, for precise numerical simulations, we employ the fractional Euler’s method, a sophisticated computational technique that allows us to effectively simulate and interpret the results both numerically and graphically. These graphs illustrate distinct variable-orders, providing a comprehensive understanding of the model’s behavior under different conditions. Here, it should be kept in mind that we have select various continuous functions for variable to present our graphical illustration.

The study evaluates the potential of solar, wind, and hybrid PV/WT renewable energy systems for green hydrogen production in four Iraqi cities. Through a comparative analysis of six distinct scenarios involving the deployment of 60 MWp solar panels, 30 MWp wind turbines, and 45 MWp hybrid PV/WT systems, the research aims to ascertain the most energy-efficient and cost-effective strategy for hydrogen generation. This evaluation is aligned with the operational capacities of two types of water electrolyzers: Alkaline (AWE) and proton exchange membrane (PEM), each with a 17.5 MWp capacity. Employing the HOMER Pro software for system simulation and optimization, and considering a project timeline from 2022 to 2042, the study identifies Anbar City as the prime location for green hydrogen production, highlighting solar PV panels as the most economical option with the lowest levelized cost of energy at US $4.5/MWh. The analysis further demonstrates that hydrogen production costs are US $1.98/kg for AWE electrolyzers and US $2.72/kg for PEM electrolyzers, with net present costs of US $26.31 million and US $35.91 million, respectively. Moreover, the annual hydrogen output is estimated at 1.11 million kg for AWE and 1.19 million kg for PEM electrolyzers. These insights significantly contribute to the strategic planning and development of Iraqi green hydrogen sector, offering a valuable framework for policymakers and stakeholders invested in sustainable energy transitions.

The main objective of this study is to design the asphalt pavement structure for the Alkut-Mayssan highway in Iraq as a case study by using PCASE application to determine the necessary thickness of CR-modified asphaltic layers. Additionally, Marshall tests were used to investigate the effect of the dry process crumb rubber modifier on the thickness of the binder coarse layer based on various variables, such as the crumb rubber modifier with different content (1, 2, 3, 4, 5)% and sizes (0.3mm, 2.36mm , 4.75mm, and mix gradation). The test results show that while pavement thickness reduced as crumb rubber gradation increases, MR values increase. Additionally, as compared to the control mixture, the addition of 1% of CR in various gradations could decrease the thickness of the asphalt binder layer.

The study explores the feasibility of using a photovoltaic (PV) energy system to produce hydrogen for off-site hydrogen refueling stations (HRS) in three Iraqi cities (Karbala, Maysan, and Nineveh), focusing on a comprehensive system model consisting of a 558 MWp off-grid photovoltaic system, a 157.5 MWp proton exchange membrane (PEM) electrolyzer, a converter, and a hydrogen storage tank. Utilizing HOMER Pro software for system simulation and MATLAB, with consedaring 28 years from 2022 to 2050 life span, incorporating hourly weather data for 2022 to optimize system performance. The outcomes identify that the Karbala city as the most cost-effective for green hydrogen production, highlighting the economic benefits of PV technology, which presents the most economical option with a levelized energy cost of $5,010/GWh. The project is projected to produce 10.61 million kg of hydrogen annually at a production cost of $2.75/kg, with an overall project cost estimated at $372.77 million. The results are of strategic significance for Iraq transportation sector, supporting the development of a robust green hydrogen infrastructure for HRS. This infrastructure is expected to promote sustainable transportation practices and reduce reliance on fossil fuels, contributing significantly to the energy transition in Iraq. This techno-economic analysis provides a foundational assessment for stakeholders considering investments in renewable hydrogen production and infrastructure development.

Abstract Background Adaptation is a key strategy to extend the reach of evidence-based interventions to prevent violence in new populations, but there is a dearth of practical case examples. The Good School Toolkit was developed by Ugandan NGO Raising Voices for use in primary schools (GST-P). We describe our systematic approach to adapting the GST-P for use in secondary schools in Uganda, and reflect on the utility of the process as well as limitations of existing adaptation frameworks. Methods We adapted the GST-P in four phases, which included: I) clarifying the logic model and core intervention components using a streamlined process; II) conducting formative research (cross-sectional survey, focus groups, etc.) to understand the new population; III) selecting and preparing new intervention components and modifying existing intervention components; and IV) pretesting new intervention components with teachers and students in Uganda. Results We identified core components using a logic model. Formative research showed results largely in line with our apriori hypotheses. Teacher violence remained highly prevalent in secondary versus primary schools (> 65% of secondary students reported past year exposure), while peer violence significantly increased (secondary = 52% vs. primary girls = 40%, P

Background: The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of Acute kidney injury (AKI). The objective of this study is to determine the frequency of AKI and its outcome in birth asphyxia. Methods: This cross-sectional study was carried out in the Department of Pediatric Medicine from March 2019 to September 2019. A total of 111 newborns with birth asphyxia of gestational age 37–41 weeks were included. Neonates born to mothers having hypertension and diabetes mellitus, patients with congenital kidney anomalies like polycystic kidney disease and renal agenesis, and mothers taking nephrotoxic drugs or any other known cause of AKI like hypovolemic shock were excluded. Urine output (UOP) and final outcome of the patient were also noted. AKI was noted. Results: The mean gestational age was 38.29 ± 1.07 weeks. The mean weight of neonates was 3.08 ± 0.31 kg. The frequency of AKI in birth asphyxia was 20 (18.02%) neonates. Complete recovery in AKI patients was seen in 07 (35.0%) and death in 13 (65.0%) patients. Conclusion: This study has shown that the frequency of AKI in birth asphyxia was found in 18.02% neonates with complete recovery seen in 35.0% and death in 65.0% patients.

The demand for sustainable and sustainable biotechnological processes has developed as a result of a growing interest in converting agricultural waste into valuable products. In this study, fungal strainswere isolated from soil environment ofoil palm empty fruit bunchesandscreened for humic acid production. In Osun state, Nigeria, soil sample was taken from a local palm oil mill. Different colonies of fungi were obtained for further research using the serial dilution plating procedure. Plate screening was used to evaluate the fungal biomass as well as colony diameter of the fungal isolates, and a submerged fermentation test was used to measure the amount of humic acid concentration the isolates produced. Fungal isolates were identified by using molecular methods and morphological analysis. The fungi species Aspergillusniger, Rhizopusstolonifer, and Penicilliumchrysogenum were isolated from the soil environment. When compared to Rhizopusstolonifer, Aspergillusniger grew more superiorly in terms of zone diameter (26.5 1.50 mm) and biomass (2.23 0.16 g), while Penicilliumchrysogenum showed no growth. Throughout the fermentation process, Aspergillusnigeralso produced a greater quantity of humic acid, with concentrations varying from 0.70 mg/l to 2.20 mg/l. Aspergillusniger strain HR18's existence was confirmed by molecular analysis. This experiment proved that Aspergillusniger can efficiently produce humic acid from OPEFB, providing a useful method for waste utilization and sustainable practices.

Globally, intimate partner violence (IPV) against women is a serious concern, with significant underreporting in Pakistan. This study aimed to explore the patterns of IPV among pregnant women in a Pakistani setting. An exploratory study using nonprobability purposive sampling recruited 363 pregnant women visiting for check-ups at Akbar Niazi Teaching Hospital, Islamabad. Participants were interviewed using a structured questionnaire developed from an extensive literature review and prior research. Data analysis was performed using SPSS, descriptive statistics, bar charts, and chi-square tests, with the significance threshold set at p < 0.05. The demographic analysis revealed that a majority of women (56.75%) were aged 20–29, whereas most husbands fell within the 30–39 age group (68.60%). Educational disparities were significant (p < 0.001), with 48.76% of women lacking formal education versus 34.16% of their husbands having higher secondary education or above. The working status highlighted economic dependency, with 91.74% of women not working. Over 61% of pregnancies were unplanned, with 32.28% of participants reporting contraceptive nonuse due to partner opposition. The most reported controlling behavior was the restriction of medical care access (63.36%). Psychological violence was prevalent (25.07% reported humiliation or intimidation), while physical violence was less common (4.96% experienced object throwing). Sexual violence instances were comparatively rare, with 2.75% reporting nonconsensual sexual relations. This study underscores significant sociodemographic and economic disparities affecting pregnant women's exposure to IPV, with psychological violence emerging as the leading form of IPV experienced during pregnancy. These findings underscore the necessity for targeted interventions to improve healthcare access and support pregnant women's autonomy and well-being amidst IPV challenges.

The integration of modern technology in healthcare education, mainly through digital media platforms, is pivotal for enhancing healthcare professionals' proficiency in birth preparedness and complication readiness (BP/CR). This study aimed to assess the effectiveness of digital media interventions on BP/CR knowledge among healthcare providers, reflecting on broader implications for global healthcare delivery and patient education. In this quasi-experimental study, 70 healthcare professionals were recruited using a nonprobability convenience sampling method. The training protocol was developed after an in-depth literature review, while the evaluation questionnaire incorporated provider-level index indicators aligned with Johns Hopkins University's BP/CR guidelines to ensure a comprehensive assessment framework. The intervention utilized widely accessible digital platforms, i.e., WhatsApp and email, aimed to deliver educational content, with its effectiveness gauged through pre- and postintervention assessments analyzed using SPSS 25.00. The study findings demonstrated significant improvements in BP/CR knowledge postintervention across various care domains. The results showed significant increases in BP/CR knowledge postintervention: focused antenatal care knowledge improved from 34.00% to 69.00% (p < 0.001), and knowledge of third-stage labor management increased from 21.00% to 56.00% (p < 0.001). Furthermore, significant improvements were also observed in neonatal care and emergency obstetric and neonatal care management knowledge (p < 0.001). These results affirm the role of digital media in improving healthcare education, suggesting its integration into healthcare policies to reduce maternal mortality and support professionals in resource-limited settings.

BackgroundCurrent treatment modalities for Major Depressive Disorder have variable efficacies and a variety of side effects. To amend this, many trials for short term, well tolerated monotherapies are underway. One such option is Zuranolone (SAGE-217), which is a recent FDA approved antidepressant for Post Partum depression (PPD) and is undergoing clinical trials for PPD, major depressive disorder (MDD) and essential tremors (ET).ObjectivesPool currently available data that compare Zuranolone to Placebo for the treatment of Major Depressive Disorder and evaluate its efficacy and safety profile.MethodsWe retrieved data from PUBMED and SCOPUS from inception to July 2023. We included articles comparing Zuranolone or SAGE 217 with placebo in patients suffering from Major Depressive Disorder. Review Manager 5.4 was used to analyze the outcomes including changes in the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Montgomery–Åsberg Depression Rating Scale (MADRS) scores from baseline as well as any treatment emergent adverse events (TEAEs) and severe adverse events.ResultsOur review analyzed 4 trials and the data of 1,357 patients. Patients treated with Zuranolone indicated a statistically significant effect in the change from baseline in HAM-D score (p = 0.0009; MD [95% CI]: −2.03 [−3.23, −0.84]) as well as in MADRS score (p = 0.02; MD [95% CI]: −2.30[−4.31, −0.30]) and HAM-A score (p = 0.03; MD [95% CI]: −1.41[−2.70, −0.11]) on 15th day when compared to the Placebo group. Zuranolone was also significantly associated with a higher response rate (p = 0.0008; OR [95% CI]: 1.63[1.14, 2.35]) and higher remission rate (p = 0.03; OR [95% CI]: 1.65[1.05, 2.59]) when compared with the placebo. As for safety, Zuranolone was significantly associated with 1 or more TEAE (p = 0.006; RR [95% CI]: 1.14[1.04, 1.24]) but an insignificant association with side effects that lead to drug discontinuation (p = 0.70; RR [95% CI]: 1.18[0.51, 2.76]) and serious adverse events (p = 0.48; RR [95% CI]: 1.46 [0.52, 4.10]) when compared with placebo.ConclusionZuranolone is an effective and safe drug for short course major depressive disorder monotherapy. It shows results in 14 days (compared to 2–4 weeks that SSRI’s take) and has anti-anxiolytic effects as well. However, only 4 trials have been used for the analysis and the sample size was small. The trials reviewed also cannot determine the long-term effects of the drug. More trials are needed to determine long term effects.

The Internet of Vehicles (IoV) emerges as a pivotal extension of the Internet of Things (IoT), specifically geared towards transforming the automotive landscape. In this evolving ecosystem, the demand for a seamless end-to-end system becomes paramount for enhancing operational efficiency and safety. Hence, this study introduces an innovative method for real-time driver identification by integrating cloud computing with deep learning. Utilizing the integrated capabilities of Google Cloud, Thingsboard, and Apache Kafka, the developed solution tailored for IoV technology is adept at managing real-time data collection, processing, prediction, and visualization, with resilience against sensor data anomalies. Also, this research suggests an appropriate method for driver identification by utilizing a combination of Convolutional Neural Networks (CNN) and multi-head self-attention in the proposed approach. The proposed model is validated on two datasets: Security and collected. Moreover, the results show that the proposed model surpassed the previous works by achieving an accuracy and F1 score of 99.95%. Even when challenged with data anomalies, this model maintains a high accuracy of 96.2%. By achieving accurate driver identification results, the proposed end-to-end IoV system can aid in optimizing fleet management, vehicle security, personalized driving experiences, insurance, and risk assessment. This emphasizes its potential for road safety and managing transportation more effectively.

Abstract Human Papillomavirus (HPV) is the most common cause of sexually transmitted diseases and causes a wide range of pathologies including cervical carcinoma. Integration of the HR-HPV DNA into the host genome plays a crucial role in cervical carcinoma. An alteration of the pRb pathways by the E7 proteins is one of the mechanisms that’s account for the transforming capacity of high-risk papillomavirus. For the proper understanding of the underline mechanism of the progression of the disease, the present study investigate the correlation of concentration of host pRb protein, viral E7 oncoprotein and viral load in early and advanced stages of cervical carcinoma. It was found that the viral load in early stages (stage I and II) was less (log10 transformed mean value 2.6 and 3.0) compared to advanced stages (stage III and IV) (Log10 transformed value 5.0 and 5.8) having high expression of HPV E7 onco-protein and reduced level of pRb protein, signifying the role of viral load and expression level of E7 oncoprotein in the progression of cervical cancer.

Abstract Overview Dengue fever, a viral illness transmitted by the Aedes mosquito, is capable of causing a range of serious complications, including fulminant hepatic failure, renal dysfunction, encephalitis, encephalopathy, neuromuscular and ophthalmic disorders, seizures, and cardiomyopathy. Case description This report details the case of a 30-year-old lactating woman with no notable medical history who presented to the emergency department with symptoms of high-grade fever, altered mental status, and seizures. Upon imaging, bilateral infarcts in the thalami and cerebellar hemispheres were observed, consistent with cerebellitis and dengue encephalitis. Patient treatment and outcome The patient was admitted to the intensive care unit and received appropriate treatment. Following a critical phase and successful patient stabilization, she was transferred to a high dependency unit for a week before being discharged with recommendations for follow-up care. Conclusion This case illustrates the broad spectrum of complications that can arise as a result of dengue infection and the importance of timely diagnosis and management in improving patient outcomes. Further investigation is required to better understand the mechanisms underlying these complications and to formulate specific guidelines for the prevention and treatment of dengue shock syndrome.

Acute pancreatitis (AP) is a multi-causal disease with a high rate of hospitalisation. Only a few clinical studies have investigated the aetiological background, severity, and outcome of AP in Pakistan. Hence, this study was carried out to determine the aforementioned factors and correlate them with outcomes in a tertiary care setting. This was a cross-sectional, retrospective study conducted at the Department of Gastroenterology, Aga Khan University Hospital, Karachi, from January 1, 2022, to December 31, 2022. Data was analysed using statistical software SPSS version 25. Vomiting was the predominant presenting complaint and was seen in 139 (78.5%) patients. Gallstones were the predominant cause in 68 (37%) patients, followed by idiopathic pancreatitis in 22 (12%) patients. Thirteen (7.1%) patients passed away. Patients with systemic complications were likely to suffer from severe disease (p=0.02), whereas those with local complications were at an increased risk of mortality (p=0.04). ---Continue

Background Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare. Aims We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion. Method We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes. Results Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors. Conclusions We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

In recent times, there have been calls from within the developing nations for increased ownership by governmental research bodies and universities of the priority research setting and research that aligns with national health strategies. This is a review paper of the studies that have been published on clinical trials in developing countries, with a focus mainly on Pakistan. The literature review used online databases such as PubMed, Scopus, and Google Scholar, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov trial registries to search for clinical trials conducted in Pakistan between January 2000 and December 2022 and analyzed. The results revealed that clinical research in Pakistan is hindered by a number of barriers, including a lack of funding, skilled personnel, and regulatory issues. Lack of funding is a common obstacle, and the majority of funding for clinical trials originates from Western countries or pharmaceutical companies established in the West. In conclusion, clinical studies in developing countries, especially in Pakistan, are hindered by a plethora of barriers, and to improve the current state, increasing funding, streamlining ethical approval procedures, simplifying regulatory systems, addressing cultural and religious concerns, and participating in global efforts to bridge the gap in health-based research are crucial.

Purpose: This research study aims to investigate the relationship between enterprise risk management (ERM) components and non-financial companies’ financial performance (FP), which are listed at PSX, while exploring the corporate reputation (CR) role as a mediation between ERM components and financial indicators performance. Design/Methodology/Approach: This study used a questionnaire survey, and 340 responses were collected from non-financial sector firms’ board executives and top management. The PLS-SEM technique was employed for the data analysis using smart PLS 4.0 software. Findings: the results showed that ERM components significantly influence the corporate reputation. Further, corporate reputation positively and significantly mediates between ERM components and financial performance. This study plays a crucial role in pinpointing and addressing risks within non-financial firms, aiming to enhance the prosperity of the non-financial sector and contribute to overall economic growth through the ERM components framework. Implications/Originality/Value: Future research could extend to various sectors, encompassing financial and non-financial companies, service firms, and the food industry. Such studies could explore the influence of ERM components on financial performance, particularly emphasizing reputation as a critical resource for success in competitive markets.

Protecting electronic documents, especially those containing sensitive data, is a major challenge in an open web. The data security industry has long struggled to manage the security of e-books, data shows that information security issues can cause significant economic losses after three years Although cryptographic methods have been proposed as a solution in of these challenges Focusing on speed and efficiency The shortcomings of traditional encryption methods have been thoroughly examined Although a number of network management techniques assure retention privacy and integrity though, when it comes to encryption. Digital signature algorithms, although effective in detecting unauthorized changes and limiting the scope for copyright protection, do not ensure the confidentiality of shared electronic documents When addressing research gaps addressing this issue, the paper proposes a security framework for electronic documents that combines three important security mechanisms: encryption, digital signatures, and watermark algorithms Dhishu By matching their strengths, constraints are overcome. The combination of encryption and digital signatures is explored as a promising approach to protecting electronic documents, ensuring authenticity and confidentiality Importantly, the need to explore security mechanisms such as digital is highlighted emphasis on handwriting, encryption, and watermarking systems in depth.

Purpose: The purpose of this research is to examine the information processing strategies' influence on the financial satisfaction of investors. This research also investigates the mediating influence of financial opportunities. Design/Methodology/Approach: The proposed model's relationship is examined using mixed methodology. Qualitative data is gathered by using in-depth interviews. While quantitative data is collected through questionnaires. Findings: This study's results explain that financial opportunities significantly mediate the relationship. Further, information processing strategies have a significant influence on financial opportunities. This unique study contributed to the literature and developed a financial opportunity scale. Implications/Originality/Value: This study suggested that understanding and knowledge of financial opportunities would help to increase the financial decisions of investors. This research also highlights implications and limitations to investors and practitioners.

Objective: To examine the clinical spectrum of breast cancer, its symptoms, presentation, histologic types and different types of its genetic aberrations in the women of reproductive age. Methodology: This Retrospective study was conducted at the Heavy Industries Taxila (HIT) Hospital, Taxila Cantt, from March 2022 to December 2022. The Temporal sampling technique was used to collect the data. We looked at the data of patients with breast cancer that were treated at the HIT hospital Taxila. The retrospective data was collected from the files of the patients who visited HIT Hospital, dated back from January 2011 to December 2020. The study included women of reproductive age with breast cancer symptoms, regardless of whether they had a family history of the disease. The women with metastatic breast lesions and breast trauma were excluded from the study. Age, hormone receptor status, axillary lymph node status, histologic grade and subtype, tumor size margin status, menopausal status, human epidermal growth factor receptor-2 (HER2)/neu status, and the entire genetic spectrum were all included in the charts. The clinical spectrum, staging, and genetic spectrum are all described in tables. Results: The disease's genetic makeup was found to be quite diverse, with abnormalities in genes; ATM, BARD1, CDH1, and BRCA2 making up 2 (3%) each, 3 (4%) breast cancer gene 1 (BRCA1) and BRCA2 abnormalities making up 48 (67%) of the cases. Twelve (16%) of the patients had TP53 mutations, while two (2%) of the patients had NF1 and RECQL gene alterations. Conclusions: This study identifies multiple genes that contribute to the development of breast cancer, including BRCA1, BRCA2, TP53, BARD1 and Cadherin 1 (CDH1) genes.

Systemic Lupus Erythematosus (SLE) is an auto-immune disease in which the immune system assaults its tissues. We aimed to analyse the maternal and foetal outcomes during pregnancy in SLE mothers. A literature search was conducted by two investigators to assess SLE's outcomes on maternal and foetal during pregnancies. We searched PubMed/Medline, Embase, and Google scholar to collect evidence from different research studies, draw the conclusion, and report it. In our investigation, we found out that SLE could cause a spectrum of complications during pregnancy, not only for the mother but also for the foetus. It could affect fertility and cause difficult pregnancies for the couple as well which includes certain complications such as: preterm labour and delivery, high blood pressure (preeclampsia), placental insufficiency, miscarriage or stillbirth, whereas in the foetus SLE can cause mortality, preterm birth, and neonatal lupus (a temporary condition in the baby caused by SLE-related antibodies) and structural abnormalities. The literature suggests that SLE could prove fatal for the foetus and induce many complications in the mother. However, this could be avoided if pregnancy is planned right from the start and proper management is provided to the mother during pregnancy and delivery.p

Objective: In this paper, we examine the current crisis of regarding preparedness of healthcare industries in Pakistan, analyzing the causes, effects, and potential recommendations to this problem. Methods: Highlighting the efforts and issues surrounding this topic is necessary for developing and implementing research-based solutions that accurately reflect the current state of the healthcare industry. This short overview is prepared in accordance with accepted practices in published studies around the world. Our findings were based on a search of the literature databases PubMed, Google Scholar, Journals Online, and the Internet Library. Results: Searching for ''Healthcare Preparedness in Pakistan'' yielded the expected results. Particularly of interest to the researchers was the question of why, despite efforts to boost vaccination rates and emergency immunization response capacities in the event of epidemics, progress on SDG3 immunization indicators has been minimal. Immunization is critically important because vaccine-preventable diseases pose a significant risk to the general population. Pakistan's authorities and government should take deliberate action to increase immunization rates. Conclusion: Particularly disadvantaged countries and regions are hit the worst by climate change. Pakistan continues to be hit hard by diseases like acute watery diarrhea, dengue fever, malaria, and COVID-19 are on the rise as a result of the flooding, especially in shelters and areas where water and sanitation systems have been affected. After devastating floods in KP, Sindh, and Punjab, over 70 suspected cases of diphtheria were reported. Diphtheria epidemics illustrate the precarious position of flood victims. It would be catastrophic if the newly found diphtheria strain or the covid-19 variation reached the underserved flood victims. Immunization protects against life-threatening illnesses so its government responsibility to improve immunization rates in Pakistan.

Abstract Background Management of pterygium is dependent on the grading of pterygium and its clinical presentation (inflamed or quiescent), and surgical excision is the final choice of treatment for the pterygium extending beyond the limbus. Infectious keratitis is one of the most commonly reported complications in recent years. To the best of our knowledge, Klebsiella keratitis after pterygium surgery has not been described in the current literature. Here, we report a patient with corneal ulcer formation following pterygium surgical excision. Case presentation A 62-year-old woman presented with complaints of pain, blurred vision, photophobia and redness in her left eye for a month. She had a history of pterygium surgical excision two months ago. Slit-lamp examination showed conjunctival congestion, a central whitish corneal ulcer with a central epithelial defect, and hypopyon. Corneal scraped sample revealed multidrug resistant (MDR) Klebsiella pneumonia and the strain was found to be sensitive to cefoxitin and ciprofloxacin. Intracameral cefuroxime (1 mg/0.1 mL) injection, fortified cefuroxime ophthalmic suspension (50 mg/mL) and moxifloxacin ophthalmic suspension (0.5%) were successfully administered to control the infection. Since residual central stromal opacification remained persistent, final visual acuity did not improve beyond finger counting at two meters. Conclusions Klebsiella keratitis is a rare and sight-threatening complication following pterygium excision. This report emphasizes the importance of close follow-up examination following pterygium surgeries.

Monkeypox virus (MPXV) is a double-stranded DNA zoonotic virus of the Poxviridae family. Infected persons, animals, or inanimate items can all spread the virus to humans when they come into close contact. The first human-to-human transmission was reported in 1970 in the Democratic Republic of Congo. The outbreak emerged in May 2022 involved mostly men who had sex with men (MSM). Patients usually present with symptoms of rash along with fever, flu-like symptoms, and lesions in the genital and perineal region. A rising concern is ocular manifestations seen with MPVX like conjunctivitis, blepharitis, keratitis, and corneal lesions, especially in unvaccinated patients which might lead to blindness. Although it is self-limiting with supportive care, many patients benefited from tecovirimat. Combination therapy of brincidofovir and tecovirimat was also used for severe disease. Smallpox vaccinations will also play a vital role as unvaccinated patients had serious complications. Risk counseling should be carried out to prevent further spread amongst high-risk populations. Ophthalmologists should also remain aware of these ocular manifestations during the current outbreak and keep it as a differential diagnosis whenever they come across with aforementioned complaints that can be seen in MPVX illness.

Climate variability is a major challenge concerning food security; therefore, there is a need for pragmatic solutions to improve agricultural production. Henceforth, this study was planned to optimize the planting time of exotic safflowers under the prevailing conditions in Faisalabad, Pakistan. A study was executed by employing a split-plot design with six safflower accessions and five sowing dates ranging from 31 October 2019 to 31 December 2019. The results of the experimental safflower accession PI-198990 produced significant seed yields (2432 kg ha−1, 2772 kg ha−1 and 2366 kg ha−1) when sown on 30 November 2019, 15 December 2019, and 31 December 2019, respectively. On the other hand, on 31 October 2019 and 30 November 2019, sown safflower accessions PI-208677 and PI-250187 were the best performers, respectively. However, a higher achene oil percentage (31.5% and 30.8%) was noted in accessions PI-250187 and PI-314650 when sown on 31 December 2019 and 15 December 2019, respectively. The highest oleic acid content (22.92% and 22.83%) was determined in accession PI-314650 when planted on 30 November 2019 and 15 December 2019, respectively, whereas a higher linoleic acid content was observed on 31 October 2019 and 30 November 2019. Stability analysis showed that safflower accession PI-210834 was the most stable under all sowing environments, followed by PI-314650. Correlation analysis showed that oil percentage showed a negative correlation with phenological traits and growing degree days, and oil yield showed a strong positive relationship with heads, seed yield, biological yield, thousand seed weight, and harvest index.

The foot-and-mouth disease virus is a highly contagious and economically devastating virus of cloven-hooved animals, including cattle, buffalo, sheep, and goats, causing reduced animal productivity and posing international trade restrictions. For decades, chemically inactivated vaccines have been serving as the most effective strategy for the management of foot-and-mouth disease. Inactivated vaccines are commercially produced in cell culture systems, which require successful propagation and adaptation of field isolates, demanding a high cost and laborious time. Cell culture adaptation is chiefly indebted to amino acid substitutions in surface-exposed capsid proteins, altering the necessity of RGD-dependent receptors to heparan sulfate macromolecules for virus binding. Several amino acid substations in VP1, VP2, and VP3 capsid proteins of FMDV, both at structural and functional levels, have been characterized previously. This literature review combines frequently reported amino acid substitutions in virus capsid proteins, their critical roles in virus adaptation, and functional characterization of the substitutions. Furthermore, this data can facilitate molecular virologists to develop new vaccine strains against the foot-and-mouth disease virus, revolutionizing vaccinology via reverse genetic engineering and synthetic biology.

Introduction:The occurrence of iatrogenic bile duct injuries is few, however potentially linked to life-threatening complications, particularly following the advent of laparoscopic cholecystectomy. Aims &Objectives: To evaluate the presentation of post-cholecystectomy bile duct injuries in a tertiary care hospital. Place and Duration of Study: This study was done in the Department of General Surgery at Combined Military Hospital Rawalpindi from Nov 2020 to Dec 2021. Material &Methods: This cross-sectional study was conducted on 15 subjects with post-cholecystectomy bile duct injuries.All the patients who presented to the emergency department and outdoor were included in the study and had post-cholecystectomy CBD injuries. Laparoscopic and open BDI were classified according to Strasberg classification. In descriptive statistics, mean, and standard deviation was used, and in qualitative analysis, frequency and percentages were calculated with the help of the SPSS 23 version, a p-value of? 0.05 was considered significant. Results: In our study, 5 (33.3 %) males and 10 (66.7 %) were females, with a mean age of 47.27 ± 4.79. The presentation on the admission of patients was as follows, 3 (20.0 %) patients had biloma, 4 (26.7 %) had jaundice, 2 (13.3 %) had abdominal pain, 1 (6.7 %) had external biliary fistula, 3 (20.0 %) had Biliary peritonitis and 2 (13.3 %) had a fever. Conclusion: The most common consequence of cholecystectomy was complete resolution, but bile leak and major duct damage cause considerable morbidity, death, and healthcare expenditures. Better outcome was achieved when a nonprimary and skilled hepatobiliary surgeon repaired severe bile duct damage.

Objectives: The objective of this study was to determine the prevalence and factors associated with malnutrition among PLHIV accessing ART at Muhammad Shuwa Memorial Hospital (MSMH). Methods: A facility-based cross-sectional study recruited 384 PLHIV accessing ART at MSMH using convenience sampling. Heights and weights were measured in metre (m) and kilogram (kg) respectively to determine body mass index (BMI). BMI 25.5 kg/m2 indicated overweight/obesity. Results: The prevalence of undernutrition and overnutrition among participants was 13% and 30.2%, respectively. Factors such as being female (AOR = 17.72; 95% CI: 4.214–74.548), aged 30 years and above (AOR = 9.87; 95% CI: 2.984–32.631), being unmarried (AOR = 0.34; 95% CI: 0.122–0.936), having a monthly income of N30,000 or higher (AOR = 0.34; 95% CI: 0.122–0.936), having a WHO clinical stage 2 and above (AOR = 35.9; 95% CI: 6.061–212.596), having a viral load of 1000cp/ml or higher (AOR = 4.95; 95% CI: 1.136–21.576), being on ART for 5 years and above (AOR = 0.01; 95% CI: 0.002–0.06), and having inadequate dietary diversity (AOR = 0.03; 95% CI: 0.003–0.18) were associated with undernutrition. On the other hand, factors such as being aged 30 years and above (AOR = 6.68; 95% CI: 2.261–22.845), being unemployed (AOR = 2.833; 95% CI: 1.419–5.984), being on DTG-based regimen (AOR = 0.025; 95% CI: 0.003–0.101), not experiencing eating difficulties (AOR = 11.53; 95% CI: 1.706–254.494), and having inadequate dietary diversity (AOR = 0.200; 95% CI: 0.105–0.371) were associated with overnutrition. Conclusion: Prevalence of both undernutrition and overweight or obesity is observed among PLHIV at MSMH. Consequently, it is essential to include nutrition education as an integral component of the comprehensive care provided to PLHIV.

The core idea behind precision medicine is to pinpoint the subpopulations that differ from one another in terms of disease risk, drug responsiveness, and treatment outcomes due to differences in biology and other traits. Biomarkers are found through genomic sequencing. Multi-dimensional clinical and biological data are created using these biomarkers. Better analytic methods are needed for these multidimensional data, which can be accomplished by using artificial intelligence (AI). An updated review of 80 latest original publications is presented on four main fronts—preventive medicine, medication development, treatment outcomes, and diagnostic medicine—All these studies effectively illustrated the significance of AI in precision medicine. Artificial intelligence (AI) has revolutionized precision medicine by swiftly analyzing vast amounts of data to provide tailored treatments and predictive diagnostics. Through machine learning algorithms and high-resolution imaging, AI assists in precise diagnoses and early disease detection. AI’s ability to decode complex biological factors aids in identifying novel therapeutic targets, allowing personalized interventions and optimizing treatment outcomes. Furthermore, AI accelerates drug discovery by navigating chemical structures and predicting drug-target interactions, expediting the development of life-saving medications. With its unrivaled capacity to comprehend and interpret data, AI stands as an invaluable tool in the pursuit of enhanced patient care and improved health outcomes. It’s evident that AI can open a new horizon for precision medicine by translating complex data into actionable information. To get better results in this regard and to fully exploit the great potential of AI, further research is required on this pressing subject.