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UV light-emitting diodes (LEDs) have been regarded as feasible alternatives for traditional UV lamps since the early 2000s, owing to their improved safety features, environmental advantages, and efficiency. Because of the inherent challenges associated with lower intensity of LEDs over extended distances, our findings demonstrated the optimized disinfection efficiency using various LED setups. This study evaluated the antimicrobial effectiveness of single, six, and eight-LED configurations against Staphylococcus aureus (S. aureus), specifically emphasizing attaining the utmost disinfection efficiency within an extended range of up to 60 cm. With an 8-LED configuration, the study achieved a substantial reduction of 6.10×104 CFU/mL from an initial level of 5.20×109 CFU/mL, corresponding to 4.9-log10 inactivation, requiring a dose of 264 µJ-cm−2. 2.9-log10 inactivation was achieved using a 6-LED, yielding lower yet comparable efficiency requiring 192 µJ-cm−2 of dose. However, with 60 µJ-cm−2 of dose, a single LED could only reduce the bacterial burden from the initial level to merely 0.2-log10 inactivation, corresponding to 2.9 × 109 CFU/mL, under similar exposure settings. In conclusion, UV-LEDs show promise for disinfection, with LED configuration and distance significantly impacting their efficiency, holding perspective for various applications, particularly within healthcare facilities.

Objective: To determine the effect of alpha blocker drugs on reduction of Double J Stent related symptoms. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Urology, The Kidney Centre, Post Graduate Training Institute, Karachi Pakistan, from May 2014 to Nov 2019. Methodology: Total 92 patients who had unilateral stent, inserted retrograde or antegrade, were studied. On 7th postoperative day double J stent related symptoms were documented on Ureteral Stent Symptom Questionnaire and alpha-blocker was started if score is >10. After 4 weeks, data was again collected to assess mean change in Ureteral Stent Symptom Questionnaire score. Results: Of 92 patients, pre-treatment mean Ureteral Stent Symptom Questionnaire score was 38.36±16.07 and post treatment was 14.87±8.62. Mean difference between pre and post Ureteral Stent Symptom Questionnaire score was found significant (p

Upper gastrointestinal bleeding (UGIB) carries a high risk of morbidity and mortality despite recent improvements in diagnosis and management. Many patients failed to respond to initial endoscopic and medical management. Transcatheter arterial embolization (TAE) is now considered the next line of therapy over surgery in refractory UGIB because of its good safety profile and high technical and clinical success rate. We discuss the case of a 66-year-old female patient who presented with massive UGIB and had TAE after endoscopic hemostasis failed. She developed widespread ischemia involving multiple organs following the procedure, including the liver, gallbladder, pancreas, spleen, and small intestine, as a result of an abnormal communication between the gastroduodenal artery (GDA) and superior mesenteric artery (SMA), resulting in PVA particle reflux and widespread ischemic injury. It is important to carefully evaluate the vascular anatomic variations before the procedure to avoid potential complications of ischemia.

Background: Predicting stone clearance before intervention can be useful to plan the modality of treatment and calculate the cost of procedures. Therefore, this study aims to determine the frequency of successful stone clearance in a patient undergoing percutaneous nephrolithotomy (PCNL) with different categories of Guy's Stone Score (GSS). Methodology: A total of 115 patients undergoing standard PCNL from January to December 2018 were included in this study. According to GSS I-IV, patients were then categorized into four groups after having pre-operative Computed Tomography of Kidney, Ureter, and Bladder (KUB). All the patients received standard general anesthesia and underwent standard PCNL in a prone position. The Percutaneous nephrostomy 18-gauge needle is passed into the pelvis of the kidney, Pelvi-calyceal system opacified and confirmed using fluoroscopy, a guidewire is passed, and 30 Fr Amplatz sheath is introduced after serial dilatation. A 26 Fr nephroscope is then inserted through the working sheath, and the stone is fragmented and removed. Finally, a nephrostomy drain tube is kept at the puncture site. The outcome was accessed in terms of stone clearance rate after PCNL on the 2nd postoperative day using the radiological modality of CT-KUB. Results: Among the 115 patients here were 48(41.7%) categorized as GSS I, 26(22.6%) categorized as GSSII, 20(17.4%) categorized as GSS III, and 21(18.3%) categorized as GSS IV. The overall stone clearance observed was 64.3%, individual stone clearance was GSS I=91.66%, GSS II=53.84%, GSS III=50%, and GSS IV=28.57%. Stone clearance among the different GSS categories was significantly different (p

With the global energy crisis, increasing demand, and a national-level emphasis on electric vehicles (EVs), numerous innovations are being witnessed throughout the EV industry. EVs are equipped with sensors that maintain a sustainable environment for the betterment of society and enhance human sustainability. However, at the same time, as is the case for any new digital technology, they are susceptible to threats to security and privacy. Recent incidents demonstrate that these sensors have been misused for car and energy theft, financial fraud, data compromise, and have caused severe health and safety problems, amongst other things. To the best of our knowledge, this paper provides a first systematic analysis of EV sustainability, digital technologies that enhance sustainability, their potential cybersecurity threats, and corresponding defense. Firstly, three robust taxonomies have been presented to identify the dangers that can affect long-term sustainability domains, including (1) life and well-being, (2) safe environment, and (3) innovation and development. Second, this research measures the impact of cybersecurity threats on EVs and correspondingly to their sustainability goals. Third, it details the extent to which specific security controls can mitigate these threats, thereby allowing for a smooth transition toward secure and sustainable future smart cities.

Objective:The aim of this study is to compare safety and efficacy of supine versus prone percutaneous nephrolithotomy (PCNL) in terms of stonefree rate, operative time, anesthesia time and blood loss in a retrospective case-control trial.Materials and Methods:Fifty patients underwent supine PCNL during the study period (group A). Equal number of patients, who underwent prone PCNL during same period with similar demographic and clinical attributes, were taken as controls (group B). Demographic details, such as gender and age, and body mass index, stone size, stone location and stone laterality were comparable between the two groups. Pre- and post-operative hemoglobin (Hb) levels in patients in both groups were tabulated. Variables analyzed to compare the groups included operative time, anesthesia time, fall in Hb, blood transfusion, stone clearance and need for auxiliary procedure.Results:The median operative time (minutes) in patients of group A [35; interquartile ratio (IQR): 25], was significantly different from group B (70; IQR: 40) (p=0.000). The median anesthesia time (minutes) in patients in group A (50; IQR: 25) was significantly different from group B (85; 45) (p=0.000). The median fall in Hb (g/dL) in patients in group A (1.700; IQR: 1.2) was significantly different from group B (1.200; IQR: 2.4) (p=0.967). Two patients in group A and 7 in group B needed blood transfusion (p=0.080). Thirty two patient in group A and 34 in group B achieved stonefree status (p=0.833). Eleven patients in group A and 6 in group B needed auxiliary procedure in the form of extracorporeal shockwave lithotripsy (p=0.287).Conclusion:Supine PCNL is as safe and effective as conventionally performed prone PCNL, with an added benefit of decreased operative and anesthesia time.

The growing use of the internet has resulted in an exponential rise in the use of web applications. Businesses, industries, financial and educational institutions, and the general populace depend on web applications. This mammoth rise in their usage has also resulted in many security issues that make these web applications vulnerable, thereby affecting the confidentiality, integrity, and availability of associated information systems. It has, therefore, become necessary to find vulnerabilities in these information system resources to guarantee information security. A publicly available web application vulnerability scanner is a computer program that assesses web application security by employing automated penetration testing techniques that reduce the time, cost, and resources required for web application penetration testing and eliminates test engineers’ dependency on human knowledge. However, these security scanners possess various weaknesses of not scanning complete web applications and generating wrong test results. Moreover, intensive research has been carried out to quantitatively enumerate web application security scanners’ results to inspect their effectiveness and limitations. However, the findings show no well-defined method or criteria available for assessing their results. In this research, we have evaluated the performance of web application vulnerability scanners by testing intentionally defined vulnerable applications and the level of their respective precision and accuracy. This was achieved by classifying the analyzed tools using the most common parameters. The evaluation is based on an extracted list of vulnerabilities from OWASP (Open Web Application Security Project).

Background: Nephrostomy tract itself is the most common source of hemorrhage during percutaneous nephrolithotomy, which can be avoided by puncturing through the calyx with minimal angulation between calyceal system and the nephroscope shaft. Smaller the sheath diameter, lesser would be the bleeding. Our objective was to compare mean change in hemoglobin (HB) level in patients undergoing percutaneous nephrolithotomy (PCNL) with 24 versus 30 French Amplatz sheath. Methods: In this study, 142 patients were randomly divided into Group A undergoing procedure with 24 French Amplatz sheath; and Group B with 30 French sheath. At the end of procedure in both groups, nephrostomy tube was kept for 24 hours. On first post-operative day, patients’ HB was checked and compared with pre-operative data, along with blood transfusion rates. SPSS 20 was used for data analysis and p-value < 0.05 was considered significant. Results: Median age and interquartile range of Group-A and Group-B patients was (40; 18) and (41; 21) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000]. Conclusion: It was observed that use of 24 French Amplatz sheath lead to less renal hemorrhage and less hemoglobin drop compared to standard 30 French Amplatz sheath. Thus, small size Amplatz sheath in percutaneous nephrolithotomy may be considered effective and safe option for treatment of renal stones.

The Internet of Things (IoT) is an emerging field consisting of Internet-based globally connected network architecture. A subset of IoT is the Internet of Healthcare Things (IoHT) that consists of smart healthcare devices having significant importance in monitoring, processing, storing, and transmitting sensitive information. It is experiencing novel challenges regarding data privacy protection. This article discusses different components of IoHT and categorizes various healthcare devices based on their functionality and deployment. This article highlights the possible points and reasons for data leakage, such as conflicts in laws, the use of sub-standard devices, lack of awareness, and the non-availability of dedicated local law enforcement agencies. This article draws attention to the escalating demand for a suitable regulatory framework and analyzes compliance problems of IoHT devices concerning healthcare data privacy and protection regulations. Furthermore, the article provides some recommendations to improve the security and privacy of IoHT implementation.

Objective: Percutaneous nephrolithotomy (PCNL) is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA) would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI), stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb) and hematocrit (Hct) levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05). Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR) 4, while in TA group was 1.3 (IQR 7.8) (p=0.001). Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8) and in TA group was 2.4 (IQR 13) (p

Wireless Sensor Networks (WSN) is a network of sensors, actuators, mobile and wearable devices that have processing and communication modules to monitor physical and environmental conditions. Currently millions of these type of smart devices serving in many fields like military, environment, and health services. Due to their unique deployment places even in hostile territories WSN are subject to various kinds of attacks. Self configuration, autonomous device addition, network connection and resource limitation are the main features of WSN that makes it highly prone to network attacks. Denial of Service (DoS) attacks which targets the availability of a WSN system is one of the most potent threat to which a WSN must be resilient in order to continue operations. This studies aim to analyze and classify the WSN DoS threats and their countermeasures. Based on the survey we present the best approach to designing a WSN resilient against DoS attacks.

Our study investigates vertebral fractures in individuals with distal radius fractures. Among 512 patients, 41.21% had vertebral fractures, predominantly in the lumbar spine. These findings highlight the importance of screening for vertebral fractures in this population, informing early intervention strategies to mitigate risks associated with osteoporosis., Purpose: This study's main goal was to look into the frequency, location, kind, and severity of asymptomatic vertebral fragility fractures (VFF) in people who had fractures of the fragility of the distal radius. Although VFF is frequently misdiagnosed, it is linked to higher mortality, morbidity, and hip fracture risk. The study also attempted to investigate the relationship between VFF and certain demographic and lifestyle factors, as well as FRAX data, in this patient population., Methods: Between January, 2021, and January, 2022, individuals with low-energy distal radial fractures who presented to the emergency room of tertiary care hospital of Karachi, Pakistan, were the subject of a cross-sectional study and were 45 years of age or older except those who fitted the exclusion criteria (n = 208). The thoracic and/or lumbar spine was imaged using radiology, and information on demographics, way of life, and FRAX (Fracture Risk Assessment Tool) was gathered. Using the Genant semiquantitative approach, an impartial and blinded orthopaedist identified VF in the images and determined their severity. SPSS version 20 was used to analyse the data., Results: Two hundred eleven (41.21%) of them were found to have radiographic VFF and only 12 (2.34%) of the 512 patients who were tested were getting osteoporotic therapy. The thoracic spine (32.7%), followed by the lumbar spine (43.12%), was the area most frequently afflicted. In 24.17% of the patients, multiple fractures of the thoracolumbar spine were found. The wedge form (54.5%), followed by biconcave (30.81%) and crush (14.7%), was the most prevalent VFF type. The majority of detected VFF were rated as having a 25-40% height loss (64.9%) then severe (> 40%) fractures (35.1%), according to the Genant grading method. Notably, there were no variations in smoking, drinking, BMI, or FRAX score between patients with and without VFF that were statistically significant., Conclusion: Based on our study's findings, it is clear that osteoporotic vertebral fragility fractures occur in almost half of individuals with distal radius fractures. The lumbar spine is notably the most affected region, predominantly with wedge fractures. Given the high prevalence of asymptomatic vertebral fragility fractures (VFF), proactive measures are necessary to mitigate associated risks. Prioritising comprehensive fall risk assessments for these patients and interventions to enhance bone mineral density and strength are crucial. Early identification of asymptomatic VFF enables timely intervention, optimising patient care and minimising the risk of complications in this vulnerable population., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Motorbike spoke wheel injuries (SWIs) among children are a notable public health concern, especially in low and middle-income regions. The primary objective of this study is to comprehensively examine the patterns of motorbike spoke wheel injuries (SWIs) in children. Additionally, the study introduces a novel classification system for these injuries. The implementation of this classification system aims to streamline the management of SWIs, making it more efficient and facilitating the development of standardized treatment protocols. This prospective observational study was conducted in the Accident and Emergency Department from January 2019 to 2021. Children < 14 years of age of either gender with foot and ankle injury due to motorbike spoke wheels as passengers and presenting within 3 days were included. The motorbike SWI was assessed for its location and classified by a new classification as Class I, Soft tissue injury without skin loss; Class II, Skin loss of more than 1 cm without underlying tissue involvement; Class III, Skin loss with underlying tissue involvement, this class is further divided on basis of underlying soft-tissue involvement; Class IV: mangled foot/toe. Management plan and outcome were noted. In our study158 children suffering from SWI were registered with a mean age of 6.2 ± 5.4 years, 127 (80.37%) males and 31 (19.62%) females. Class I injury was seen in 18 (11.39%) patients, class II in 69 (43.67%), and class III in 68 (43.03%) patients. Class III injuries were further subcategorized as follows: IIIT (Tendon) injuries, which accounted for 32 cases (20.25%); IIIB (Bone) injuries, with 29 cases (18.35%); and IIINV (Neurovascular) injuries, identified in 7 cases (4.43%). Class IV injuries were observed in 3 (1.8%) children. The flap was needed in 33 (20.88%) patients. There were no complications like flap necrosis or graft rejection. In this current study, a new classification system specific for a motorbike SWI has been introduced along with its application on children presenting at tertiary care hospital's emergency department. The application of the proposed classification will enable universal management guidelines for SWIs, especially in the Ino-Pak region where SWIs are common., (© 2023. The Author(s).)

Grounded in self-regulation theory, this research assesses the relationship between employees' experiences of workplace ostracism and organizational deviance, further exploring the mediating function of procrastination and the buffering role of psychological flexibility. Results based on longitudinal (three-wave) data collected from employees in North American organizations illustrate that workplace ostracism elicits organizational deviance because employees suffer from impaired self-regulation, shown through procrastination. Accordingly, this study identifies procrastination as a way by which workplace ostracism facilitates organizational deviance but highlights that the association between procrastination and deviant behavior is mitigated when employees can actively engage in psychological flexibility. Examining the interplay between these variables may present an opportunity to potentially understand how to curb adverse workplace outcomes by encouraging employees to adapt their behaviors in the pursuit of organizational goals, despite the distracting thoughts and emotions associated with the experience of workplace ostracism.

Background: Review of the published articles does not show any study done to see if children with torus fracture are with Vitamin D deficiency. The aim of this study was to determine association of inadequacy of Vitamin D level with torus fracture and its predictors in children in Karachi Pakistan., Methods: Patient underage of 13 years came with torus fracture were included in study, and managed non-operatively with below elbow cast. Proforma was made which includes demographic data (age, gender, nutritional status) and exposure to sunlight, dietary habits, kind to apparel and type of accommodation they were living at. All participants underwent measurement of serum vitamin D level., Results: Out of 558 children presented with limb fractures in emergency department, 190 (34.05%) had torus fracture, with mean age of 6.0 ± 4.2 years. 93 (48.94%) in pre-school group, 59 (31.05%) in school and 38 (20%) were breast-fed. On nutritional status, malnourished were 72 (37.89%), out of which 32 (44.44%) had first-degree malnutrition. On vitamin D level status only 52 (27.36%) participants had Vitamin D within normal range while 86 (45.26%) were found Vitamin D deficient. We found that vitamin D level is directly related to nutritional status, duration of sun exposure maternal vitamin d levels and not significantly related to age, gender, type of accommodation and different fabric types., Conclusion: In this study torus fracture in children is significantly associated with Vitamin D deficiency, with common predictors including nutritional status, maternal Vitamin D level for lactating mothers and duration of exposure of sunlight. Vitamin D supplementation in children can prevent a significant number of fractures via national programs for food fortification and increase the awareness of general population on the importance of sunlight exposure and intake of food rich in Vitamin D., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objectives: To establish a reliable XN-HPC cutoff, for an effective CD34 + cell count of ≥2 × 10 6 cells/kg of the recipient's body weight, in harvested bone marrow products in allogenic transplantation., Methods: The study was carried out in two phases. In retrospective Phase 1, data from 47 donors were analyzed. Sysmex analyzer XN-20 and BD FACS Calibur were employed to process XN-HPC and CD34 + cell enumeration, respectively. To make the two variables comparable, both XN-HPC and CD34 + cell counts were reported as the number of cells/kg of the recipient's body weight. Spearman's rank correlation coefficient was calculated for CD34 + cells and XN-HPC, followed by the calculation of the receiver operating characteristic (ROC) curve to identify the XN-HPC value which could effectively predict the cutoff of ≥2 × 10 6 CD34 + cells/kg of the recipient's body weight. In Phase 2, the computed XN-HPC cutoff was validated in a prospective set of 53 donors by obtaining the positive and negative predictive values., Results: Statistically significant correlation was obtained between XN-HPC and CD34 + cell count with Spearman's rho of 0.54 ( p -value <0.001). The optimal XN-HPC cutoff, for the required CD34 + ve cell count of ≥2 × 10 6 cells/kg of the recipient's body weight, was calculated to be ≥2.80×10 6 cells/kg of the recipient's body weight with the specificity and sensitivity of 100% and 31%, respectively. The ROC curve demonstrated the area under the curve to be 0.74. Phase 2 validation revealed 100% PPV., Conclusions: For harvested bone marrow products with XN-HPC of ≥2.80×10 6 cell/kg of the recipient's body weight, CD34 + cell enumeration by flow cytometry can safely be disposed of.

Rooted in research into personality, we propose that the Big Five traits would be related to fear of COVID-19 (FOC), which in turn would lead to heightened job burnout, reduced job satisfaction, and decreased performance. Utilizing a three-wave time-lagged design, we collected our data from employees working in the United States and Canada ( N  = 300 × 3). We found good support for our hypotheses. Extraversion, neuroticism, and conscientiousness had significant direct effects on FOC. Fear of COVID-19 was positively related to job burnout and negatively related to job satisfaction and performance. Extraversion, neuroticism, and conscientiousness had significant indirect effects on burnout, job satisfaction, and job performance via FOC. Hence, this study identifies a key mechanism, an individual's worry about losing their valuable resources (e.g. their health, and that of their family members and friends, etc.), through which selected dimensions of personality might affect employees' work outcomes. We discuss our findings and provide suggestions for future research in this domain., Competing Interests: There is no conflict of interest between authors., (© 2022 International Association of Applied Psychology.)

Objective  This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods  We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results  The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p  = 0.178), in the knee society score (78.67 versus 81.46; p  = 0.33), recurrence (0 versus 0%; p  = 1), and complications (25 versus 7.69%; p  = 0.21). Conclusions  Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: This study aims to evaluate the awareness of osteoporosis and related risk factors in elderly Asian patients who present with distal radius fractures. The distal radius fracture is one of the most frequent fractures in the elderly cohort, owing to osteoporosis, and maybe a harbinger for further fractures, however, data is scarce regarding awareness of this condition among these patients., Method: This cross-sectional study was conducted on patients aged 45 and above that presented in the emergency department with low-energy distal radial fractures in Karachi from January-December 2018. Data were collected via a self-designed questionnaire, assessing the demographic information, knowledge about osteoporosis and its risk factors. The data was analysed using SPSS 20 for statistical significance., Results: From a total of 550 patients with a mean age of 70.5 ± 32.82 years, there were 442 (80.36%) females and 108 (19.63%) males. On educational consideration, 243 (44.18%) patients could not read or write and only 110 (20%) of the patients received secondary school education. Only 123 (22.36%) were well informed about osteoporosis, the predominant source of information being their physician. There were 427 (77.63%) patients who were unaware of osteoporosis, 16% of which were smokers, 26% indicated they exercised at least 30 minutes daily, and 2% reported drinking alcohol occasionally. On dietary supplements, 24.27% of patients reported calcium and 17.81% reported vitamin D supplement consumption on regular basis., Conclusion: We found a positive correlation between a patient's education status and osteoporosis awareness We believe that the role of the physician could be crucial in preventing further fractures in such patients via physician lead educational campaigns to target modifiable risk factors., (© 2021 John Wiley & Sons Ltd.)

To investigate how employees' impression management behavior, targeted upward at organizational leaders, relates to their peer-rated organizational influence, this study considers both a mediating role of peer-rated workplace popularity and a moderating role of self-rated social dominance orientation. Multisource, three-wave data from employees and their peers in the power-distant, collectivistic country of Pakistan reveal that upward impression management behavior, despite raising some potential organizational concerns, is associated with peer-rated workplace popularity for employees, who in turn can wield greater influence over colleagues. The mediating role of peer-rated workplace popularity also is more prominent to the extent that employees accept social hierarchies, because this orientation makes their use of upward impression management tactics to advance their own and their peers' personal interests more purposeful.

With a basis in the transactional theory of stress and coping, this study investigates the relationship between employees' exposure to workplace ostracism and their job performance, while also considering the mediating role of acquiescence silence and the moderating role of mindfulness. Multisource, three-wave data from employees and their peers in Pakistani organizations reveal that ostracism in the workplace hinders job performance because employees passively withhold relevant ideas about their work due to feelings of acquiescence. The mediating role of acquiescence silence is mitigated if employees can draw from their mindfulness trait. This study accordingly identifies a key mechanism - the passive withholding of pertinent ideas, based on submission - by which workplace ostracism hampers job performance, and it reveals how this process might be contained by encouraging employees' receptive attention and awareness focused on present experiences.

Introduction Many young females present with an advanced stage of breast cancer, which has a negative effect on the prognosis. Digital breast tomosynthesis is a new emerging imaging technique that aids in improving the specificity of mammography with subsequent early detection of breast cancer, especially in women with radiographically dense breasts. Tomosynthesis is subjectively preferred to conventional mammography and may offer superior diagnostic accuracy for the evaluation of breast lesions. Method Two breast radiologists retrospectively reviewed asymmetric densities using protocols that were institutional review board-approved in 185 patients aged 18 - 70 years (mean: 48 years) who underwent diagnostic mammography and tomosynthesis. Each asymmetric density was interpreted once with tomosynthesis and once with supplemental mammographic views; both modes included the mediolateral oblique and craniocaudal views in a fully crossed and balanced design by using a five-category Breast Imaging Reporting and Data System (BI-RADS) assessment and a probability-of-malignancy score. If the abnormality persisted and appeared benign or completely disappeared on both modalities, the agreement between additional views and tomosynthesis was determined by calculating Kappa value. If there was a discrepancy between additional views and tomosynthesis, the abnormality was subjected to ultrasound. In our study, 89 asymmetric densities were subjected to ultrasound. Results In a total of 182 cases, 84 (46.15%) were categorized as BIRADS-0; 97 (53.30 %) as BIRADS-I, and one (0.55 %) as BIRADS-II on an additional view. Among the asymmetric densities categorized as BIRADS-0 on additional mammography views, digital breast tomosynthesis categorized 72, six, five, and one patient as BIRADS-0, BIRADS-I, BIRADS-II, and BIRADS-IV, respectively. For densities categorized as BIRADS-I (97) on additional view, digital breast tomosynthesis categorized 10 and 87 densities as BIRADS-0 and BIRADS-I, respectively. No change in the BIRADS category was observed among BIRADS-II and BIRADS-IV. A significant difference was observed with the chi-square test among BIRADS categories assigned by an additional view and digital breast tomosynthesis with a p-value of < 0.001. There was, however, a substantial agreement among additional views and tomosynthesis with a kappa value of 0.767. Conclusion Our study results suggest that tomosynthesis may be equivalent to, if not more equivalent to, additional imaging in the assessment of mammographically-detected asymmetric densities, thus improving BI-RADS classification and patient management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Waheed et al.)

With a basis in conservation of resources theory, this study investigates the relationship between employees' exposure to perceived contract breaches and their job performance, while also considering the mediating role of knowledge hiding and the moderating role of positive affectivity. Multisource, three-wave data from employees and their peers in Pakistani organizations reveal that breaches in the psychological contract hinder job performance, because employees respond with an unwillingness to contribute valuable knowledge to execute their job tasks. This mediating role of knowledge hiding is mitigated if employees can draw from their own positive affectivity trait. This study accordingly identifies a key factor, intentional attempts to conceal knowledge requested by other members, that can backfire and make employees suffer doubly: from unfulfilled organizational promises and from lower performance. It also reveals how this risk might be contained, that is, by encouraging employees' positive affect.

Introduction Magnetic resonance imaging (MRI) is widely used in the evaluation of cervical canal stenosis and spinal cord compression. Kang et al. formulated a new MRI grading system for assessing canal stenosis which takes cord signal change into account. The purpose of the study was to determine the agreement between Kang's grading system and neurological symptoms. Methods  A cross-sectional study was conducted at Aga Khan University Hospital between April 2014 and December 2015. Patients meeting inclusion criteria were enrolled. T2 sagittal and T2 axial MRI images were acquired and reported by a consultant neuroradiologist, in accordance with the MRI grading system suggested by Kang et al. Neurologic clinical symptoms were acquired by the history taken by the principal investigator. More than one neurologic symptoms and Kang MRI grade 2 or 3 were taken as positive evidence of cord compression resulting from canal stenosis. Results Amongst 126 subjects, 54% were females. Mean age of patients was 50.3 ± 14.3 years (range 19-83 years). Average disease duration was 4.61 ± 3.73 (range 1-24 months). In the majority of the patients, the findings were found at the C5-C6 level. 65.1% of patients were identified positive for cervical canal stenosis by Kang grading system. Most common neurological symptoms were pain (99%) and numbness (56%). Cohen's Kappa was run to evaluate the agreement between neurological symptoms and Kang grading system. There was a strong agreement between the two methods, K = 0.81 (95% CI 0.70-0.92), p < 0.001. Conclusion There was a substantial agreement between Kang's grading system and the presence of clinical symptoms. The agreement was greatest in females, older patients, and those with longer duration of symptoms., Competing Interests: The authors have declared that no competing interests exist.

Background: Platelet concentrates represent a new approach to improve tissue regeneration and can be used alone or together with autogenous bone, recombinant human growth factors, and/or other biomaterials, to enhance tissue regeneration. Among platelet concentrates, concentrated growth factors (CGFs) exhibit an interesting clinical and biotechnological application potential., Objective: The aim of this study was to evaluate the in vitro release of 4 growth factors (bone morphogenetic proteins [BMP] -2, BMP-7, transforming growth factor [TGF] -β1, and insulin-like growth factor [IGF] -1) by the enzyme-linked immunosorbent assay (ELISA) technique, in CGFs mixed or not with β-tricalcium phosphate (β-TCP), using or not the Round-up device, at different times., Methods: CGFs were obtained from healthy volunteers, mixed or not with β-TCP, using or not the Round-up device. The release of 4 growth factors from these CGFs was then measured at 5 hours, 1, 3, 6, and 8 days, using the ELISA assay., Results: Comparison of the results obtained with those achieved for CGFs alone showed that BMP2 and BMP-7 release, significantly increased in CGFs mixed with Round-up and β-TCP, TGF-β1 release was similar to CGFs alone, whereas IG-1 release was lower compared with CGFs alone., Conclusion: The present data suggest that β-TCP addition to CGF could enhance and improve tissue regeneration, especially bone regeneration, increasing the release of some growth factors that play an important role in osteogenesis.

Background: The three-wheeler Qing-qi and Compressed Natural Gas (CNG) auto-rickshaws were introduced in Karachi to meet the transportation demand of the growing population. These vehicles have directly or indirectly been implicated in a number of road traffic violations as well as road accidents. This study aims to describe the crash characteristics and injury patterns for Qing-qi rickshaw occupants and other road users hit by Qing-qi rickshaw in Karachi, Pakistan., Methods: An Observational/ Descriptive study was conducted at Accident & Emergency and Orthopaedic Surgery Department, Jinnah Post Graduate Medical Centre, Karachi Pakistan from July 2014 to June 2015.All patients who came with Qing-qi rickshaw accident in Accident & Emergency (A&E) of JPMC were included. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews., Results: Four hundred and eighty-six rickshaw related injuries were noted in road traffic accidents by Qing-gi rickshaw. Age range was 2-85 (43.5±58.68). 350 injured victims were males and 136 were females. By occupation most victims were laborers and daily wage workers (45%) and students (21%). Overloading of vehicle with more than two passengers was found in (28.5%). The most common cause of injury was collision with a moving vehicle (56%), followed by fall from rickshaw. The most common contributing factor was the overloading of rickshaw and roll over on turning (61%). Injury severity on arrival were mild (49%), moderate were (32%), and severe were (19%). Injuries related to head and neck (26%), face (14%), thorax and abdomen (5%), lower extremity and pelvic girdle (31%) and upper extremity (23%) were observed., Conclusions: Qing-qi rickshaw injuries are common and these vehicles are vulnerable to road traffic accidents. Occupants and road users are both at risk of injuries.