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Yaqoob Qaseem,1 Kirk Kohwa Hou,1,2 Moritz S Pettenkofer1 1Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; 2Doheny Eye Institute, Los Angeles, CA, USACorrespondence: Moritz S Pettenkofer, Retina Division, Stein Eye Institute, University of California Los Angeles, 200 Stein Plaza Driveway, Los Angeles, CA, 90095, USA, Email mpettenkofer@mednet.ucla.eduPurpose: To examine response to faricimab in neovascular age-related macular degeneration (nARMD) refractory to traditional anti-vascular endothelial growth factor (anti-VEGF) agents.Patients and methods: Retrospective chart review was conducted on eyes with nARMD with persistent subretinal and/or intraretinal fluid despite previously receiving ≥ 15 injections with ≥ 2 different anti-VEGF agents. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters were collected at baseline, initial post-injection visit, and most recent visit with OCT following last faricimab.Results: Nineteen eyes were included. Average logMAR BCVA was 0.47 ± 0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92 μm at baseline, 279 ± 88 μm at initial follow-up (p = 0.001), and 274 ± 100 μm at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both initial and final follow-up visits.Conclusion: Faricimab mildly decreased CST and reduced fluid in some nARMD eyes refractory to traditional anti-VEGF agents but had minimal effect on BCVA.Keywords: anti-VEGF, choroidal neovascularization, faricimab, neovascular age-related macular degeneration

The composition, structure and distribution of vegetation are influenced by diverse environmental factors. Such research inquiries provide the initial data for future conservation and management efforts. The study area of North Waziristan district, Khyber Pakhtunkhwa, Pakistan comprises diverse forests of the Spin Ghar Mountain Range (at the border areas of Pakistan and Afghanistan), and a highly remote, mountainous, and unexplored region. There was little information on the complex relationships that existed between the study area's ambient environment and vegetation. This study hypothesized that the varying environmental complexity in the study area and vegetation variety may be significantly correlated, and the ranking of leading influencing factors might enhance our ecological understanding. A total of 61 study sites comprising 183 transects (50 m each) were randomly selected to record the vegetation-environment data from January-2018 to December-2020 (3 years). Monte Carlo permutation testing, hierarchical clustering of study samples, indicator species analysis, and ordination were applied to assess the sampling data. The results indicated that there were a total of 391 vascular plant species which were further classified into seven significantly different (p

Dependence on the depleting fossil fuels, particularly in the transportation sector, calls for sustainable, green solutions such as electrification, which address the challenges of providing alternate sources of power at low emissions. Electric vehicles are the centerpiece of the transportation electrification sector. Reducing the time for charging from hours to a few minutes gives an extra sheen to the prospect of transportation electrification. However, massive upscaling of the electric power infrastructure is required to accommodate the demands of large-scale transportation electrification. This article explores a sustainable strategy involving distributed energy resources to meet the elevated power and energy demand due to DC fast charging and ultra-fast charging EV load on the electric power distribution network. The mixed integer quadratic optimization model developed ensures seamless integration of the renewable resources, the EV load, and the distribution grid while adhering to the power quality constraints. This paper demonstrates that it is possible to serve a 155 kW aggregated (peak power load) DC fast charging load with a 100 kW interconnect. Similarly for an ultrafast -charging station a peak reduction factor of 9.11 compared to unmanaged charging is achieved at the interconnection point. The methodology is developed, and results are compared against a rule-based system for multiple scenarios. Additionally, validation based on OPAL RT RT-4500 for a sample scenario is presented.

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

Abstract Clinical practice and public health guidelines are important tools for translating research findings into practice with the aim of assisting health practitioners as well as patients and consumers in health behavior and healthcare decision-making. Numerous programs for guideline development exist around the world, with growing international collaboration to improve their quality. One of the key features in developing trustworthy guidelines is that recommendations should be based on high-quality systematic reviews of the best available evidence. The review process used by guideline developers to identify and grade relevant evidence for developing recommendations should be systematic, transparent and unbiased. In this paper, we provide an overview of current international developments in the field of practice guidelines and methods to develop guidelines, with a specific focus on the role of systematic reviews. The Guidelines International Network (G-I-N) aims to stimulate collaboration between guideline developers and systematic reviewers to optimize the use of available evidence in guideline development and to increase efficiency in the guideline development process. Considering the significant benefit of systematic reviews for the guideline community, the G-I-N Board of Trustees supports the international prospective register of systematic reviews (PROSPERO) initiative. G-I-N also recently launched a Data Extraction Resource (GINDER) to present and share data extracted from individual studies in a standardized template. PROSPERO and GINDER are complementary tools to enhance collaboration between guideline developers and systematic reviewers to allow for alignment of activities and a reduction in duplication of effort.

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The study aimed to compute the effective dose (E) and size-specific dose estimate (SSDE) of routine adult patients undergoing thorax and abdominal computed tomography (CT) imaging and to present their multivariate analysis. All adult thorax and abdominal CT examinations conducted from March 2022 to June 2022 were prospectively included in this study. The Water Equivalent Diameter (Dw) and SSDE of all the examinations were computed from CT dose index volume (CTDIvol) and Dose length product (DLP) displayed on the dose report in the CT console. The multivariate statistical analysis was performed to investigate the correlation of SSDE and E on CTDIvol, Dw area of the region of interest (ROI) (AreaROI), body mass index (BMI), conversion factor (fsize) and hounsfield (HUmean) number in the ROI at 95% level of significance (P < 0.05). The linear regression analysis was performed to investigate the dependence of SSDE and E on other parameters for both abdominal and thorax patients. A total number of 135 (Abdomen = 61 and Thorax = 74) measurements were performed. The mean value of effective dose for abdomen and thorax patients was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv, respectively. The SSDE was observed to be 13.24 ± 3.61 and 13.04 ± 3.61 mGy for thorax and abdomen respectively. The multivariate analysis suggests that SSDE for abdominal CT is found significantly dependent on CTDIvol, Dw and fsize with P < 0.05 and E is found to be significantly dependent on DLP, AreaROI, Dw and fsize at 95% level of confidence for abdominal CT imaging. SSDE for thorax CT was found significantly dependent on BMI, CTDIvol, HUmean, Dw and fsize at 95% level of confidence. Furthermore, E was observed dependent on DLP at P < 0.05. The linear regression analysis also shows that E is strongly correlated with DLP (r = 1.0) for both thorax and abdominal CT, further the SSDE was observed strongly correlated with CTDIvol with r = 0.79 and r = 0.86 for abdomen and thorax CT respectively. A strong correlation was observed between BMI and for Dw abdominal CT imaging (r = 0.68). The mean value of SSDE for thorax is slightly greater than abdomen. The average value of effective dose for abdomen and thorax measurements was found to be 7.17 ± 3.94 and 4.89 ± 2.16 mSv and , correspondingly. SSDE for both abdomen and thorax CT is significantly dependent on CTDIvol, Dw and fsize at 95% level of confidence. The strong correlation was also observed E on DLP and SSDE on CTDIvol for both Abdomen and Thorax CT. The strong dependence of Dw on BMI (r = 0.68) is due to the excessive fat concentration around the stomach and abdomen.

The present study was conducted to determine the relationship between compassionate and self-image goals with academic resilience among undergraduate students. For this study, Compassionate and Self-Image Goals Scale developed by Crocker and Canevello (2008) and Academic Resilience Scale developed by Cassidy (2016) were used. The study was conducted with 140 undergraduate students at Aligarh Muslim University, Aligarh, India. Participants were selected through a simple random sampling method. The correlation technique was used to analyze the data. The results revealed that more females had compassionate goals in comparison to males. The findings also revealed that students having compassionate goals were highly academically resilient. The result also highlighted that students belonging to science faculty having compassionate goals were highly academically resilient in comparison to students belonging to non-science faculty. It further revealed that students having self-image goals belonging to science and non-science faculties were not highly academically resilient.

The study aimed to identify the effect of using Jigsaw strategy in teaching science on the acquisition of scientific concepts among the fourth graders of Bani Kinana Directorate of Education compared to the traditional way. The study sample consisted of 70 male and female students, divided into two groups: experimental and control where the students of the experimental group studied through the Jigsaw strategy and the students of the control group studied the same units in the traditional way.An achievement test was developed in the mentioned units of science to measure the extent of the acquisition of scientific concepts, which had sufficient validity and reliability. The test was applied on the study sample and the appropriate statistical analyses were conducted. The results indicated that there were statistically significant differences at the significance level (0.05) for the variable of the group in the post measurement as the value of (F) was (18.366) by a statistical significance of (0.000), and the differences were in favor of the experimental group and that there were no statistically significant differences at the level of (0.05) for the variable of gender. The researcher recommended the adoption of the teaching method by using the Jigsaw strategy in teaching science because of its effect on the acquisition of scientific concepts.

In the United States, several performance measures that address the treatment of pain are used in payment, public reporting, and accountability programs. The American College of Physicians embraces performance measurement as a means to improve quality of care but believes that a performance measure must be methodologically sound and evidence-based in order to be considered for inclusion in payment, accountability, or reporting programs. This paper reviews current performance measures for pain to inform stakeholders' selection of measures to implement. Pain is a debilitating symptom generally caused by injuries or various conditions. It can be acute, subacute, or chronic and can have a significant impact on a patient's quality of life. The goal of managing pain is to relieve or reduce suffering and improve patient functioning. Several performance measures that address the treatment of pain are used in payment, public reporting, or accountability programs. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care. ACP believes that a performance measure must be methodologically sound and evidence-based to be considered for inclusion in payment, accountability, or reporting programs. However, a plethora of performance measures that provide minimal or no value to patient care have inundated physicians, practices, and systems with the burden of collecting and reporting data. ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. There is a need for a higher standard for a performance measure when reputation and reimbursement are on the line. This paper aims to present a review of current performance measures for pain to inform physicians, payers, and policymakers in their selection and use of performance measures. The PMC reviewed 6 performance measures for pain relevant to internal medicine physicians, of which 3 were considered valid at their intended levels of attribution ("Use of Imaging for Low Back Pain," "Use of Opioids at High Dosage in Persons Without Cancer," and "Use of Opioids From Multiple Providers in Persons Without Cancer"). This paper also proposes a performance measure concept to address a quality-of-care gap based on the current clinical guideline from ACP and the American Academy of Family Physicians, "Nonpharmacologic and Pharmacologic Management of Acute Pain From Non–low Back, Musculoskeletal Injuries in Adults." [ABSTRACT FROM AUTHOR]

The study aimed to explore the trends of the male and female teachers of the basic elementary stages towards using the Smart Board in Bani Kinanah Directorate of Education and the relationship of some variables such as sex, academic qualification, and years of experience. The study sample consisted of (130) male and female teachers. To achieve the objectives of the study, data were collected using a questionnaire to measure the trend towards Smart Board after confirming its validity and reliability; to statistically process data, the arithmetic means, standard deviations, and 3-way-ANOVA were used.The results of the study indicated the existence of a high and statistically significant degree in the trends of the male and female teachers of the basic elementary stages towards using the Smart Board as a whole where the arithmetic mean was (3.79). The results also showed no statistically significant differences at the level of significance (a=0.05) in the trends of the male and female teachers of the basic elementary stages towards using the Smart Board from the perspective of the male and female teachers in Bani Kinanah Directorate of Education according to the variables of (sex, years of experience, and scientific qualification), where the "F" values were not statistically significant.

This study aimed at exploring the level of Diagnostic Tests' Preparation Skills among the teachers of the first Three Elementary Grades at the Directorate of Education of Bani Kinana District, and its relationship to the variables of gender, academic qualification, and years of experience. The sample of the study consisted of (264) male and female teachers. In order to achieve the aims of the study, data were collected through a questionnaire that was developed for measuring the level of attitudes towards the preparation of diagnostic tests. Validity and reliability of the scale were tested. Statistical analyses applied included means, standard deviations, 3-way ANOVA. Results showed a medium degree of the presence of a moderate level of diagnostic tests' preparation skills among the teachers of the first elementary grades in the Directorate of education in Bani Kenanah district, with a mean of (3.56). Results showed also lack of statistically significant differences at the significance level of (a=0.05), in the level of diagnostic tests' preparation skills among the teachers of the first three elementary grades in the directorate of education in Bani Kenanah District, due to the variables of gender and number of years of experience. Results showed statistically significant differences, at the significance level of (a=0.05) in the diagnostic tests' preparation skills among the teachers of the first elementary grades in the Directorate of education in Bani Kenanah district, due to the variable academic qualification. The difference was between (high diploma) and (M.A. degree or Higher), and on behalf of the (M.A. degree or more).

Purpose: To study the imaging and clinical perspectives of a recent epidemic of rhinocerebral mucormycosis during the COVID-19 (coronavirus disease) pandemic in India. Materials and Methods: This retrospective study included clinical and imaging data of 24 diagnosed cases of acute rhinocerebral mucormycosis who were presented to our hospital in May 2021. The clinical profile and imaging data of the patients were documented. Results: 18 patients (75.0%) had moderate to severe COVID-19 illness with a history of oral or intravenous corticosteroid intake. 19 patients (79.2%) had presented with hyperglycemia at the time of admission. Nasal discharges with or without black crusts and facial swelling (79.2%) were the most commonly reported complaints, followed by headaches or facial pain (62.5%). All cases demonstrated the involvement of one or more paranasal sinuses in imaging, with predominantly unilateral involvement. Extra sinusoidal involvement was commonly seen, with abnormalities seen in retromaxillary and masticator space, orbit, face, oral cavity, pterygopalatine fossa, and deep spaces of the neck, cavernous sinus, and brain. Conclusion: An upsurge of mucormycosis cases during the COVID-19 pandemic appears to be closely related to uncontrolled hyperglycemia and corticosteroid therapy. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable in establishing an early diagnosis, defining the extent of disease, and helping in immediate surgical planning.

[This corrects the article DOI: 10.1371/journal.pone.0224061.].

The current study was conducted on the valley of Duhok and the agricultural lands irrigated from it, where three sites were identified for collecting samples quarterly from soil and sediment using clean plastic bags for the purpose of measuring lead, nickel, cobalt and copper. Pollution load index (PLI), Nemerow pollution index (PIN), Potential Ecological Risk (PER) and Geo-accumulation Index (Igeo) were also calculated according to the internationally approved methods. The results indicated that most of lead, nickel and copper concentrations in soils and sediments exceeded the limits allowed by WHO, reaching annual rates (96.758, 168.746 and 29.88) , (111.25, 219.65 and 48.162) mg.kg-1, respectively. This fluctuation in concentrations was reflected in the values of the studied indicators for both soil and sediment, where 50% and 58% of the studied specimen are of the polluted grade and the remnant are of the non-polluted grade according to the PLI values. So is the case with PIN where 58% of the soil specimen and 41.6% of the sediment samples were of the severe pollution grade, while 25% and 33.3% of the specimen were of the heavy pollution grade and the remnant were slightly pollution grade. The same applies to the results of the PER index values, where 50% and 41.67% of the specimen were from the Medium ecological risk category, and the rest were from the low ecological risk category, likewise for the (Igeo) values, 100% and 96% of the soil and sediment samples were from the Weakly polluted category.

Objective: To emphasize the importance of antenatal diagnosis of the morbidly adherent placenta, employ management options accordingly and their impact on the patient’s outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Okara Pakistan, Jan 2018 to Aug 2020. Methodology: One hundred and twenty-four patients were enrolled in the study. Diagnosed morbidly adherent placenta was made through trans-abdominal ultrasound, and a Doppler study in selected cases of posterior placenta previa magnetic resonance imaging (MRI) was performed. The surgical approach was either a high transverse placenta sparing or a classical incision on the uterus. After delivery of baby, conservative management included resection of part of uterus with adherent placenta followed by reconstruction of the lower uterine segment, segmental resection of myometrial tissue and hemostatic sutures, and over sewing of placental bed. The requirement of blood transfusion, intensive care unit stay, post-operative recovery, and day of discharge, along with all demographic and surgical details, was noted. Results: In 87(70%) patients, high transverse or placental sparing incision was made to assess the baby. Over sewing of the placental bed was done in 37(29.8%) patients, and myometrial segment resection was done in 57(46%) patients. An obstetrical hysterectomy was carried out in 30 patients. Blood transfusion of > 4 units RCCs was required in 92(74%) patients. 16% the patients required intensive care management. Conclusion: Antenatal diagnosis of morbidly adherent placenta through useful imaging modality allowed for a planned surgical approach and minimized......