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BACKGROUND: Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The “July effect”—described as increased complication rates during the transition of new trainees—has been studied in other procedures, but has not been thoroughly evaluated for EGD. METHODS: We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June. RESULTS: Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July–September) vs 1.95% (April–June), with an adjusted odds ratio of 1.09 (P

Acute liver failure following COVID-19 infection and/or vaccination is very rare and can be secondary to hemophagocytic lymphohistiocytosis (HLH). Liver injury in such cases appears to be extrinsic and thus treatment hinges on prompt diagnosis and reversal of the primary disease. We describe a patient who developed acute liver failure secondary to HLH after receiving a second dose of the Pfizer COVID-19 vaccine. Persistently elevated liver function tests, fevers, and cytopenia following COVID-19 vaccination should prompt clinicians to calculate an H-score to evaluate for the presence of HLH.

Solar power is a promising alternative energy source for a sustainable environment for developing countries in the Asian continent. The assessment of its sustainability particularly in the South Asian countries necessitates a complete and rigorous statistical investigation. In the current study, we investigate solar energy profile and potential in Pakistan’s Sindh province as a case study. Although the electrification of Sindh Province using off-grid solar PV systems is relatively easy and also most convenient, the challenge is to measure the province’s capacity of solar power and its economic viability. Results show that the rural areas of Pakistan have sufficient solar irradiance in order to produce power. The suitable inclination angles of solar power modules contain the significant capacity of solar power for electricity production. Finding regarding economic viability shows that an off-grid solar photovoltaic system ensures the electricity at price of PKR 6.87/kWh while this is cheap source of energy as compared to traditional energy source (about 20.79 PKR /kWh). Furthermore, the system of off-grid solar photovoltaic could reduce, 119,000 metric tons of CO2 per year simultaneously it ensure the all remote rural areas implement the off-grid solar energy system. The study provides a useful renewable roadmap for energy in South Asian countries and those presently captivating distant and off-grid regions.

Renewable energy decreases the threat of energy insecurity. Solar energy systems are proving to be an easy and cheaper solution to energy crisis worldwide. Developing countries including Pakistan have augmented efforts to boost the current solar capacity. The identification of desired solar power point plant fabrication requires robust analysis of several factors. Adequate research has not been done on the site selection process for solar projects in Pakistan. This study identifies and proposes multiple point states having solar energy potential. Based on the multiple main and sub-criteria obtained from the literature, a mathematical formulation has been used to install the solar projects at rural areas of Pakistan. An empirical assessment of the off-grid rural solar power projects in Pakistan has also been conducted in this case study. The results reveal that mass, money supply and ratio are important, while the transmission on the matrix, the cost of land and the sun were generated. The study found the district of Barkhan (R2) of Baluchistan to be the most ideal site, followed by Jacobabad (R3) and Mastung (R3). With respect to economic viability, this study found that solar energy systems provide electricity which is much cheaper than conventional energy supplied in the country. This study could be useful reference for South Asian countries including India, Bangladesh, and Afghanistan, which are currently electrifying remote and rural areas through solar energy system.

The study examines the volatility spillover between selected emerging Asian and developed stock markets. Moreover, the study analyzes the impact of the financial crisis on volatility spillover between the stock markets. This study used monthly observations for the period 2001-01 to 2017-12 on three emerging markets of Pakistan, China, India and three developed markets of Hong Kong, Japan and the US. First, the asymmetric volatility transmission between the stocks is analyzed by extended EGARCH representation. The study found the existence of asymmetric volatility spillovers throughout the financial crisis. The researcher estimated the VECM granger causality test in the next step. The outcomes revealed existence of bidirectional spillover between Pakistan and India, the US to Japan and Hong Kong. Unidirectional relationship was found from Pakistan and the US to Hong Kong, India to the US and Hong Kong to China. Overall, the results suggest a significant relationship between emerging and developed markets due to integration.

Introduction: Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. Methods: We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. Results: We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74–0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77–1.11; moderate certainty) and did not increase the risk of adverse events. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.

The present study investigates the causality between energy consumption, natural resources, and carbon emissions volatility. For empirical results, the study analyzed panel data of a Group of Twenty (G-20) countries from 1995 to 2018. The results of Pooled Mean Group (PMG) showed that the consumption of conventional energy sources increases the carbon emissions in the region under consideration. The results also showed that economic growth and carbon emissions are associated with each other according to the Environmental Kuznets Curve hypothesis. The findings showed that rent on mineral resources, oil resources, and forest rent have a positive and significant impact on carbon emissions in G-20 countries. The findings of this study show the complex nature of the relationship between natural resources consumption and carbon dioxide emissions. The study suggests a three-dimensional policy framework for the group of twenty countries of economic cooperation to address the environmental issues with a special focus on natural resources preservation and green economic growth.

The construction of green finance index is a three-tiered process that involves macroeconomic, ecological, and monetary indicators. Therefore, this research is one of the first thorough assessments of the impacts of green financing regulations in China, examining 30 provinces during the period of 2010 to 2017. Data envelopment analysis models for 30 provinces in China have been tested by using non-radial models and longitudinal datasets. The findings demonstrate that between 2010 and 2017, the efficiency of China's provinces such as Beijing, Fujian, Guangdong, Hainan, Hebei, Jiangsu, Liaoning, Shandong, Shanghai, Tianjin, and Zhejiang and provinces of central regions as well as western provinces of country green economies has increased with distinct geographical disparities becoming more apparent. The geographical distribution of economic efficacy in the green economy is greatest in the eastern parts and poorest in the Chongqing, Gansu, Guangxi, Guizhou, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Sichuan, Tibet, Xinjiang, and Yunnan. The study revealed that sustainable financial growth may be accomplished via the creation of green financing, which can be achieved by employing different solutions across the macroeconomic, institutional, and ecological considerations. The western and central areas, however, have a significant negative association. There are substantial variations in factors at the state and federal level from the viewpoint of dependent variables. Eventually, the research offers some suggestions for future ecological impact of China, along with the creation of new environmental legislation.

The current study is intended to analyze the long-run relationship between deficit in balance of payments (BOPs) and tourism for the period of 1976–2015 using the autoregressive distributed lag (AR...

The present study attempted to analyze the impact of corruption on output and income inequality in long run and short run using time series data spanning from 1980 to 2013 for Pakistan. After testing stationary properties through Augmented Dickey Fuller (ADF) and Phillips Perron (PP) unit root tests, Auto Regressive Distributed Lag (ARDL) developed by (Pesaran & Shin, 1999) and (Pesaran, Shin, & Smith, 2001) has been applied. Data have been obtained from World development Indicators (WDI), Pakistan’s Economic Survey, International Country Risk Guide (ICRG), Deininger and Squire and UNO-WIDER data set. Findings of the study indicate that corruption exerts negative and statistically significant effects on output while positive and statistically significantly effect on income inequality in the long run. In short run, corruption affects output positively and significantly. Impact of corruption on income inequality is also positive but statistically insignificant in short run. Government expenditures positively affect output but the income inequality negatively in Pakistan.

Remaining paper is constructed as follows: Section two explains the electricity background in Sindh province, and Sect. 3 describes methodology with data sources.

The key development objective of Pakistan, since its existence, has been to reduce poverty, inequality and to improve the condition of its people. While this goal seems very important in itself yet is also necessary for the eradication of other social, political and economic problems. The objective to eradicate poverty has remained same but methodology to analysing this has changed. It can be said that failure of most of the poverty strategies is due to lack of clear choice of poverty definition. A sound development policy including poverty alleviation hinges upon accurate and well-defined measurements of multidimensional socio-economic characteristics which reflect the ground realities confronting the poor and down trodden rather than using some abstract/income based criteria for poverty measurement. Conventionally welfare has generally been measured using income or expenditures criteria. Similarly, in Pakistan poverty has been measured mostly in uni-dimension, income or expenditures variables. However, recent literature on poverty has pointed out some drawbacks in measuring uni-dimensional poverty in terms of money. It is argued that uni-dimensional poverty measures are insufficient to understand the wellbeing of individuals. Poverty is a multidimensional concept rather than a unidimensional. Uni-dimensional poverty is unable to capture a true picture of poverty because poverty is more than income deprivation

Present study examined macroeconomic determinants of external debt in Pakistan using annual time series data from 1976 to 2010.Cointegration technique has been used to find long run equilibrium relationship while short run dynamics have been analyzed using ECM. By applying ARDL model results depicted that Fiscal deficit, Nominal exchange rate and Trade openness are statistically significant determinants of external debt as they increase the debt burden of Pakistan. Foreign aid is also positively related to external debt but statistically insignificant. In contrast Terms of trade are negatively related to external debt being statistically insignificant.

This study uses Alkire and Foster’s (2007) methodology to measure Multidimensional Energy Poverty in Pakistan using Pakistan Social Living standard Measurement (PSLM) data for 2007-08. This measure also satisfies the property of decomposability. Multidimensional Energy Poverty Index (MEPI) has been calculated. Value of MEP headcount for rural Pakistan is 71 percent as compared to 29 percent in urban areas of Pakistan. Multidimensional Energy Poverty headcount for rural Pakistan is 71.4 percent and 28.6 percent of the households residing in rural areas of Pakistan are energy poor. Households of Pakistan are most deprived in cooking fuel dimension (55 percent) while deprivation is the least in dimension of home appliances ownership (15 percent). In urban areas of Pakistan, households are more deprived in dimension of cooking fuels (23 percent) followed by indoor pollution (19 percent). Almost one third households of rural Pakistan are deprived in dimension of indoor pollution (69 percent). Contribution of indoor pollution (32 percent) to multidimensional energy poverty headcount in Pakistan is the highest followed by the cooking fuels dimension (31 percent) and collectively these two dimensions contribute up to 63 percent in overall Multidimensional Energy Poverty headcount for Pakistan. Study further concludes that households deprivation in energy decreases with the increase in value of cut offs. Overall indoor pollution, cooking fuel and entertainment appliances are the three major contributors, to overall MEP headcount not only as a whole but region wise also. Based on results, the study established that there is significant and higher incidence and severity of energy poverty in rural areas as compared to urban areas in Pakistan

Results of previous studies on the correlation between exchange rate changes and trade balance are unpersuasive. The present endeavor tries to understand the direction of changes between trade balance and exchange rate and how the depreciation in exchange rate takes place by incorporating the absorption and monetary approaches including Marshal Lerner condition. Our results reveal that existence of long run relationship between exchange rate, income and money supply on trade balance examined through ARDL bounds testing approach. The lag of dependent variable i.e. trade balance has significant impact on the current year trade balance due to pervious year trade policy. At the same time, depreciation in exchange rate deteriorates the trade balance thus adoption of such trade policies that boost the trade balance in future are desirable. The results have also been indicated that beneficial impact of trade policies on trade balance is nullifying by the exchange rate depreciation. Low level of money supply rather than income plays an important role to improve the trade balance in Pakistan. The prevalence of Keynesian postulation exists in Pakistan that states 'income increase will encourage general public to purchase more imported goods and thus deteriorates the trade balance'. This paper would highlight some new insights for policy formulation regarding trade, exchange rate, and economic growth.

Present study employs Alkire and Foster’s (2007) methodology to measure Multidimensional Energy Poverty (MEP) at provincial level in Pakistan. MEP Headcount has been calculated using PSLM data. Indoor pollution is found to be the largest contributor to MEP Headcount in all four provinces of Pakistan while cooking fuel is the second largest contributor. Results of MEP Headcount show that 47%, 51%, 69% and 66% of the households residing in Punjab, Sindh, Khyber Pakhtoon Khaw (KPK) and Baluchistan provinces of Pakistan respectively are energy poor. Households of all the four provinces are most deprived in the dimension of indoor pollution i.e. in the range of 49% to 63% followed by cooking fuel i.e. in the range of 35% to 59%. Deprivation is least in the dimension of home appliances for all provinces except Baluchistan which is least deprived in entertainment appliances dimension.

The study analyzes long run and short run association among the real rate of interest on deposits, financial liberalization, economic growth, terms of trade, real remittances by Pakistani emigrants and domestic savings behavior in Pakistan, using annual time series data for 1973-2007. ARDL Bounds Testing Approach has been applied for co-integration. To test integration order of the variables, DF-GLS and Ng-Perron Tests have been employed. The results reveal that the real interest rate, financial liberalization and economic growth positively affect domestic savings in Pakistan in the long run. The co-efficient of liberalization dummy is also positive and statistically significant, suggesting a need for increased liberalization and deregulation of interest rate for mobilization of savings. Conversely, the terms of trade and real remittances by Pakistani emigrants show negative relationship with domestic savings, supporting Complementarity Hypothesis of Mckinnon-Shaw (1973).

The present study examines long run and short run association among Investment, Savings, Real Interest rate onBank deposits and Bank Credit to the private sector, accompanied with the impact of financial liberalization onkey macro economic variables in Pakistan for the period 1973 to 2007. ARDL Bounds Testing Approach hasbeen applied for co-integration of annual time series data. To test the order of integration of the variables,DF-GLS and Ng-Perron Tests have been employed. The results show that Private Investment is positivelyaffected by Savings, Real interest rate on bank deposits, Bank credit to private sector and Public investment inthe long run in a developing country like Pakistan, supporting Complementarity Hypothesis of Mckinnon-Shaw(1973).