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This paper researches the way in which marriage as a concept has evolved in Pakistani culture. Pakistani individuals are studied and researched within Pakistan, as well as outside in foreign countries. The customary arranged marriage situation is studied, as well as its effects on the life of both the husband and wife. We also look at the evolution and how change has brought love marriages or arranged love marriages have begun to arise within Pakistani culture. The effect of love marriages on Pakistani culture and its connection to violence has also been studied. Ultimately, Pakistani culture regarding marriage has been evolving over time and in the future, we hope to see even more change which includes an acceptance for customs and traditions that are new.

Digital games are increasingly used to support learning across a diverse range of cognitive, affective and psychomotor domains in health professions education. Game‐based learning will likely become an important competency for educators. However, educators can perceive game building as out of their reach due to a lack of expertise in digital technology. This toolbox offers advice to health professions educators who would like to build a simple game for learning known as a digital educational escape room.

Conditional gene regulation inDrosophilathrough binary expression systems like theLexA-LexAopsystem provides a superb tool for investigating gene and tissue function. To increase the availability of defined LexA enhancer trap insertions, we present molecular, genetic and tissue expression studies of 301 novel Stan-X LexA enhancer traps derived from mobilization of the index SX4 line. This includes insertions into distinct loci on the X, II and III chromosomes that were not previously associated with enhancer traps or targeted LexA constructs, an insertion intoptc, and eleven insertions into natural transposons. A subset of enhancer traps was expressed in CNS neurons known to produce and secrete insulin, an essential regulator of growth, development and metabolism. Fly lines described here were generated and characterized through studies by students and teachers in an international network of genetics classes at public, independent high schools, and universities serving a diversity of students, including those underrepresented in science. Thus, a unique partnership between secondary schools and university-based programs has produced and characterized novel resources inDrosophila, establishing instructional paradigms devoted to unscripted experimental science.

Context Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy. Objective The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Data Sources MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease. Data Extraction Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE. Data Analysis A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol. Conclusion Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence. Systematic Review Registration PROSPERO registration number CRD42015023580.

Background: The Hospital Readmission Reduction Program (HRRP) sought to reduce readmissions by penalising centres with readmissions above the national average, and heart failure (HF) is the leading driver of the readmission penalty. Recent Medicare analyses question the effectiveness of this strategy. This study evaluated the efficacy of HRRP by utilising large national datasets and is the first to analyse based on heart failure subtypes. Methods: Aggregate data was used from the National Inpatient Sample (NIS) to study mortality and the National Readmissions Database (NRD) to study readmissions. Both included all payer-types and were stratified by heart failure subtype and time (pre- and post-HRRP implementation). Results: Patients with HF with preserved ejection fraction (HFpEF) tended to be older females with a higher proportion of comorbidities compared to patients with HF with reduced ejection fraction (HFrEF). In the post-HRRP period, readmission rates decreased for HFrEF (21.4% versus 22.3%, p

Looking at the current scenario of the global pandemic with Coronavirus Disease 2019 (COVID-19) and the dramatic rise of variant COVID-19 cases it is reasonable to reason that one’s immunity (innate, adaptive, or passive) plays a vital role in an individual’s susceptibility as well as the severity. While the population is getting passively immunized with vaccination, the innate and adaptive immune response should also be emphasized. Vitamins and minerals play an important role in developing and modulating the immune response in the human body. Of which, one is, Vitamin D. Besides playing a major role in Calcium metabolism, Vitamin D is involved in modulating various immune system pathways to contain the virus, which includes dampening Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) entry and replication, reducing pro-inflammatory cytokines and increasing anti-inflammatory cytokines, increasing the synthesis of a natural antimicrobial peptide, and activating protective cells such as macrophages that can kill SARS-CoV-2. Vitamin D also possesses a neuroprotective property that is linked to the modulation of neurotrophins. In the current situation of the pandemic, an important connection between Vitamin D deficiency and poor health outcomes in COVID-19 patients have been reported. Furthermore, adequate Vitamin D levels were linked to a lower risk of unconsciousness and hypoxia. Vitamin D deficiency affects over half of the world's population. A low serum concentration of Vitamin D is a risk factor for acute respiratory tract infection. Vitamin D supplementation, on the other hand, is linked to a reduced risk of acute respiratory tract infections. Here, we conducted a literature review of publicly available information to summarize the link between Vitamin D levels and the severity of COVID-19 infection. The main objective of this manuscript is to review and provide information reported by published literature from publically available papers on online databases regarding the significance of Vitamin D in immune response and its prophylactic and therapeutic role in the management of COVID-19.

To investigate gut microbiota and intestinal barrier function changes after orthopedic surgery in elderly patients with either normal cognition (NC) or a prodromal Alzheimer disease phenotype (pAD) comprising either subjective cognitive decline (SCD) or amnestic mild cognitive impairment (aMCI).Homeostatic disturbances induced by surgical trauma and/or stress can potentially alter the gut microbiota and intestinal barrier function in elderly patients before and after orthopedic surgery.In this prospective cohort study, 135 patients were subject to preoperative neuropsychological assessment and then classified into: NC (n=40), SCD (n=58), or aMCI (n=37). Their gut microbiota, bacterial endotoxin (lipopolysaccharide), tight junction (TJ) protein, and inflammatory cytokines in blood were measured before surgery and on postsurgical day 1, 3, and 7 (or before discharge).The short-chain fatty acid (SCFA)-producing bacteria were lower while the gram-negative bacteria, lipopolysaccharide and TJ were higher preoperatively in both the SCD and aMCI (pAD) groups compared with the NC group. After surgery, a decrease in SCFA-producing bacteria, and an increase in both gram-negative bacteria and plasma claudin were significant in the pAD groups relative to the NC group. SCFA-producing bacteria were negatively correlated with TJ and cytokines in pAD patients on postsurgical day 7. Furthermore, surgery-induced perioperative metabolic stress and inflammatory responses were associated with gut microbiota alterations.Surgery exacerbates both preexisting microbiota dysbiosis and intestinal barrier dysfunction in pAD patients, all of which may be associated with systemic inflammation and, in turn, may lead to further cognitive deterioration.

The Internet of Things (IoT) is an emerging technology and provides connectivity among physical objects with the support of 5G communication. In recent decades, there have been a lot of applications based on IoT technology for the sustainability of smart cities, such as farming, e-healthcare, education, smart homes, weather monitoring, etc. These applications communicate in a collaborative manner between embedded IoT devices and systematize daily routine tasks. In the literature, many solutions facilitate remote users to gather the observed data by accessing the stored information on the cloud network and lead to smart systems. However, most of the solutions raise significant research challenges regarding information sharing in mobile IoT networks and must be able to stabilize the performance of smart operations in terms of security and intelligence. Many solutions are based on 5G communication to support high user mobility and increase the connectivity among a huge number of IoT devices. However, such approaches lack user and data privacy against anonymous threats and incur resource costs. In this paper, we present a mobility support 5G architecture with real-time routing for sustainable smart cities that aims to decrease the loss of data against network disconnectivity and increase the reliability for 5G-based public healthcare networks. The proposed architecture firstly establishes a mutual relationship among the nodes and mobile sink with shared secret information and lightweight processing. Secondly, multi-secured levels are proposed to protect the interaction with smart transmission systems by increasing the trust threshold over the insecure channels. The conducted experiments are analyzed, and it is concluded that their performance significantly increases the information sustainability for mobile networks in terms of security and routing.

Osteoarthritis (OA) is a multifactorial disease leading to degeneration of articular cartilage, causing morbidity in approximately 8.5 million of the UK population. As the dense extracellular matrix of articular cartilage is primarily composed of collagen, cartilage repair strategies have exploited the biocompatibility and mechanical strength of bovine and porcine collagen to produce robust scaffolds for procedures such as matrix-induced chondrocyte implantation (MACI). However, mammalian sourced collagens pose safety risks such as bovine spongiform encephalopathy, transmissible spongiform encephalopathy and possible transmission of viral vectors. This study characterised a non-mammalian jellyfish (Rhizostoma pulmo) collagen as an alternative, safer source in scaffold production for clinical use. Jellyfish collagen demonstrated comparable scaffold structural properties and stability when compared to mammalian collagen. Jellyfish collagen also displayed comparable immunogenic responses (platelet and leukocyte activation/cell death) and cytokine release profile in comparison to mammalian collagen in vitro. Further histological analysis of jellyfish collagen revealed bovine chondroprogenitor cell invasion and proliferation in the scaffold structures, where the scaffold supported enhanced chondrogenesis in the presence of TGFβ1. This study highlights the potential of jellyfish collagen as a safe and biocompatible biomaterial for both OA repair and further regenerative medicine applications.

> ‘Are you sure you can handle it?’ > > ‘You’re quite bossy, you’d fit right in.’ > > ‘When will you have time for kids?’ > > ‘Oh, your partner wants to become a surgeon? Great news for you!’ > > ‘Nurse, can you get the doctor for me?’ > > ‘It’s good you’re making the sacrifice to become a general practitioner now — means more time for your family!’ As female medical students it is difficult to ignore the detrimental impact of such comments on our self-confidence and career considerations. Throughout medical school we’ve experienced and observed obvious gender disparities — during clinical placement encounters, discussions with medical professionals, and casual career talks with peers. During clinical placements, we noticed differences in gender representation in certain specialities. One was trauma & orthopaedics (T&O). During morning handover our curiosity was piqued when we witnessed the dynamic between male and female doctors. Male doctors demonstrated their clinical acumen with comfortable confidence, unlike their outnumbered female colleagues. We noticed the latter would often shy away from voicing their opinions and looked more anxious when questioned by senior colleagues. When handover had finished and we had the opportunity to strike up a conversation we were disheartened by the similarity between our speculations and the female junior doctors’ thoughts. There was no hint of dislike towards T&O itself — far from it. However, they admitted the atmosphere precipitated by gender dynamics had made their experience less enjoyable. They mentioned how not having many female consultants around also dissuaded them from confidently feeling part of the team. It seemed that problems weren’t just arising from the immediate team. During multiple encounters with other healthcare professionals, assumptions were made that they couldn’t be T&O doctors because of their ‘frail’ physique, since T&O was ‘manually arduous’. These opinions weren’t just confined to T&O. One female intensive care …

Objective To analyze the incidence, predictors, and cost of 30-day left atrial appendage closure readmissions utilizing the Nationwide Readmissions Database (NRD) and to develop a scoring system to predict readmission risk. Background Determining incidence and predictors of 30-day readmission post-left atrial appendage closure can direct resources towards high-risk patients. Methods International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify patients. We excluded patients who were discharged or died in December 2016. Influential factors were identified by univariate analysis and clinical suspicion. Continuous variables were compared using the Student’s T-test and categorical variables were compared using chi-square or Fisher’s exact test. A logistic regression model and scoring system were developed and validated. Results 2975 patients were identified and 243 (8.2%) readmitted within 30 days. Non-routine disposition (p

Dear Editor,We read Butt et al.’s article [1] on guidance for medical students in general practice with great intrigue.As clinical year medical students, this article encouraged us to reflect on ou...

The USA is currently reported to have the highest incidence of COVID-19. We believe the absolute incidence to be true but the relative rate of incidence per 100,000 persons to be artificially high. Here we discuss elements of the US government and national structure to support and expand our theories of why these differences may exist.

We estimated the impact on the US export economy of an illustrative infectious disease outbreak scenario in Southeast Asia that has 3 stages starting in 1 country and, if uncontained, spreads to 9 countries. We used 2014-2016 West Africa Ebola epidemic–related World Bank estimates of 3.3% and 16.1% reductions in gross domestic product (GDP). We also used US Department of Commerce job data to calculate export-related jobs at risk to any outbreak-related disruption in US exports. Assuming a direct correlation between GDP reductions and reduced demand for US exports, we estimated that the illustrative outbreak would cost from approximately $13 million to approximately $64 million (1 country) to $8 billion to $41 billion (9 countries) and place 1,500 to almost 1.4 million export-related US jobs at risk. Our analysis illustrates how global health security is enhanced, and the US economy is protected, when public health threats are rapidly detected and contained at their source., The authors estimated the impact on the US export economy of an illustrative infectious disease outbreak scenario that has 3 stages starting in 1 country and, if uncontained, spreads to 9 countries. Assuming a direct correlation between GDP reductions and reduced demand for US exports, they estimated that the outbreak would cost from $16 million to $27 million (1 country) to $10 million to $18 billion (9 countries) and place 1,500 to almost 1.4 million export-related US jobs at risk.

To reduce the health security risk and impact of outbreaks around the world, the US Centers for Disease Control and Prevention and its partners are building capabilities to prevent, detect, and contain outbreaks in 49 global health security priority countries. We examine the extent of economic vulnerability to the US export economy posed by trade disruptions in these 49 countries. Using 2015 US Department of Commerce data, we assessed the value of US exports and the number of US jobs supported by those exports. US exports to the 49 countries exceeded $308 billion and supported more than 1.6 million jobs across all US states in agriculture, manufacturing, mining, oil and gas, services, and other sectors. These exports represented 13.7% of all US export revenue worldwide and 14.3% of all US jobs supported by all US exports. The economic linkages between the United States and these global health security priority countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics., The authors examine the extent of economic vulnerability to the US export economy posed by trade disruptions in the 49 global health security priority countries. Using 2015 US Department of Commerce data, they assess the value of US exports and the number of US jobs supported by those exports.

The novel coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly since emerging in late 2019, leading the World Health Organization (WHO) to declare the disease a global pandemic on March 11, 2020. Governments around the world have had to quickly adapt and respond to curb transmission of the virus and to provide care for the many who have been infected. The strain that the outbreak imposes on health systems will undoubtedly impact the sexual and reproductive health of individuals living in low- and middle-income countries (LMICs); however, sexual and reproductive health will also be affected by societal responses to the pandemic, such as local or national lockdowns that force health services to shut down if they are not deemed essential, as well as the consequences of physical distancing, travel restrictions and economic slowdowns.

The BioModelAnalyzer (BMA) is a web based tool for the development of discrete models of biological systems. Through a graphical user interface, it allows rapid development of complex models of gene and protein interaction networks and stability analysis without requiring users to be proficient computer programmers. Whilst stability is a useful specification for testing many systems, testing temporal specifications in BMA presently requires the user to perform simulations. Here we describe the LTL module, which includes a graphical and natural language interfaces to testing LTL queries. The graphical interface allows for graphical construction of the queries and presents results visually in keeping with the current style of BMA. The Natural language interface complements the graphical interface by allowing a gentler introduction to formal logic and exposing educational resources.

Background: Consultation-liaison (C-L) psychiatry is the subspecialty of psychiatry dealing with mental health disorders in nonpsychiatric settings. The ubiquity of mental health problems has increased the need for such a service to exist in general hospital psychiatric units, as many psychiatric patients report to a different specialty of medicine for the first time. This study aims to evaluate the utilization of psychiatry C-L services by nonpsychiatric inpatient units in a general hospital psychiatry unit taking into consideration the paucity of data for understanding the trends and improving service provision in the future. Materials and Methods: A retrospective chart review of all inpatient referrals received by the psychiatry department from July 2015 to February 2017 was conducted. The sociodemographic profile, source of referral, reason for referral, and psychiatric diagnosis using the International Statistical Classification of Diseases-10 were analyzed using descriptive statistical methods. Results: A total of 605 patients were referred, which comprised 0.86% of total indoor admissions. Maximum number of consultations was sought from internal medicine. “Unexplained physical symptoms” was the most common reason for referral (35%). Consequently, neurotic, stress-related, and somatoform disorder (25.5%) was the most common psychiatric diagnosis followed by mood disorder (19.8%). Conclusion: Poor and variable referral rate from various departments highlights the increasing need to sensitize all clinicians regarding psychiatric comorbidity. There is a need to explore factors that would result in increasing referral rates and making psychiatric consultation services effective and efficient.