Hypophosphatasia: presentation and response to asfotase alfa

Hypophosphatasia (HPP) is a rare bone disease with limited scientific evidence on the tolerability and safety of its novel treatment, Asfotase Alfa (AA). We report 7 HPP patients' heterogenous presentations and the significant improvement in various clinical outcomes attained with AA shedding light on this highly effective and safe therapy.

INTRODUCTION

Hypophosphatasia (HPP) is a rare inherited metabolic bone disorder characterized by a deficiency in the tissue non-specific alkaline phosphatase (TNSALP) due to loss of function mutation in the ALPL gene. HPP is associated with impaired skeletal mineralization due to elevations in inorganic pyrophosphate and altered phosphate : pyrophosphate ratio. Asfotase alfa (AA) "enzyme replacement" was approved for treatment of HPP in 2015. We present 7 patients with HPP, 5 with pediatric-onset, and 2 with adult-onset, who have been treated with AA and describe the efficacy and safety in these patients.

METHODS

7 patients (4 females, 3 males) aged 19-68 years with HPP were included in this study. Diagnosis of HPP was confirmed by DNA analysis. AA was administered in doses of 6mg/kg/week with a mean follow-up of 6 months (SD= 5).

RESULTS

Subjective improvement in muscle strength, muscle pain, walking ability, and walking distance with a reduction in the use of gait aids was seen "with AA in HPP patients." Muscle strength and pain improved by up to 70% from baseline as quantified subjectively by patients. Walking distance improved by up to 100%. Patients also reported improved cognition, mood, and energy levels, with up to 90% improvement in mood and 75% improvement in energy levels. 4 out of 6 patients first noted clinical signs of improvement after 3 months of being on therapy. 1 out of the 7 patients sustained a toe fracture 10 months from being on AA. AA was well-tolerated with injection site reactions being the most reported adverse effect.

CONCLUSION

HPP treatment with AA in individuals with both pediatric and adult-onset forms resulted in significant subjective improvement in musculoskeletal and cognitive manifestations in addition to patients' quality of life. The drug was well tolerated in 6 patients. 1 patient discontinued therapy because of minor adverse effects with myalgias.

Analytical assessment of clinical sensitivity and specificities of pharmaceutical rapid SARS-CoV-2 detection nasopharyngeal swab testing kits in Pakistan

Despite of the global unity against COVID-19 pandemic, the threat of SARS-CoV-2 variants on the lives of human being is still not over. SARS-CoV-2 pandemic has urged the need of rapid viral detection at earliest. To cope with gradually expanding scenario of SARS-CoV-2, accurate diagnosis is extremely crucial factor which should be noticed by international health organizations. Limited research followed by sporadic marketing of SARS-CoV-2 rapid pharmaceutical detection kits raises critical questions against quality assurance and quality control measures. Herein we aimed to interrogate effectivity and specificity analysis of SARS-CoV-2 pharmaceutical rapid detection kits (nasopharyngeal swab based) using conventional gold standard triple target real-time polymerase chain reaction (USFDA approved). A cross-sectional study was conducted over 1500 suspected SARS-CoV-2 patients. 100 real time-PCR confirmed patients were evaluated for pharmaceutical RDT kits based upon nasopharyngeal swab based kits. The SARS-CoV-2 nasopharyngeal swab based rapid diagnostic kit (NSP RDTs) analysis showed 78% reactivity. Among real time PCR confirmed negative subjects, 49.3% represented false positivity. The positive predictive analysis revealed 67.82%, while negative predictive values were 64.40%. The NSP RDTs showed limited sensitivities and specificities as compared to gold standard real time PCR. Valid and authentic detection of SARS-CoV-2 is deemed necessary for accurate COVID-19 surveillance across the globe. Current study highlights the potential consequences of inadequate detection of SARS-CoV-2 and emerging novel mutants, compromising vaccine preventable diseases. Current study emphasizes need to wake higher authorities including strategic organizations for designing adequate measures to prevent future SARS-CoV-2 epidemics.

Unlocking biogas potential: Spatial analysis, economic viability, and climate resilience in southern regions of Khyber Pakhtunkhwa, Pakistan

Across the world, the growing embrace of anaerobic digestion for deriving energy from biogas presents substantial economic and environmental benefits. This strategic approach carries particular significance for Pakistan, which is actively striving to meet its renewable energy objectives. The study focuses on a comprehensive examination of the spatial distribution of biogas potential originating from livestock farm manure in the southern areas of Khyber Pakhtunkhwa. This factor plays a pivotal role in ascertaining the best location and economic feasibility of a bioenergy facility. The study employs a spatial analysis algorithm to estimate biogas production. By integrating livestock data, manure production metrics, and collection statistics, the algorithm provides a high-resolution assessment at 1 km interval. The analysis unveil a biogas potential of 1.40 billion cubic meters of bio-methane sourced from manure. District D.I.Khan emerges as the leading producer, generating 201.40 million cubic meters of bio-methane. Several maps illustrate optimal sites and potential capacities for biogas facilities utilizing manure. The study proposes the practicality of establishing 868 biogas plants within the surveyed geographic region. Collectively, these plants would generate a substantial 909.34 Megawatt electrical (Mwe), while individual capacities spanning from 120 Kilowatt electrical (Kwe) to an impressive 997 KWe. These findings offer a clear path for strategically siting biogas plants, a crucial component of the global battle against climate change. Moreover, the findings of this study have played a significant role in shaping guidelines aimed at mitigating methane emissions, promoting the generation of renewable energy, and advocating for sustainable waste management practices. These guidelines serve as invaluable tools for climate mitigation and adaptation endeavors.

Oleuropein, a phenolic component of Olea europaea L. ameliorates CCl4-induced liver injury in rats through the regulation of oxidative stress and inflammation

OBJECTIVE

This study aimed to assess the hepatoprotective role of oleuropein (Olp), a phenolic compound found in olive, against carbon tetrachloride (CCl4)-induced liver damage in rats.

MATERIALS AND METHODS

The research involved male albino rats, which received intraperitoneal injections of 100 mg/kg b.w. of oleuropein for 8 consecutive weeks before being subjected to carbon tetrachloride (CCl4) at a dosage of 1.0 ml/kg b.w. Changes induced by CCl4 in antioxidant and inflammatory marker levels were assessed using ELISA assay kits. Moreover, CCl4-induced liver tissue architecture alteration, fibrosis, and expression pattern of protein were evaluated by performing H&E, Sirius red, Masson trichrome, and immunohistochemistry staining.

RESULTS

Increased serum transaminases and massive hepatic damage were observed by this liver toxicant. The hepatic injury was further evidenced by a significant decrease in antioxidant enzyme activity [superoxide dismutase (SOD), glutathione peroxidase (GPx), Glutathione (GSH) and Total Antioxidant Capacity (T-AOC)]. The administration of CCl4 resulted in an increased inflammatory response, which was measured by C-reactive protein, interleukin-6, as well as tumor necrosis factor-alpha. Olp as a curative regimen led to significant attenuation in the inflammatory response and oxidative/nitrosative stress. This polyphenol treatment improved the hepatic tissue architecture and decreased fibrosis. In the CCl4 treatment group, the expression pattern of IL-6 protein was high, whereas expression was decreased after Olp, as evidenced by immunohistochemistry staining.

CONCLUSIONS

The study suggests that oleuropein treatment has the potential to reduce liver damage caused by CCl4 induction by inhibiting oxidative stress and inflammation and maintaining liver tissue architecture. This could make it a promising treatment option for liver pathogenesis.

Disinfection by methylthionine chloride and chitosan in combination with Photo radiation therapy on caries affected dentin nano hardness, adhesive integrity, and bond failure

OBJECTIVE

The aim of the study was to assess the disinfection efficacy, bond integrity, and nano hardness of caries-affected dentin (CAD) surface bonded to resin cement when disinfected with chlorhexidine (CHX), Methylene blue activated by Photodynamic therapy (MB-PDT), chitosan, silver diamine fluoride (SDF), chitosan activated by PDT, and SDF-diode laser against S. mutans.

MATERIALS AND METHODS

A total of 60 human mandibular molars were extracted non-traumatically and gathered using ICDAS criteria. The dentin surface was prepared, leaving CAD to receive a disinfection procedure. After inoculation with S. mutans, the CAD samples were divided into six groups and disinfected with various disinfectants (n = 10) CHX, MB-PDT, chitosan, chitosan-PDT, SDF, and SDF+ diode laser. Survival rates of S. mutans were analyzed following the restoration of samples with resin cement via the etch and rinse method to assess SBS. Also, nano hardness was analyzed. Statistical analysis was performed by using the ANOVA and the Tukey multiple test (p<0.05). The Kruskal-Wallis test was used to evaluate the change in survival rate.

RESULTS

Related to the survival rates, the SDF+ diode laser displayed the highest reduction in S. mutans levels and chitosan presented the lowest level of disinfection. The intergroup comparison revealed that CHX and chitosan-PDT displayed comparable outcomes of S. mutans survival rate to that of SDF+ diode laser (p>0.05). Likewise, MB-PDT and SDF displayed a comparable survival rate of S. mutans to Chitosan disinfection (p>0.05). Considering SBS and nano hardness, the highest SBS and NH were exhibited by the SDF+ diode laser, and the lowest SBS and NH values were exhibited by MB-PDT. The intragroup comparison revealed that CAD specimens disinfected with Chitosan-PDT showed comparable SBS and NH values to the SDF+ diode laser (p>0.05). CHX, chitosan, and SDF exhibited bond values and NH comparable to MB-PDT (p<0.05).

CONCLUSIONS

Synergistic use of Silver diamine fluoride with diode laser and chitosan activated by PDT can be used as an alternative to CHX for controlling S. mutans growth, promoting enhanced bond efficacy and nano hardness for bonding resin cement to the caries-affected dentin.

Ammonia gas treatment in low cost biological reactor

Ammonia gas contributes to a number of environmental and human health concerns. The use of chalk, a cheap alkalinity source may reduce costs for biological systems. This research studies a closed liquid flow reactor to treat ammonia gas using chalk as biomass media and alkalinity source with high value calcium nitrate fertilizer production. The proposed reactor showed complete ammonia gas removal at high rate (500 mg N/L/day) and with low cost; where chalk dissolution and ammonia gas absorption contributed to alkalinity in the water for nitrification. High calcium ion concentration (up to 10,000 mg Ca2+ as CaCO3/L) showed only minor effects on ammonia absorption and nitrification rate.

Mechanical Control of Polaritonic States in Lead Halide Perovskite Phonons Strongly Coupled in THz Microcavity

We demonstrate the generation and control of polaritonic states in perovskite phonon polaritons, which are strongly coupled in the middle of a flexible Fabry-Perot cavity. We fabricated flexible perovskite films on a microporous substrate coated with graphene oxide, which led to a virtually free-standing film incorporated into the microcavity. Rabi splitting was observed when the cavity resonance was in tune with that of the phonons. The Rabi splitting energy increased as the film thickness increased, reaching 1.9 meV, which is 2.4-fold higher than the criterion for the strong coupling regime. We obtained dispersion curves for various perovskite film thicknesses exhibiting two polariton branches; clear beats between the two polaritonic branches were observed in the time domain. Flexible cavity devices with perovskite phonons enable macroscopic control over the polaritonic energy states through bending processes, which add an additional degree of freedom in the manipulation of polaritonic devices.

Navigating China's carbon neutrality journey: insights from policy instruments and implementation strategies across provincial regions

China's critical reliance on well-crafted public policies, coupled with the effective execution of central government directives at the local level, drives the achievement of the "dual carbon" goal including the peaking of CO2 emissions and attaining carbon neutrality. Therefore, examining policy records can unveil the holistic strategy for attaining carbon neutrality during the period of peak CO2 emissions; at the same time, it can also highlight the potential obstacles in policy implementation. In this study, we adopt a policy instruments perspective to investigate data related to policies addressing peak CO2 emissions across 29 provincial administrative regions in China. We apply Nvivo12 software to conduct a quantitative literature assessment and content analysis to establish a theoretical framework for the policy process. This framework encompasses dimensions such as political feasibility, regional coordination, attributes of low-carbon initiatives, and policy refinement. Subsequently, we employ the model to carry out a retrospective analysis of policy documents pertaining to peak CO2 emissions in China. Our research findings underscore the pivotal role of political feasibility in shaping policy effectiveness, while also highlighting the facilitative influence of regional coordination, shedding light on the essential synergy between provinces and cities in achieving emissions reduction goals. Similarly, the estimated results highlight the motivating impact of specific attributes within low-carbon initiatives. Moreover, policy enhancements are identified as a critical driver in advancing the path toward carbon neutrality. Consequently, to achieve the objective of carbon neutrality, it is imperative for every province and city to sequentially reach the peak of CO2 emissions. Our research offers a comprehensive "China strategy," providing valuable insights to guide future policy formulation and accelerate progress toward sustainable environmental objectives.

Navigating carbon emissions in G-7 economies: a quantile regression analysis of environmental-economic interplay

This study employs panel data from 1990 to 2020 for the G-7 countries (Canada, France, Germany, Italy, Japan, the UK, and the USA) and employs the examination of heterogeneous slope coefficients and cross-sectional dependence tests as preliminary steps before conducting cointegration analysis and second-generation unit-root tests. This study employs the method of movement quantile regression (MMQR) to analyze long-run and short-run relationships. The findings from the MMQR model indicate that economic growth and imports have a negative impact on consumption-based CO2 (CCO2) emissions, which worsens at higher quantiles. On the other hand, exports, energy efficiency, and renewable energy output (REO) have a positive effect on mitigating CCO2 emissions, with this effect becoming more pronounced at higher quantiles. Furthermore, the robustness of the results was confirmed through rigorous checks using quantile regression with optimized Markov Chain Monte Carlo techniques, which is a reliable non-parametric approach. These checks consistently demonstrated a significant impact on CCO2 emissions, thus validating the findings obtained from MMQR. Based on the outcomes, this study recommends that each G-7 nations should make efforts to regulate their CCO2 emissions by adopting measures that foster ecological equilibrium. Moreover, fostering export-driven sectors, exploring innovative strategies for REO, and improving energy efficiency are crucial measures for effectively tackling CCO2 emissions within the G-7 countries. The study highlights that renewable energy output (REO) and energy efficiency effectively mitigate CCO2 emissions at higher quantiles, suggesting the importance of policy measures supporting their development. Additionally, policies targeting import reduction, export promotion, and carbon pricing mechanisms emerge as strategies to curb emissions and foster sustainable development.

Untangling the causal mechanisms and spatial dynamics of digital financial development's impact on energy intensity: insights from panel data of Chinese provinces

The prime focus of the present investigation delves into the linkage between digital financial services and energy intensity within the geographic confines of China, utilizing provincial-level panel data spanning from 2011 to 2021. Digital finance has rapidly developed due to changes in information technology, and its role in achieving green transformation, reducing energy consumption, and lowering energy intensity in Chinese society is critical. By conducting empirical analysis utilizing diverse models, we have tested our hypotheses and found that digital finance's improvement can contribute to the reduction in energy intensity at the regional level while still considering endogeneity concerns. This effect is mediated by the promotion of technological innovation and the facilitation of green development in industries. Digital finance's impact on energy intensity is contingent upon resource endowments, such as the level of traditional financial development and the degree of information. Moreover, digital finance's adverse impact on energy intensity becomes more pronounced beyond certain threshold values. However, digital finance can increase energy intensity in neighboring regions through spatial spillover effects. Drawing upon our findings, we recommend bolstering the development of digital finance, augmenting the capability for autonomous innovation, and devising specialized strategies for digital finance advancement to fully harness the potential of digital finance in curbing energy intensity. This study interprets the value of digital finance from the new perspective of energy intensity. By exploring the internal links between digital finance and energy intensity, the study enriches the research results on the impact of digital finance on energy intensity.

Variation of digital economy's effect on carbon emissions: improving energy efficiency and structure for energy conservation and emission reduction

The significance of accurately assessing the influence of digital economy growth upon reducing emission of carbon in the context of worldwide climate governance cannot be overstated. This is crucial in encouraging low-carbon economic advancement at national level, achieving carbon peak and neutrality as soon as possible, and creating a shared future for humanity. A mediating effect model is established using cross-country panel data from 100 countries, ranging from 1990 to 2019, to assess the influence of digital economy development upon emission of carbon and to explore its underlying mechanism. The study found that: the growth of national emission of carbon can be considerably suppressed by digital economy development, and the reduction of emissions is positively associated to each country's level of economic advancement. Digital economy growth influences regional emission of carbon via intermediary channels like energy structure and efficiency, with energy intensity having a particularly noticeable intermediary impact. The inhibitory influence of digital economy development upon emission of carbon differs among countries with different levels of income, and improvements in energy structure and efficiency can precede to energy savings and emission reduction in both middle- and high-income countries. The above findings offer policy guidance for harmoniously advancing the growth of digital economy and climate management, hastening the low-carbon transformation of national economies, and implementing China's carbon peaking initiative.

Hepatitis C virus associated ALT, AST, GGT, Bili T, HB, HBA1C, CREAT, PT, aPPT, AFP, CEA, CA 125, CA 19-9, iPTH biomarkers, computed tomography and HCV burden of disease during pre COVID-19 era (2018-2019) and post COVID-19 era (2020-2022) in Pakistan

The national burden of HCV has significantly mounted over the period of last few decades placing Pakistan at the worst placement of second largest burden of HCV globally. Herein for the first time from Pakistan, we examined clinical correlation of potential biomarkers with HCV. Nation-wide study was conducted on 13,348 suspected HCV patients during 2018-2022. During pre-COVID-19 era of 2018-2019, prevalence of HCV remained 30%. During 2018, among HCV positive patients, 91% of ALT, 63% of AST, 67% of GGT, 28% of Bili T, 62% of HB, 15% of HBA1C, 25% of CREAT, 15% of PT, 15% of aPTT and 64% of AFP were abnormal. During 2019, among HCV infected 74.47% of ALT, 63.54% of AST, 70.24% of GGT, 24.71% of Bili T, 8.77% of HB and 75% of AFP were raised. CT/CAT scan revealed 4.65% liver complications (mild 13.04%, moderate 30.43% and severe 56.52%). During 2020, HCV prevalence remained 25%. 65.17% of ALT, 64.20% of AST, 68.75% of GGT, 31.25% of Bili T, 20.97% of HB, 4.65% of CREAT and 73.68% of AFP levels were raised. CAT analysis revealed liver complications among 4.41% (14.81% mild, 40.74% moderate, and 44.44% sever). 85.71% of participants diabetes was out of control. During 2021, HCV prevalence remained 27.1%. ALT (73.86%), AST (50.6%), GGT (67.95%), Bili T (28.21%), HB (20%), CREAT (5.8%) and AFP (82.14%) levels were abnormal. During 2022, the levels of ALT (56.06%), AST (56.36%), GGT (56.6%), Bili T (19.23%), HB (43.48%), HBA1C (14.81), CREAT (18.92%), AFP (93.75%) were abnormal. CAT analysis revealed 7.46% liver complications (25% mild, 30.36% moderate, and 42.86% sever). During 2021-2022, 83.33% of subject's diabetes was not controlled.

Evaluation of histo-toxicity of nimesulide in Black Kites (Milvus migrans): a pharmacodynamic study

The present experimental work was conducted to elucidate the toxicity of nimesulide at three different doses in black kites (Milvus migrans). M. migrans is one of the most common raptors near human habitations. The goal of the current investigation was to determine whether nimesulide is similarly hazardous to raptors as was diclofenac sodium and to investigate the acute oral toxicity of nimesulide in these birds. For this study, eight adult male black kites (M. migrans) were randomly divided into four groups. M. migrans in the control group (n = 02) were not treated with nimesulide. The other three groups were given nimesulide doses. The birds in the first (n = 02) were declared the control group. The second (n = 02), third (n = 02), and fourth groups were administered nimesulide at a low, medium, and high dose of 2, 4, and 6 mg/kg live body weight of bird/day, respectively, for 10 days. Nimesulide-addled birds became listless and despondent, then anorexic. The birds were standing there with their eyes closed and showing no signs of life. There was an increase in saliva production, a slowing of breathing, and dilated pupils. No clinical signs were observed in the control group. No mortality was seen in the control or treated groups. The control group did not show lesions of gout, but black kites intoxicated with nimesulide at 2, 4, and 6 mg/kg live body weight of bird/day showed inflammation, apoptosis, hemorrhage, necrosis, and leukocytic infiltration tissues of the liver, kidney, and heart of black kites (M. migrans) treated with different concentrations of nimesulide. The treated groups also showed apoptosis of myofibrils and hyperplasia. The hypertrophy, atrophy, fibrosis, necrosis of skeletal muscles and hemorrhage were prominent in the muscles of black kites (M. migrans) intoxicated with nimesulide. All observed histological alterations got worse in a dose-related way. There was no significant difference in AST, ALT, ALP, serum uric acid, but a significant difference was observed in the values of serum urea (p = 0.001) and serum creatinine (p = 0.019).

Role of agricultural credit guarantee policies in encouraging green agricultural development: farmers' perspectives and responses, and the regulatory function of household capital

Green agriculture is anticipated to be the leading trend for achieving sustainable and high-quality development in the agricultural sector in the future. The success of credit guarantee policies in promoting green agricultural development is closely linked to the level of participation and response from farmers in securing agricultural credit guarantee loans. We examined how farmers in Xiji, Ningxia, perceive agricultural credit guarantee policies and their involvement in such loans by analyzing 706 survey responses. Our analysis utilized a combination of statistical techniques, including principal component analysis, Heckman's two-stage model, and moderating effect model. The results indicate that out of the 706 surveyed farmers, 29.32% of households (207 households) had knowledge of the agricultural credit guarantee policy. While 66.86% of households (472 households) expressed interest in participating in agricultural credit guarantee loans, only 23.65% of households actually took part or participated multiple times. The overall awareness of the agricultural credit guarantee policy among farmers and their participation rate are both low. An increase in farmers' awareness of the agricultural credit guarantee policy can have a significant impact on their willingness and frequency of participation. The farmer's understanding of the agricultural credit guarantee policy has a significant impact on their decision to participate in credit guarantee loans. However, this effect can vary based on the farmer's income level, household capital, and factors such as social security, personal characteristics, location, and type of household business. To improve the support provided to farmers, it is advised to increase their awareness and understanding of agricultural credit guarantee policies. Furthermore, loan products and services should be personalized according to the capital available to each farmer's household, and the agricultural credit guarantee system and process should be enhanced to provide better assistance.

Analysis of financial support efficiency and influencing factors of listed seed companies from the perspective of energy consumption and carbon emissions

The seed industry has a prominent role in strengthening ecological stability and national food security as it provides the basic ground for agriculture sector. In the current research, the effectiveness of financial support provided to listed seed enterprises and its influencing factors from the perspectives of energy consumption and carbon emissions are examined using a three-stage DEA-Tobit model. The dataset for the underlined study variables mainly comes from the financial data published by 32 listed seed enterprises and the China Energy Statistical Yearbook from 2016 to 2021. In order to make the results more accurate, the influence of external environmental factors such as economic development level, total energy consumption, and total carbon emission on listed seed enterprises are excluded. The results revealed that the mean value of financial support efficiency of listed seed enterprises increased significantly after excluding the influence of external environmental and random factors. External environmental factors such as regional energy consumption and carbon dioxide emission played an important role in the process of the financial system supporting the development of listed seed enterprises. The development of some listed seed enterprises with high financial support efficiency came at the cost of high local carbon dioxide emission and high energy consumption. Internal factors such as operating profit, equity concentration, financial structure, and enterprise size are the key intra-firm factors that affect the efficiency of financial support for listed seed enterprises. Thus, it is suggested that enterprises must pay attention to the environmental performance to reach a win-win situation in reducing and improving the energy consumption and financial performance, respectively. Similarly, the improvement of energy use efficiency through endogenous and external innovation should be prioritized to achieve sustainable economic development.

Investigating the rationale for low-carbon production techniques in agriculture for climate change mitigation and fostering sustainable development via achieving lowcarbon targets

In China, agricultural activities are a major source of greenhouse gas emissions, ranking second only to another significant source. This presents a significant obstacle to reducing emissions and jeopardizes both the availability of food and the sustainable growth of agriculture. It is primarily the farmers who utilize cultivated land and are thus accountable for the initiation of these emissions. Farmers' role is significant in adopting green and low-carbon (LC) agricultural production practices, and their actions are directly tied to the achievement of the dual goals of carbon reduction. Understanding their motivations for engaging in LC production and the factors that influence their willingness to do so is important for both theory and practice. In this study, data was collected from 260 questionnaires in 13 counties across five major cities in Shaanxi Province. The purpose was to identify factors that impact farmers' motivation and willingness to engage in LC agriculture using linear regression analysis. A structural equation model was constructed to better understand the underlying mechanisms that influence farmers' actions towards LC farming practices. The study's findings indicate that (1) farmers' behavior towards LC production practices is notably impacted by internal motivation based on joy and internal motivation based on responsibility (IMR); (2) IMR has the most pronounced effect on farmers' adoption of LC production practices; (3) the internal motivation based on joy, IMR, behavior attitude, subjective norm, and perceived behavior control are related to each other; and (4) the multi-group analysis of the data indicates that the impact of internal motivation based on joy and IMR on adopting sustainable farming practices may vary among different groups. It is essential to support farmers who have strong intrinsic motivation to engage in sustainable agriculture. Additionally, policymakers must promote positive attitudes towards sustainable farming to achieve the desired environmental (LC) objectives.

Does green finance promote agricultural green total factor productivity? Considering green credit, green investment, green securities, and carbon finance in China

The Chinese government has proposed a "double carbon" target as a response to climate change and has been incorporated in the vision 2035. Agriculture's green development is intrinsically related to financial support, but conventional financial mechanisms fall short in their efforts to foster economic growth and curb environmental degradation. The current research examines the theoretical effects of green finance on agricultural green total factor productivity in the context of "double carbon." The mediating effect and moderating effect models are used to empirically examine this mechanism based on the panel data (2015-2019) of 30 provinces in China. The estimated results suggest that green finance development can significantly increase agricultural green total factor productivity, with an inverted U effect and an apparent regional heterogeneity. The eastern region has a stronger promotional effect than the central and western regions. The advanced industrial structure plays a mediating effect on the impact of green finance on agricultural green total factor productivity. Rural human capital can effectively mediate the mediating effect of advanced industrial structure on the impact of green finance on agricultural green total factor productivity. The aforementioned results offer fresh perspectives and empirical evidence for China's green finance policy improvement, harmonizing regional green finance development, promotion of industrial structure improvement, and rural human capital optimization.

Does location of the households' matters? Identifying the households' willingness to pay and preference heterogeneity in advancement of vulnerable ecosystem services: An approach of choice experiment

The present research underlines the need to expand far outside bundling or hierarchical providing strategy that often focuses on a specific habitat or ecosystem and creates a location-based strategy that considers how dependency in other parts of the region with ecosystem functions and processes leads to complements and resources' trade-offs. Thus, for assessment of spatial heterogeneity based on willingness to pay (WTP) for upgrading environmental attributes across Heihe River Basin (HRB), a choice experiment survey was carried out in the entire river basin. The HRB is one of the big inland river in the Northwestern region of China and is selected on basis of its geomorphological and geographical significance. A sum of 1679 individuals were interviewed through choice experiment technique from whole river basin consisting of five main cities and 33 adjoining rural areas. The Random Parameter logit model, Krinsky-Robb technique as well as delta method were applied for the evaluation of spatial heterogeneity and estimation of individual specific WTP, respectively. Spatial heterogeneity is verified among sampled individuals' preferences about upgradation of environmental attributes, such as, observed preferences of individuals' and their varying corresponding WTP amounts for per unit's upgradation in agriculture product quality, greenhouse gases reduction, farmland landscape, and biodiversity, which reflects heterogeneous tastes and preferences of the selected individuals. In addition, the assessed outcomes for identifying the impacts of distance decay through random parameter logit model depicted the vital role of distance influence on respondents' WTP for restoring the degraded environmental attributes, such that among 3 ad hoc distance bands, WTP of those sampled individuals who are in proximity of ≤ 10 km to HRB is more than the rest of the individuals, i.e., individuals living in the range of ≤ 20 km and > 20 km. For instance, WTP for agriculture product quality is 119.147 CNY/year in ≤ 10 km and is higher than the remainders.

Quantifying the spatial preferences heterogeneity to upgrade the endemic ecological attributes for a cleaner environment: Evaluating the feasibility of benefit transfer among sub-basins of an inland river

The role of wetlands in the conservation of global biodiversity is very significant due to the provision of various benefits to households. The assessment of these benefits and general public perception in terms of their willingness to pay for restoring the degraded ecosystem services is also heterogeneous because of their spatial preferences. This research employed a choice experiment technique to evaluate willingness to pay of the households to improve the current degraded ecosystem services and assessed benefit transfer among upper, middle and lower sub-basins of Heihe River. The outcomes of the study were estimated through two models, i.e. the conditional logit and random parameter logit models. The heterogeneous willingness to pay amounts for ecosystem services confirm the variations in taste and preferences of the respondents across all sub-basins. Considering spatial heterogeneity of the preferences, the random parameter logit model resulted in smaller transfer errors than the conditional logit model. The values of transfer errors estimated by the random parameter logit model from the lower to the upper sub-basin, from the upper to the middle sub-basin and from the middle to the lower sub-basin were 17.76%, 80.65% and 33.92%, respectively, and the reason for these smaller values is the consideration of taste and preferences of the respondents. On the other hand, the estimated values of transfer errors for the same settings in the conditional logit model were 21.93%, 109.31% and 43.08%, respectively. The transfer error values thus validate the transfer of benefits across all the sub-basins of the river. Therefore, the current findings are helpful in proper management of ecosystem services and permit for benefit transfer from one sub-basin to another sub-basin of Heihe River.

A novel scoring system to predict cardiac device implantation in patients presenting with syncope

Background

Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations.

Purpose

To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope.

Methods

A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation.

Results

The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p&lt;0.001), male sex (p=0.006), impaired left ventricular function (p=0.04) and presence of hypertension (p=0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see Table 1).

Conclusions

Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age &gt;75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1).

Funding Acknowledgement

Type of funding sources: None.

Does farmers' agricultural investment is impacted by green finance policies and financial constraint? From the perspective of farmers' heterogeneity in Northwest China

Green finance is a situation in which finance and environmental conservation are combined. Green credit management is a crucial green financial mechanism for achieving a win-win situation with economic development and environmental conservation through prudent credit resource allocation. Similarly, the continued involvement of farmers in green finance policies as micro-actors is critical to policy execution in rural regions. In current research, we utilized 2520 micro-surveys to measure the effects of green finance policies on agricultural investment of farmers in a difference-in-differences framework and developed a mediation effect model based on the degree of coupling coordination between financial development and environmental sustainability. It investigates the effects of heterogeneity in farmers' management on the mediating effect of financial restrictions. The study results show that, in comparison to the favorable effects of green finance policies on agricultural investment of farmers, the inclusion of a financial constraint variable reduces that benefit. Furthermore, farmers that engage in non-agricultural management practices are more likely to benefit from green finance policies and are impacted by the intermediate mechanism's financial restrictions. The construction of a rural green financial system should accomplish differentiated positioning and rapid development.

163 Anterior Sacral Meningocystocele Manifesting as Vague Gastrointestinal and Urinary Syndromes – Two Case Reports

Aim

Anterior Sacral Meningocystocele (ASM) carries a unique place in the current literature regarding its rarity. The condition arises in association with a congenital defect of the sacrum and coccyx through which the caudal part of the meninges may herniate to form a cyst-like structure. The disorder derives from a genetic defect of the coccyx and sacrum of which some meningeal segments protrude or herniate, forming a cyst-like entity.

Method

We report two cases of ASM. The first is a 65-year-old male with active complaints of urinary retention and hesitancy for two weeks and chronic constipation associated with lower back pain. The second, a 17-year-old girl, was presenting with abdominal bloating, pain, and backache. Magnetic resonance imaging (MRI) of the pelvis and lumbosacral spine was conducted for both patients, respectively, each scan exhibiting evidence of ASM development. Surgical correction and closure of the ASM's were performed via a posterior midline approach, which successfully alleviated the symptoms presented clinically by both patients.

Conclusions

ASM may develop asymptomatically, often with incidental discovery. Although ASM is well-regarded as a rare anomaly, diagnosis of such a defect must always be kept pertinent when a cystic structure in the pelvis is unveiled on ultrasound or during surgery. Puncture or aspiration of the cyst should be avoided if the diagnosis is in doubt. A posterior midline approach with careful obliteration of the meningocele sac opening may be curative.

An Estimation of the Effect of Green Financial Policies and Constraints on Agriculture Investment: Evidences of Sustainable Development Achievement in Northwest China

Farming' community actively participating as micro-actors in green finance schemes is critical for regional planning and development. On the basis of the extent to which financial progress and sustainable development are coordinated, in a difference-in-differences approach, this article employed 2350 small investigations to estimate the influence of green-finance strategies on peasants' agriculture investment and developed a mediation effect method. It investigates the role of peasant managerial variability in mediating the influence of financial constraints. The results indicate that the introduction of a financial restriction variable reduces the positive impacts of green-finance regulations on peasants' agricultural investment. Moreover, peasants who participate in non-agricultural management exercises are more inclined to take advantage of green financing regulations and are affected via financial restrictions in mediate means. The building of a green-finance sector in remote regions should accomplish unique positioning and rapid growth.

Drought stress enhances the efficiency of floral dip method of Agrobacterium-mediated transformation in Arabidopsis thaliana

The Agrobacterium-mediated floral dip protocol is the most extensively used transformation method for a model plant Arabidopsis thaliana. Several useful methods for Agrobacterium tumefaciens-mediated transformations of Arabidopsis are existing, but they are time consuming and with low transformation efficiency. Here, we developed a transgenic Arabidopsis lines TET12p::TET12-RFP in a short period of time and enhanced transformation efficiency by using a modified transformation method by applying drought stress after floral dip. In this protocol, Agrobacterium cells carrying TET12p::TET12-RFP recombinant vectors were resuspended in a solution of 5% sucrose, 0.05% (v/v) silwet L-77 to transform female gametes of developing Arabidopsis inflorescences. Treated Arabidopsis were then applied with different levels of drought stresses to stimulate plants for the utilization of maximum plant energy in seed maturation process. The applied stresses achieved the fast maturation of already treated inflorescences while stopped the growing of newly arising untreated inflorescence, thus decreased the chances of wrong collection of untransformed seeds. Consequently, the collected seeds were mostly transgenic with a transformation frequency of at least 10%, thus the screening for positive transformants selection was more advantageous on a selective medium as compared to a classical floral dip method. Within 2-3 months, two hundred of individual transgenic plants were produced from just 10 infiltrated plants. This study concludes that application of drought stresses in a specific stage of plant is a beneficial strategy for achieving the transgenic Arabidopsis in a short period of time with high transformation efficiency.

Magnesium sulfate as a potential dye additive for chlorophyll-based organic sensitiser of the dye-sensitised solar cell (DSSC)

In this work, a new chlorophyll dye-sensitiser derived from mitragyna speciosa (MS) leaves, also known as Kratom, was employed for dye-sensitised solar cells (DSSCs). The influence of magnesium sulfate (MgSO₄), a low-cost dye additive, and suitable extraction solvents on the performance of DSSCs were examined. Here, the optical properties were investigated using UV-Visible spectroscopy and the functional anchoring group were investigated by FTIR spectroscopy. Meanwhile, the photovoltaic parameters were investigated by I-V measurements. The highest conversion efficiency is obtained when using a dye extracted from methanol solvent in combination with MgSO₄ additive, namely methanolic magnesium sulfate (MMSO). This higher power conversion efficiency is mainly attributed to the enhancement of the hydroxyl group in the MMSO dye solutions, which promotes higher dye adsorption and provides an organic dye passivation layer that reduces back-recombination in the cell. Furthermore, MgSO₄ aids in the replenishment of magnesium lost in the chlorophyll porphyrin ring during the degradation process. These combined effects have contributed to the overall conversion efficiency of the MMSO cell at 0.26 %, followed by 0.24 % for ethanolic magnesium sulfate (EMSO), respectively.

Prioritizing stakeholders' preferences for policy scenarios of vulnerable ecosystems with spatial heterogeneity in choice experiment: Coupling stated preferences with elevation

Understanding public preferences and evaluating the river basin are essential for effective river basin management, and enhancing its environmental attributes can provide considerable non-market benefits. As such, the study explores the heterogeneity in people's preferences and rankings of river ecosystem services based on their willingness to pay (WTP) to upgrade these services. A research survey was conducted throughout the river basin using a choice experiment approach. In this study, we evaluated the impact of study area elevation (a spatial attribute) on residents' willingness to pay for rehabilitation of environmental attributes. The study incorporates 6 ecological attributes in order to examine the differences in people's willingness to pay at various elevation levels. A total of five cities and 33 surrounding villages and townships were surveyed, while five elevation groups were made on an ad hoc basis to split samples, i.e., 1000-1600 m, ≤1600-2200 m, ≤2200-2800 m, > 2800-3400 m, and 3400-4000 m. The results of the mixed logit model recognized that people living at different elevations value rehabilitation of varying environmental attributes differently. For example, the inhabitants in Group 1 (1000-1600 mm) are willing to pay RMB 6.70 per year for biodiversity upgrades; while the WTP of the people for the same attributes is RMB 32.68 in Group 5 (3400-4000 mm). The Krinsky Robb approach confirmed that agricultural product quality and greenhouse gases (GHGs) were the most highly valued attributes, with a willingness to pay of RMB 90.40 and RMB 47.17, respectively. Applying these results as a reference for sustainable improvements and uplift of deteriorated ecological qualities is an example of how they may be helpful in bettering the world.

Identifying impact of international trade and renewable energy consumption on environmental quality improvement and their role in global warming

There is a lack of proper research that highlights the impact of institutional quality (IQ) and renewable energy consumption (REC) on the carbon emission (CE). The significance of IQ and REC in the achievement of zero CE is highlighted in this research. The current research reports the effects of these important factors on the consumption-based carbon emissions in the G-7 countries from 1995 to 2018. Based on the outcome of the cointegration test, the long-run connection is recognized between IQ, REC, GDP, exports, imports, and consumption-based CE. The findings also validated that there exist significant decrease and increase in the CE in both the short and long run; for instance, IQ, REC, and exports decrease the CE, while imports and GDP increase the CE. The estimates of causality test showed that policies aimed at improving IQ, REC, GDP, exports, and imports have a significant impact on the CE. Consequently, based on these results, policymakers in the G-7 must prioritize IQ and REC to enhance environmental quality and attain carbon neutrality.

Identifying impact of international trade and renewable energy consumption on environmental quality improvement and their role in global warming

There is a lack of proper research that highlights the impact of institutional quality (IQ) and renewable energy consumption (REC) on the carbon emission (CE). The significance of IQ and REC in the achievement of zero CE is highlighted in this research. The current research reports the effects of these important factors on the consumption-based carbon emissions in the G-7 countries from 1995 to 2018. Based on the outcome of the cointegration test, the long-run connection is recognized between IQ, REC, GDP, exports, imports, and consumption-based CE. The findings also validated that there exist significant decrease and increase in the CE in both the short and long run; for instance, IQ, REC, and exports decrease the CE, while imports and GDP increase the CE. The estimates of causality test showed that policies aimed at improving IQ, REC, GDP, exports, and imports have a significant impact on the CE. Consequently, based on these results, policymakers in the G-7 must prioritize IQ and REC to enhance environmental quality and attain carbon neutrality.

Role of institutional quality and renewable energy consumption in achieving carbon neutrality: Case study of G-7 economies

This research emphasized the significance of institutional quality and renewable energy consumption in achieving the desired objective of zero carbon emissions. Following the COP21 (Paris Conference), many countries have fixed their national level objectives for achieving the carbon neutrality and to tackle the problem of global warming. Many researchers have focused their efforts on the aspects that contribute to environmental degradation. Meanwhile, there is a scarcity of appropriate research that highlights the environmental implications of institutional quality and renewable energy consumption. Therefore, the current study examines the influence of these significant determinants on CCO₂ emissions in the G-7 countries from 1990 to 2018. The long run relationship between institutional quality, renewable energy consumption, GDP, exports, imports, and CCO₂ emissions is approved, based on the assessed results of cointegration test. Besides that, the estimated results have endorsed a considerable decrease and increase in carbon emission both in the short and long run, i.e., institutional quality, renewable energy consumption, and exports reduce emissions, while imports and GDP raise emissions. The Dumitrescu and Hurlin causality test results show that policies aiming at improving institutional quality, renewable energy consumption, GDP, exports, and imports have a significant effect on CO₂ emissions. As a result of these findings which recommends that G-7 countries' policymakers should emphasize institutional quality and renewable energy consumption in order to improve environmental quality by reducing carbon emissions and to achieve carbon neutrality.

An impact of climate change and groundwater salinity on shadow price of water, farmers' revenue, and socioeconomic and environmental indicators in district Kohat-Pakistan

Globally, agricultural productivity is adversely impacted due to climatic changes as the temperatures rises and precipitation decreases, and especially in Pakistan, which ultimately enhanced groundwater salinity and harmed water quality in the country. However, the impacts of groundwater salinity and climate change on farmers' revenue have not been fully understood in Pakistan. Therefore, the focus of current research is the assessment of shadow price of water, farmers' revenue, and socioeconomic and environmental indicators affected by variations in groundwater salinity, precipitation, and temperature. The estimation of crop yield sensitivity to groundwater salinity, precipitation, and temperature and their prediction for 2030, 2040, and 2050 time periods was accomplished through the technique of General Maximum Entropy and Response-Yield function. Moreover, the assessment of groundwater quality and climate variable impacts on socioeconomic and environmental indicators was obtained through Target Motad-PMP model. In the end, the most suitable climate change scenario in the study area was established by applying a multi-criteria decision-making method. The results revealed that groundwater salinity and temperature expressed a significantly increasing trend with the Z values of 5.82 and 2.15, respectively. While the precipitation depicted a significantly decreasing trend (Z value = -3.37). The negative impact of climatic changes and groundwater salinity was revealed for revenue risk and shadow prices of water. The most negative impact on income risk and shadow prices is during 2050 horizon with a decrease by 11.4 and 19.4% respectively. The environmental index is the most important with a priority of 43.4% compared to the socio-economic indicators. The sub-index water use is also significant in the study area with a priority of 28.1%. A2 is the most appropriate climate scenario conferring to the TOPSIS ranking method. Therefore, the A2 scenario should be taken into account for the policy of adaptation to the climate change wonder in district Kohat.

Do credit constraints affect the technical efficiency of Boro rice growers? Evidence from the District Pabna in Bangladesh

This study analyzes the effects of credit constraints on technical efficiency of Boro rice growers in the district of Pabna in Bangladesh. Using a simple random sampling technique, the data was collected from 570 Boro rice growers from the Pabna district of Bangladesh. Before conducting a field survey, a theoretical model was designed to identify credit-constrained and non-constrained rice growers. We have analyzed the collected data in two phases: first, we investigated the technical efficiency of Boro rice growers using the stochastic frontier model (SFA); and second, we used an inefficiency effect model to estimate the influence of credit constraints on technical efficiency. Findings indicate that credit-constrained rice growers (CCRG) are 6.7% less technically efficient than credit non-constrained rice growers (CNRG). Findings further indicate that the education level of the household head, family size, certified seed, sowing time, access to extension services, off-farm income, and household savings have significant effects on the technical efficiency of both groups of rice growers. Furthermore, credit size has a significantly positive impact, whereas the interest rate imposed on the principal amount has a significantly negative impact.

Study of resveratrol against bone loss by using in-silico and in-vitro methods

By applying the in-silico method, resveratrol was docked on those proteins which are responsible for bone loss. The Molecular docking data between the resveratrol and Receptor activator of nuclear factor-kappa-Β ligand [RANKL] receptors proved that resveratrol binds tightly to the receptors, showed the highest binding affinities of -6.9, -7.6, -7.1, -6.9, -6.7, and -7.1 kcal/mol. According to in-vitro data, Resveratrol reduced the osteoclasts after treating Marrow-Derived Macrophages [BMM] with Macrophage colony-stimulating factor [MCSF] 20ng / ml and RANKL 50ng / ml, with different concentrations of resveratrol (2.5, 10 μg / ml) For 7 days, the cells were treated with MCSF (20 ng / ml) and RANKL (40 ng / ml) together with concentrated trimethyl ether and resveratrol (2.5, 10 μg / ml) within 12 hours. Which, not affect cell survival. After fixing osteoclast cells with formaldehyde fixative on glass coverslip followed by incubation with 0.1% Triton X-100 in PBS for 5 min and after that stain with rhodamine phalloidin staining for actin and Hoechst for nuclei. Fluorescence microscopy was performed to see the distribution of filaments actin [F.actin]. Finally, resveratrol reduced the actin ring formation. Resveratrol is the best bioactive compound for drug preparation against bone loss.

Dietary habits of lesser bandicoot rat (Bandicota Bengalensis) in an agro-ecosystem, Pothwar Plateau, Pakistan

Dietary habits of bandicoot rats (bandicota bengalensis) were investigated in the agricultural crops of the Pothwar Plateau, Pakistan by analysing stomach contents. The research activities were conducted in major field crops including wheat-groundnut and in the fallow lands during non-crop season at the field boundaries. The specimens were captured from the fields using kill/snap traps, and dissected to collect their stomach samples for laboratory analysis. Light microscopic slides of the plant material were recovered from stomach samples and the reference materials were collected from the field. Results revealed that the bandicoot rat predominantly fed upon cultivated crops during cropping season but consumed wild vegetation during non-cropping season. There was no significance difference between summer and winter diets. Most frequently consumed crop food items were wheat (Triticum aestivum; 28.57%), groundnut (Arachis hypogea; 11.26%), sorghum (Sorghum bicolor; 10.17%), chickpea (Cicer arietinum; 9.52%), maize (Zea mays; 6.49%), millet (Pennisetum glaucum; 5.84%), barley (Hordeum vulgare; 4.98%) and mustard (Brassica campestris; 4.98%). Among wild vegetation were consumed khbal gha (Cynodon dactylon; 7.79%), baron dhab (Demostachya bipinnata; 7.36%) and Prickly flower (Achyranthes aspera; 3.03%). The study concludes that, in addition to consuming wheat and groundnut crops, the Lesser bandicoot rat also subsists on grasses, weeds, and some fodder crops, as important component of its diet in agro-ecosystem of the Pothwar Plateau.

Death caused by covid-19 in top ten countries in Asia affected by covid-19 pandemic with special reference to Pakistan

The COVID-19 is a contagious viral disease, was first emerged in Wuhan, China in December 2019 and became the whole world on alert. The mortality rate in top most countries in Asia with special reference to Pakistan has been focused. Since February 26 to September 2020 the total confirmed cases and mortality rate was measured through Wikipedia and the notable journals. Iran is the only country having highest number of deaths (5.73%) followed by Indonesia (3.77%) while Saudi Arabia shows the lowest number of deaths as 1.39%. In Pakistan the first case was confirmed in 26th February, 2020. The nCov-19 has closely related to severe acute respiratory syndrome (SARS) hence SARS COV-2 was named. This virus is responsible for more than 33.9 million deaths in over all the world as of 20th September, 2020. The number of new cases is increasing time to time. Sindh province of Pakistan has reported the highest number of cases till September, 20, 2020 as compared to other parts of the country and has the highest number of death followed by Khyber Pakhtunkhwa. Because of the person to person contact the disease is spreading rapidly. The individuals who has already infected with other diseases like cancer or diabetic etc. are vulnerable. The nCOV-19 is the most contagious due to its mode of transmission. There is still no vaccine is available for the treatment of disease caused by nCoV-2019. It is therefore the only option to control this pandemic is to adopt effective preventive measures.

Three-dimensional simulation of aesthetic outcome from breast-conserving surgery compared with viewing photographs or standard care: randomized clinical trial

INTRODUCTION

Over half of women with surgically managed breast cancer in the UK undergo breast-conserving treatment (BCT). While photographs are shown prior to reconstructive surgery or complex oncoplastic procedures, standard practice prior to breast conservation is to simply describe the likely aesthetic changes. Patients have expressed the desire for more personalized information about likely appearance after surgery. The hypothesis was that viewing a three-dimensional (3D) simulation improves patients' confidence in knowing their likely aesthetic outcome after surgery.

METHODS

A randomized, controlled trial of 117 women planning unilateral BCT was undertaken. The randomization was three-way: standard of care (verbal description alone, control group), viewing two-dimensional (2D) photographs, or viewing a 3D simulation before surgery. The primary endpoint was the comparison between groups' median answer on a visual analogue scale (VAS) for the question administered before surgery: 'How confident are you that you know how your breasts are likely to look after treatment?'

RESULTS

The median VAS in the control group was 5.2 (i.q.r. 2.6-7.8); 8.0 (i.q.r. 5.7-8.7) for 2D photography, and 8.9 (i.q.r. 8.2-9.5) for 3D simulation. There was a significant difference between groups (P < 0.010) with post-hoc pairwise comparisons demonstrating a statistically significant difference between 3D simulation and both standard care and viewing 2D photographs (P < 0.010 and P = 0.012, respectively).

CONCLUSION

This RCT has demonstrated that women who viewed an individualized 3D simulation of likely aesthetic outcome for BCT were more confident going into surgery than those who received standard care or who were shown 2D photographs of other women. The impact on longer-term satisfaction with outcome remains to be determined.Registration number: NCT03250260 (http://www.clinicaltrials.gov).

Feasibility of youth empowerment initiative for identifying never- and under-immunized children

Background

One-in-every 5 children globally remains deprived of life-saving vaccines. We developed and implemented the Adolescent Health and Leadership Program (AHLP) among school girls from grades 8-10 (Kiran Sitaras (KSs); Shining Stars) to provide them with soft skills and community mobilization skills and equipping them to become community advocates for immunization. We evaluated the feasibility of KS community mobilization through validating KSs' ability to accurately identify and link never- and under-immunized children with immunization services.

Methods

We implemented a mixed-methods study in six public schools located in peri-urban areas of Karachi, Pakistan. After the development and roll-out of AHLP in schools, KSs conducted door-to-door visits in their neighborhoods to identify never-and under-immunized children. This was followed by verification visits by field staff to establish accuracy and immunization camps to vaccinate never- and under-immunized children identified by KSs.

Results

From January 28 to February 22, 2020, 591 KSs visited 10,330 households, screened 3,295 under-2 children and identified 7.5% (247/3,295) never- and 27.0% (889/3,295) under-immunized children, with an accuracy of 90.4% and 49.6%, respectively. In January 2021, 291 never- and under-immunized children were invited to immunization camps, of which 28.9% (84/291) received vaccinations, while 57.0% (166/291) did not respond to the invite and 14.1% (41/291) were deemed ineligible (illness, overage, etc.).

Conclusions

We demonstrated the feasibility of empowering adolescent girls to boost immunization uptake in LMIC settings. Engaging young women from within the community provides an organic and sustainable solution for promoting immunization coverage and equity today and ensuring they will continue to champion the cause in their capacity as tomorrow's mothers. We are actively scaling-up our solution across the country to create a force of 100,000+ KSs to magnify our efforts.

Key messages

The Kiran Sitara initiative, via its community-centered approach, leverages the force of adolescent school girls to boost demand and referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify never- and under-immunized children, and subsequently increase vaccine-uptake.

Feasibility of an artificially intelligent vaccines chatbot in Pakistan: A mixed methods evaluation

Background

Despite free vaccination services, gaps in information access impede immunization uptake in low and middle-income countries (LMICs), including Pakistan. We developed Bablibot (Babybot), a local-language, text-based chatbot to connect caregivers with immunization-related information in real-time, and evaluated its feasibility and acceptability in resolving immunization-related queries among Karachi's low-income communities.

Methods

We developed Bablibot using Natural Language Processing (NLP), Machine Learning, and Human in the Loop features. We conducted a sequential mixed-methods pilot in Karachi where caregivers were recruited when visiting selected immunization centers for any childhood vaccine except Measles 2 (last vaccine visit) or were informed through targeted text messages. We assessed Bablibot's feasibility and acceptability through user-engagement metrics and thematic analysis of qualitative interviews conducted with 20 pilot participants.

Results

Between March 9, 2020 and April 15, 2021, Bablibot accrued 677 users and participated in 874 conversations. Of 2,202 pilot-enrolled caregivers, 210 (10%) interacted with the bot; other 467 users were not pilot participants. Most queries were about due dates (25%; 221/874), delaying vaccination (17%; 146/874), or side-effect management (16%;137/874). The conversations now constitute a valuable training database for future local-language bots. Over 90% (277/307) of responses to text-based exit surveys indicated user satisfaction. Qualitative analysis showed caregivers appreciate Bablibot's convenience, reliability, and responsiveness.

Conclusions

Our results demonstrate the feasibility and acceptability of local-language NLP chatbots in providing immunization information. Text-based chatbots can minimize workload on helpline operators, in addition to quickly resolving queries that otherwise lead to delay or default. Bablibot's conversation data provides learning infrastructure for future health-related bots.

Key messages

An AI-based NLP chatbot is a feasible and acceptable intervention for providing immunization-related information to large number of caregivers 24/7 in limited resource setting. By serving as a remote, low-cost and confidential bi-directional channel, chatbots can address gaps in information access, especially for women, and have long term impact on immunization uptake.

1-year impact of COVID-19 on childhood immunizations in Pakistan: analysis of &gt; 3.7 million children

 

Covid-19 has universally disrupted primary health care, but routine childhood immunizations are one the most affected services. We analyzed big data in vaccines for measuring the 1-year impact of Covid-19 on outline childhood immunizations for the 48 million population in the Sindh province of Pakistan. We extracted and analyzed >3.7m real-time immunization records of 0-23 months old children from the Sindh Government's Electronic Immunization Registry (EIR). Using a 6-month baseline preceding the COVID-19 lockdown, we quantified the lockdown's (March 23-May 9, 2020) impact on daily immunization rates by geographical area and the change in coverage rates at the one-year mark since the lockdown. The lockdown resulted in 53% drop in the number of immunizations. The impact in rural areas as more than in urban areas (54.9% decline vs 47.5% decline from baseline), and slums had a slightly larger decrease in immunization coverage than non-slum areas (53.8% vs. 51.3%). Of 1,246,321 children who missed immunizations during first year of the pandemic, 76% of these children were eventually vaccinated by the end of March 2021. Similarly, of the 417,553 children who had dropped out during the initial 7-week national lockdown (March 23-May 10, 2020), 79% were immunized by March 2021. Our analysis of EIR data shows that the catch-up and recovery of coverage rates have primarily been driven through intensive outreach vaccination efforts instead of an increase in demand. One year since the onset of the pandemic, the average daily immunization doses administered through outreach increased by 121 percent above baseline estimates. In contrast, vaccines administered at immunization clinics were still 22 percent below baseline. The example of Pakistan shows LMICs can successfully deploy mitigation strategies to catch up with missed children during Covid-19 and sustain routine childhood immunizations to close immunity gaps.

Key messages

Although the lockdown resulted in a 53% drop in immunizations, at the 1-year mark since the pandemic started, 76% of children who missed immunizations are vaccinated.

Pakistan data shows LMICs can rectify routine immunization coverage and immunity gaps and rebound successfully to their pre-COVID-19 coverage rates.

Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan

Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.

Association between atrial high rate episode burden and autonomic and vascular function in patients with implanted cardiac device

Background

Patients who experience frequent atrial high rate episodes (AHREs), recorded on implantable cardiac devices, are at an increased risk of stroke and systemic embolism. Increased duration of AHRE is related to higher risk of thromboembolic event. The underlying pathophysiology is unclear; however, autonomic and/or endothelial dysfunction may contribute.

Purpose

We tested the hypothesis that patients with high AHRE burden have worse autonomic and vascular function compared to patients with low AHRE burden.

Design

We studied 44 patients split in two groups: high AHRE burden (longest AHRE ≥24 hours; n=22) and low AHRE burden (longest AHRE &lt;24 hours; n=22). Resting time- and frequency-domain measures of HRV were determined to index cardiac autonomic function. High-resolution ultrasound was used to measure brachial artery diameter at rest and during reactive hyperaemia (endothelium-dependent flow mediated dilation (FMD)).

Results

FMD was higher in the low AHRE burden group compared to high AHRE group (5.5% [95% confidence interval (CI):3.4–7.6] vs 3.1% [95% CI: 1.9–6.2]; p=0.04) (table 1). Mean heart rate (p&lt;0.001) and AHRE burden (p=0.02) were independent predictors of FMD on multivariate analysis. Time-domain, frequency-domain and non-linear indices of HRV were not significantly different between the groups. A slower heart rate (Spearman's rho 0.369; p=0.01) and high AHRE burden (Spearman's rho −0.315; p=0.04) were independently associated with changes seen on FMD following adjustment for multiple variables (p=0.001 and p=0.03 respectively).

Conclusion

Endothelium-dependent FMD is impaired in patients with high AHRE burden, while HRV derived indices of autonomic function were not affected by AHRE burden. Endothelial dysfunction may play an important role in the adverse outcomes seen in patients who experience frequent AHRE.

Funding Acknowledgement

Type of funding sources: None.

Self-Inflicted Pneumomediastinum: A Case Report

Self-inflicted wound can present with various scenarios. It is well known that the purpose of a self-inflicted wound is to avoid obligatory duties. During war, soldiers get self-inflicted wounds to seek medical leave in the hope to save their lives from deadly battle. Self-induced pneumomediastinum from oral lesion with valsalva maneuver was a rare practice among prisoners to get rid of that imprisoned life and to stay in the hospital. Self-inflicted wound is also commonly seen in patient with psychosomatic disorders. It relates observations from forensic medicine and psychiatry to specific clinical symptoms, toxicological circumstances and social influences e.g. stress incurred by everyday life, war, imprisonment etc. In particular cases, it clears up criminal and civil jurisdiction. It also gives importance to private insurers about cases of self-mutilation. There is also concern about insurers, forensic scientists and psychiatrist about their responsibilities and the procedure they follow in the examination, their jurisdiction and the treatment involving the cases of self-inflected injuries. To our knowledge, self-inflicted subcutaneous emphysema causing pneumomediastinum by a normal young boy out of curiosity and without any apparent ill motive, is an unusual finding and possibly no such case report was published before.

Wild birds trade in Dera Ismael Khan and Bannu divisions of Khyber PakhtunKhwa (KPK) Province, Pakistan

Wildlife trade is a profitable economic activity. Birds are among the most heavily traded animals worldwide, with numerous species threatened by pet trade. The present case study was stretched for period of one year to find out the status of wild birds' trade in Bannu and Dera Ismael Khan Divisions. The study was aimed to find out the types of species, commercial prices of bird, trade routes, overall income generated from birds' trade and the status of dealers whether licensed or not. Bimonthly visits were conducted to interview 52 bird dealers/pet shops owners/venders (23 in Dera Ismael Khan and 29 in Bannu). A sum of 16 conceivable sites were visited during the study period. Out of these, 8 sites were located in Dera Ismael Khan and 8 sites in Bannu Division. The highest priced species was Demoiselle crane (Grus virgo) and the lowest priced species was house sparrow (Passer domesticus). Total number of species traded in both regions were 8 and 14 while the income generated by bird trade was amounting to PkR 1,322,200 and 7,128,950 in Dera Ismael Khan and Bannu respectively. Majority of the birds were trapped locally with the exception of few from adjacent areas. Commercial activity led by illegal bird traders was found 75% and 100% species in Dera Ismael Khan and Bannu respectively. There was no significant difference between prices of birds, number of species sold and income generated by bird trade in two divisions.

Mosquitocidal activities of Chenopodium botrys whole plant n-hexane extract against Culex quinquefasciatus

This research aimed to investigate various mosquitocidal activities of Chenopodium botrys whole- plant n-hexane extract against Culex quinquefasciatus. The extract showed remarkable larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus. During the larvicidal and pupicidal activities, the 24-hour lethal concentration (LC50) of extract against 2nd instar larvae, 4th instar larvae and pupae were 324.6, 495.6 and 950.8 ppm, respectively. During the CDC (Centers for Disease Control and Prevention) bottle bioassay for adulticidal activity, the median knockdown times (KDT50) at 1.25% concentration was 123.4 minutes. During the filter paper impregnation bioassay for adulticidal activity, the KDT50 value at 0.138 mg/cm2 concentration was 48.6 minutes. The extract was fractionated into 14 fractions through silica gel column chromatography which were then combined into six fractions on the basis of similar retention factor (Rf) value. These fractions were screened for adulticidal activity by applying CDC bottle bioassay. The fraction obtained through 60:40 to 50:50% n-hexanes-chloroform mobile phase with 0.5 Rf value showed 100% adulticidal activity at 0.2% concentration. During oviposition deterrent activity, the highest concentration (1000 ppm) showed 71.3 ± 4.4% effective repellence and 0.6 ± 0.1 oviposition activity index. During adult emergence inhibition activity, the median emergence inhibition (EI50) value was 312.3 ppm. From the outcome of the present investigation, it is concluded that the n-hexane extract of C. botrys whole- plant possesses strong larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus.

Tracking sustainable development efficiency with human-environmental system relationship: An application of DPSIR and super efficiency SBM model

Sustainable development of the Yellow River Basin, China, has gained comprehensive realistic and academic attention as a significant part of high-quality development. Current study used the 30 years (1997-2017) panel data of 9 provinces and constructed Drivers, Pressure, State, Impact and Response analysis framework and super efficiency Slack-Based Measure (DPSIR-SBM) model to evaluate rural sustainable development efficiency (RSDE). For the reason, the convergence, divergence and their influencing factors are discussed from three aspects, which are σ convergence, absolute β convergence and conditional β convergence. The research findings revealed that the RSDE in yellow river basin display a fluctuating downward pattern per an average decrease rate of 0.03%, while regional differences exist in three sub-basins. The upper and lower basins display a fluctuating upward pattern, whereas the middle basin present a fluctuating downward pattern. Moreover, regional differences were also observed from the average RSDE, followed by the spatial pattern of "upper basin > lower basin > middle basin". σ convergence exist in the whole basin as well as in its upper basin, while absolute β convergence exists in the whole basin and in the lower basin, and there exists conditional β convergence in the whole as well as in all the three sub-basins. Initial RSDE, planting structure, financial autonomy rate and mechanization level inhibit the improvement of RSDE, while urbanization level and rural GDP per capita have negative and non-significant impact on RSDE of the whole basin.

An evaluation of influencing factors and public attitudes for the adoption of biogas system in rural communities to overcome energy crisis: A case study of Pakistan

Energy is the backbone of a country's economy and development. The potential contribution of renewable energy technology to energy stability, climate change mitigation and economic growth is immense. Biogas, is a renewable energy resource and enriched with methane, produced through the breakdown of organic matters (anaerobically). The large quantity of livestock has significant contributions in Pakistan's economy, and also having a high potential for production of biogas. Therefore, this study was conducted in 6 southern districts of Khyber Pakhtunkhwa province of Pakistan, to identify the expected willingness of households for adopting any biogas system. A sum of 360 households (livestock-farmers) was selected for data collection by the procedure of equal allocation. The identification of the influencing factors on the household's willingness to adopt any biogas system was determined through probit analysis. It has been validated from the research outcomes of probit analysis that the selected household's qualification, electricity shortfall on daily basis and its impact on children's education and female work, awareness of the selected household's about the biogas utilization and its benefits as well as the availability of space have demonstrated their significance and relationship with the household's willingness to adopt biogas system. The overall model is statistically significant at 1% significance level and confirmed the impact of socioeconomic features as the prominent factors for the household's decision to adopt a biogas system. This study suggests the public awareness, which has more significant impact on identifying the household's adoption behavior. Similarly, adequate investments both at the private and public level, should be encouraged for promoting biogas technology. At the same time, the government's fiscal policy should be subsidized which will encourage the lower-income populations' participation in adopting and installing biogas plants.

Plant age, crop stage and surrounding habitats: their impact on sucking pests and predators complex in cotton (Gossypium hirsutum L.) field plots in arid climate at district Layyah, Punjab, Pakistan

Sucking pests are major threat to cotton field crop which cause unbearable losses to the crop yield. Aim of the current study was to record seasonal dynamics of major sucking insect pests including whitefly, jassid, thrips and their natural arthropod predators i.e. green lacewings and spiders in cotton field plots. The effects of surrounding field crops on pests' density and predatory efficiency of predators were also recorded. For sampling and survey of insects, the visual counting was found to be the most efficient method for recording the abundance of insects, trailed by net sweeping and tapping. Whitefly was the most dominant sucking pest found on the vegetative stage of cotton, followed by jassid and thrips. Fluctuated populations of predatory arthropods, spiders and green lacewings were also recorded during whole cropping season however, the densities of pests and predators varied with crop phenology. Spiders' population was encouraging at both vegetative and flowering stage and also the same trend of jassid and whitefly were observed at both stages of the crop. Surrounding habitats showed non-significant effect on population densities of insect pests and predators. For abiotic factors, the spiders showed strong positive correlation with humidity and temperature. However, green lacewing was only positively correlated with humidity. On the other hand, the populations of whitefly, jassid and thrips showed non-significant correlation with both temperature and humidity. Overall densities of sucking insect pests were found above economic threshold level. The plant age, crop stage and surrounding habitats effect on the population fluctuation of pests as well as the predators' abundance. The future studies are also warranted to investigate the altered habitats and multiple trap cropping to find out their impact on unattended insect predators and parasitoids in cotton crop.

Induction of secondary metabolites on nanoparticles stress in callus culture of Artemisia annua L

Nanoparticles are known bio elicitors in plant biotechnology. Different concentrations of ZnO, CuO and CoO nanoparticles were used for the enhanced accumulation of secondary metabolites and antioxidant activities in the callus derived from root, shoot and leaf of Artemisia annua L. Biomass of callus was somehow affected on high concentrations of Nps. Phenolic content was observed maximum (60µg) in shoot callus at 0.1mg/l of CuONps. Total antioxidant activity was observed maximum (33µg) in root callus at 0.1mg/l of ZnOnps. Total reducing power maximum (33µg) was observed in root callus at concentration of 0.05 mg/l of CoONps. Maximum radical scavenging activity was observed in shoot callus at 0.05mg/l of ZnONps. Rutin gallic acid and caffic acid were also determined in most of the samples by HPLC. The study concludes that different Nps have positive effect on the induction of secondary metabolites in A.annua plant.

Euphlyctis Cyanophlyctis Schneider, 1799 (Amphibia: Dicroglossidae) in district Lower Dir, Pakistan

Euphlyctis cyanophlyctis (the skittering frog) is one of the most widespread species in Pakistan. Present study was aimed to know the presence of Euphlyctis cyanophlyctis in urban and rural areas of Lower Dir, the North-western Pakistan. A total of 33 frogs were collected, including 15 from rural and 18 from urban areas. The frogs were caught by hands covered with gloves instead of using nets. The collection was managed from August to October 2016 and from April to May 2018. Morphometric analysis, coloration as well as photographs of the frogs have been provided in detail. Skittering frogs were seen frequent in swampy areas near the water bodies. These frogs were mostly seen after sunset.

In-vitro and in-vivo evaluation of the antibacterial potential of Typha elephantina

The present study was aimed to evaluate the in-vitro and in-vivo antibacterial effects of the Typha elephantina aqueous extract (TE.AQ), ethanolic extract (TE.ET) and T. elephantina methanolic extract (TE.ME) against eight selected clinical pathogens. The test samples were tested for in-vitro analysis (by disc diffusion method) at different concentrations of 5, 15, 25, 50 and 100 mg/dL against both gram positive and gram-negative strains. The highest potential was observed in TE.ME at a concentration of 100 mg/dL against Pseudomonas aeruginosa exhibiting 19.67 ± 0.577 mm zone of inhibition (ZOI). The same fraction also showed good activity against Staphylococus aureus with ZOI of 17.50 ± 0.70 mm. The TE.ET was found most active against P. aeruginosa and Streptococcus pyogenes having ZOI of 18.53 ± 0.503 and 16.2 ± 1.55 mm respectively at a concentration of 100 mg/dL. The most sensitive bacteria P. aeruginosa was selected for in-vivo study (using poultry chicks) for induction of infection in chicks. The effects of TE.AQ, TE.ET and TE.ME were determined at concentrations of 300 mg/kg body weight based on hematological parameters, liver enzymes and gross pathological findings of lungs and livers. The findings of the in-vivo study in chick's model showed that treatment of experimental animals with TE.ME significantly restored the hematological parameters, liver enzymes and architecture of lungs and livers. Based on scientific evidence, the current study suggests that TE.ME may serve as a best and new natural antibacterial agent and can be used against infections caused by P. aeruginosa.