Occurrence of fungal microbial contamination in drinking water of megacity of Karachi (Pakistan) and their physico-chemical control

The water quality in Karachi (Pakistan) is uncertain due to the occurrence of fungi and other microorganisms. A total of twenty-five water samples were collected from public places, educational institutes, hospitals, water supply systems and surface water of the canal of Karachi (Pakistan). The different fungal species including Acremonium sp., Alternaria alternata, Aspergillus flavus, A. fumigatus, A. sulphureus, Cladosporium sp., Fusarium sp., Clonostachys (Gliocladium) sp., Macrophomina phaseolina, Mucor racemosus, Paecilomyces sp. Penicillium chrysogenum, P. citrinum, P. commune, P. expansum, Rhizoctonia sp. and Stachybotrys sp. were isolated from these drinking water samples. However, the bacteria, microalgae and some other microorganisms were present in low concentrations. The reason for fungi infection and production of mycotoxicity depends upon various factors and the availability of their nutrients in filtration plants. The major threats to human health are fungal mycotoxicity which is responsible for carcinogenic and other lethal diseases. Mostly, the genus Aspergillus was dominated and isolated with a maximum of 88-98% of occurrence in the different samples of drinking water by the direct plate-spread method. For the control of fungi, various Physico-chemical coagulation treatments were used, but Potassium alum, clay pot, and hot water treatment disinfected effectively 69-70% removal of the fungi and its spore or mycelia from the water. In addition, it is concluded that drinking water purifications such as chlorination, filtration and lime did not eliminate thermophilic fungal spores or mycelia including Penicillium, Paecilomyces and Mucor from the water.

Energy transition and environmental stability prospects for OECD economies: The prominence role of environmental governance, and economic complexity: Does the geopolitical risk matter?

The global increase in temperature and climate change signals the need for humanity to reduce greenhouse gas emissions and to adopt eco-friendly lifestyles. The 2023 United Nations Climate Change Conference (COP28) in the UAE emphasized this, urging nations to commit to the Paris Agreement and pursue a greener, carbon-free future. In recent decades, climate change has become a critical issue, primarily because of the extensive use of fossil fuels and conventional energy resources. Economic growth has led to an increase in energy consumption and widespread environmental damage. The present study empirically explores whether any changes in environmental governance, economic complexity, geopolitical risk, and the interaction term influence energy transition and environmental stability in OECD economies over the period 1990-2021. Novel econometric methods, including Westerlund co-integration and the Method of Moments Quantile Regression (MMQR), are employed to address complexities such as cross-sectional dependency and panel causality. The key findings from the MMQR technique showed a positive link between environmental governance and economic complexity in driving sustainable energy transitions, thus bolstering environmental resilience in OECD countries. However, economic complexity counterbalances environmental stability. Significantly, geopolitical risk acts as a moderating variable, enhancing the effects of governance and complexity on sustainable energy practices and environmental stability. Based on these insights, this study recommends strategic initiatives, including investment in eco-friendly technologies, to fast-track the shift to clean energy and strengthen environmental resilience in OECD countries. These strategies align with the broader objectives of global sustainable development, offering a path towards a greener and more sustainable future.

Quantitative ethnomedicinal study and conservation status of medicinal flora used by the indigenous peoples of Sultan Khail valley, Dir Upper, Pakistan

The present study was conducted to explore the ethnomedicinal uses, quantitative analysis and conservation status of medicinal flora of Sultan Khail valley, Dir Upper, Pakistan. The data was collected during 2017-2019 using a semi-structured questionnaire. Ethnomedicinal uses of plant species were determined and the plant species were classified based on habits, parts used, and method of preparation of remedies. Frequency of citation (FC), relative frequency of citation (RFC) and family importance values (FIV) were calculated. The plant species were assessed for their conservation status as per IUCN standard criteria. The inhabitants of the Sultan Khail valley use 88 plant species belonging to 57 families for the treatment of different human diseases. Lamiaceae was the dominant family represented with 8 medicinal species (9%) followed by Rosaceae (5 species, 6%). The most commonly used plant parts were leaves (33.1%) followed by fruits (16.1%), while the main method of remedy preparation was decoctions (33.3%). The highest RFC value was recorded for Geranium wallichianum (0.47), followed by Berberis lycium (0.44). Lamiaceae was the most cited family (FIV, 231), followed by Polygonaceae (73). Five plant species were found to be endangered, 39 species were vulnerable, 32 species were rare, and 12 species were found to be infrequent. The medicinal flora of the area is under severe biotic pressure and needs proper conservation; otherwise, they will be lost in the near future.

Insight into the electronic structure of the centrosymmetric skyrmion magnet GdRu2Si2

The discovery of a square magnetic-skyrmion lattice in GdRu2Si2, with the smallest so far found skyrmion size and without a geometrically frustrated lattice, has attracted significant attention. In this work, we present a comprehensive study of surface and bulk electronic structures of GdRu2Si2 by utilizing momentum-resolved photoemission (ARPES) measurements and first-principles calculations. We show how the electronic structure evolves during the antiferromagnetic transition when a peculiar helical order of 4f magnetic moments within the Gd layers sets in. A nice agreement of the ARPES-derived electronic structure with the calculated one has allowed us to characterize the features of the Fermi surface (FS), unveil the nested region along kz at the corner of the 3D FS, and reveal their orbital compositions. Our findings suggest that the Ruderman-Kittel-Kasuya-Yosida interaction plays a decisive role in stabilizing the spiral-like order of Gd 4f moments responsible for the skyrmion physics in GdRu2Si2. Our results provide a deeper understanding of electronic and magnetic properties of this material, which is crucial for predicting and developing novel skyrmion-based systems.

Do environmental taxes, environmental innovation, and energy resources matter for environmental sustainability: Evidence of five sustainable economies

This study explores the relationship between environmental taxation, environmental technologies, energy resources, and consumption-based carbon emissions in five leading green economies from 2000 to 2019. The study applied the Cross-Sectional Auto-Regressive Distributed Lag (CS-ARDL) model to derive benchmark results, with Augmented Mean Group (AMG) and Common Correlated Effect Mean Group (CCEMG) techniques being utilized for conducting robustness analyses. The empirical findings suggest that environmental taxation, environmental innovations, and the consumption of renewable energy are associated with a reduction in consumption-based carbon emissions, thereby contributing to enhanced environmental sustainability. Conversely, the utilization of non-renewable energy is linked to an increase in consumption-based carbon emissions. These results align with the objectives outlined in the Sustainable Development Goals' 2030 agenda, particularly SDG 7 (Affordable and Clean Energy), SDG 9 (Industry, Innovation, and Infrastructure), and SDG 13 (Climate Action), offering valuable policy implications.

Do green logistics and green finance matter for achieving the carbon neutrality goal?

Global warming, a persistent issue, needs comprehensive solutions. Shifting to sustainable resources and promoting green initiatives like green logistics, green investments, and environmental policies (such as environmental technology and environmental tax) are potential ways to address this challenge. The current study explores relationships between these factors and transportation emissions in China, with a focus on achieving the 2060 carbon neutrality goal. To investigate the research gap, the study employs the novel econometric, method of moments quantile regression (MMQR) for benchmark estimation and the bootstrap quantile regression (BSQR) technique for sensitivity estimations from 2000/Q1 to 2019/Q4, and the study confirms the hypothesis of "carbon neutrality." The results reveal that green logistics and green finance have a negative impact on transportation emissions across all quantiles. Environmental technology, environmental tax, and renewable energy also help reduce transportation emissions. On the contrary, economic growth increases transportation emissions, with a greater effect in the early quantile stages but a diminishing impact in later stages. Based on the study's findings, policymakers should prioritize sustainable development strategies to achieve the goal of "carbon neutrality." Implementing green logistics and promoting green investments are essential steps in this direction. Additionally, greater support should be given to the renewable energy sector, green technologies, and sustainable growth to achieve the carbon neutrality goal in China by 2060.

Exploration of plant growth promoting traits and regulatory mechanisms of Bacillus anthracis PM21 in enhancing salt stress tolerance in maize

Bacillus species have been reported to reduce the negative effects of salt stress on plants; the involvement of Bacillus anthracis PM21 and the internal mechanisms involved in this process are unclear. The effects of PM21 inoculation on maize plants under salt stress were investigated in this study. The study aimed to assess the ability of Bacillus anthracis PM21 to endure high levels of salinity stress while preserving the concentration of plant growth regulators. The biomass, photosynthetic pigments, relative water content (RWC), antioxidants, osmoprotectants, inorganic ion contents, regulation of plant hormones and expression of antioxidants enzyme encoded genes were investigated under normal and salinity stress conditions. Bacillus anthracis PM21 produced a significant amount of 1-aminocyclopropane-1-carboxylate deaminase enzyme (ACC deaminase) and exopolysaccharides (EPS) under salt stress and normal conditions. PM21 also produced plant growth stimulants including indole acetic acid, gibberellic acid (GA3), kinetin, and siderophore under salinity stress and normal conditions. Under salt stress, PM21 inoculation markedly increased plant growth indices, stimulate antioxidant enzyme mechanisms, osmoprotectants, and chlorophyll content. The use of qRT-PCR to analyze the transcription of targeted genes indicated greater expression of antioxidant-encoded genes and inferred their possible function in salinity stress tolerance. Our findings shed light on the functions of PM21 and its regulatory mechanisms in plant salt stress tolerance, as well as the importance of PM21 in this process. This study will provide a thorough analysis of the theoretical framework for adopting PM21 in agricultural production as an eco-friendly method to enhance crop growth and yield under salinity stress.

Phylogenetic analysis of promoter regions of human Dolichol kinase (DOLK) and orthologous genes using bioinformatics tools

The Dolichol kinase (DOLK) gene encodes the polytopic DOLK protein associated with the endoplasmic reticulum (ER) N-glycosylation pathway catalyzing the final step in the biosynthesis of dolichol phosphate. Dolichol phosphate is an oligosaccharide carrier required for N-glycosylation of DOLK protein, with its deficiency leading to a severe hypo glycosylation phenotype in humans which can cause congenital disorders of glycosylation and death in early infancy. The aim of the present study is to identify the phylogenetic relationship between human and ortholog species based on their conserved sequences in DOLK gene. Sequence alignment of DOLK was carried out in this study and the evolutionarily conserved regulatory sequences were identified using bioinformatics. Promoter sequence of human DOLK was compared with orthologous sequences from different organisms. Conserved non-coding sequences (CNS) and motifs in promoter regions were found by analyzing upstream promoter sequences of Homo sapiens DOLK and its orthologous genes in other organisms. Conserved sequences were predicted in the promoter regions in CNS1 and CNS2. Conserved protein sequences were also identified by alignment of the orthologous sequences. Organisms with similar gene sequences are assumed to be closely related and the ER N-glycosylation pathway is conserved in them.

A cross-cultural study of high-altitude botanical resources among diverse ethnic groups in Kashmir Himalaya, India

BACKGROUND

In the Himalayas, traditional knowledge and biodiversity are strongly linked due to the symbiotic interaction between plant and cultural diversity, as well as the support provided by cultural memories, ecological awareness, and social norms. Our study was focused on documenting the vanishing knowledge in the Kashmir Himalaya with the following main objectives: 1) to document the ethnomedical and cultural knowledge of the local flora, 2) to evaluate the cross-cultural use of the flora in the region, and, finally, 3) to identify the key indicator species utilized by each ethnic group using multivariate statistical analysis.

METHODS

We used semi-structured questionnaires to conduct interviews with people of different ethnicity, gender, age, and occupational categories. The intercultural relationships of species utilization among ethnic groups were examined using a Venn diagram. The overall trends between the indicator values and the plant species used by diverse ethnic groups were illustrated using the linear regression model.

RESULTS

We recorded 46 species belonging to 25 different families used by the local people of the Kashmir Valley belonging to four ethnic groups (Gujjar, Bakarwal, Pahari, and Kashmiri). The dominant families recorded were Asteraceae and Ranunculaceae followed by Caprifoliaceae. Rhizomes were the most utilized plant part, followed by leaves. A total of 33 ailments were treated with plants, and gastrointestinal disorders were treated with most species followed by musculoskeletal diseases and dermatological problems. Across cultural relationships, the Gujjar and Pahari showed greater similarity (17%). This may be due to the fact that both ethnic groups share a common geographical landscape and are exogamous to each other. We identified key indicator species used by different ethnic groups with significant (p ≤ 0.05) values. For instance, in the Gujjar ethnic group, Aconitum heterophyllum and Phytolacca acinosa had significant indicator value, which was due to the fact that these plants were easily accessible and also had a wide range of uses. In contrast, the Bakarwal ethnic group showed different indicator species, with Rheum spiciforme and Rhododendron campanulatum being highly significant (p ≤ 0.05), because this ethnic group spends the majority of their time in high-altitude pastures, using a particularly wide variety of plant species for medicine, food, and fuelwood. While indicator values and plant usage were positively correlated for the Gujjar, Kashmiri, and Pahari ethnic groups, they were negatively correlated for the Bakarwal. The positive correlation indicates cultural preferences for certain plant use and underlines the cultural significance of each species. The current study reported new uses for the following species: raw roots of Jurinea dolomiaea used for tooth cleaning, seeds of Verbascum thapsus applied for respiratory diseases, and flowers of Saussurea simpsoniana given to anyone as a good luck wish.

CONCLUSION

The current study highlights historical ethnic group stratifications and cultural standing while comparing reported taxa across cultures. Each ethnic group made extensive ethnomedical use of plants, and knowledge, originally transmitted verbally, is now available in writing for reference. This could pave the way for providing incentives to local communities to showcase their talents, celebrate them, and gain from potential development initiatives.

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules

OBJECTIVE

The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage.

MATERIALS AND METHODS

Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM.

RESULTS

The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05).

CONCLUSIONS

SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Do e-cigarettes have a part to play in peri-implant diseases?

DESIGN

Systematic review.

DATA SOURCES

The following databases were searched for publications up to May 2022: Medline, EMBASE, Scopus, Web of Science, LILACS, Cochrane and Open Grey. Additionally, four journals were hand searched.

STUDY SELECTION

Clear inclusion and exclusion criteria were provided. A focused question was outlined using PICO format. A full search protocol was supplied, and all study designs were considered.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened 97 articles after de-duplication. Fourteen full-text articles were assessed. Data were collected using a spreadsheet.

RESULTS

Four cross-sectional studies were included in the systematic review, all reporting on male participants. Meta-analysis was performed highlighting worse outcomes in electronic cigarette (e- cigarette) user group regarding increased bone loss, probing depth, plaque index and bleeding on probing, as well as increased levels of inflammatory cytokines, when compared to never-smokers.

CONCLUSIONS

From the limited number of studies available, e-cigarettes appear to have a negative impact on dental implant outcomes in male patients.

Tuning the carrier injection barrier of hybrid metal-organic interfaces on rare earth-gold surface compounds

Magnetic hybrid metal-organic interfaces possess a great potential in areas such as organic spintronics and quantum information processing. However, tuning their carrier injection barriers on-demand is fundamental for the implementation in technological devices. We have prepared hybrid metal-organic interfaces by the adsorption of copper phthalocyanine CuPc on REAu₂ surfaces (RE = Gd, Ho and Yb) and studied their growth, electrostatics and electronic structure. CuPc exhibits a long-range commensurability and a vacuum level pinning of the molecular energy levels. We observe a significant effect of the RE valence of the substrate on the carrier injection barrier of the hybrid metal-organic interface. CuPc adsorbed on trivalent RE-based surfaces (HoAu₂ and GdAu₂) exhibits molecular level energies that may allow injection carriers significantly closer to an ambipolar injection behavior than in the divalent case (YbAu₂).

Effect of transcranial magnetic stimulation on postural control of individuals with major depressive disorder: A case report

Accidental falls and major depressive disorder (MDD) are two common conditions associated with aging. Initial treatment of MDD often starts with administering antidepressants, followed by transcranial magnetic stimulation (TMS) for treatment-resistant individuals. The purpose of this case study was to determine the effect of repetitive TMS (rTMS) on postural control of an individual with MDD. A 44-year-old male with recurrent severe MDD was assessed for postural balance during eyes closed and eyes open conditions, pre and post three consecutive sessions receiving high-frequency rTMS (NeuroStar). Total excursion and velocity of sway significantly decreased following rTMS treatment when eyes were closed (p < 0.05). Power of the sway changed, but the changes were not statistically significant. The fractal dimension confidence circle area decreased significantly in eyes closed trials (p < 0.05). It appears that rTMS application can potentially impact postural steadiness in individuals with MDD. Our results warrant further studies with larger study samples.

Endorsing sustainable development in BRICS: The role of technological innovation, renewable energy consumption, and natural resources in limiting carbon emission

This research aimed to examine the complex interaction between technological innovation, renewable energy consumption, natural resources, and carbon dioxide (CO₂) emissions of BRICS (i.e., Brazil, Russia, India, China, and South Africa) countries from 1990 to 2019, to accomplish the Paris Climate Conference (COP-21) objective of reducing CO₂ emissions to promote environmental sustainability. The long-run empirical estimations derived from the CS-ARDL technique, which considered other estimation issues like cross-sectional dependency and slope heterogeneity, indicated that technological innovation, renewable energy consumption, and natural resources increase environmental sustainability by limiting CO₂ emissions, in the short-run and long-run. The technological innovation-related activities have a CO₂ mitigating effect as shown by the negative coefficients which ranges between -0.05 and -0.14. This shows that they increase environmental sustainability and aid in achieving Sustainable Development Goals (SDGs) 13. Similarly, renewable energy and natural resources decrease CO₂ emissions as shown by the coefficient of renewable energy (-0.31 to -0.81) and natural resources (-0.01 to 0.95); thereby increasing ecological quality by limiting CO₂ emissions. Furthermore, the interaction of technological innovation with natural resource rent and renewable energy consumption also aids in mitigating CO₂ emissions and increases environmental health. Finally, panel causality analysis revealed a significant causality from all explanatory variables to CO₂ emissions. Based on the results, significant policy suggestions are provided, such as improving energy effectiveness, investing in energy technologies, and increasing renewable energy consumption to stimulate technological innovation to achieve the target of a net-zero‑carbon economy.

Antifungal activity of green synthesized selenium nanoparticles and their effect on physiological, biochemical, and antioxidant defense system of mango under mango malformation disease

Plant extract-based green synthesis of nanoparticles is an emerging class of nanotechnology that has revolutionized the entire field of biological sciences. Green synthesized nanoparticles are used as super-growth promoters and antifungal agents. In this study, selenium nanoparticles (SeNPs) were synthesized using Melia azedarach leaves extract as the main reducing and stabilizing agent and characterized by UV-visible spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive X-ray (EDX), and fourier transform infrared spectrometer (FTIR). The green synthesized SeNPs were exogenously applied on Mangifera indica infected with mango malformation disease. The SeNPs at a concentration of 30 μg/mL were found to be the best concentration which enhanced the physiological (chlorophyll and membrane stability index), and biochemical (proline and soluble sugar) parameters. The antioxidant defense system was also explored, and it was reported that green synthesized SeNPs significantly reduced the biotic stress by enhancing enzymatic and non-enzymatic activities. In vitro antifungal activity of SeNPs reported that 300 μg/mL concentration inhibited the Fusarium mangiferae the most. This study is considered the first biocompatible approach to evaluate the potential of green synthesized SeNPs to improve the health of mango malformation-infected plants and effective management strategy to inhibit the growth of F. mangifera.

Species distribution modelling of Monotheca buxifolia (Falc.) A. DC.: Present distribution and impacts of potential climate change

Species distribution modelling (SDM) is an important tool to examine the possible change in the population range and/or niche-shift under current environment and predicted climate change. Monotheca buxifolia is an economically and ecologically important tree species inhabiting Pakistan and Afghanistan in dense patches, and species range is contracting rapidly. This study hypothesize that predicted climate change might remarkably influence the existing distribution pattern of M. buxifolia in the study area. A total of 75 occurrence locations were identified comprising M. buxifolia as a dominant tree species. The Maximum Entropy (MaxEnt) algorithm was utilized to perform the SDM under current (the 1970s-2000s) and two future climate change scenarios (shared socioeconomic pathways: SSPs 245 and 585) of two time periods (the 2050s and 2070s). The optimal model settings were assessed, and simulation precision was assessed by examining the partial area under the receiver operating characteristic curve (pAUC-ROC). The results showed that out of 39 considered bio-climatic, topographic, edaphic, and remote sensing variables which were utilized in the preliminary model, 6 variables including precipitation of warmest quarter, topographic diversity, global human modification of terrestrial land, normalized difference vegetation index, isothermality, and elevation (in order) were the most influential drivers, and utilized in all reduced SDMs. A high predictive performance (pAUC-ROC; >0.9) of all the considered SDMs was recorded. A total of about 67,684 km² of geographical area was predicted as suitable habitat (p > 0.8) for M. buxifolia, and Pakistan is the leading country (with about 54,975 km² of suitable land area) under the current climate scenario. Overall, the existing distribution of the tree species in the study area might face considerable loss (i.e. rate of change %; -27 to -107) in future, and simultaneously a northward (high elevation) niche shift is predicted for all the considered future climate change scenarios. Hence, development and implementation of a coordinated conservation program is required on priority basis to save the tree species in its native geographic range.

1207 EXPLORING AUDIO-RECORDING IN TERMINAL ILLNESS - THE HOSPICE BIOGRAPHERS MODEL

Introduction

The therapeutic benefits of narrative in terminally ill patients is widely studied and evidenced in the research literature. The Hospice Biographers are a charity offering a professional free service for end-of-life patients the opportunity to audio-record their life story in a memory stick and to keep copies for themselves and for their families. The objective of this qualitative study is to explore the experience of a group of people either recording or listening to an audio-biography.

Methods

Five semi-structured in-depth interviews with terminally ill adults who recorded an audio-biography and another interview with a family member were conducted virtually. Transcripts of the zoom interviews were coded using thematic analysis.

Results

Our findings showed that patients found talking to a trained audio-biographer provided a neutral, non-judgemental interlocutor. The biographer helped them reminisce in a guided conversation navigating their life stories in chronological order. The experience of planning for the recording varied from preparing a mind-map, to writing down some guide notes or no preparation at all. Patients reported a feeling of catharsis while telling their stories as well as being able to reflect on and analyse significant life events. However, it was challenging to convey difficult emotions whilst being mindful of how patients’ life stories might be perceived by families. Although there was a degree of uncertainty about impact of the recording upon listeners, it was felt that leaving a voice-recorded account would still be informative and beneficial. A personal narrative could also provide a wider historical account of the relevant time period. Some individuals fed back that they would have valued the opportunity to edit their recording after listening and include a visual element.

Conclusions

Recording an audio-biography in terminal illness allows patients a space for reflection and provides a valued connection with immediate family members and future generations.

1285 IMPLEMENTATION OF A MEDICINE MANAGEMENT PLAN TO REDUCE MEDICATION-RELATED HARM IN OLDER PEOPLE POST-HOSPITAL DISCHARGE - AN RCT

Introduction

Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS.

Method

Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records.

Data Analysis

Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP.

Conclusion

This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites.

Reference

1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.

1283 MEDICATION-RELATED HARM (MRH) IN OLDER PEOPLE AFTER LEAVING HOSPITAL - AN UNDER-REPORTED EGYPTIAN CHALLENGE

Introduction

Ageing is associated with multimorbidity, polypharmacy and medication-related harm (MRH). A 2013 systematic review reported only one study of medication errors (MEs) in older Egyptian patients. Our study investigated MRH (adverse drug reactions (ADR), drug errors, and non-adherence) in older Egyptian adults after hospital-discharge.

Methods

Between 2018 and 2020, we recruited 400 Egyptian patients, aged ≥60 years on discharge from Geriatrics and Internal Medicine wards from 3 hospitals, and followed them up for 8 weeks. Study procedures adopted a modified PRIME trial methodology (1).

Results

The average age of study participants was 71 (range 60 to 93, SD +/- 6.29) years with 53% females. In the cohort of 325 patients completing follow up, MRH occurred in 99 patients (incidence of 30.5%), with 5 patients (5.1%) experiencing a fatal MRH. Almost two thirds (65.7%) of MRH events were secondary to ADRs, 2 % related to non-adherence, 18.2 % due to both ADR and non-adherence, and 14% related to MEs. Multivariate logistic regression analysis showed that non-adherence (p-value 0.000, OR- 95% CI: 36.029), inappropriate prescription using Beer’s criteria (p 0.000, OR- 95% CI: 6.589), length of stay &gt;7days (p 0.001, OR- 95% CI: 6.176), presence of Ischaemic Heart Disease (IHD) (p 0.000,OR- 95% CI: 5.695), Platelets count ≤ 245X 109/L (p 0.021, OR- 95% CI: 2.640), and dementia medications (p 0.017, OR- 95% CI: 4.616) were all significantly associated with MRH.

Conclusions

Medication-related harm in older Egyptian adults is common after hospital discharge. An integrated care pathway is required targeting high-risk older patients.

Reference

1. Stevenson J, Parekh N, Ali K et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatrics 2016; 16: 22. https://doi.org/10.1186/s12877-016-0191-8.

1299 CO-CREATING A VIDEO FOR TRAINING HEALTHCARE PROFESSIONALS IN DEMENTIA

Introduction

There are 400 thousand people living with dementia (PLWD) in Egypt. Most of the care for PLWD is delivered by family members. Healthcare Professionals (HCP) supporting these families need adequate training. Involving HCP in designing and producing training material ensures sustainability of these educational resources as their content will be socially and culturally relevant.

Methods

The first part of the project involved the lead author (OM) meeting with two geriatricians to identify common challenging situations in dementia. A short video for training HCP in dementia using these situations was produced, based on OM lived experience, and then shared with two old-age psychiatrists for comments. Feedback on the video was subsequently obtained via semi-structured interviews with 16 HCP (2 doctors, 1 nurse, 1 dietitian, 1 communication therapist, 2 social workers, and 9 clinical psychologists) either in person (3), over the phone (1), or virtually (12) approached in two institutions for ageing in Cairo and Alexandria in 2021. The video was finally checked by an adult psychiatrist for consistency with non-violent communication approaches. All interviews were analysed using a thematic framework. Comments and feedback were used to co-produce a final version of the video.

Results

From the initial co-design phase, six frequently-encountered situations were identified: anger, low mood, wandering, repetitive behaviour, refusing support with activities of daily living, and sleep disturbance. Five key qualities for appropriate response in these situations were agreed on: kindness, sensitivity, compassion, avoiding confrontation, and shared-decision making in activities of daily living. The subsequent co-production phase with 19 HCP resulted in an 18-minute: 43-seconds simulation video of six challenging interactions between PLWD and their carers. The video is now freely available on YouTube, https://m.youtube.com/watch?v=ylINBXZwH8M&feature=youtu.be

Conclusions

Involving healthcare professionals in dementia in co-creating a video for training their peers led to a freely available online educational resource.

Governance perspective and the effect of economic policy uncertainty on financial stability: evidence from developed and developing economies

Economic Policy Uncertainty (EPU) research has grown in importance in today's highly volatile and interconnected economy. This work investigates the relationship between EPU and Financial Stability (FS) (i.e., Z-scores and non-performing loans (NPL)) with the mediating variable of governance quality through a 23-country panel data from 2005 to 2019. The System Generalized Method of Moment (SYS-GMM) is adopted to address the issue of endogeneity, which is common in panel data regression. The two-stage Sequential of the Linear Panel Data Model (SELPDM) was also used to test the robustness of the results. According to the findings, EPU has a significant negative effect on financial stability (measured by the Z-score) and a significant positive effect on financial stability in the banking industry of most developed economies (proxied by NPL). We also discovered that good governance can be used to mitigate the negative effects of EPU on financial stability; however, this influence varies depending on region, bank, and market structure, and it was significantly greater during the global financial crisis. Finally, this study can help financial managers and policymakers develop appropriate policies to understand how banks respond to EPU.

Genetic variation between hybrid (Labeo rohita ♂, Cirrhinus mrigala ♀ and Labeo rohita) by RAPD marker

The present work was to study the genetic variability between the major carps Labeo rohita and Cirrhinus mrigala and their hybrids of L. rohita (male♂) and C. mrigala (female♀). Genetic variability was studied by employing RAPD molecular markers. 25 samples of each target species having different sizes with the same age group for the determination of interspecific variation were collected. The morphometric parameters such as body weight, total length, tail length, and lengths of dorsal and anal fins of each individual were recorded and results showed that wet body weight, total length, dorsal fin, anal fin, and tail fin length are positively correlated and then the DNA was extracted using the inorganic salt-based method and conformed by Gel electrophoresis. Twenty-four arbitrary decamer primers were used to get species-specific RAPD analysis Distinct and highly reproducible RAPD profiles with significant genetic variability was detected among species. Only five primers showed amplification. The RAPAD primer OPB-05 produced a total of seven bands out of these 5 monomorphic and 2 polymorphic, so in this case, the percentage polymorphism was 28.57%. The Hybrid show more than a 50% difference from the Labeo rohita. This shows that the Hybrid more resembles C.mrigala. Phylogenetic analysis demonstrated that hybrid (L. rohita ♂ X Cirrhinus mrigala ♀) is the closest to C. mrigala and the farthest from L. rohita. Overall data are presented concerning the applications of RAPD markers for hybrid identification, genetic diversity assessment, and studying taxonomic relationships at a molecular level.

Implant abutment disinfection using plasma of argon and 0.2% and chlorhexidine gel applications immediately before prosthesis delivery: clinical and radiographic status at 5-years of follow-up

OBJECTIVE

The purpose of this five-year follow-up study was to investigate the clinical and radiologic status of implants that had undergone abutment disinfection immediately prior to prosthetic loading (PL) using plasma of argon (PA) or 0.2% chlorhexidine (CHX) gel.

PATIENTS AND METHODS

Sixty patients who had had an implant-supported prosthesis fitted at least five years previously were recruited for this study. In groups 1, 2, and 3, implant abutment disinfection was performed using PA, 0.2% CHX, and a vapor protocol, respectively. Modified plaque index (mPI), modified bleeding index (mBI), probing depth (PD), and mesial and distal crestal bone loss (CBL) were measured. A questionnaire on routine oral hygiene, smoking habits, and systemic health status was also administered. Sample size estimation was performed, and group comparisons were made. Probability values less than 0.05 were considered statistically significant.

RESULTS

Group 1, 2, and 3 included 20 (20 implants) patients each. At five-year's follow-up, there was no difference in mBI, mPI, and PD in all groups. There was no significant difference in peri-implant CBL in all patients. None of the patients were immunosuppressed or had periodontal disease, and or had used nicotinic products within the past five years. Toothbrushing twice daily was reported by at least 90% of individuals in all groups. Flossing of interproximal spaces once daily was reported by at minimum 60% of individuals in all groups.

CONCLUSIONS

Disinfection of implant abutments directly before PL can be performed using AP, or 0.2% CHX gel.

Association between plasma desmosine, a marker of elastin degradation, and total atherosclerotic burden measured by whole body magnetic resonance angiography

Background

Elastin degradation has been implicated in the pathophysiology of vulnerable atherosclerotic plaque. Desmosine is the cross-link component in the elastin molecule and is exclusively released from mature elastin breakdown, thus has the potential to be a physiologically relevant biomarker of atherosclerosis.

Objectives

The aim of the present study was: 1. To investigate whether patients with known cardiovascular disease (CVD) have higher elastin degradation as indicated by plasma desmosine (pDES); 2. to determine the relationship between pDES and total atherosclerotic burden.

Methods

We measured pDES by a validated stable isotope dilution LC-MS/MS method1 in a total of 146 subjects from the SUMMIT (SUrrogate markers for Micro- and Macro-vascular hard endpoints for Innovative diabetes Tools) study2. (62% male, mean age 64±8 (SD) years). This included 62 patients with prior clinical diagnosis of CVD (including coronary artery disease (CAD), cerebrovascular disease and/or lower extremity arterial disease (LEAD)), and 84 patients without a clinical diagnosis of CVD. Total atherosclerotic burden was measured by whole body magnetic resonance angiography (WB-MRA). The WB-MRA data was divided into 31 anatomical arterial segments with each segment scored according to degree of luminal narrowing: 0 = no stenosis, 1 = &lt;50% stenosis, 2 = 51–70% stenosis, 3 = 71–99% stenosis, 4 = vessel occlusion. The segment scores were summed and from this, a standardized atheroma score (SAS) was calculated by summing each individual segment's stenosis score, and divided by the number of diagnostic segments before dividing by 4 which is the maximum potential score. Relationship between SAS and pDES levels was investigated using multiple linear regression models

Results

pDES levels were significantly greater in patients with established clinical CVD compared to patients with no CVD (CVD patients, 0.56 (0.45–0.67) ng/mL; patients with no CVD, 0.47 (0.41–0.54)ng/mL; p=0.001). Median SAS for the study population was 4 (2–10). Overall pDES levels showed a strong correlation with SAS (r=0.44, p≤0.001). Univariable analysis suggested a significant association between pDES and whole-body atheroma score as measured by SAS. (β 29.31, p&lt;0.001). This association persisted in the multivariable regression model adjusting for traditional cardiovascular risk factors including age, gender, BMI, systolic blood pressure, diabetes, smoking status and LDL. (adjusted β 18.75, p=0.004)

Conclusion

pDES levels are elevated in patients with clinical CVD when compared to those with no clinical history of CVD. pDES is also strongly associated with global atheroma burden. Overall, these findings support the role of pDES as a potential biomarker for atherosclerosis.

Funding Acknowledgement

Type of funding sources: None.

The nexus of financial development, technological innovation, institutional quality, and environmental quality: evidence from OECD economies

The present study investigates the effect of institution quality, technological innovation, and financial development on environment quality using 37 OECD nations from 1998 to 2018. The cross-sectional dependence (CD) and Lagrange multiplier (LM) techniques are used to measure the cross-sectional dependence. The second-generation panel unit root tests and panel cointegration tests are applied to examine the unit-root properties and long-run association existence between variables. Finally, we employed the two-step (SYS-GMM) methodology to estimate the coefficient values. The findings showed that financial development has a positive effect on selected carbon (CO2) emission dimensions. When the moderating term is introduced, it was identified that institutional quality and technology innovation conditioning effects are crucial between financial development and CO2 emission. Our evidence-based study provides significant results for technology innovation and institutional quality moderating role in reducing CO2 emissions in OECD economies. Our findings are also robust to alternative measures, which could be useful for policymakers to formulate long-term and short-term strategies and policies for a better sustainable environment.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Biochemical Characterization of Halotolerant Bacillus safensis PM22 and Its Potential to Enhance Growth of Maize under Salinity Stress

Salinity stress is one of the primary abiotic stresses limiting crop growth and yield. Plants respond to salinity stress with several morphophysiological, molecular, and biochemical mechanisms, however, these mechanisms need to be improved further to cope with salt stress effectively. In this regard, the use of plant growth-promoting (PGP) and halotolerant bacteria is thought to be very efficient for enhancing growth and salinity tolerance in plants. The current study aims to assess Bacillus safensis PM22 for its ability to promote plant growth and resistance to salt. The PM22 produced substantial amounts of exopolysaccharides, indole-3-acetic acid, siderophore, and 1-aminocyclopropane-1-carboxylic acid deaminase (ACC-deaminase) under saline conditions. Additionally, inoculation of the halotolerant bacteria PM22 reduced the severity of salinity stress in plants and increased root and shoot length at various salt concentrations (0, 180, 240, and 300 mM). Furthermore, PM22-inoculated plants showed markedly enhanced photosynthetic pigment, carotenoid, leaf relative water content, 2,2-diphenyl-1-picrylhydrazyl (DPPH) activity, salt tolerance index, total soluble sugar, total protein, and ascorbic acid contents compared to non-inoculated control maize plants. PM22 substantially increased antioxidant (enzymatic and non-enzymatic) activities in maize plants, including ascorbate peroxidase, peroxidase, superoxide dismutase, catalase, total flavonoid, and phenol levels. Maize plants inoculated with PM22 also exhibited a significant reduction in electrolyte leakage, hydrogen peroxide, malondialdehyde, glycine betaine, and proline contents compared to non-inoculated control plants. These physiological appearances were further validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), which revealed the upregulation of expression in genes responsible for stress tolerance. In the current investigation, Bacillus safensis PM22 showed plant growth-promoting and salt tolerance attributes and can be utilized as a bio-inoculant to improve yield in salt stress affected areas.

Environmental concerns of financial inclusion and economic policy uncertainty in the era of globalization: evidence from low & high globalized OECD economies

Environmental consequences of financial aspects, policy uncertainties and rapid globalization is the topic of intense debate in present years. However, this study contribute to existing literature in an innovative way. We classified the 33 OECD economies in two group's lower globalized economies (LGE) and highly globalized economies (HGE), based on their level of globalization. Considering the cross-sectional dependency and slope heterogeneity in the data this study employed the Augmented Mean Group method to estimate the influence of financial inclusion, economic policy uncertainty and globalization on the environment quality of both groups for the period 1996-2019. The results revealed a negative significant impact of financial inclusion, while a positive significant impact of economic policy uncertainty on CO2 emissions in both groups, LGE and HGE. However the globalization estimated to have positive impact on CO2 emission in LGE's, in HGE's it is significantly impeding the CO2 emission. The interaction of globalization with financial inclusion and economic policy uncertainty respectively found negative and positive to effect the CO2 in both LGE's and HGE's. The study suggests that, LGE's are need to prepare for economic globalization, move toward adopting energy-efficient technology and promote trade in less-polluting products in order to sustain their environment quality. The outcomes of this study are robust by employing different model specifications.

What is the value of simulated patient assessment in structured clinical examinations of undergraduate students, and how should it be used?

INTRODUCTION

The aim of this study was to explore correlations between clinical assessor and simulated patient (SP) scores drawn from summative Integrated Structured Clinical Examination (ISCE) and inform the best use of SP scores in future assessments.

MATERIALS AND METHODS

This retrospective study explores summative clinical assessor and formative SP numeric scores drawn from summative ISCE assessments spanning three academic years (2017-18 to 2019-20). Analyses were carried out using R 3.5.1 (R Core Team, 2018), with the stats package.

RESULTS

The sample consisted of 169 final-year BDS students across the three cohorts and included 95 females (56.2%) and 74 males (43.8%). Data from eight substations where SPs were included, were explored. Kendall's Tau, a non-parametric correlation, was used to investigate the relationships between the assessor and SP scores. Clinical assessor scores were out of a total of 20 points across various assessed domains within each substation. The formative SP assessment was out of 10 points with the same five affective domains related to communication included in each substation. Overall, the assessor and patient substation scores were not correlated (τ = 0.04, p = .272) indicating that communication skills alone, as assessed by patients, do not correlate with more holistic performance across other domains. There was significant positive correlation for two of the eight substations with the other substations showing very little correlation.

CONCLUSION

This study shows that assessment of student performance by SPs does not show a correlation with examiner scores and may provide additional information relating to affective skills of students. Notwithstanding the limitations of this study, the findings underscore the need to investigate further the value of involvement of SPs in clinical assessments to explore if scores by SPs can be used to enhance the validity of assessments if used summatively.

Artificial intelligence - can it be used to outsmart oral cancer?

Data Sources Electronic search on PubMed, Cochrane, Scopus, Embase, Google Scholar, Saudi Digital Library and Web of Science, and hand searching carried out for studies published January 2000-March 2021. Language was restricted to English.Study selection Original research studies involving artificial intelligence technology for oral cancer diagnosis and prognosis prediction were considered. The studies had to provide quantitative data of their evaluation analysis. The exclusion criteria were reported. No limit was set on study design.Data extraction and synthesis The initial search yielded 628 articles. Following deduplication, 340 full-text articles were screened. QUADAS-2 tool was used to assess the quality of the included studies regarding diagnostic accuracy.Results A total of 16 studies were included with various study designs: 14 cross-sectional, one cohort and one retrospective study. Six studies reviewed the diagnosis aspect. All studies indicate an overall positive trend of artificial intelligence technology.Conclusions Artificial intelligence appears to have good accuracy in oral cancer diagnosis and its prediction.

Multiple lump and rogue wave for time fractional resonant nonlinear Schrödinger equation under parabolic law with weak nonlocal nonlinearity

This article retrieve lump, lump with one kink and rogue wave soliton for the time fractional resonant nonlinear Schrödinger equation with parabolic law having weak nonlocal nonlinearity. According to theory of dynamical systems, Schrödinger equation may be converted into plane systems. We use Hirota bilinear method to obtained these solutions. At the end, we present graphical representation of our results in various dimensions.

705 CHARACTERISING OLDER ADULTS’ RISK OF HARM FROM BLOOD-PRESSURE LOWERING MEDICATIONS: A SUB-ANALYSIS FROM THE PRIME STUDY

Introduction

Hypertension is a major risk factor for cardiovascular disease and death. Randomised trials in older adults with relatively few co-morbidities recommend treatment of their hypertension [1]. However, blood-pressure lowering medications increase the risk of medication-related harm (MRH) from adverse drug reactions (ADRs), non-adherence, medication errors and drug–drug interactions. We aimed to identify characteristics associated with MRH in older people on blood-pressure lowering medications.

Method

The PRIME (prospective study to develop a model to stratify the risk of MRH in hospitalized elderly patients in the UK) study investigating the incidence and cost of MRH in 1280 older people in Southern England [2]. Adults ≥65 years were recruited from five teaching hospitals at hospital discharge and followed up for 8-weeks. Telephone interviews with study participants, review of primary care records and hospital readmissions were undertaken to identify MRH. PRIME study participants taking blood-pressure lowering medications, as defined by National Institute for Health and Care Excellence hypertension guidelines [3], were included in this analysis.

Results

Sixty-six percent of the PRIME cohort (n = 841) were taking blood-pressure lowering medications. Patients on four blood-pressure lowering medications were five times more likely to experience MRH compared to those taking just one medication (OR 4.96; 95%CI 1.63-15.13;p = 0.01). Most harm events were serious (80%,n = 123), requiring dose change or treatment cessation. Most MRH cases were potentially preventable (49%,n = 75).

Conclusion

MRH from blood-pressure lowering medication in older people is common, serious, and potentially preventable. Decisions around maximising cardiovascular risk reduction must be carefully considered in the context of MRH from blood-pressure lowering medications.

References

1. Sheppard JP, Lown M, Burt J et al. Generalizability of blood pressure lowering trials to older patients: cross-sectional analysis. J Am Geriatr Soc 2020; 68: 2508–15.

2. Parekh N, Ali K, Stevenson JM et al. Incidence and cost of medication harm in older adults following hospital discharge: a multicentre prospective study in the UK. Br J Clin Pharmacol 2018; 84: 1789–97.

3. National Institute for Health and Care Excellence (2019). Available at https://www.nice.org.uk/guidance/ng136. Accessed 27/11/2020.

736 REAL-TIME MOBILITY DATA FROM WEARABLE DEVICES PREDICTING FALLS RISK IN OLDER ADULTS

Introduction

Falls are a common cause of injuries in people over 65 years, usually resulting in life-threatening or life-altering sequalae for affected individuals. Falls risk assessment typically requires a face-to-face evaluation delivered by a trained professional in a clinical setting, thus limiting their application for many older people with falls. Therefore, there is a need for a remote monitoring system (RMS) that captures mobility data to assess comprehensively an older individual’s true falls risk undertaking their everyday activities in their usual environment.

Methods

A pilot study was conducted with 16 participants over 65 years classified as high (n = 9) or low falls risk (n = 7) based on their fall’s history. A RMS was developed, which combines inertial measurement unit (IMU) data from a wearable device and online real-time Machine Learning (ML) to generate a two-stage fall risk assessment. In stage one, a ML activity motion classifier identified raw IMU data from participants as either, walking, resting or transitional movements (turning or sitting to standing). In stage two, previously classified motion segments were analysed by a ML fall-risk classifier, providing an objective risk assessment based on gait characteristics during everyday motion. Falls incidence was recorded prospectively at one year follow-up.

Results

The motion classifier achieved an 94.8% accuracy in differentiating between resting, walking and transitional movements. The fall risk classifier initially trained with retrospective fall history data achieved an 87.5% accuracy with 88.9% sensitivity and specificity, which is comparable to other accurate classifiers in published literature. The fall risk classifier retrained with prospective one year follow-up data achieved a 73% accuracy which was superior to the 67% accuracy of the Timed Up and Go test for falls prediction.

Conclusion

Our study shows the potential of a machine-learning remote monitoring system using information from mobility data to classify an older person’s falls’ risk.

Multiple lump and interaction solutions for fifth-order variable coefficient nonlinear-Schrödinger dynamical equation

Lump and their interactions with kink, periodic and rogue waves, and periodic cross lump waves will be studied for fifth-order variable coefficient nonlinear-Schrödinger equation in this paper. With the combinations of bilinear, exponent, and trigonometric functions, we'll study different lump soliton solutions. With interaction phenomenon we'll set up some new analytical solutions and also represents them in graphical ways.

Which factor explains the life-history of Xanthium strumarium L., an aggressive alien invasive plant species, along its altitudinal gradient?

Invasive biology acknowledges the concept of better performance by invasive plants in the introduced range. Xanthium strumarium L. is one of the successful invasive species in Khyber Pakhtunkhwa, Pakistan. The phenological pattern, vegetative and reproductive traits plasticity analysis of the species was explored to explain the invasive success across the altitudinal gradient in the current invaded habitats. Phenological patterns and timing (seedling, vegetative growth, flowering and fruiting, drying, and seed bank) were observed during a full year for two seasons. We also examine plant functional traits at altitudes of 500, 1000, and 1500 m a.s.l. to assess traits and biomass variations. The X. strumarium exhibits late vegetative and reproductive phenology at higher altitudes, enabling them to occupy an empty niche and benefit from decreased competition for resource acquisition. The lower altitude plants show a higher growth rate (stem size increase, number of leaves, and leaf area) due to the higher nutrient availability. Higher altitude plants have the highest reproductive biomass and biomass ratio revealing plant abilities to be reproductively adapted in the higher altitudes. Among climatic variables, mean yearly temperature, mean annual yearly humidity, and mean day length in hours, while in soil variables, organic matter and nitrogen percentage significantly affect the phenological and morphological stages. Therefore, we conclude that X. strumarium can invade higher altitudes with a shift in its phenological and morphological changes making the invasion process successful.

Correction: Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds

Correction for 'Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds' by L. Fernandez et al., Nanoscale, 2020, 12, 22258-22267, DOI: 10.1039/D0NR04964F.

Prevalence of parasites in selected captive bird species

Blood and fecal samples of chukar partridge (Alectoris chukar), albino pheasant (Phasianus colchicus), silver pheasant (Lophura nycthemera), rose-ringed parakeet (Psittacula krameri) and turkeys (Meleagris gallopavo) were analyzed to check parasitic prevalence. To record parasites these five avian species were placed kept in separate cages at Avian Conservation and Research Center, Department of Wildlife an Ecology, University of Veterinary and Animal Sciences, Lahore, Pakistan. 100 fecal and 100 blood samples for each bird species were inspected to analyze internal parasites. During present study, 17 species of endoparasites 14 from fecal samples and three from blood were examined. Two species of ectoparasites i.e. mite Dermanyssus gallinae 42% and fowl ticks Args persicus 41%were studied. Blood parasites included Plasmodium juxtanucleare 50%, Leucoctoyzoon simond having parasitic prevalence 40%, and Aegyptinella pullorum having parasitic prevalence of 40%. Parasitic species recorded from fecal samples included 6 species of nematodes viz. Allodpa suctoria 2%. Syngamus trachea with parasitic prevalence of 60%, Capillaria annulata 37.5%, Ascardia galli 24%, Capillaria anatis 40% and Heterakis gallinarum 28.3%. Similarly, two species of trematodes viz. Prosthogonimus ovatus having parasitic prevalence of 50% and Prosthogonimus macrorchis 21% were also documented from fecal avian samples . Single cestode species Raillietina echinobothrida having parasitic prevalence of 72% and 3 protozoan species i.e. Eimeria maxima having parasitic prevalence of 21%, Giardia lamblia 41% and Histomonas meleagridis 18% were documented during corpological analysis. In our recommendation, proper sanitation, medication and vaccination of bird's enclousres are suggested to avoid parasites.

Development of chitosan based microencapsulated spray dried powder of tuna fish oil: oil load impact and oxidative stability

The impact of fish oil concentration on the oxidative stability of microcapsules through the spray drying process using chitosan and maltodextrin as wall material was studied. Emulsions were prepared with different Tuna fish oil (TFO) content (TFO-10%, TFO20%, TF030% TF0-40%) while wall material concentration was kept constant. Microencapsulated powder resulting from emulsion prepared with high fish oil load have high moisture content, wettability, total oil and low encapsulation efficiency, hygroscopicity and bulk tapped density. Oxidative stability was evaluated periodically by placing microcapsules at room temperature. Microcapsules prepared with TFO-10% presented high oxidative stability in terms of peroxide value (2.94±0.04) and anisidine value (1.54±0.02) after 30 days of storage. It was concluded that optimal amounts of fish oil for microencapsulation are 10% and 20% using chitosan and maltodextrin that extended its shelf life during study period.

Posterior Aneurysmorrhaphy & Lateralization Of Aneurysmal Fistula Vein: A Modification Of Existing Aneurysmectomy Techniques

BACKGROUND

To present a new modification of aneurysmectomy technique for the management of aneurysmal fistula vein. This cross-sectional study was carried out at Vascular Surgery department, Combined Military Hospital Rawalpindi from 1st October 2014 to 30th December 2018.

METHODS

This modified aneurysmectomy procedure was performed in 20 patients. Massive diffuse venous dilatation of vein, necrosis of overlying skin, reduction in the cannulation area and pain were the indications of surgery. Revision was performed by rotating the mobilized vein to 180°, excising redundant vein, reducing diameter, repairing venotomy posteriorly and placing the vein in a mobilized skin flap over the fascia of biceps muscle away from skin suture line, to facilitate subsequent cannulation and post puncture haemostasis. The rationale of this modification was to prevent damage to the usual anteriorly placed suture line during needle insertion for haemodialysis. The data were analysed by using SPSS version 25.0.

RESULTS

The mean age of patients was 45.45±14.75 years with a range of 12-65 years. Sixteen patients (80.0%) were having brachiocephalic fistula while 4 patients (20.0%) had radio cephalic fistula. The mean time of reuse of AVF after vein Aneurysmectomy was 24.55±5.3 days with half of the patients having reuse of AVF after 3 weeks. Three (15%) patients developed hematoma while 2 (10%) patients developed skin necrosis. Fifteen (75%) patients had no surgery related complications after procedure.

CONCLUSIONS

Posterior suturing and lateralization of aneurysmal vein under mobilized skin flap is a safe, effective and easy to learn modification of aneurysmectomy procedure for the management of aneurysmal dilatation of fistula vein.

Amelioration potential of Moringa oleifera extracts against sodium arsenate induced embryotoxicity and genotoxicity in mouse (Mus musculus)

Previous studies have suggested that arsenic crosses the placenta and affects the fetus development. The study under consideration aims to show comparative ameliorative effect of Moringa oleifera leaf and flower extracts against sodium arsenate induced fetus toxicity of mice. Pregnant mice (N=44) were kept in lab and divided into eleven group from (A to K) and were orally administered the doses 6 mg/kg, 12 mg/kg for sodium arsenate, 150 mg/kg and 300 mg/kg for Moringa oleifera leaf extracts (MOLE) and 150 mg/kg and 300 mg/kg for Moringa oleifera flower extracts (MOFE) comparing with control. The investigation revealed evident reduction in the fetuses weight, hind limb, fore limb, tail and snout length, crown rump and head circumferences well as malformations in tail, feet, arms, legs, skin and eyes in the negative control group (only administered with sodium arsenate). Co-administration of sodium arsenate with MOLE and MOFE ameliorate the reversed effect of sodium arsenate on the shape, length, body weight and DNA damage of fetus significantly at 95% confidence interval. However, Moringa oleifera leaf extract showed more significant results in comparison to Moringa oleifera flower extract. Hence concluded that Moringa oleifera leaf extract ameliorated the embryo toxic effects of sodium arsenate and can be used against environmental teratogens.

THREAT ANALYSIS OF REASONS LEADING TO FAILURE OF PERMANENT HEAMODIALYSIS ACCESS

Objective: To analyze the commonest threats which lead to the failure of a permanent vascular haemodialysis access. Study Design: Prospective observational study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Rawalpindi, from Nov 2018 to Nov 2019. Methodology: All patients who presented with arteriovenous fistula (AVF) or arteriovenous graft (AVG) related complications which can potentially fail an access were included. The frequency, with which these complications occurred, was noted. Results: A total of 158 patients were included, 73 (46.20%) were male and 85 (53.80%) were females. The complications observed in order of frequency were arteriovenous fistulathrombosis (anastomotic or draining vein) in 60 (38%), pseudo aneurysms in 39 (24.68%), stealing veins causing non-maturity of the access in 14 (8.86%), venous hypertension causing extremity edema in 14 (8.86%) (7 due to stealing veins and 7 due to central venous stenosis), AVF anastomotic or draining vein stenosis in 8 (5.06%), wound hematoma in 5 (3.16%), wound infection in 5 (3.16%), true aneurysm of the draining vein in 4 (2.56%), steal syndrome in 3 (1.9%), wound seroma in 3 (1.9%), post op arm edema(not related to central vein stenosis orstealing veins) in 2 (1.26%) and compression neuropathy in 1 (0.6%) of the patients. Conclusion: Complications of vascular access are the potential threats to the life of a permanent vascular access. Early diagnosis and timely intervention can help in fistula salvage.

DIAGNOSTIC DILEMMA AND TREATMENT CHALLENGES IN IDIOPATHIC GRANULOMATOUS MASTITIS

Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis Study Design: Prospective observational study. Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020. Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months. Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively. Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.

Industrial growth and CO2 emissions in Vietnam: the key role of financial development and fossil fuel consumption

The increase in greenhouse gas emission has a major global issue, catching the attention of the researcher and policymakers around the world. The combustion of fossil fuel is the main cause of the rising greenhouse gas emission particularly in developing countries including Vietnam. Meanwhile, the purpose of the study is to evaluate the linkage between fossil fuel consumption, financial development, industrial progression, and CO₂ emission over the period from 1970 to 2019, particularly in Vietnam. The study applied the ARDL econometric technique and Bayer-Hanck cointegration approach with structural break to confirm long run relationship and the EKC hypothesis between industrial growth and CO₂ emission, in Vietnam, which assume the U-shaped link between CO₂ emission and industrial growth in Vietnam. Which further confirmed by Lind and Mehlum U test in addition, the Granger causality exists between fossil fuel consumption and CO₂ emission in both short run and long run. The causal relationship is unidirectional in the short run running from fossil fuel consumption and carbon dioxide emission; therefore, the study proposed to adopt low-carbon emission technology.

Influence of 4f filling on electronic and magnetic properties of rare earth-Au surface compounds

One-atom-thick rare-earth/noble metal (RE-NM) compounds are attractive materials to investigate two-dimensional magnetism, since they are easy to synthesize into a common RE-NM2 structure with high crystal perfection. Here we perform a comparative study of the GdAu2, HoAu2, and YbAu2 monolayer compounds grown on Au(111). We find the same atomic lattice quality and moiré superlattice periodicity in the three cases, but different electronic properties and magnetism. The YbAu2 monolayer reveals the characteristic electronic signatures of a mixed-valence configuration in the Yb atom. In contrast, GdAu2 and HoAu2 show the trivalent character of the rare-earth and ferromagnetic transitions below 22 K. Yet, the GdAu2 monolayer has an in-plane magnetic easy-axis, versus the out-of-plane one in HoAu2. The electronic bands of the two trivalent compounds are very similar, while the divalent YbAu2 monolayer exhibits different band features. In the latter, a strong 4f-5d hybridization is manifested in neatly resolved avoided crossings near the Fermi level. First principles theory points to a residual presence of empty 4f states, explaining the fluctuating valence of Yb in the YbAu2 monolayer.