Sequential mediation analysis of physical activity, healthy diet, BMI, and academic burnout in the Pakistani educational landscape.

Research has indicated a negative impact of physical activity on academic burnout among students, however, there is a paucity of evidence about the underlying mechanism of this association in Pakistani students. The present research seeks to investigate the relationship between physical activity and academic burnout by investigating the potential mediating effects of adherence to the Mediterranean diet (MD) and body mass index (BMI). A sample of 596 students using a cross-sectional survey design was gathered from two public universities (Riphah International University and Mohammed Ali Jinnah University) in Rawalpindi, Pakistan from June to July 2022. The study participants were asked to fill out the Physical Activity Rating Scale-3, the Learning Burnout Scale, and the Test of Adherence to MD questionnaires. The study employed descriptive, bivariate, and path analysis through regression utilizing the SPSS software version 27. The findings demonstrated a negative correlation between academic burnout and BMI, physical activity, and adherence to the MD. The relationship between physical activity and academic burnout was mediated by BMI. Physical activity and academic burnout were inversely correlated, with adherence to the MD and BMI interacting as sequential mediators. The outcomes of this research have expanded our knowledge of the association between physical activity and academic burnout and have suggested crucial and appropriate strategies for addressing student academic burnout.

Psychological dynamics of pandemic resilience: a tale of two cultures.

The present work endeavours to explore the experiences of university-level students from Pakistan and Nepal after the COVID-19 outbreak. A comprehensive electronic survey was carried out utilising a meticulous cluster sampling technique encompassing two distinct populations, i.e. Pakistan and Nepal, during the period extending from September 2022 to January 2023. A total of 2496 participants completed the questionnaire (Pakistani population: 55.45% and Nepalese population: 44.55%). We utilised the Mental Health Continuum-Short Form (MHC-SF), Pittsburgh Sleep Quality Index (PSQI), feeling of loneliness (UCLA), interdependent happy scale (IHS), and fear of COVID-19 scale (FCV-19S). Notably, a significant intercultural disparity was observed, particularly concerning the level of COVID-19 fear which was higher among the Nepalese population. However, this particular variable did not demonstrate any significant associations with other variables, except for the social dimension of MHC-SF. There was a negative correlation observed between this variable and IHS within the Pakistani population. Irrespective of the varying degrees of apprehension towards COVID-19 within the two distinct cultural contexts, there exists a significant positive correlation between the assessed psychological assets and individual well-being, as well as the resumption of regular activities after the outbreak.

Monolignol Potential and Insights into Direct Depolymerization of Fruit and Nutshell Remains for High Value Sustainable Aromatics.

The inedible parts of nuts and stone fruits are low-cost and lignin-rich feedstock for more sustainable production of aromatic chemicals in comparison with the agricultural and forestry residues. However, the depolymerization performances on food-related biomass remains unclear, owing to the broad physicochemical variations from the edible parts of the fruits and plant species. In this study, the monomer production potentials of ten major fruit and nutshell biomass were investigated with comprehensive numerical information derived from instrumental analysis, such as plant cell wall chemical compositions, syringyl/guaiacyl (S/G ratios, and contents of lignin substructure linkages (ß-O-4, ß-ß, ß-5). A standardized one-pot reductive catalytic fractionation (RCF) process was applied to benchmark the monomer yields, and the results were statistically analyzed. Among all the tested biomass, mango endocarp provided the highest monolignol yields of 37.1 % per dry substrates. Positive S-lignin (70-84 %) resulted in higher monomer yield mainly due to more cleavable ß-O-4 linkages and less condensed C-C linkages. Strong positive relationships were identified between ß-O-4 and S-lignin and between ß-5 and G-lignin. The analytical, numerical, and experimental results of this study shed lights to process design of lignin-first biorefinery in food-processing industries and waste management works.

Potential determinants of parental hesitancy to vaccinate their children against COVID-19 infection: a cross-sectional investigation.

Coronavirus disease 2019 (COVID-19) vaccination hesitancy has emerged as a substantial concern among the adult population globally. However, limited evidence is available about parental hesitancy to vaccinate their children against COVID-19 within the Pakistani context. Thus, the present investigation aimed to assess parental attitudes, perceptions, and willingness regarding vaccination hesitancy and associated predictors of getting their children vaccinated against COVID-19. We conducted a cross-sectional population-based, self-administered online questionnaire in Punjab, Pakistan, on randomly selected parents between October 2022 and February 2023. The data were collected based on socio-demographics, attitudes, perceptions, and willingness of parents regarding COVID-19 vaccine hesitancy for their children. Adjusted odds ratios with 95% confidence intervals were estimated to identify the predictors of vaccine hesitancy. The findings demonstrated that among 1,478 participants, a total of 40% believed that the COVID-19 vaccine may pose a greater risk to children than adults, while 38% exhibited no concerns. Around 13% of children were not vaccinated in our study sample. More than half expressed hesitancy toward vaccination, and only 35.25% were inclined to get their children vaccinated in our study sample. In addition, only 16% of the parents believed that the COVID-19 vaccination may cause an alteration in their children's DNA. A similar proportion of parents were aware of the significance of getting their children vaccinated and expressed their willingness to vaccinate their children to prevent the COVID-19 infection. However, a higher odds ratio was observed in females with a higher educational background and those in the healthcare profession. In conclusion, healthcare awareness-supporting programs for educating parents should be designed and implemented. These insights might aid in the development of strategies to eradicate barriers in existing coronavirus vaccination programs and may vaccinate a larger child population to reduce the adverse consequences of the pandemic.

Potential Correlation Between Self-Compassion and Bedtime Procrastination: The Mediating Role of Emotion Regulation.

Purpose: The present research aims to investigate the potential correlations between self-compassion and bedtime procrastination, a significant behavior related to sleep. In this research, we put forward the hypothesis that a reduction in negative affect and the implementation of adaptative emotion regulation strategies can elucidate the established connections between self-compassion and a decreased tendency for bedtime procrastination. Methods: Two cross-sectional online surveys (Survey I: n=241 and Survey II: n=546) were carried out via a convenient sampling method. Prior to their inclusion, all participants underwent a thorough assessment to confirm no evidence of clinical insomnia. The study participants in both survey investigations were asked to complete various psychometric assessments, including self-compassion, positive and negative affect, and bedtime procrastination; however, the study participants in Survey II additionally underwent the administration of a cognitive reappraisal assessment. Results: In Survey I, a multiple mediation analysis was conducted to examine the mediating effects of self-compassion on reducing bedtime procrastination through a reduction in negative affect. The results supported the hypothesized relationships, indicating that self-compassion had the expected mediated effects by mitigating negative affective states. However, contrary to expectations, higher positive affect did not mediate the relationship between self-compassion and reduced bedtime procrastination. The findings of Survey II were confirmed through the utilization of path analysis. Moreover, this analysis provided additional evidence to suggest that the mechanism of cognitive reappraisal could account for the observed decrease in negative affect associated with self-compassion. The present study found a notable and sustained impact of self-compassion on reducing instances of delaying bedtime activities. Conclusion: The present research contributes novel empirical evidence suggesting a negative association between self-compassion and the propensity to engage in bedtime procrastination. This relationship can be attributed partly to the implementation of an adaptative emotion regulation mechanism that effectively alleviates negative affect.

Substrate-related factors and kinetic studies of Carbohydrate-Rich food wastes on enzymatic saccharification.

Food waste biorefinery is a sustainable approach to producing green chemicals, however the essential substrate-related factors hindering the efficacy of enzymatic hydrolysis have never been clarified. This study explored the key rate-limiting parameters and mechanisms of carbohydrate-rich food after different cooking and storing methods, i.e., impacts of compositions, structural diversities, and hornification. Shake-flask enzymatic kinetics determined the optimal dosages (0.5 wt% glucoamylase, 3 wt% cellulase) for food waste hydrolysis. First order kinetics and simulation results determined that reaction coefficient (K) of cooked starchy food was âˆ¼ 3.63 h-1 (92 % amylum digestibility) within 2 h, while those for cooked cellulosic vegetables were 0.25-0.5 h-1 after 12 h of hydrolysis. Drying and frying reduced âˆ¼ 71-89 % hydrolysis rates for rice, while hydrothermal pretreatment increased the hydrolysis rate by 82 % on vegetable wastes. This study provided insights into advanced control strategy and reduced the operational costs by optimized enzyme doses for food waste valorization.

Potential determinants of vaccine hesitancy among celiac disease patients: a single cohort analysis.

Introduction: Though researchers and scholars have greatly emphasized addressing the influencing factors of vaccination hesitancy, little attention has been paid to patients with celiac disease. Addressing the variables hampering attitudes might help direct appropriate patient advocacy and doctor-patient communication endeavors to encourage vaccination among celiac disease patients. The present investigation seeks to explore the coverage against vaccine-preventable diseases, vaccination attitudes, and related possible factors among celiac disease patients in the Pakistani setting. Methods: A self-reported online survey was conducted in Islamabad, Pakistan, for celiac disease patients aged 18 and above. The questionnaire was completed by 226 participants, with a response rate of 43.8%. The influencing variables for vaccination hesitancy were examined, and 95% confidence intervals for the crude and adjusted odds ratios were computed. Results: Among the study population, the majority were females, with a ratio of 75.66%. A prominent proportion of 69.03% was observed for influenza vaccination, while 39.82% were unable to recall all of the vaccinations they had previously received. Only 7% of the patients were considered to have a negative attitude toward vaccination, compared to an estimated 76% who were in favor of it. The significantly positive influencing factors observed toward vaccination were being well-educated (graduate, master, or above), possible recurrence of vaccine-preventable diseases with declining vaccination coverage (adjusted OR: 13.36), and increased confidence in vaccines from health care experts compared to electronic media (adjusted OR: 8.41). Contrarily, practicing complementary and alternative medicines (adjusted OR: 5.59), willingness to get vaccinated again in the future (adjusted OR: 15.59), and prior negative perspectives (adjusted OR: 1.01) were the determinants with a significant negative association. Discussion: In conclusion, the outcomes of the current work raise the possibility that health practitioners may be accountable for inappropriately prescribing vaccines to this demographic since 77% of the participants had a favorable attitude toward vaccination. These findings could serve as a springboard for creating targeted immunization efforts to raise vaccination coverage against vaccine-preventive diseases among celiac disease patients.

An overview of floral regulatory genes in annual and perennial plants.

The floral initiation in angiosperms is a complex process influenced by endogenous and exogenous signals. With this approach, we aim to provide a comprehensive review to integrate this complex floral regulatory process and summarize the regulatory genes and their functions in annuals and perennials. Seven primary paths leading to flowering have been discovered in Arabidopsis under several growth condition that include; photoperiod, ambient temperature, vernalization, gibberellins, autonomous, aging and carbohydrates. These pathways involve a series of interlinked signaling pathways that respond to both internal and external signals, such as light, temperature, hormones, and developmental cues, to coordinate the expression of genes that are involved in flower development. Among them, the photoperiodic pathway was the most important and conserved as some of the fundamental loci and mechanisms are shared even by closely related plant species. The activation of floral regulatory genes such as FLC, FT, LFY, and SOC1 that determine floral meristem identity and the transition to the flowering stage result from the merging of these pathways. Recent studies confirmed that alternative splicing, antisense RNA and epigenetic modification play crucial roles by regulating the expression of genes related to blooming. In this review, we documented recent progress in the floral transition time in annuals and perennials, with emphasis on the specific regulatory mechanisms along with the application of various molecular approaches including overexpression studies, RNA interference and Virus-induced flowering. Furthermore, the similarities and differences between annual and perennial flowering will aid significant contributions to the field by elucidating the mechanisms of perennial plant development and floral initiation regulation.

Reverse osmosis membrane functionalized with aminated graphene oxide and polydopamine nanospheres plugging for enhanced NDMA rejection and anti-fouling performance.

The use of reverse osmosis (RO) for water reclamation has become an essential part of the water supply owing to the ever-increasing water demand and the utmost performance of the RO membranes. Despite the global RO implementation, its inferior rejection against low molecular weight contaminants of emerging concerns (CECs) (i.e., N-nitrosodimethylamine (NDMA)) and propensity to fouling remain bottle-neck thus affecting process robustness for water reuse. This study aims to enhance both the rejection and antifouling properties of the RO membrane. Herein for the first time, we report RO membrane modification using polydopamine nanospheres (PDAns) followed by aminated-graphene oxide (AGO) deposition as an effective approach to overcome these challenges. The modification of the RO membrane using PDAns-AGO resulted in 89.3 ± 2.7% rejection compared to the pristine RO membrane which demonstrated 69.2 ± 2.1% NDMA rejection. This significant improvement can be ascribed to the plugging and shielding of defective areas (formed during interfacial polymerization) of the polyamide layer through active PDAns and AGO layers and to the added sieving mechanism that arose through narrow channels of the AGO owing to its reduction. Moreover, the in-situ and non-destructive fouling monitoring using optical coherence tomography (OCT) revealed that the PDAns-AGO coating enhanced both the anti-scaling and anti-biofouling characteristics. The improved hydrophilicity and bactericidal effect together with roughness and surface charge suppression synergistically enhanced anti-fouling properties. This study provides a new direction for safe and cost-effective water reuse practices. The membrane with high selectivity against CECs such as NDMA has the potential to eliminate permeate staging using second pass RO and other advanced oxidation processes which are utilized as a tertiary treatment to make reclaimed water suitable for potable/non-potable application.

Inflammatory biomarkers and cardiac injury in COVID-19 patients.

Introduction: Cardiac injury has received considerable attention due to the higher risk of morbidity and mortality associated with coronavirus disease. However, in a developing country, there is a scarcity of data on cardiac injury in COVID-19 patients related to inflammatory biomarkers. Methods: Therefore, the present research retrospectively analyzes data from three territorial hospitals in Pakistan's Punjab province to investigate the potential impact of the cardiac injury on the mortality and severity of COVID-19-infected patients. We evaluated 2,051 patients between January 16 and April 18, 2022, with confirmed COVID-19. The in-hospital mortality recorded for the selected sample size was about 16.28%. Results: The majority of the participants were identified as male (64%) with a median age of 65 years. Also, fever, fatigue, and dyspnea were reported as common symptoms. An aggregate of 623 patients (30.38%) had a cardiac injury, and when these patients are compared to those without cardiac injury, the participants were significantly older and had more comorbidities with higher leukocyte counts, elevated levels of C-reactive protein, interleukin-6, procalcitonin, myohemoglobin, creatinine kinase-myocardial band, serum creatinine, high-sensitivity troponin-I, N-terminal pro-B-type natriuretic peptide had a significant amount of multiple ground-glass opacity and bilateral pulmonary infiltration in radiographic results. Participants with heart injury required more non-invasive or invasive mechanical respiration than those who did not have a cardiac injury. Individuals with cardiac injury had higher rates of sepsis, acute respiratory distress syndrome (ARDS), d-dimer concentration, and respiratory failure than those without cardiac injury. Patients who had had a cardiac injury died at a higher rate than those who had not suffered cardiac damage. In the multivariable logistic regression analysis, participants with cardiac injury showed greater odds of COVID-19 mortality and were found associated with older age (OR = 1.99, 95% CI = 0.04-3.19), elevated cardiac troponin I (OR = 18.64, 95% CI = 13.16-23.01), the complication of sepsis (OR = 10.39, 95% CI = 7.41-13.39) and ARDS (OR = 6.65, 95% CI = 4.04-8.91). Conclusion: Cardiac injury is a frequent complication among patients with coronavirus-induced infection in Punjab, Pakistan, and it is significantly linked to a greater risk of in-hospital mortality.

Particulate air pollution and metabolic risk factors: Which are more prone to cardiac mortality.

This study explored multiplex, country-level connections between a wide range of cardiac risk factors and associated mortality within the South Asian Association for Regional Cooperation (SAARC) countries. The grey relational analysis (GRA) methodology is used to evaluate data from 2001 to 2018 to compute scores and rank countries based on cardiac mortality. Subsequently, we used the conservative (Min-Max) technique to determine which South Asian country contributes the most to cardiac mortality. The Hurwicz criterion is further applied for optimization by highlighting the risk factors with the highest impact on cardiac mortality. Empirical findings revealed that India and Nepal are the leading drivers of cardiovascular disease (CVD) mortality among all SAARC nations based on the results of the GRA methodology. Moreover, the outcomes based on the Hurwicz criterion and the conservative criterion indicated that CVD mortality is considerably impacted by household air pollution from the combustion of solid fuel, with India as a potential contributor in the SAARC region. The outcomes of this research may enable international organizations and public health policymakers to make better decisions and investments within the SAARC region to minimize the burden of CVD while also strengthening environmentally sustainable healthcare practices.

Does the intubation timeline affect the in-hospital mortality of COVID-19 patients? A retrospective cohort study.

Background: Effective strategies for managing coronavirus disease 19 (COVID-19) patients suffering from acute respiratory distress are constantly evolving. The timeline and threshold for transitioning from non-invasive ventilation to intermittent mandatory ventilation in critical cases who develop COVID-19-related respiratory distress are undetermined. The present research intends to investigate if emergency room intubations in COVID-19 patients affect mortality. Methods: Between January 1, 2021 and June 30, 2021, we retrospectively reviewed chart analysis on all patients with confirmed positive COVID-19 screening and who underwent endotracheal intubation. Depending on when the intubation was performed; early in the emergency room or delayed outside the emergency room, patients were separated into two cohorts. In addition to comorbid clinical manifestations, the quick sequential organ failure assessment (qSOFA) score, and in-hospital mortality were all recorded as demographic and clinical information. Results: Fifty-eight of the 224 corona-positive patients who underwent intubation had their intubations performed in the emergency room. Age, sex, alcohol use, and smoking status did not significantly differ between the two categories at the baseline. The mean qSOFA score was higher in the early intubation cohort (3.5; p < 0.000) along with more underlying comorbidities (3.0; p < 0.000). When compared to the late intubation cohort (45.78%), patients treated with early intubation had a significantly greater death rate (67.24%). Conclusion: In summary, we discovered that patients who underwent intubation in the emergency units exhibited a high quick SOFA score as well as maximum co-morbid conditions than patients intubated somewhere else in the hospital. The findings of our investigation imply that intubating patients too early might be risky.

Uptake of COVID-19 booster shot among healthcare workers: A mediation analysis approach.

Since the thrust of previous research investigations has been on people's willingness to get immunized against the COVID-19 infection, the underpinning principle of compliance has received very little attention. Addressing the possible drivers and mechanisms influencing vaccine acceptance may provide significant insights for limiting the pandemic. In response, we intend to investigate the influence of decision regret and the consequences of post-vaccination adverse effects on the inclination to undertake booster shots. An electronic survey that was self-administered was conducted in Rawalpindi, Pakistan. The questionnaire was completed by 1,369 participants, with a response rate of 41%. 1,343 of them (98.10%) had received both doses of the COVID-19 vaccination. Besides, the present research has also adopted a mediation model. Our findings demonstrate that unfavorable vaccination responses in healthcare workers significantly affect their likelihood of receiving booster shots. Interestingly, healthcare workers who had adverse experiences after being immunized were more prone to regret their prior immunization decisions, which in response affected their decision to get a booster shot. The motivation to receive the booster dosage and adverse post-vaccination responses were mediated by decision regret. The outcomes suggested indissociable connections between unfavorable vaccination responses, decision regret, and the likelihood of receiving a booster shot. To strengthen immunization acceptance intent and enhance the likelihood of receiving COVID-19 booster shots, it is recommended that awareness of these post-vaccination adverse events be extensively integrated into immunization awareness programs and policy measures supporting booster doses.

Micronutrient deficiencies and cardiac health.

Inadequate diet and nutritional quality are potentially correlated with an escalated risk of cardiac-related morbidity and mortality. A plethora of knowledge is available regarding the influence of heart-healthy dietary patterns in response to disability-adjusted life years (DALYs), yet little is known regarding the best approaches to adopt. In response, the present investigation aims to bridge this knowledge gap by implementing mathematical machine learning grey methodology to assess the degree of influence and the potential contributing factors in DALYs due to ischemic heart disease and stroke, in conjunction with the Hurwicz (Min-Max) criterion. The outcomes highlighted that a diet low in fruits is a potential contributor to IHD-related DALYS, whereas a diet low in vegetables is a more grounded contributor to stroke-related DALYs in Spain, among others. Moreover, the Hurwicz approach highlighted IHD to be more impacted due to dietary and nutritional factors than stroke. In conclusion, our investigation strongly supports a balanced diet and precision nutrition guidelines as a strategy for reducing cardiac-related diseases in the Spanish population. It is a public health primary consideration to build an ambiance that encourages, rather than hinders, compliance with cardioprotective dietary practices among all people.

Biomass pyrolysis: A review on recent advancements and green hydrogen production.

Biomass pyrolysis has recently gained increasing attention as a thermochemical conversion process for obtaining value-added products, thanks to the development of cutting-edge, innovative and cost-effective pyrolysis processes. Over time, new and novel pyrolysis techniques have emerged, and these processes can be tuned to maximize the production of high-quality hydrogen. This review examines recent advancements in biomass pyrolysis by classifying them into conventional, advanced and emerging approaches. A comprehensive overview on the recent advancements in biomass pyrolysis, highlighting the current status for industrial applications is presented. Further, the impact of each technique under different approaches on conversion of biomass for hydrogen production is evaluated. Techniques, such as inline catalytic pyrolysis, microwave pyrolysis, etc., can be employed for the sustainable production of hydrogen. Finally, the techno-economic analysis is presented to understand the viability of pyrolysis at large scale. The outlook highlights discernments into future directions, aimed to overcome the current shortcomings.

Cardiovascular Disease Mortality and Potential Risk Factor in China: A Multi-Dimensional Assessment by a Grey Relational Approach.

Objectives: This study aims to investigate the impact of hypertension, diabetes, and high blood cholesterol on increased mortality from cardiovascular diseases such as coronary heart disease, stroke, and pulmonary heart disease in a multi-dimensional way. Methods: The grey relational analysis methodology is adopted to assess the connection between cardiac risk factors and related mortality. The Hurwicz and the Conservative (Min-Max) criterion approach are also utilized to identify the prospective risk factor that contributes the most to increased cardiac mortality. Results: The findings reveal that hypertension has a more grounded relationship with stroke and pulmonary heart disease mortality, whereas high blood cholesterol appears to be the leading contributor to deaths from coronary heart disease. The results based on the Hurwicz and the Min-Max criterion show a robust connection between dyslipidemia, coronary heart disease, and cardiovascular disease mortality. Conclusion: Combating uncontrolled blood cholesterol and blood pressure levels would necessitate a multi-pronged strategy at both the national and local levels. Besides, the suggested methodologies provide a valuable tool and additional practical knowledge for public health policymakers and decision-makers in drawing rational decisions to combat China's rising CVD burden.

Bioconversion of food and lignocellulosic wastes employing sugar platform: A review of enzymatic hydrolysis and kinetics.

Bioenergy and biochemicals can be sustainably produced through fermentation and anaerobic digestion (AD). However, this bioconversion processes could be more economical if the hydrolysis rates of substrates in bioreactors can be accelerated. In this review, the feasibilities of including enzymatic hydrolysis (EH) in various bioconversion systems were studied to facilitate the biological synergy. The reaction kinetics of EH in bioconversion systems comparing pretreated lignocellulosic biomass (LCB) and food waste (FW) substrates were reviewed. Possible strategies to improve the hydrolysis efficiency were explored, including co-cultivation during enzyme production and replacement of pure enzyme with on-site produced fungal mash during EH. Key insights into improvement of current AD and fermentation technologies were summarized and further formed into suggestions of future directions in techno-economic feasibility of biorefinery using mixture of the first-generation food crop feedstock with FW; and/or co-digestion of FW with LCB.

Pyrolysis of anaerobic digested residues in the presence of catalyst-sorbent bifunctional material: Pyrolysis characteristics, kinetics and evolved gas analysis.

We investigated the potential application of anaerobically digested residues for generating bioenergy in the presence of alkali bifunctional material, sodium zirconate (Na2ZrO3, NZ) using a thermogravimetric analyzer connected to a mass spectrometer. Isoconversional kinetic models, compensation effect and master-plots method were used on data obtained under multiple heating rates (10, 15 and 20 °C min-1) to calculate the activation energy (Eα) and pre-exponential value (A) and reaction mechanism. The average Eα for blend samples C-DSW (NZ mixed with digested municipal solid waste (DSW)), and C-DSM (NZ mixed with digested swine manure (DSM)) were 172.24 and 171.63 kJ mol-1, which were much lower when compared to plain samples, DSW (202.51 kJ mol-1) and DSM (215.22 kJ mol-1). The total gas yields increased by 19.5 and 17.1% for NZ blended samples C-DSW and C-DSM, respectively. In addition, the hydrogen yields also increased by 79 and 44% for C-DSW and C-DSM, respectively.

Application of Grey-Based SWARA and COPRAS Techniques in Disease Mortality Risk Assessment.

The health industry is amongst the most affected systems in terms of multiobjective decision-making, rendering the final solution, vulnerable to errors; however, multicriteria decision analysis (MDCA) emerges as a supportive tool for the process of decision-making. Therefore, the present study seeks to offer an MCDA framework for assessing and identifying the potential influence of socioeconomic risk factors on noncommunicable disease mortality. We adopted a subjective approach of grey-based Step-wise Weight Assessment Ratio Analysis (SWARA) and COmplex PRoportional Assessment (COPRAS) approach to calculate weights of parameters and criteria, respectively, and then rank them based on their degree of significance. The findings reveal that CRD mortality is potentially affected by the selected socioeconomic risk variables followed by IHD and cancer. Implementing MCDA techniques in the present study will assist the public health practitioners and policymakers in drawing decisions on the best strategy to reduce CRD mortality, which contributes significantly to raising overall mortality.

Association of Mortality-Related Risk Factors in Patients with COVID-19: A Retrospective Cohort Study.

COVID-19 is a rapidly disseminating infectious disease conferred by the World Health Organization (WHO) as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics data have been identified for patients with COVID-19, but mortality-related risk factors and a comprehensive clinical course of disease in a developing country have not been specifically defined. This retrospective, single-center cohort study involved all successive inpatients having a positive COVID-19 polymerase chain reaction (PCR), with deceased or discharged clinical outcomes from 1 January to 10 May 2021. Data were extracted from electronic medical records on demographic, clinical, radiological, and laboratory findings as well as complications faced and treatment provided during follow-up, involving serial samples for viral RNA identification, and compared between the dead and survivors. To investigate the risk factors associated with in-hospital mortality, we employed the multivariate logistic regression model. In this study, 2048 patients were involved, 1458 of whom were discharged, and 590 died in hospital. More than half of patients were identified as male with old age being the potential risk factor of mortality. Exactly 94.8% of all patients presented with fever at the time of admission. Several comorbidities were present in the study population, with the most frequent comorbidity being cardiovascular diseases (1177 of 2048) and hypertension (975 of 2048) followed by cerebrovascular disease and diabetes mellitus. Mortality rates for infected patients were observed as higher in severe patients (46.3%) compared with non-severe cases (26.1%) during a follow-up. Multivariate regression analysis showed a significant association of in-hospital mortality of patients with older age, presence of hypertension and cardiovascular diseases as underlying comorbidities, increased level of cardiac troponin I and d-dimer concentration on admission, as well as septicemia and ARDS as a complication during illness. To minimize the risk of death in COVID19 patients, as well as the risk of severe complications, urgent public health measures should be properly planned and implemented on those vulnerable populations. To detect early manifestations of clinical problems, thorough and regular follow-up is warranted.