Comparative study of SPI success factors in global and in-house environment for large-scale software companies.

Background: Software process improvement (SPI) is an indispensable phenomenon in the evolution of a software development company that adopts global software development (GSD) or in-house development. Several software development companies do not only adhere to in-house development but also go for the GSD paradigm. Both development approaches are of paramount significance because of their respective advantages. Many studies have been conducted to find the SPI success factors in the case of companies that opt for in-house development. Still, less attention has been paid to the SPI success factors in the case of the GSD environment for large-scale software companies. Factors that contribute to the SPI success of small as well as medium-sized companies have been identified, but large-scale companies have still been overlooked. The research aims to identify the success factors of SPI for both development approaches (GSD and in-house) in the case of large-scale software companies. Methods: Two systematic literature reviews have been performed. An industrial survey has been conducted to detect additional SPI success factors for both development environments. In the subsequent step, a comparison has been made to find similar SPI success factors in both development environments. Lastly, another industrial survey is conducted to compare the common SPI success factors of GSD and in-house software development, in the case of large-scale companies, to divulge which SPI success factor carries more value in which development environment. For this reason, parametric (Pearson correlation) and non-parametric (Kendall's Tau correlation and the Spearman correlation) tests have been performed. Results: The 17 common SPI factors have been identified. The pinpointed common success factors expedite and contribute to SPI in both environments in the case of large-scale companies.

EfficientRMT-Net-An Efficient ResNet-50 and Vision Transformers Approach for Classifying Potato Plant Leaf Diseases.

The primary objective of this study is to develop an advanced, automated system for the early detection and classification of leaf diseases in potato plants, which are among the most cultivated vegetable crops worldwide. These diseases, notably early and late blight caused by Alternaria solani and Phytophthora infestans, significantly impact the quantity and quality of global potato production. We hypothesize that the integration of Vision Transformer (ViT) and ResNet-50 architectures in a new model, named EfficientRMT-Net, can effectively and accurately identify various potato leaf diseases. This approach aims to overcome the limitations of traditional methods, which are often labor-intensive, time-consuming, and prone to inaccuracies due to the unpredictability of disease presentation. EfficientRMT-Net leverages the CNN model for distinct feature extraction and employs depth-wise convolution (DWC) to reduce computational demands. A stage block structure is also incorporated to improve scalability and sensitive area detection, enhancing transferability across different datasets. The classification tasks are performed using a global average pooling layer and a fully connected layer. The model was trained, validated, and tested on custom datasets specifically curated for potato leaf disease detection. EfficientRMT-Net's performance was compared with other deep learning and transfer learning techniques to establish its efficacy. Preliminary results show that EfficientRMT-Net achieves an accuracy of 97.65% on a general image dataset and 99.12% on a specialized Potato leaf image dataset, outperforming existing methods. The model demonstrates a high level of proficiency in correctly classifying and identifying potato leaf diseases, even in cases of distorted samples. The EfficientRMT-Net model provides an efficient and accurate solution for classifying potato plant leaf diseases, potentially enabling farmers to enhance crop yield while optimizing resource utilization. This study confirms our hypothesis, showcasing the effectiveness of combining ViT and ResNet-50 architectures in addressing complex agricultural challenges.

Genomic analysis of wolves from Pakistan clarifies boundaries among three divergent wolf lineages.

Among the three main divergent lineages of gray wolf (Canis lupus), the Holarctic lineage is the most widespread and best-studied, particularly in North America and Europe. Less is known about Tibetan (also called Himalayan) and Indian wolf lineages in southern Asia, especially in areas surrounding Pakistan where all three lineages are thought to meet. Given the endangered status of the Indian wolf in neighboring India and unclear southwestern boundary of the Tibetan wolf range, we conducted mitochondrial and genome-wide sequencing of wolves from Pakistan and Kyrgyzstan. Sequences of the mitochondrial D-loop region of 81 wolves from Pakistan indicated contact zones between Holarctic and Indian lineages across the northern and western mountains of Pakistan. Reduced-representation genome sequencing of 8 wolves indicated an east-to-west cline of Indian to Holarctic ancestry, consistent with a contact zone between these two lineages in Pakistan. The western boundary of the Tibetan lineage corresponded to the Ladakh region of India's Himalayas with a narrow zone of admixture spanning this boundary from the Karakoram Mountains of northern Pakistan into Ladakh, India. Our results highlight the conservation significance of Pakistan's wolf populations, especially the remaining populations in Sindh and Southern Punjab that represent the highly endangered Indian lineage.

MixNet-LD: An Automated Classification System for Multiple Lung Diseases Using Modified MixNet Model.

The lungs are critical components of the respiratory system because they allow for the exchange of oxygen and carbon dioxide within our bodies. However, a variety of conditions can affect the lungs, resulting in serious health consequences. Lung disease treatment aims to control its severity, which is usually irrevocable. The fundamental objective of this endeavor is to build a consistent and automated approach for establishing the intensity of lung illness. This paper describes MixNet-LD, a unique automated approach aimed at identifying and categorizing the severity of lung illnesses using an upgraded pre-trained MixNet model. One of the first steps in developing the MixNet-LD system was to build a pre-processing strategy that uses Grad-Cam to decrease noise, highlight irregularities, and eventually improve the classification performance of lung illnesses. Data augmentation strategies were used to rectify the dataset's unbalanced distribution of classes and prevent overfitting. Furthermore, dense blocks were used to improve classification outcomes across the four severity categories of lung disorders. In practice, the MixNet-LD model achieves cutting-edge performance while maintaining model size and manageable complexity. The proposed approach was tested using a variety of datasets gathered from credible internet sources as well as a novel private dataset known as Pak-Lungs. A pre-trained model was used on the dataset to obtain important characteristics from lung disease images. The pictures were then categorized into categories such as normal, COVID-19, pneumonia, tuberculosis, and lung cancer using a linear layer of the SVM classifier with a linear activation function. The MixNet-LD system underwent testing in four distinct tests and achieved a remarkable accuracy of 98.5% on the difficult lung disease dataset. The acquired findings and comparisons demonstrate the MixNet-LD system's improved performance and learning capabilities. These findings show that the proposed approach may effectively increase the accuracy of classification models in medicinal image investigations. This research helps to develop new strategies for effective medical image processing in clinical settings.

RDS-DR: An Improved Deep Learning Model for Classifying Severity Levels of Diabetic Retinopathy.

A well-known eye disorder called diabetic retinopathy (DR) is linked to elevated blood glucose levels. Cotton wool spots, confined veins in the cranial nerve, AV nicking, and hemorrhages in the optic disc are some of its symptoms, which often appear later. Serious side effects of DR might include vision loss, damage to the visual nerves, and obstruction of the retinal arteries. Researchers have devised an automated method utilizing AI and deep learning models to enable the early diagnosis of this illness. This research gathered digital fundus images from renowned Pakistani eye hospitals to generate a new "DR-Insight" dataset and known online sources. A novel methodology named the residual-dense system (RDS-DR) was then devised to assess diabetic retinopathy. To develop this model, we have integrated residual and dense blocks, along with a transition layer, into a deep neural network. The RDS-DR system is trained on the collected dataset of 9860 fundus images. The RDS-DR categorization method demonstrated an impressive accuracy of 97.5% on this dataset. These findings show that the model produces beneficial outcomes and may be used by healthcare practitioners as a diagnostic tool. It is important to emphasize that the system's goal is to augment optometrists' expertise rather than replace it. In terms of accuracy, the RDS-DR technique fared better than the cutting-edge models VGG19, VGG16, Inception V-3, and Xception. This emphasizes how successful the suggested method is for classifying diabetic retinopathy (DR).

Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report.

Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year's duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated.

Knowledge assessment of radiologists, radiology residents, and radiographers regarding contrast materials and management of adverse drug reactions occurring due to contrast materials: a cross-sectional study.

The purpose of this study was to assess the knowledge of the radiology personnel regarding contrast media used in radiology and the management of associated adverse drug reactions. Methods: A questionnaire-based cross-sectional study was conducted from 21 February to 31 March 2019 in five major hospitals of Peshawar, Pakistan. A 30-item questionnaire was adopted from the existing literature containing both open and closed-ended questions and the authors conducted a pilot study among 25 participants to assess the face validity of the tool. A universal sampling technique was adopted. Descriptive statistics were used to summarize the findings of the study. Results: Less than half of the participants could correctly classify iodinated contrast media used in radiology on the basis of ionicity and osmolaity. Sixty-three percent chose severe contrast material-induced allergic reaction as type I hypersensitivity reaction while almost half of them correctly identified the features of iodinated contrast media associated with lesser side effects. Very few of them (6.7%) had read the ACR 2018 manual on contrast media. Regarding the risk factors for acute adverse reactions and signs/symptoms of anaphylaxis few could answer satisfactorily. Twenty-eight percent of participants correctly identified epinephrine as the initial medication in an anaphylactic reaction. Regarding the preferred route of administration, concentration and dose of epinephrine, the participants' correct response was quite poor (43.8%, 6.7%, and 8.6%, respectively). More than 65% of participants could name a single intravenous corticosteroid and antihistamine. Conclusion: Radiology personnel's knowledge regarding contrast material and management of severe contrast material-induced allergic reactions is unsatisfactory.

Prevalence of Workplace Bullying Among Healthcare Professionals in Tertiary Care Hospitals in Pakistan.

Workplace bullying (WPB) in the healthcare system (HCS), whether perpetrated by healthcare professionals (HCPs) or patients, is a serious problem. The goal of this research study was to find out how common WPB is among HCPs. We conducted a questionnaire-based cross-sectional study in the three public tertiary care hospitals of Karachi, Pakistan from May to October 2020. A validated Negative Acts Questionnaire-Revised (NAQ-R) was used to measure WPB prevalence. The final sample size was 449, out of which 72.4% were females and 27.6% were males. The majority of respondents were house officers or 1st-year trainees who had completed their MBBS (n = 252, 56.1%). Residents (n = 197, 43.9%) who were pursuing specialty training made up the remainder of the respondents. As per NAQ-R cut-offs, the prevalence of bullied, being bullied, and not bullied was 41, 29, and 30%, respectively. WPB prevalence was higher in males (53%) than females (38%), whereas it occurred more often in residents (48%) than house officers (36%). We found similar findings while using the self-reported definition for WPB. Based on our findings, we conclude that WPB is pervasive among HCPs, particularly for males and residents in tertiary care hospitals in Pakistan.

Cow bone-derived biochar enhances microbial biomass and alters bacterial community composition and diversity in a smelter contaminated soil.

Bone waste could be utilized as a potential amendment for remediation of smelter-contaminated soils. Nevertheless, the influences of cow bone-derived biochar (CB) on soil microbial biomass and microbial community composition in multi-metal contaminated mining soils are still not clearly documented. Hence, the cow bone was used as feedstock material for biochar preparation and pyrolyzed at two temperatures such as 500 °C (CB500) and 800 °C (CB800), and added to a smelter soil at the dosage of 0 (unamended control), 2.5, 5, and 10% (w/w); then, the soil treatments were cultivated by maize. The CB effect on soil biochemical attributes and response of soil microbial biomass, bacterial communities, and diversity indices were examined after harvesting maize. Addition of CB enhanced total nutrient contents (i.e., total nitrogen up to 26% and total phosphorus P up to 27%) and the nutrients availability (i.e., NH4 up to 50%; NO3 up to 31%; Olsen P up to 48%; extractable K up to 18%; dissolved organic carbon up to 74%) in the treated soil, as compared to the control. The CB500 application revealed higher microbial biomass C (up to 66%), P (up to 41%), and bacterial gene abundance (up to 76%) than the control. However, comparatively a lower microbial biomass nitrogen and diversity indices were observed in the biochar (both with CB500 and CB800) treated soils than in the unamended soils. At the phylum level, the highest dose (10% of CB500 and CB800 resulted in contrasting effects on the Proteobacteria diversity. The CB50010 favored the Pseudomonas abundance (up to 793%), Saccharibacteria (583%), Parcubacteria (138%), Actinobacteria (65%), and Firmicutes (48%) microbial communities, while CB80010 favored the Saccharibacteria (386%), Proteobacteria (12%) and Acidobacteria (11%), as compared to the control. These results imply that CB500 and CB800 have a remarkable impact on microbial biomass and bacterial diversity in smelter contaminated soils. Particularly, CB500 was found to be suitable for enhancing microbial biomass, bacterial growth of specific phylum, and diversity, which can be useful for bioremediation of mining soils.

A Rare Case of a Type IV Dual Left Anterior Descending Artery and Ectopic Left Anterior Descending and Circumflex Arteries Requiring Surgery.

Congenital anomalous coronary arteries (CACAs) comprise an important variant of the coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain; Q waves in electrocardiographic leads II, III, and aVF; and positive serum troponin I enzyme. Left heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the left main coronary artery (LMCA). The left anterior descending (LAD) and the left circumflex artery arose from the ostium of the right coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior descending artery. The patient was discharged after an uneventful 1-week hospital course.

Multiple endocrine neoplasia type 1 with suspicion of Zollinger Ellison syndrome in a family with history of renal stones and hypercalcemia in a limited resource setting: a case report.

Multiple endocrine neoplasia type 1 (MEN 1) syndrome is a rare autosomal dominant endocrine tumour syndrome, which can be diagnosed clinically based on family history and the existence of MEN 1-associated tumours or molecularly based on genetic testing. We described the case of a Hispanic 55-year-old male presenting with dysphagia, chest pain and diarrhoea for three months with a family history of hypercalcaemia and nephrolithiasis in first-degree relatives. Primary hyperparathyroidism was suggested by hypercalcaemia, elevated parathyroid hormone level, hypercalciuria, nephrolithiasis on abdominal computed tomography scan and enlarged parathyroid gland on computed tomography pulmonary angiogram. Also, patient had hypergastrinemia and a hypodense lesion in the pancreas on computed tomography scan of abdomen. These findings suggested MEN 1 syndrome with high suspicion of associated Zollinger Ellison syndrome. Our case highlights the importance of family history and high clinical suspicion in patients presenting with primary hyperparathyroidism and hypergastrinemia.

Time to Reconsider the Inhaled Drugs for Tuberculosis.

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Safety and Adequacy of Ultrasound-Guided Percutaneous Renal Biopsy in Children: A Single-Center Experience.

Background Ultrasound-guided percutaneous renal biopsy (PCRB) is a commonly used technique to obtain renal tissue for histopathological diagnosis in children and adolescents. The objectives of this study include determining the indications for renal biopsy, documenting the safety and efficacy of ultrasound-guided PCRB, and documenting its complications along with histopathological findings in children. Methodology The Ethical Review Committee approved this cross-sectional study. Data of all children with either nephrotic or nephritic syndrome from January 2017 to September 2020 (at The Kidney Center Post Graduate Training Institute Karachi) who underwent ultrasound-guided PCRB were collected and analyzed. An ultrasonic examination was performed both before and after the biopsy. Results During the research period, 104 individuals underwent PCRB. The average age of the children biopsied was 7.44 ± 4.12 years (range = 1-17 years). The most prevalent reason for biopsy was nephrotic syndrome. Almost 94% of PCRBs were effective. Post-biopsy complications were detected in 16 cases, with peri-nephric hematoma being the most prevalent. Conclusions In children, ultrasound-guided PCRB can safely be performed under sedation in experienced hands with an automated biopsy gun needle. The use of real-time ultrasound guidance as well as the automated biopsy gun ensures good outcomes.

Molecular assessment of microbial diversity on eggshell of chukar partridges (Alectoris chukar) under semi-captive conditions.

Due to human activity, climatic changes and habitat damage, the Chukar partridge (Alectoris chukar) is experiencing a population decrease. The goal of this work was to isolate and identify the inner eggshell microflora in order to learn more about their function in A. chukar embryo mortality and hatchability in semi-captive settings. During the egg-laying season, 204 eggs were gathered from the Balkasar Research Complex in Chakwal, Pakistan. These eggshells were divided into four categories after incubation: un-pricked with dead embryo, pricked with dead embryo, hatched, and unfertilized eggs. A total of 47 (23.03%) samples tested positive for gram-positive bacteria, which were then identified using 16S rRNA sequence analysis. Bacillus subtilis, Bacillus cereus, Bacillus amyloliquefaciens, Bacillus toyonensis, Bacillus thuringiensis and Staphylococcus sciuri were among the identified species. Hatched eggshells had the highest percentage of bacterial flora (36.17%), followed by un-pricked with dead embryo (23.40%) and pricked with death embryo (21.27%), and unfertilized eggshells had the lowest percentage (19.14%). As a result, the findings of this study revealed that microbial contamination of eggshells could be a cause of early embryonic stage degeneration and bird death.

Accidental Penetrating Thoracic Injury with a Screwdriver in a Child: A Case Report.

Accidental penetrating injuries are common among children, either with a sharp or a blunt object. The screwdriver is an uncommon weapon; therefore, injuries caused by it represent an even rarer subset. Inadvertent injuries in the chest with a screwdriver as a stabbing weapon are extremely unusual. Penetrating chest injuries can be fatal if they cause wounds in the cardiac chambers or major thoracic vessels. We describe a 9-year-old child with an unintentional penetrating thoracic injury caused by a screwdriver. An explorative left anterior thoracotomy showed that the tip of the implanted screwdriver was lying near the left subclavian vessels and the apex of the lung, but it did not perforate any of those. The screwdriver was dislodged, and the wound was closed. The patient had an event-free 1-week hospital stay.

Statins Are Associated With Increased Insulin Resistance and Secretion.

Objective: Statin treatment reduces the risk of atherosclerotic cardiovascular disease but is associated with a modest increased risk of type 2 diabetes, especially in those with insulin resistance or prediabetes. Our objective was to determine the physiological mechanism for the increased type 2 diabetes risk. Approach and Results: We conducted an open-label clinical trial of atorvastatin 40 mg daily in adults without known atherosclerotic cardiovascular disease or type 2 diabetes at baseline. The co-primary outcomes were changes at 10 weeks versus baseline in insulin resistance as assessed by steady-state plasma glucose during the insulin suppression test and insulin secretion as assessed by insulin secretion rate area under the curve (ISRAUC) during the graded-glucose infusion test. Secondary outcomes included glucose and insulin, both fasting and during oral glucose tolerance test. Of 75 participants who enrolled, 71 completed the study (median age 61 years, 37% women, 65% non-Hispanic White, median body mass index, 27.8 kg/m2). Atorvastatin reduced LDL (low-density lipoprotein)-cholesterol (median decrease 53%, P<0.001) but did not change body weight. Compared with baseline, atorvastatin increased insulin resistance (steady-state plasma glucose) by a median of 8% (P=0.01) and insulin secretion (ISRAUC) by a median of 9% (P<0.001). There were small increases in oral glucose tolerance test glucoseAUC (median increase, 0.05%; P=0.03) and fasting insulin (median increase, 7%; P=0.01). Conclusions: In individuals without type 2 diabetes, high-intensity atorvastatin for 10 weeks increases insulin resistance and insulin secretion. Over time, the risk of new-onset diabetes with statin use may increase in individuals who become more insulin resistant but are unable to maintain compensatory increases in insulin secretion.

The Role of Warfarin and Rivaroxaban in the Treatment of Cerebral Venous Thrombosis.

Cerebral venous thrombosis (CVT) is a rare complication of hypercoagulable states such as pregnancy, lupus anticoagulant syndrome, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, malignancies, and the use of oral contraceptive pills. It most commonly occurs in young people, especially women, but can occur in the elderly as well. The signs and symptoms vary from focal neurological deficiencies to alteration in mental status. In this review, we compare the efficacy and safety profile of traditional anticoagulants heparin and vitamin K antagonists (warfarin) to novel oral anticoagulants, which include rivaroxaban, apixaban, dabigatran. The advantages of the new anticoagulants are their effectiveness, short half-life, oral intake instead of parenteral, and the decreased need for constantly monitoring prothrombin time (PT), activated partial thromboplastin time (APTT), and the international normalized ratio (INR). In this review, we discuss studies that demonstrate that these novel oral anticoagulants are effective and safe in treating cerebral venous thrombosis without many adverse effects when compared with traditional treatment options. There are also some case reports that point towards the effectiveness of newer agents; however, we need more studies with bigger samples to reach a conclusion in favor of new oral anticoagulants. The studies that have already been conducted can become the basis for conducting newer studies that can revolutionize the modern treatment for conditions like CVT.

Assessing subspecies status of leopards (Panthera pardus) of northern Pakistan using mitochondrial DNA.

Despite being classified as critically endangered, little work has been done on leopard protection in Pakistan. Once widely present throughout this region, leopards are now sparsely distributed, and possibly extinct from much of their previously recorded habitat. While leopards show morphological and genetic variation across their species range worldwide, resulting in the classification of nine different subspecies, the leopard genetic structure across Pakistan is unknown, with previous studies including only a very limited sampling. To clarify the genetic status of leopards in Pakistan we investigated the sequence variation in the subunit 5 of the mitochondrial gene NADH from 43 tissue samples and compared it with 238 sequences available from online databases. Phylogenetic analysis clearly separates the Pakistani leopards from the African and Arabian clades, confirming that leopards from Pakistan are members of the Asian clade. Furthermore, we identified two separate subspecies haplotypes within our dataset: P. p. fusca (N = 23) and P. p. saxicolor (N = 12).

Anticancer, antimicrobial and antioxidant potential of sterically tuned bis-N-heterocyclic salts.

The current study was conducted to evaluate the antimicrobial, antioxidant, antileishmanial and cytotoxic potential of designed derivatives of 1,1'-(1,3-phenylenebis(methylene))bis(3-alkyl/aryl-1H-benzimidazol-3-ium) salts. The antibacterial potential of the test compounds was investigated against Staphylococcus aureus, Pseudomonas aeruginosa and two methicillin-resistant S. aureus (MRSA) strains (MRSA10, MRSA11), where compound 6 showed the best results. For brine shrimp lethality bioassay (BSLB), compound 6 again showed up to 100% mortality at 200 µg/mL and 56.7% mortality at 6.25 µg/mL. Antileishmanial assay was performed against Leishmania tropica at 20 µg/mL dosage, where 6 showed the most promising activity with 16.26% survival (83.74% mortality; IC50=14.63 µg/mL). The anticancer potential of the selected benzimidazole derivatives was evaluated against two selected cell lines (human colorectal cancer, HCT-116 and breast adenocarcinoma, MCF-7) using sulforhodamine B (SRB) assay. Compound 6 was found to be the most effective cytotoxic compound with 75% inhibition of HCT-116 proliferation at 1 mg/mL concentration. Succinctly, 6 exhibited impressive pharmacological potential that might be attributed to its higher lipophilic character owing to the longer N-substituted alkyl chains when compared to the other test compounds.