Genomic Insights from a Deeply Phenotyped Highly Consanguineous Neurodevelopmental Disorders Cohort.

PURPOSE: The genetic underpinning of neurodevelopmental disorders (NDDs) in diverse ethnic populations, especially those with high rates of consanguinity, remains largely unexplored. Here, we aim to elucidate genomic insight from 576 well phenotyped and highly consanguineous (16%) NDD cohort. METHODS: We employed chromosomal microarray (CMA; N:247), exome sequencing (ES; N:127), combined CMA and ES (N:202) and long-read genome sequencing to identify genetic etiology. Deep clinical multi-variate data was coupled with genomic variants for stratification analysis. RESULTS: Genetic diagnosis rates were 17% with CMA, 29.92% with ES, and 37.13% with combined CMA and ES. Notably, children of consanguineous parents showed a significantly higher diagnostic yield (p<0.01) compared to those from non-consanguineous parents. Among the ES-identified pathogenic variants, 36.19% (38/105) were novel, implicating 35 unique genes. Long-read sequencing of seizure participants unresolved by combined test identified expanded FMR1 trinucleotide repeats. Additionally, we identified two recurrent X-linked variants in the G6PD in 3.65% (12/329) of NDD participants. These variants were absent in large population control cohorts and cohort comprising neurodevelopmental and neuropsychiatric populations of European descendants, indicating a possible associated risk factor potentially resulting from ancient genetic drift. CONCLUSION: This study unveils unique clinical and genomic insights from a consanguinity rich Bangladeshi NDD cohort, highlighting a strong association of G6PD with NDD in this population.

Unlocking the potential of methionine: a dietary supplement for preventing colitis.

The incidence rate of colitis and conversion of colitis into colorectal cancer is increasing. However, the results of drug treatments are inconsistent with variable side effects; therefore, it is necessary to find alternative ways of treating colitis, e.g. through dietary supplements. One such dietary supplement could be sulfur-containing amino acids, which are known to have anti-inflammatory, antioxidant, and gut microbiota homeostasis effects. Therefore, the aim of the present study was to explore the effect of methionine supplementation in the diet of mice on experimental dextran sulfate sodium (DSS)-induced colitis. Here, 24 male C57BL/6J mice were split into three experimental treatment groups in such a way that each treatment group had four replicates and each replicate had two mice. The control group was colitis-free, while colitis was induced by the administration of DSS in the DSS groups. In the DSS and DSS plus methionine (DSS + Met) groups, DSS was provided in drinking water containing 3% DSS on days 1-5 and later provided with purified water on days 6-7. It was found that supplementing with methionine could activate pathways like Nrf2, and inhibit pathways like TLR4 and Nlrp3 to realize anti-inflammatory and antioxidant effects. Moreover, methionine could alter the microbiota of the gut in the experimental mice, whereby exploration of the gut microbiota demonstrated that methionine supplementation in the diet increased the abundance of parabacteroides and the production of propionate and butyrate. The current study shows that the dietary prophylactic supplementation of methionine has a beneficial effect on resisting colitis, providing new insights for the prevention of colitis.

Graphene-coated nickel in biological environments: role of structural defects.

Graphene (Gr) is a promising material for addressing microbially induced corrosion (MIC) issues that cause staggering economic losses, estimated at nearly $55 billion annually in the US alone. However, structural defects including edges, grain boundaries, and cracks can compromise its performance in aggressive biological environments. Owing to the technological relevance of nickel (Ni), its key roles in biological mechanisms, and the strong hybridization of d-electrons of Ni with Gr π-orbitals, we explore the effects of the key defects in Gr/Ni exposed to archetype sulfate-reducing bacteria (SRB). Electrochemical and spectroscopy tests revealed that the grain boundaries play a stronger role than cracks. The edges and grain boundaries in as-grown Gr on Ni (dGr/Ni) aggravated corrosion by two-fold, while the cracks in the transferred counterpart that lacked these defects improved corrosion resistance by 2-fold. A combination of biotic and abiotic studies corroborated the unique roles of grain boundaries as sulfur reservoirs to promote the attachment of sessile SRB cells and subsequent redox reactions. Analysis of distinct biogenic products confirmed the role of grain boundaries on pitting corrosion. These insights can guide the rational design of graphene coatings specifically for biological environments prone to MIC.

Risk Factors for Post-Stroke Seizures in a Tertiary Care Center: A Case-Control Study.

Purpose: Stroke is the second leading cause of global deaths. Post-stroke seizures (PSS) can lead to lasting complications, such as prolonged hospitalizations, increased disability rates, and higher mortality. Our study investigates the associated factors that contribute to post-stroke seizures in patients at a local tertiary hospital. Patients and Methods: We designed a case-control study where patients admitted with PSS were recruited with consent. Controls admitted for stroke without seizure were then included. Suitability based on exclusion criteria was ensured before recording their sociodemographic and clinical data. An EEG was performed and read by two certified neurologists before the data was analyzed. Results: We recruited 180 participants, 90 cases and 90 matched controls. Gender (p=0.013), race (p=0.015), dyslipidemia (p<0.001), prior stroke (p<0.031), large artery atherosclerosis (p<0.001), small vessel occlusions (p<0.001), blood pressure on presentation (p<0.028) and thrombolysis administration (p<0.029) were significantly associated with the occurrence of PSS. An increase in odds of PSS was observed in the male gender (1.974), dyslipidemia (3.480), small vessel occlusions (4.578), and in participants with epileptiform changes on EEG (3.630). Conversely, lower odds of PSS were seen in participants with high blood pressure on presentation (0.505), large artery atherosclerosis (0.266), and those who underwent thrombolysis (0.319). Conclusion: This study emphasized that identifying post-stroke seizures may be aided by EEGs and recognizing at-risk groups, which include males of Chinese descent in Asia, dyslipidemia, small vessel occlusions, those with low to normal blood pressure on presentation, and epileptiform changes in EEGs.

The research aims to establish the risk factors associated with post-stroke seizures in an Asian population and their similarity to the Western literature. Our findings highlight the critical risk factors to identify in at-risk patients, which may prompt changes in guidelines in future to enhance patient outcomes and improve the quality of care.

A scoping review on adult patients with de novo glomerular diseases following COVID-19 infection or vaccine.

BACKGROUND: There are increasing reports of glomerular disease (GD) following COVID-19 infection and vaccination. Current evidence on the possible link between COVID-19 infection or vaccination and GD is conflicting. OBJECTIVE: The present study undertakes a scoping review of research to describe the relationship between COVID-19 infection and vaccination with GD and the common management strategies and overall outcomes of the disease to identify knowledge gaps and guide further research. ELIGIBILITY CRITERIA: All original research studies published in English until 5th September 2022 were considered for inclusion in the review. Exclusion criteria were animal studies, autopsy studies, and data involving patients who were paediatric patients (< 16 years), were transplant recipients, had a recurrence of glomerular disease, had concomitant cancer or non-COVID-19 infection which may cause glomerular disease, or did not receive a renal biopsy. SOURCES OF EVIDENCE: The five electronic databases searched were MEDLINE, PubMed, Scopus, EMBASE, and Cochrane. METHODS: Two separate search strings related to COVID-19, and glomerular disease were combined using the Boolean operator 'AND'. Filters were used to limit publications to original research studies published in English. Search results from each database were imported into Covidence software ( www.covidence.org ) and used for de-duplication, article screening, and data extraction. Descriptive analyses were used to summarise demographics, diagnoses, and treatment outcomes. RESULTS: After removing duplicates, 6853 titles and abstracts were screened. Of the 188 studies included, 106 studies described 341 patients with GD following COVID-19 infection and 82 described 146 patients with GD following a COVID-19 vaccination. IgA nephropathy was the most common GD pathology reported following COVID-19 vaccination with GD most common following mRNA vaccines. Collapsing focal segmental glomerulosclerosis was the most common GD following COVID-19 infection. Immunosuppressive treatment of GD was more common in the vaccine cohort than in the infection cohort. CONCLUSION: Despite the significant number of COVID-19 infections and vaccinations around the world, our understanding of GD associated with COVID-19 infection and vaccination remains poor, and more research is needed to understand the possible relationship better.

Revealing the Chemical and Structural Complexity of Electrochemical Ion Exchange in Layered Oxide Materials.

Soft chemistry techniques, such as ion exchange, hold great potential for the development of battery electrode materials that cannot be stabilized via conventional equilibrium synthesis methods. Nevertheless, the intricate mechanisms governing ion exchange remain elusive. Herein, we investigate the evolution of the long-range and local structure, as well as the ion (de)intercalation mechanism during electrochemical Li-to-Na ion exchange initiated from an O3-type lithium-layered oxide cathode. The in situ-formed mixed-cation electrolyte leads to competitive intercalation of Li and Na ions. While Li ion intercalation predominates at the beginning of initial discharge, Na ion cointercalation into a different layer results in ion redistribution and phase separation, with the emergence of a P3-Na phase alongside an O3-Li phase. Further, this study spatially resolves the heterogeneous nature of electrochemical ion exchange reactions within individual particles and provides insights into the correlations between local Ni redox processes and phase separation. Overall, electrochemical ion exchange leads to a mixed-phase cathode and alters its reaction kinetics. Those findings have important implications for the development of new metastable materials for renewable energy devices and ion separation applications.

Exploring Potential Human Health Risks Linked to Heavy Metal(Loid)s in Dietary Fishes: Utilizing Data-Driven and Computational Modelling Approaches.

There are significant concerns about the risks to human health posed by metal(loid) contamination in dietary fishes in Bangladesh. Therefore, this study aimed to evaluate heavy metal(loid) contamination in fish and their associated health risks using published data from 2000 to 2022. Additionally, the safe limit of fish consumption was estimated using the target hazard quotient (THQ) followed by computational modelling and artificial neural networks (ANN). Results showed that freshwater and herbivorous fishes pose the least non-cancer risks, whereas saltwater and carnivorous fishes pose the highest non-cancer risks to Bangladeshi consumers. However, freshwater and omnivorous fish consumption pose the highest cancer risks compared to all studied metal(loid)s. In particular, among the heavy metal(loid)s, As, Cr, Hg, and Ni pose significant cancer and non-cancer risks to Bangladeshi consumers. On the contrary, the ANN and Decision tree regression (DTR) characterized the dataset, simulation model, or data testing condition, reaching 94.7% accuracy and allowing us to measure the safest fish consumption limit. The herbivorous fishes are less contaminated and allow greater consumption (175.09 g day-1). Contrarily, the allowable intake rates of carnivorous and omnivorous fishes are 153.05 and 168.63 g day-1, respectively. Besides, the safe consumption rate of saltwater fishes was 156.51 g day-1, which was lower than freshwater (180.59 g day-1) and euryhaline fishes (182.17 g day-1). Therefore, this study will assist fish consumers in selecting less contaminated fish, ensuring safe consumption levels, and ultimately reducing health risks associated with metal(loid) contamination in fish.

Clinical outcomes of patients with deferred revascularisation based on fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) negative coronary artery lesions in Pakistani population.

OBJECTIVE: To assess long-term clinical outcomes and factors associated with target vessel revascularisation in patients with deferred revascularisation based on negative fractional flow reserve and negative instantaneous wave-free ratio. METHODS: The longitudinal, retrospective study was conducted from July 1, 2020, to January 1, 2022, at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2012 to January 2020 of patients with deferred revascularisation having intermediate to severe coronary lesions on coronary angiogram and had negative fractional flow reserve >0.80 or instantaneous wave-free ratio >0.89 and had not undergone immediate or planned revascularisation on the basis of negative physiological assessment. Data was collected from the institutional records, while final follow-up was taken by reviewing the medical records or telephonic interviews regarding any major adverse cardiac event after the index procedure. Data was analysed using Stata 14.2. RESULTS: Of the 345 patients, 245(71%) were males. The overall mean age was 62±11 years. There were 194(56%) patients who presented with stable angina and 151(44%) presented with acute coronary syndrome. Mean fractional flow reserve was 0.87±0.04 and mean instantaneous wave-free ratio was 0.93±0.03. Multivessel disease was present in 223(65%) patients. Median follow-up period was 29 months (IQR: 24-36 months). Major adverse cardiovascular events occurred in 22(6%) patients, and target vessel revascularisation was required in 11(3%). Diabetes and percentage of stenosis were found to be independent predictors of major adverse cardiovascular events (p<0.05). CONCLUSIONS: Deferral of revascularisation and opting for medical treatment for coronary artery stenosis with higher fractional flow reserve or instantaneous wave-free ratio could be considered a safe and reasonable strategy.

From Food Waste to Sustainable Agriculture: Nutritive Value of Potato By-Product in Total Mixed Ration for Angus Bulls.

Raw potato fries are a type of potato by-product (PBP), and they have great potential as a partial replacement of grain in animal feeds to improve the environmental sustainability of food production. This study aimed to investigate the effects of replacing corn with different levels of PBP (0%, 12.84%, 25.65%, and 38.44%) in the total mixed ration (TMR) of Angus bull. Sixty 16-month-old Angus bulls (548.5 ± 15.0 kg, mean ± SD) were randomly assigned to four treatments. The results indicated that with the increase in the substitution amount of PBP, the body weight decreased significantly. The dry matter apparent digestibility and starch apparent digestibility linearly decreased as PBP replacement increased. The feed ingredient composition in the TMR varied, leading to a corresponding change in the rumen microbiota, especially in cellulolytic bacteria and amylolytic bacteria. The abundance of Succiniclasticum in the 12.84% PBP and 38.44% PBP diets was significantly higher than that in the 0% PBP and 25.65% PBP diets. The abundance of Ruminococcus linearly increased. In conclusion, using PBP to replace corn for beef cattle had no negative impact on rumen fermentation, and the decrease in apparent digestibility explained the change in growth performance. Its application in practical production is highly cost-effective and a strategy to reduce food waste.

Factors Associated with Psychological Distress, Fear, and Coping Strategies during the COVID-19 Pandemic in Thailand: A Cross-Sectional Study.

Introduction: Despite being initially perceived as a local infectious disease, COVID-19 has emerged as one of the most perilous global health threats, significantly impacting the psychological well-being of individuals worldwide. Objective: This cross-sectional descriptive study investigates the psychological distress, fear, and coping mechanisms among Thai people residing in Thailand during the COVID-19 pandemic. Methods: This online cross-sectional survey targeted Thai individuals during the first and third waves of the COVID-19 pandemic. Participants aged 18 and above who provided consent self-reported their responses to the Kessler Psychological Distress Scale, Fear of COVID-19 Scale, and Brief Resilient Coping Scale. Data collection occurred between November 2020 and January 2021 across four regions of Thailand. Univariate and multivariate logistic regression analyses explored associations between contextual factors and the variables of interest. Results: Out of 498 survey respondents, with an average age of 43.07 (SD = 13.69) years, 81.9% were female, and 61.6% self-identified as healthcare workers, with 47.59% identified as frontline healthcare workers. Findings revealed that 46% of participants experienced moderate-to-very high levels of psychological distress, 14.3% reported high levels of fear of COVID-19, and 35.1% exhibited low resilient coping. Factors such as changes in employment status or financial situations, comorbidities, contact with known or suspected COVID-19 cases, recent healthcare utilization for COVID-19-related stress, and elevated fear of COVID-19 were associated with higher levels of psychological distress. Conversely, being nurses and perceived better mental health status were linked to more effective coping strategies. Conclusion: These results emphasize the critical importance of government interventions to safeguard the psychological well-being of healthcare workers and the broader Thai population. Urgent measures to bolster resilience among these groups during and after the pandemic are imperative.

Exploring General Practitioners' Knowledge, Attitudes, and Practices towards E-Cigarette Use/Vaping in Children and Adolescents: A Pilot Cross-Sectional Study in Sydney.

(1) Background: The increasing use of e-cigarettes/vaping in children and adolescents has been recognised as a global health concern. We aim to explore the Knowledge, Attitude, and Practice of General Practitioners (GPs) in Sydney regarding the use of e-cigarettes in children and adolescents and identify the barriers to addressing this issue. (2) Methods: This pilot study was a cross-sectional study conducted using an electronic questionnaire with a Likert scale and free-text responses. (3) Results: Fifty-three GPs participated in the study (male = 24 and female = 29) with a mean age of 50 ± 5.5 years. There was strong agreement (mean 4.5) about respiratory adverse effects and addictive potential. However, there was less awareness of cardiac side effects and the occurrence of burns. There is a lack of conversation about e-cigarettes in GP practice and a deficit of confidence in GPs regarding managing e-cigarette use in children and adolescents. (4) Conclusions: Our pilot study has shown that GPs are somewhat knowledgeable about the potential adverse effects of the use of e-cigarettes in children and adolescents, though there is a lack of knowledge of the complete spectrum of adverse effects and more importantly, there is a paucity of a structured approach to discuss the use of e-cigarettes with children and adolescents, and there is a low level of confidence in addressing these issues. There is a need for educational interventions for GPs to increase awareness of the potential adverse effects of using e-cigarettes and build confidence in providing management to children and adolescents regarding the use of e-cigarettes.

Correlates of Tobacco Use Among People with Mental Illness Within Asia: A Scoping Review.

Tobacco use among people with mental illness is one of the contributing risk factors for premature morbidity and mortality. Two in three people with mental illness are current smokers with deteriorating physical health and quality of life. This review outlines the prevalence and predictors of tobacco use among people with mental illness in Asia. Twenty-five cross-sectional studies were selected from the exhaustive search of databases. Ten countries emerged based on the number of studies conducted within Asia among people diagnosed with mental illness and tobacco use, namely, India (8), China (7), Pakistan (2), Singapore (2), Sri Lanka (01), Japan (01), Jordan (01), Malaysia (01), Korea (01), and Taiwan (01). The prevalence of tobacco use was in the range of 3.6% to 89.4%, with the measure of precision at 95% confidence. The highest and lowest prevalence was reported in China, followed by India. Being male, separated, lower education, unemployed, lack of family support, a psychotic diagnosis, lack of knowledge, motivation, and a coping mechanism were predictors of tobacco use. This review emphasized the extent and predictors of tobacco use among this vulnerable group that need to be reflected while initiating and implementing cessation strategies by healthcare providers.

Supervised Automation of Cell Counting in Confocal Microscopic Cochlear Imaging Datasets Using Macro in Imaris.

Analyzing confocal microscopic data of biological samples using the Imaris software poses challenges due to its time-consuming nature involving tedious multiple steps and possibility of human errors. Here, we developed a supervised automation protocol to minimize manual input in cell and spot counting on confocal images obtained from mouse cochlear sections. The protocol increases efficiency by incorporating image recognition and object-oriented macros. Moreover, the protocol being adaptable allows scientists in diverse other fields to customize it for their specific needs.

Efficacy of educational interventions on improving medical emergency readiness of rural healthcare providers: a scoping review.

BACKGROUND: Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers' knowledge, skills, and confidence to meet patients' emergency needs. Rural healthcare professionals' medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers' emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers' medical emergency readiness. OBJECTIVES: This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers' medical emergency readiness globally. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data. RESULTS: From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers' emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers' medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally. CONCLUSION: The review concluded that rural healthcare providers' medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions' behavioural outcomes, especially among rural healthcare providers in low to middle-income countries.

Evaluation of microcirculatory protection in percutaneous revascularisation: A stent implantation technique and device comparison.

BACKGROUND: Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is prognostically important and may also be a cause of persistent angina. The stent balloon inflation technique or material properties may influence the degree of CMD post-PCI. METHODS: Thirty-six patients with stable angina attending for elective PCI were randomized to either slow drug eluting stent (DES) implantation technique (DES slow group): +2 atm. every 5 s., maintained for a further 30 s or a standard stent implantation technique (DES std group): rapid inflation and deflation. PressureWire X with thermodilution at rest and hyperemia and optical coherence tomography (OCT) were performed pre- and post-PCI. Combined primary endpoints were changes in index of microvascular resistance (delta IMR) and coronary flow reserve (delta CFR) following PCI. The secondary endpoints included differences in cardiac troponin I (delta cTnI) at 6 h post-PCI, Seattle angina questionnaire (SAQ) at 1, 3, 6, and 12 months and OCT measures of stent results immediately post-PCI and at 3 months. RESULTS: Both groups were well matched, with similar baseline characteristics and OCT-defined plaque characteristics. Delta IMR was significantly better in the DES slow PCI arm with a median difference of -4.14 (95% CI -10.49, -0.39, p = 0.04). Delta CFR was also numerically higher with a median difference of 0.47 (95% CI -0.52, 1.31, p = 0.46). This did not translate to improved delta median cTnI (1.5 (34.8) vs. 0 (27.5) ng/L, p = 0.75) or median SAQ score at 3 months, (85 (20) vs. 95 (17.5), p = 0.47). CONCLUSION: Slow stent implantation is associated with less CMD after elective PCI in patients with stable angina.

Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: evidence from a cross-sectional study.

BACKGROUND: The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally. METHODS: An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations. RESULTS: A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15-2.02)], having an academic appointment [2.45 (1.78-3.27)], having multiple co-morbidities [1.86 (1.41-2.48)], perceived burnout [1.99 (1.54-2.56)] and moderate to very high level of psychological distress [1.68 (1.18-2.39)]. Perceived burnout was associated with being female [1.35 (1.12-1.63)], having multiple co-morbidities [1.53 (1.20-1.97)], perceived job insecurity [1.99 (1.55-2.57)], and moderate to very high levels of psychological distress [3.23 (2.42-4.30)]. Staff with multiple co-morbidities [1.46 (1.11-1.92)], mental health issues [2.73 (1.79-4.15)], perceived job insecurity [1.61 (1.13-2.30)], and perceived burnout [3.22 (2.41-4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69-4.19)] were more likely to have medium to high resilient coping. CONCLUSIONS: Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Assessing the impact of sea level rise on the Indus delta in Pakistan: A comprehensive analysis of flooded areas and future vulnerabilities.

This research investigates the impact of sea level rise (SLR) on the Indus Delta, a vital ecosystem increasingly vulnerable to climate change repercussions. The objective of this study is to comprehensively assess the flooded areas under various shared socioeconomic pathway (SSP) scenarios based on the Intergovernmental Panel on Climate Change's (IPCC) 6th Assessment Report. The study employs a GIS-based bathtub model, utilizing historical (1995-2014) and IPCC-projected (2020-2150) tide gauge data from Karachi, Kandla, and Okha stations to identify potential inundated areas threatened by coastal flooding. Additionally, it analyzes LANDSAT-derived multispectral images to identify coastal erosion hotspots and changes in the landscape. A supervised random forest classifier is used to classify major landforms and understand alterations in land cover. Furthermore, neural network-based cellular automata simulations are applied to predict future land cover for 2050, 2100, and 2150 at risk of inundation. The results indicate that under different SSP scenarios, the estimated inundated land area varies from 307.36 km2 (5 % confidence on SSP1-1.9) to 7150.8 km2 (95 % confidence on SSP5-8.5). By 2150, the region will lose over 550 km2 of agricultural land and 535 km2 of mangroves (mean SLR projection). This work emphasizes identifying sensitive land cover for SLR-induced coastal flooding. It might fuel future policy and modeling endeavors to reduce SLR uncertainty and build effective coastal inundation mitigation methods.

A novel dual-band elliptical ring slot MIMO antenna with orthogonal circular polarization for 5G applications.

This paper presents a dual-band 4-element multiple-input-multiple-output (MIMO) antenna featuring orthogonal circular polarization (CP) for Sub-6 GHz 5G applications. The single antenna combines a non-uniform width elliptical ring slot and a feed network, utilizing two L-shaped secondary feed lines to generate CP within the targeted frequency bands (3.55-3.80 GHz and 4.60-4.80 GHz). Using the single antenna as a unit antenna, a 4-element MIMO configuration is devised, employing a mirror technique for element placement to achieve orthogonal CP. This placement method effectively enhances coverage area and enlarges the 3-dB axial ratio bandwidth in the lower band (3.40-3.80 GHz). The common ground connections among elements are established via four strip lines. The antenna shows a good diversity performance considering the envelope correlation coefficient (ECC) result of less than 0.04 and isolation greater than 15 dB. The simulated gains of the MIMO antenna are 4 and 5 dBic in the respective bands. The single and MIMO antennas are fabricated, and the antennas' performances are evaluated. A good agreement is observed between the measured and simulated results. The dual CP and diversity performances of the MIMO antenna make it more efficient for 5G wireless applications.

Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review.

For patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. The aims of this scoping review were to collate definitions, proportions, symptoms, risk factors and outcomes for presentations without cardiac chest pain. Full-text peer reviewed articles covering acute coronary syndrome symptoms without cardiac chest pain were included. MEDLINE, CINAHL, Scopus and Embase were systematically searched from 2000 to April 2023 with adult and English limiters; 41 articles were selected from 2,954. Dyspnoea was the most reported (n=39) and most prevalent symptom (11.6-72%). Neurological symptoms, fatigue/weakness, nausea/ vomiting, atypical chest pain and diaphoresis were also common. Advancing age appeared independently associated with presentations without cardiac chest pain; however, findings were mixed regarding other risk factors (sex and diabetes). Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. There is a need for structured data collection, analysis and interpretation.