Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model.

BACKGROUND: Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR). METHOD: Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR. RESULTS: The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan. CONCLUSION: The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

Label-free hematology analysis using deep-ultraviolet microscopy.

Hematological analysis, via a complete blood count (CBC) and microscopy, is critical for screening, diagnosing, and monitoring blood conditions and diseases but requires complex equipment, multiple chemical reagents, laborious system calibration and procedures, and highly trained personnel for operation. Here we introduce a hematological assay based on label-free molecular imaging with deep-ultraviolet microscopy that can provide fast quantitative information of key hematological parameters to facilitate and improve hematological analysis. We demonstrate that this label-free approach yields 1) a quantitative five-part white blood cell differential, 2) quantitative red blood cell and hemoglobin characterization, 3) clear identification of platelets, and 4) detailed subcellular morphology. Analysis of tens of thousands of live cells is achieved in minutes without any sample preparation. Finally, we introduce a pseudocolorization scheme that accurately recapitulates the appearance of cells under conventional staining protocols for microscopic analysis of blood smears and bone marrow aspirates. Diagnostic efficacy is evaluated by a panel of hematologists performing a blind analysis of blood smears from healthy donors and thrombocytopenic and sickle cell disease patients. This work has significant implications toward simplifying and improving CBC and blood smear analysis, which is currently performed manually via bright-field microscopy, and toward the development of a low-cost, easy-to-use, and fast hematological analyzer as a point-of-care device and for low-resource settings.

Enhancing drought stress tolerance in Camelina (Camelina sativa L.) through exogenous application of potassium.

The current study was performed under controlled conditions to study the effects of exogenous potassium application on carotenoid contents and drought tolerance in Camelina. Water deficit levels such as 100% FC (control) and 40% FC (drought stress) were imposed after germination of Camelina plants grown to maturity, and different treatments of exogenous K+ were applied at the vegetative stage. We have reported 17 traits of plant growth, physiology, antioxidant enzyme activity, focusing on carotenoids in Camelina to explore their potential yield and yield components. For this purpose, we used multivariate analysis techniques (descriptive statistics, correlation matrix, analysis of variance [ANOVA] and principal components analysis [PCA] to determine the best relation between potassium and studied traits). The results showed a large number of variations in the studied trait under control and water deficit condition. Plant fresh weight (g) was negatively correlated with shoot length and SOD insignificantly correlated with plant fresh weight (g) under water deficit conditions. Potassium loading predicted that foliar application (3 mM K2 SO4 ), foliar application (6 mM KNO3 ), foliar application (12 mM KNO3 ) and foliar application (12 mM K2 SO4 ) are the important doses that contribute the most to enhance the growth, physiological and biochemical activities and carotenoids to improve the Camelina yield under water deficit condition. These doses should be considered in the future to improve the Camelina yield under semi-arid conditions with increased genetic diversity (varietal selection).

MiRNA fine tuning for crop improvement: using advance computational models and biotechnological tools.

MiRNAs modulate target genes expression at post-transcriptional levels, by reducing spatial abundance of mRNAs. MiRNAs regulats plant metabolism, and emerged as regulators of plant stress responses. Which make miRNAs promising candidates for fine tuning to affectively alter crop stress tolerance and other important traits. With recent advancements in the computational biology and biotechnology miRNAs structure and target prediction is possible resulting in pin point editing; miRNA modulation can be done by up or down regulating miRNAs using recently available biotechnological tools (CRISPR Cas9, TALENS and RNAi). In this review we have focused on miRNA biogenesis, miRNA roles in plant development, plant stress responses and roles in signaling pathways. Additionally we have discussed latest computational prediction models for miRNA to target gene interaction and biotechnological systems used recently for miRNA modulation. We have also highlighted setbacks and limitations in the way of miRNA modulation; providing entirely a new direction for improvement in plant genomics primarily focusing miRNAs.

The Development of a Green Innovative Bioactive Film for Industrial Application as a New Emerging Technology to Protect the Quality of Fruits.

Today, the most significant challenge encountered by food manufacturers is degradation in the food quality during storage, which is countered by expensive packing, which causes enormous monetary and environmental costs. Edible packaging is a potential alternative for protecting food quality and improving shelf life by delaying microbial growth and providing moisture and gas barrier properties. For the first time, the current article reports the preparation of the new films from Ditriterpenoids and Secomeliacins isolated from Melia azedarach (Dharek) Azadirachta indica plants to protect the quality of fruits. After evaluating these films, their mechanical, specific respirational, coating crystal elongation, elastic, water vapor transmission rate (WVTR), film thickness, and nanoindentation test properties are applied to apple fruit for several storage periods: 0, 3, 6, 9 days. The fruits were evaluated for postharvest quality by screening several essential phytochemical, physiological responses under film coating and storage conditions. It was observed that prepared films were highly active during storage periods. Coated fruits showed improved quality due to the protection of the film, which lowered the transmission rate and enhanced the diffusion rate, followed by an increase in the shelf life. The coating crystals were higher in Film-5 and lower activity in untreated films. It was observed that the application of films through dipping was a simple technique at a laboratory scale, whereas extrusion and spraying were preferred on a commercial scale. The phytochemicals screening of treated fruits during the storage period showed that a maximum of eight important bioactive compounds were present in fruits after the treatment of films. It was resolved that new active films (1-5) were helpful in the effective maintenance of fruit quality and all essential compounds during storage periods. It was concluded that these films could be helpful for fruits growers and the processing industry to maintain fruit quality during the storage period as a new emerging technology.

Echocardiographic based cardiac evaluation in children with severe acute malnutrition.

OBJECTIVE: To identify echocardiography-based myocardial changes in children with severe acute malnutrition. Methods: The prospective study was conducted from January to November 2020 at a territory care paediatric hospital in Multan, Pakistan, and comprised severe acute malnutrition patients of either gender aged 1-60 months and an equal number of matching healthy controls. Malnutrition was categorised using the World Health Organisation criteria. Echocardiographic evaluation was done by expert cardiologists. Values for ejection fraction shortening, left ventricular mass, E/A wave ratio as well as mitral and tricuspid annular plane systolic excursions were noted. Data was analysed using SPSS 21. RESULTS: Of the 150 subjects, 75(50%) each were cases and controls. Age and gender were not significantly different between the groups (p>0.05). Left ventricular mass and left ventricular mass index with body surface area were significantly reduced in the cases compared to the controls, and the same was the case with left ventricular ejection fractional shortening (p<0.05). There was no significant difference between the groups in terms of E/A wave ratio as well as mitral and tricuspid annular plane systolic excursions (p>0.05). Among the cases, cardiac evaluation showed 26(34.6%) were kwashiorkor and 49(65.3%) were marasmic patients. CONCLUSIONS: Left ventricular parameters in malnourished children were found to be reduced. As such, the assessment of these parameters may appear to be a significant indicator for timely identification of cardiac malfunction in severe acute malnutrition cases.

Do sentiments of professors feedback change after migrating from in-person to online modalities? Pre- and during COVID-19 experience.

The COVID-19 pandemic forced higher education institutions to alter how they offer classes at an unprecedented pace. Due to ambiguities and lockdown restrictions, the transition phase negatively impacted students' and professors emotions. As a result, lecturers had to cope with unfamiliar online class teaching responsibilities and develop new teaching dynamics. This work aims to analyze one of the most adversely affected procedures of teaching, the written feedback provided to students. This research strives to explore whether the professors' feedback style altered from face-to-face education to online education on digital platforms during the COVID-19 restrictions. This exploratory-design study uses a mixed methodology to explain the subject on hand based on data collected from 117 undergraduate students. Sentiment lexicographers are utilized to address and identify the emotions expressed in the texts. Trust was the most frequent emotion expressed in face-to-face and online courses. It is also observed that the sentiments of joy and sadness changed significantly among online and face-to-face groups based on the professors' feedback style and approach. Finally, the study reveals that the joy words and the sadness words associated with the learning process are the most commonly utilized sentiments. This study suggests that when the courses transitioned from face-to-face to online learning, the professors' feedback changed to a more positive feeling that expressed appreciation for the students' work, encouraging them to strive for their complete academic development, and usher them into a better learning environment.

Stunting diagnostic and awareness: impact assessment study of sociodemographic factors of stunting among school-going children of Pakistan.

BACKGROUND: Stunting is a major public health issue in most of developing countries. Although, its worldwide prevalence is decreasing slowly but the number of stunted children is still rising in Pakistan. Stunting is highly associated with several long-term consequences, including higher rate of mortality and morbidity, deficient cognitive growth, school performance, learning capacity, work capacity and work productivity. To prevent stunting, we proposed Stunting Diagnostic and Education app. This app includes detailed knowledge of stunting and it's all forms, symptoms, causes, video tutorials and guidelines by the Pediatricians and Nutritionists. METHODS: A cross-sectional study has been conducted in schools of Multan District, Pakistan for the period of January 2019 to June 2019. Sample data of 1420 children, aged 4 to 18 years using three age groups, were analyzed by using SPSS version 21.0 to assess the prevalence of stunting and to analyze the risk factors associated with it in children under and over 5 age. Chi square test was applied in comparison with rural and urban participants and p-value < 0.05 was considered as significant. This study includes distribution of sociodemographic characteristics, parental education, working status of mothers, dietary patterns of school going children and prevalence of stunting in school going children. After getting study results, Stunting Diagnostic and Education app was developed according to the instructions of child experts and nutritionists. RESULTS: 354 (24.93%) participants were stunted out of 1420, 11.9% children were obese and 63.17% children were normal. Out of 354 stunted children, higher ratio of stunting was found in the age group of 8-11 years children with 51.98 percentage. 37.85% stunted children were found in the age group of 4-7 years and 10.17% stunting was found in the age group of 12-18 years children. It was observed in the study that male children were highly stunted than female with 57.91 and 42.09% respectively. Children living in rural areas were more stunted affected as compared to the children living in urban society with percentage 58.76 and 41.24 respectively. CONCLUSIONS: Our study concluded that 24.93% children were stunted, out of which, age group of 8-11 years children were highly stunted. The study showed that the literacy of mother or caregiver had high impact on children's health. Therefore, Stunting Diagnostic and Education app was developed to educate mothers to diagnose stunting and to teach about the prevention of stunting.

High-Quality Skilled Nursing Facilities Are Associated With Decreased Episode-of-Care Costs Following Total Hip and Knee Arthroplasty.

BACKGROUND: With the increasing popularity of alternative payment models following total hip (THA) and knee arthroplasty (TKA), efforts have focused on reducing post-acute care (PAC) costs, particularly patients discharged to skilled nursing facilities (SNFs). The purpose of this study is to determine if preferentially discharging patients to high-quality SNFs can reduce bundled payment costs for primary THA and TKA. METHODS: At our institution, a quality improvement initiative for SNFs was implemented at the start of 2017, preferentially discharging patients to internally credentialed facilities, designated by several quality measures. Claims data from Centers for Medicare and Medicaid Services were queried to identify patients discharged to SNF following primary total joint arthroplasty. We compared costs and outcomes between patients discharged to credentialed SNF sites and those discharged to other sites. RESULTS: Between 2015 and 2018, of a consecutive series of 8778 primary THA and TKA patients, 1284 (14.6%) were discharged to an SNF. Following initiation of the program, 498 patients were discharged to an SNF, 301 (60.4%) of which were sent to a credentialed facility. Patients at credentialed facilities had significantly lower SNF costs ($11,184 vs $8198, P < .0001), PAC costs ($18,952 vs $15,148, P < .0001), and episode-of-care costs ($34,557 vs $30,831, P < .0001), with no difference in readmissions (10% vs 12%, P = .33) or complications (8% vs 6%, P = .15). Controlling for confounding variables, being discharged to a credentialed facility decreased SNF costs by $1961 (P = .0020) and PAC costs by $3126 (P = .0031) per patient. CONCLUSION: Quality improvement efforts through partnership with selective SNFs can significantly decrease PAC costs for patients undergoing primary THA and TKA.

First report of neonatal early-onset sepsis caused by multi-drug-resistant Raoultella ornithinolytica.

Raoultella ornithinolytica is increasingly being isolated as a causative organism in human infections. Most of the infections caused by R. ornithinolytica are hospital acquired and occur in patients who are immunocompromised, had invasive procedures or have indwelling catheters. This is a first report of early onset neonatal sepsis caused by multi-drug-resistant R. ornithinolytica. The infection was not very severe and was characterised by generalized flushing of the skin. Patient made complete recovery once appropriate antibiotics were started.

Is mini-laparoscopic cholecystectomy any better than the gold standard?: A comparative study.

BACKGROUND: Mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC), which has long been established as the "Gold Standard" for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits. MATERIALS AND METHODS: Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire. RESULTS: In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min), which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P < 0.01). CONCLUSION: Our experience suggests that MLC can safely be used as an alternative to SLC. Compared to SLC, it has the added benefit of an early return to work along with excellent cosmetic results. Further large scale trials are required to prove any additional benefit of MLC.

Recent advances and role of melatonin in post-harvest quality preservation of shiitake (Lentinula edodes).

Shiitake mushrooms are renowned for their popularity and robust nutritional value, are susceptible to spoilage due to their inherent biodegradability. Nevertheless, because of their lack of protection, these mushrooms have a short shelf life. Throughout the post-harvest phase, mushrooms experience a persistent decline in quality. This is evidenced by changes such as discoloration, reduced moisture content, texture changes, an increase in microbial count, and the depletion of nutrients and flavor. Ensuring postharvest quality preservation and prolonging mushroom shelf life necessitates the utilization of post-harvest preservation techniques, including physical, chemical, and thermal processes. This review provides a comprehensive overview of the deterioration processes affecting mushroom quality, covering elements such as moisture loss, discoloration, texture alterations, increased microbial count, and the depletion of nutrients and flavor. It also explores the key factors influencing these processes, such as temperature, relative humidity, water activity, and respiration rate. Furthermore, the review delves into recent progress in preserving mushrooms through techniques such as drying, cooling, packaging, irradiation, washing, and coating.

Special Issue in "Nanomaterials and Their Applications in Sensing and Biosensing".

The identification of the target molecule is required for rapid and reliable clinical diagnosis and disease monitoring [...].

Context awareness based Sketch-DeepNet architecture for hand-drawn sketches classification and recognition in AIoT.

A sketch is a black-and-white, 2-D graphical representation of an object and contains fewer visual details as compared to a colored image. Despite fewer details, humans can recognize a sketch and its context very efficiently and consistently across languages, cultures, and age groups, but it is a difficult task for computers to recognize such low-detail sketches and get context out of them. With the tremendous increase in popularity of IoT devices such as smartphones and smart cameras, etc., it has become more critical to recognize free hand-drawn sketches in computer vision and human-computer interaction in order to build a successful artificial intelligence of things (AIoT) system that can first recognize the sketches and then understand the context of multiple drawings. Earlier models which addressed this problem are scale-invariant feature transform (SIFT) and bag-of-words (BoW). Both SIFT and BoW used hand-crafted features and scale-invariant algorithms to address this issue. But these models are complex and time-consuming due to the manual process of features setup. The deep neural networks (DNNs) performed well with object recognition on many large-scale datasets such as ImageNet and CIFAR-10. However, the DDN approach cannot be carried out for hand-drawn sketches problems. The reason is that the data source is images, and all sketches in the images are, for example, 'birds' instead of their specific category (e.g., 'sparrow'). Some deep learning approaches for sketch recognition problems exist in the literature, but the results are not promising because there is still room for improvement. This article proposed a convolutional neural network (CNN) architecture called Sketch-DeepNet for the sketch recognition task. The proposed Sketch-DeepNet architecture used the TU-Berlin dataset for classification. The experimental results show that the proposed method beats the performance of the state-of-the-art sketch classification methods. The proposed model achieved 95.05% accuracy as compared to existing models DeformNet (62.6%), Sketch-DNN (72.2%), Sketch-a-Net (77.95%), SketchNet (80.42%), Thinning-DNN (74.3%), CNN-PCA-SVM (72.5%), Hybrid-CNN (84.42%), and human recognition accuracy of 73% on the TU-Berlin dataset.

Reasons behind declining of cases during the COVID-19 wavelets in Pakistan: public healthcare system or government smart lockdown policy?

The latest statistics show that COVID-19 is still very active, and cases are on the rise across various countries and regions. On the other hand, statistics from Pakistan show a declining trend, especially during the first wave of the COVID-19 pandemic. To understand this declining trend and answering our established question, "What are the reasons behind the decline of the COVID-19 cases in Pakistan - public healthcare facilities or government smart lockdown policy?" narrative literature-based evidence collected from government official websites, reports and also Google Scholar. Our findings suggest that the government's innovative smart lockdown strategy and its execution at the right time with the consensus of all stakeholders accompanied with the observing of COVID-19 standard operation procedures resulted in controlling the pandemic. Effective smart lockdown policy allows the government to identify shortcomings of and improve the capabilities of healthcare for the continuation of balanced socio-economic activities to avoid future spread-out of the pandemic in the time of crisis under national and World Health Organization guidelines.

Critical Assessment of Various Neurosurgery Training Programs of Pakistan.

AIM: To assess the real challenges faced by neurosurgery residents in developing countries with limited resources and massive workload. MATERIAL AND METHODS: This is a cross-sectional study based on the questionnaire filled by the neurosurgery trainees in Pakistan directed at their training, stress factors, surgical competency, research interest, job satisfaction, and future endeavors. RESULTS: A total of 75 neurosurgery residents participated in study; 73.3% were male. About 61.3% were working for more than 72 hours per week. Average sleeping hours per day were less than 7 hours for 92% of trainees. Only 78.6% were able to receive teaching sessions for at least once a week or more. Practical handling of neurosurgical gadgets like microscope and endoscope was never experienced by 26.7% and 18.7%, respectively. Even the senior most residents were able to perform only 41.08% of their surgeries independently. Financial support was only acceptable to 21.3%, and 60.9% want to leave the country upon training completion. CONCLUSION: The training programs in the developing countries need critical changes to provide favorable learning conditions with availability of appropriate surgical tools, structural changes of training programs, development of research interest, and improvement on the socioeconomic needs of the trainee.

Effect of Different Fertilizations on the Plant-Available Nitrogen in Soil Profile (0-100 cm): A Study on Chinese Cabbage.

The aim of this study is to analyze the variations in the plant-available nitrogen (PAN) concentrations in the soil profile. Different fertilizers were applied for Chinese cabbage plantation (CCP) in the experimental fields of the Shunyi region. The treatments used for the comparative analysis are (i) no fertilizer and plantation (NVP), (ii) no fertilizer with CCP (CTP), (iii) fertilization as urea (URP), and (iv) potassium nitrate (KNP) and chicken manure (CMP) with CCP. It was concluded that the yield was significantly high in URP, CMP, and KNP as compared to CTP. In URP, maximum PAN in soil layers 0-60 cm was recorded during crop production and in 60-100 cm after harvesting as compared to other treatments. Significant variations in soil pH and electrical conductivity (EC) for the soil profile (0-100 cm) from the initial values with respect to time and treatments were observed. CMP showed maximum ammonium in the upper layers of 0-60 cm throughout the season, whereas minimum PAN was observed in NVP but increased in lower layers of 60-100 cm. In general, all fertilizers raised the PAN below the soil 60-100 cm which indicates their potential for nitrate leaching (NL).