Beyond the surface: Exploring the temporally stable factors influencing injury severities in large-truck crashes using mixed logit models.

An analysis of crash data spanning four years (January 1, 2015, to December 31, 2018) from the State of Washington is conducted to investigate factors influencing injury severity outcomes in large truck-involved crashes. The study utilizes a mixed logit model that accounts for unobserved heterogeneity to capture the variation influenced by other variables. Transferability and temporal stability across the years are assessed using the likelihood ratio test. A wide range of attributes, including driver characteristics, vehicle features, crash-related attributes, roadway conditions, environmental factors, and temporal elements, are considered. Despite a significant temporal instability warranted by the likelihood ratio test across the years, twenty-one parameters consistently exhibit stable effects on injury severity over the years of which thirteen are new. The identified stable parameters included over speeding, following too closely, falling asleep, missing/ faulty airbags, head-on collisions, crashes involving two or more than three vehicles, rear-end collisions, lane width, low-light conditions, sag curves, New Jersey barriers, snowy weather, and morning hours. The temporally stable factors affecting injury severities in large truck crashes are crucial in developing the needed to address these crashes. The findings of this study offer valuable insights for researchers, stakeholders in the trucking industry, and policymakers, empowering them to develop targeted policies that not only improve traffic safety but also alleviate associated economic losses.

Rice farmers' preferences for seed quality, packaging, and source: A study from northern Bangladesh.

The use of quality seeds is crucial to improve rice yield, food security, and farmers' livelihoods. The large informal seed system, limited access to quality seeds, and low seed replacement rate challenge increasing rice yield. Despite robust government initiatives to support the seed system, progress has been slow. Besides, the need for farmers' behavioural change, enhanced coordination, and communication at the local level has not received adequate attention. We investigate rice farmers' preferences for quality seed, packet sizes, types, and sources, and assess the impact of utilizing good quality seed. We collected quantitative data from 1196 rice farmers in northern Bangladesh in 2019. To identify major factors influencing farmers' preferences regarding quality seed, packet sizes, packet types, and seed sources, we employed ordered logit and multinomial logit models. Additionally, we used the propensity score matching procedure to assess the impact of good quality and formal seed sources on the rice yield. The findings revealed that farmers strongly prefer using seeds from formal sources despite limited accessibility. Of the total farmers, 34% use public source seeds, 33% use private source seeds, and the rest rely on their own saved seeds. The use of good quality seeds increased rice yields from the base yield by 0.07-0.28 t/ha. We found about a 48% gap in accessing good-quality seeds, indicating significant potential for scaling up the seed systems. Farmers using formal seed sources yielded 0.03-0.15 t/ha more than informal seed users. Farmers strongly prefer 5 kg packets due to their cost-effectiveness, easy storage, and handling convenience. Additionally, farmers prefer polycoated jute sacks for their versatility, multi-purpose applications, and resistance to pests. The econometric model results showed that farmers' preferences were significantly influenced by gender, farm type, crop yield, seed price, market distance, various stakeholders' advice, and seed supply systems' constraints. The government should implement policies and programs to strengthen a well-connected seed network in rural areas, promoting inclusivity, and enhancing rice productivity. Besides, farmers' needs and preferences should be considered in designing and implementing seed-related initiatives to foster sustainable agricultural development.

Climate-smart rice (Oryza sativa L.) genotypes identification using stability analysis, multi-trait selection index, and genotype-environment interaction at different irrigation regimes with adaptation to universal warming.

Climate change has brought an alarming situation in the scarcity of fresh water for irrigation due to the present global water crisis, climate variability, drought, increasing demands of water from the industrial sectors, and contamination of water resources. Accurately evaluating the potential of future rice genotypes in large-scale, multi-environment experiments may be challenging. A key component of the accurate assessment is the examination of stability in growth contexts and genotype-environment interaction. Using a split-plot design with three replications, the study was carried out in nine locations with five genotypes under continuous flooding (CF) and alternate wet and dry (AWD) conditions. Utilizing the web-based warehouse inventory search tool (WIST), the water status was determined. To evaluate yield performance for stability and adaptability, AMMI and GGE biplots were used. The genotypes clearly reacted inversely to the various environments, and substantial interactions were identified. Out of all the environments, G3 (BRRI dhan29) had the greatest grain production, whereas G2 (Binadhan-8) had the lowest. The range between the greatest and lowest mean values of rice grain output (4.95 to 4.62 t ha-1) was consistent across five distinct rice genotypes. The genotype means varied from 5.03 to 4.73 t ha-1 depending on the environment. In AWD, all genotypes out performed in the CF system. With just a little interaction effect, the score was almost zero for several genotypes (E1, E2, E6, and E7 for the AWD technique, and E5, E6, E8, and E9 for the CF method) because they performed better in particular settings. The GGE biplot provided more evidence in support of the AMMI study results. The study's findings made it clear that the AMMI model provides a substantial amount of information when evaluating varietal performance across many environments. Out of the five accessions that were analyzed, one was found to be top-ranking by the multi-trait genotype ideotype distance index, meaning that it may be investigated for validation stability measures. The study's findings provide helpful information on the variety selection for the settings in which BRRI dhan47 and BRRI dhan29, respectively, performed effectively in AWD and CF systems. Plant breeders might use this knowledge to choose newer kinds and to design breeding initiatives. In conclusion, intermittent irrigation could be an effective adaptation technique for simultaneously saving water and mitigating GHG while maintaining high rice grain yields in rice cultivation systems.

Subcutaneous Emphysema Complicating the Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report From North-Western Nigeria.

Measles is a highly infectious, vaccine-preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Subcutaneous emphysema (SE) is a rare complication of measles that can be challenging to manage and may portend poor outcomes if untreated. We present a case of a two-year-old unimmunized rural dweller who presented with facial, neck, and chest swellings three days after being managed for measles exanthem from a referral hospital. Clinical findings were consistent with massive SE comorbid with malnutrition complicating the convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47 days in the hospital during which the social welfare unit of the hospital supported the treatment. SE is a rare complication of measles infection that can be challenging to manage, especially when comorbid with malnutrition in an indigent child. The application of a multidisciplinary team approach and the use of CTTD with NPWT may shorten the duration of hospital stay for the patient.

Knowledge, attitudes, and perceptions of healthcare students and professionals on the use of artificial intelligence in healthcare in Pakistan.

The advent of artificial intelligence (AI) technologies has emerged as a promising solution to enhance healthcare efficiency and improve patient outcomes. The objective of this study is to analyse the knowledge, attitudes, and perceptions of healthcare professionals in Pakistan about AI in healthcare. We conducted a cross-sectional study using a questionnaire distributed via Google Forms. This was distributed to healthcare professionals (e.g., doctors, nurses, medical students, and allied healthcare workers) working or studying in Pakistan. Consent was taken from all participants before initiating the questionnaire. The questions were related to participant demographics, basic understanding of AI, AI in education and practice, AI applications in healthcare systems, AI's impact on healthcare professions and the socio-ethical consequences of the use of AI. We analyzed the data using Statistical Package for Social Sciences (SPSS) statistical software, version 26.0. Overall, 616 individuals responded to the survey while n = 610 (99.0%) of respondents consented to participate. The mean age of participants was 32.2 ± 12.5 years. Most of the participants (78.7%, n = 480) had never received any formal sessions or training in AI during their studies/employment. A majority of participants, 70.3% (n = 429), believed that AI would raise more ethical challenges in healthcare. In all, 66.4% (n = 405) of participants believed that AI should be taught at the undergraduate level. The survey suggests that there is insufficient training about AI in healthcare in Pakistan despite the interest of many in this area. Future work in developing a tailored curriculum regarding AI in healthcare will help bridge the gap between the interest in use of AI and training.

The impact of critical thinking skills on student pharmacist GPA at a historically Black university.

INTRODUCTION: Limited information is available regarding whether malleable factors such as critical thinking skills are associated with academic performance among underrepresented minority pharmacy students. This study assessed the relationship between critical thinking skills and grade point average (GPA) among pharmacy students attending a Historically Black College. METHODS: A cross sectional study design was utilized to evaluate the association between student's GPA and critical thinking skills. Demographic data and GPA were abstracted from student records. The health sciences reasoning test with numeracy was administered to pharmacy students at Howard University during the 2017 to 2018 academic year. Critical thinking scores were classified as weak, moderate, or strong/superior. A one way analysis of variance was conducted to ascertain if the average GPA differed based on critical thinking skills category. A multiple linear regression analysis was conducted to determine whether student's critical thinking skill category was associated with the cumulative GPA after accounting for other factors. RESULTS: Among 217 students, the mean GPA among students with a weak critical thinking skills score (3.22 ± 0.40) was lower compared to students with a strong/superior score (3.39 ± 0.33) with a p-value of 0.029. After adjusting for other factors, a strong/superior critical thinking skills score was associated with a higher GPA (p-value = 0.024) in comparison to weak critical thinking skills. CONCLUSION: Stronger critical thinking skills scores are associated with better academic performance among underrepresented minority pharmacy students.

Role of Palliative Care in the Supportive Management of AL Amyloidosis-A Review.

Light chain amyloidosis is a plasma-cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis.

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

BACKGROUND: The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. METHOD: We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. RESULTS: A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (ß = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (ß = -0.38; p = 0.002), knowledge about polio vaccine (ß = -0.25; p = 0.011), and knowledge about IPV (ß = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (ß = -0.4; p ≤ 0.0001) and lack of education (ß = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (ß = 0.26; p = 0.008) and attendance at health camp (ß = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (ß = -0.13; p = 0.008). CONCLUSIONS: This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

A research definition and framework for acute paediatric critical illness across resource-variable settings: a modified Delphi consensus.

The true global burden of paediatric critical illness remains unknown. Studies on children with life-threatening conditions are hindered by the absence of a common definition for acute paediatric critical illness (DEFCRIT) that outlines components and attributes of critical illness and does not depend on local capacity to provide critical care. We present an evidence-informed consensus definition and framework for acute paediatric critical illness. DEFCRIT was developed following a scoping review of 29 studies and key concepts identified by an interdisciplinary, international core expert panel (n=24). A modified Delphi process was then done with a panel of multidisciplinary health-care global experts (n=109) until consensus was reached on eight essential attributes and 28 statements as the basis of DEFCRIT. Consensus was reached in two Delphi rounds with an expert retention rate of 89%. The final consensus definition for acute paediatric critical illness is: an infant, child, or adolescent with an illness, injury, or post-operative state that increases the risk for or results in acute physiological instability (abnormal physiological parameters or vital organ dysfunction or failure) or a clinical support requirement (such as frequent or continuous monitoring or time-sensitive interventions) to prevent further deterioration or death. The proposed definition and framework provide the conceptual clarity needed for a unified approach for global research across resource-variable settings. Future work will centre on validating DEFCRIT and determining high priority measures and guidelines for data collection and analysis that will promote its use in research.

An Integrative Review of Micro-Credentials and Digital Badges for Pharmacy Educators.

Micro-credentials (MCs) and digital badges (DBs) have gained popularity in recent years as a means to supplement traditional degrees and certifications. MCs and DBs can play a significant role in supporting student-centered learning by offering personalized and flexible learning pathways, emphasizing real-world relevance and practical skills, and fostering a culture of continuous learning and growth. However, barriers currently exist within health professions education, including pharmacy education, that could limit the full adoption and implementation of MCs and DBs. Research on the use of MCs and DBs in Doctor of Pharmacy degree programs is sparse. In this integrative review, literature on the use of MCs and DBs in health professions education is reviewed, and perspectives on the benefits, issues, and potential future uses within Doctor of Pharmacy degree programs are presented.

Factors affecting injury severity in motorcycle crashes: Different age groups analysis using Catboost and SHAP techniques.

OBJECTIVE: Motorcycle crashes often result in severe injuries on roads that affect people's lives physically, financially, and psychologically. These injuries could be notably harmful to drivers of all age groups. The main objective of this study is to investigate the risk factors contributing to the severity of crash injuries in different age groups. METHODS: This Objective is achieved by developing accurate machine learning (ML) based prediction models. This research examines the relationship between potential risk factors of motorcycle-associated crashes using (ML) and Shapley Additive explanations (SHAP) technique. The SHAP technique further helped interpreting ML methods for traffic injury severity prediction. It indicates the significant non-linear interactions between dependent and independent variables. The data for this study was collected from the Provincial Emergency Response Service RESCUE 1122 for the Rawalpindi region (Pakistan) over three years (from 2017 to 2020). The Synthetic Minority Oversampling Technique (SMOTE) is employed to balance injury severity classes in the pre-processing phase. RESULTS: The results demonstrate that age, gender, posted speed limit, the number of lanes, and month of the year are positively associated with severe and fatal injuries. This research also assesses how the modeling framework varies between the ML and classical statistical methods. The predictive performance of proposed ML models was assessed using several evaluation metrics, and it is found that Catboost outperformed the XGBoost, Random Forest (RF) and Multinomial Logit (MNL) model. CONCLUSION: The findings of this study will assist road users, road safety authorities, stakeholders, policymakers, and decision-makers in obtaining substantial and essential guidance for reducing the severity of crash injuries in Pakistan and other countries with prevailing conditions.

Exploring the long-term seroprevalence of SARS-CoV-2 antibodies in infants born to women with clinical or laboratory-confirmed COVID-19.

INTRODUCTION: Infants are at a higher risk of severe illness with COVID-19 infection compared to older children. While COVID-19 vaccination is not recommended for young infants, they can acquire maternally-derived anti-SARS-CoV-2 antibodies passively through the placenta and breastmilk. We described the persistence of infection-induced maternal antibodies in infant circulation at 9-12 months of age. METHODOLOGY: This was a cross-sectional study nested within the INTERCOVID multinational cohort study. For each COVID positive pregnant woman, two unmatched consecutive COVID negative pregnant women were enrolled between April and September 2020. Women with a positive PCR test, radiographic signs consistent with COVID-19, or at least 2 predefined symptoms of COVID-19 were considered as COVID positive. For this nested cross-sectional study, all COVID positive and either one of the COVID negative participants recruited from the Aga Khan University, Pakistan were approached 9-12 months after delivery, and maternal and infant sera were collected for antibody detection. RESULTS: Altogether, 83 mothers provided consent, of whom 32 (38.6 %) were COVID positive and 51 (61.4 %) were COVID negative during pregnancy. Anti-SARS-CoV-2 antibodies were present in 13 (41 %) infants born to COVID positive and 19 (39 %) infants born to COVID negative mothers (p = 0.87). The presence of reactive antibodies in infants at follow-up was associated with maternal antibodies at follow-up (OR:9.50, 95 % CI:2.03-44.42; p = 0.004). COVID infection occurred in 3 (6 %) infants born to COVID negative mothers while no infant born to a COVID positive mother had a history of infection (p = 0.27). CONCLUSION: The presence of reactive anti-SARS-CoV-2 antibodies in infants at 9-12 months of age is associated with maternal seropositivity 9-12 months after delivery rather than maternal infection during pregnancy. Further studies are required to validate these findings and assess whether passive immunity in infants is protective against COVID-19 infection.

Electromechanical Performance Optimization of Ni-Doped Bi(Sc, Zr)O3-PbTiO3 Ceramics and Microstructure Analysis.

BiScO3-PbTiO3-based ceramics show great potential in high-temperature piezoelectric applications. However, their high dielectric loss tan δ and low mechanical quality factor Qm have to be optimized. In this paper, a ceramic system of (1-y)Bi(Sc0.975Zr0.025)O3-yPb(Ti1-xNix)O3 (BSZ-yPT-xNi, x = 0, 0.015, 0.025, and 0.035 and y = 0.62, 0.63, 0.64, and 0.65) was systematically investigated. Increase in x or y values leads to the enhancement of the tetragonal phase and tetragonal lattice distortion. The rhombohedral/tetragonal morphotropic phase boundary (MPB) locates in the vicinity of y = 0.64 for the x = 0 and 0.015 samples, and y = 0.63 for the x = 0.025 and 0.035 samples. For these MPB samples, the substitution of Ni2+ for Ti4+ causes domain refinement, evolving from the submicrometer lamellar domains to hierarchical domains, and finally to the high-density stripe-like nanodomains, which benefits the domain wall motion and makes the coercive field reduced. However, the alignment of defect dipoles (NiTi''-VO••) after the sufficient poling and aging treatment induces the noticeable internal bias field, which increases with the addition of Ni2+. Apparent piezoelectric "hardening" occurred, evidenced by the increase in Qm and the reduction in tan δ. Among the MPB samples, the x = 0.025/y = 0.63 ceramic shows the superior comprehensive electromechanical performance with the d33 of 380 pC/N, kt of 0.51, Qm of 112, and tan δ of 0.010. Besides, excellent temperature stability was achieved with the d33 of 367-380 pC/N, Qm of 106-112, and tan δ ≤ 0.010 in the temperature range of 25-250 °C.

Top Ten Tips Palliative Care Clinicians Should Know About Physical Therapy, Occupational Therapy, and Speech Language Pathology.

This article provides guidance on the integral role of physical therapy, occupational therapy (OT), and speech language pathology (SLP) in palliative care (PC), underlining the necessity for effective communication between physicians and therapists, the importance of caregiver education and support, the application of holistic treatment modalities in OT, the underutilization of resources in PC settings, the role of SLP professionals in feeding and nutrition, and the challenges in communication during the advanced stages of illness. The article draws on various studies and expert opinions to elucidate these issues, offering a valuable resource to health care professionals in ensuring high-quality patient-centered PC.

Interventional pain management in cancer patients-a scoping review.

BACKGROUND: Pain is the most prevalent symptom in cancer patients. To improve pain care, World Health Organization (WHO) Pain ladder was introduced in 1986 as a template for choosing pain medications in oncological settings. Since then, advancements in oncological treatments have improved the survival of cancer patients, requiring prolonged analgesia in various treatment stages. Additionally, there have been newer challenges in pain management with opioid epidemic and associated opioid use disorders. This has shifted the focus from WHO Pain Ladder and brought new importance to the rapidly evolving realm of interventional pain modalities for cancer pain management. This article reviews such interventional pain and minimally invasive neurosurgical options for pain management in cancer patients. METHODS: Systemic literature search in PubMed, Cochrane, and Embase. This included review articles, randomized controlled trials, non-randomized clinical trials (RCTs), and case series. RESULTS: A large array of interventional pain modalities are available for oncological pain management. These modalities carry relatively lower risk and provide effective analgesia while reducing concerns related to opioid use disorder. They target various areas in the anatomical and physiological pain pathways and provide more focused options for pain management at various stages of cancer and survivorship. Additionally, with improved sterile techniques, better imaging modalities, and growing technical and clinical expertise, interventional pain modalities offer a safe and often more efficacious method of pain management nowadays. Procedural modalities like intrathecal (IT) pumps, neuromodulation, kyphoplasty, and newer more targeted ablative techniques are now increasingly finding more roles and indications in cancer population. CONCLUSIONS: Interventional pain techniques are rapidly evolving and have become an integral part of cancer pain management. They can provide an additional option for cancer pain management, and can help reduce opioid consumption, and associated opioid side effects. With improvement in imaging modalities, procedural techniques, hardware, and infection control, they have a good safety profile and provide a rapid and efficacious approach for cancer pain management. This review articles aims to provide a basic understanding of various interventional pain modalities, their indications, efficacy, safety data, and associated complications.

Antimalarial drug efficacy and resistance in malaria-endemic countries in HANMAT-PIAM_net countries of the Eastern Mediterranean Region 2016-2020: Clinical and genetic studies.

INTRODUCTION: The World Health Organization recommends regular monitoring of the efficacy of nationally recommended antimalarial drugs. We present the results of studies on the efficacy of recommended antimalarials and molecular markers of artemisinin and partner resistance in Afghanistan, Pakistan, Somalia, Sudan and Yemen. METHODS: Single-arm prospective studies were conducted to evaluate the efficacy of artesunate-sulfadoxine-pyrimethamine (ASSP) in Afghanistan and Pakistan, artemether-lumefantrine (AL) in all countries, or dihydroartemisinin-piperaquine (DP) in Sudan for the treatment of Plasmodium falciparum. The efficacy of chloroquine (CQ) and AL for the treatment of Plasmodium vivax was evaluated in Afghanistan and Somalia, respectively. Patients were treated and monitored for 28 (CQ, ASSP and AL) or 42 (DP) days. Polymerase chain reaction (PCR)-corrected cure rate and parasite positivity rate at Day 3 were estimated. Mutations in the P. falciparum kelch 13 (Pfk13) gene and amplifications of plasmepsin (Pfpm2) and multidrug resistance-1 (Pfmdr-1) genes were also studied. RESULTS: A total of 1680 (249 for ASSP, 1079 for AL and 352 for DP) falciparum cases were successfully assessed. A PCR-adjusted ASSP cure rate of 100% was observed in Afghanistan and Pakistan. For AL, the cure rate was 100% in all but four sites in Sudan, where cure rates ranged from 92.1% to 98.8%. All but one patient were parasite-free at Day 3. For P. vivax, cure rates were 98.2% for CQ and 100% for AL. None of the samples from Afghanistan, Pakistan and Yemen had a Pfk13 mutation known to be associated with artemisinin resistance. In Sudan, the validated Pfk13 R622I mutation accounted for 53.8% (14/26) of the detected non-synonymous Pfk13 mutations, most of which were repeatedly detected in Gadaref. A prevalence of 2.7% and 9.3% of Pfmdr1 amplification was observed in Pakistan and Yemen, respectively. CONCLUSION: High efficacy of ASSP, AL and DP in the treatment of uncomplicated falciparum infection and of CQ and AL in the treatment of P. vivax was observed in the respective countries. The repeated detection of a relatively high rate of Pfk13 R622I mutation in Sudan underscores the need for close monitoring of the efficacy of recommended ACTs, parasite clearance rates and Pfk13 mutations in Sudan and beyond. Registration numbers of the trials: ACTRN12622000944730 and ACTRN12622000873729 for Afghanistan, ACTRN12620000426987 and ACTRN12617001025325 for Pakistan, ACTRN12618001224213 for Somalia, ACTRN12617000276358, ACTRN12622000930785 and ACTRN12618001800213 for Sudan and ACTRN12617000283370 for Yemen.

Does IPV Boost Intestinal Immunity among Children under Five Years of Age? An Experience from Pakistan.

The oral poliovirus vaccine (OPV) has been the mainstay of polio eradication, especially in low-income countries, and its use has eliminated wild poliovirus type 2. However, the inactivated poliovirus vaccine (IPV) is safer than OPV, as IPV protects against paralytic poliomyelitis without producing adverse reactions. The present study compared mucosal and humoral responses to poliovirus vaccines administered to previously OPV-immunized children to assess the immunity gap in children in areas of high poliovirus transmission. A cluster-randomized trial was implemented in three high-risk districts of Pakistan-Karachi, Kashmore, and Bajaur-from June 2013 to May 2014. This trial was community-oriented and included three arms, focusing on healthy children below five years of age. The study involved the randomization of 387 clusters, of which 360 were included in the final analysis. The control arm (A) received the routine polio program bivalent poliovirus vaccine (bOPV). The second arm (B) received additional interventions, including health camps providing routine vaccinations and preventive maternal and child health services. In addition to the interventions in arm B, the third arm (C) was also provided with IPV. Blood and stool samples were gathered from children to evaluate humoral and intestinal immunity. The highest levels of poliovirus type 1 serum antibodies were observed in Group C (IPV + OPV). The titers for poliovirus type 2 (P2) and poliovirus type 3 (P3) were noticeably higher in those who had received a routine OPV dose than in those who had not across all study groups and visits. Providing an IPV booster after at least two OPV doses could potentially fill immunity gaps in regions where OPV does not show high efficacy. However, IPV only marginally enhances humoral immunity and fails to offer intestinal immunity, which is critical to stop the infection and spread of live poliovirus in populations that have not been exposed before.

Determinants of Stunting among Children under Five in Pakistan.

INTRODUCTION: Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1000 days of life. Across south Asia, Pakistan has the second-highest prevalence of stunting. This study assessed the most recent nationally representative data, the National Nutrition Survey (NNS) 2018, to identify the stunting prevalence and determinants among Pakistani children under five. METHODS: The NNS 2018, a cross-sectional household-level survey, was used to conduct a secondary analysis. Data on malnutrition, dietary practices, and food insecurity were used to identify the prevalence of stunting among children under five years in terms of demographic, socioeconomic, and geographic characteristics. The prevalence of stunting was calculated using the World Health Organization (WHO) height for age z-score references. Univariate and multivariable logistic regressions were conducted to identify the factors associated with child stunting. RESULTS: The analysis showed that out of 52,602 children under five, 40.0% were found to be stunted. Male children living in rural areas were more susceptible to stunting. Furthermore, stunting was more prevalent among children whose mothers had no education, were between 20 and 34, and were employed. In the multivariable logistic regression, male children (AOR = 1.08, 95% CI [1.04-1.14], p < 0.001) from rural areas (AOR = 1.07, 95% CI [1.01-1.14], p = 0.014), with the presence of diarrhea in the last two weeks (AOR = 1.15, 95% CI [1.06-1.25], p < 0.001) and mothers who had no education (AOR = 1.57, 95% CI [1.42-1.73], p < 0.001) or lower levels of education (primary: AOR = 1.35, 95% CI [1.21-1.51], p < 0.001; middle: AOR = 1.29, 95% CI [1.15-1.45], p < 0.001), had higher odds of stunting. Younger children aged < 6 months (AOR = 0.53, 95% CI [0.48-0.58], p < 0.001) and 6-23 months (AOR = 0.89, 95% CI [0.84-0.94], p < 0.001), with mothers aged 35-49 years (AOR = 0.78, 95% CI [0.66-0.92], p = 0.003), had lower odds of stunting. At the household level, the odds of child stunting were higher in lower-income households (AOR = 1.64, 95% CI [1.46-1.83], p < 0.001) with ≥ 7 members (AOR = 1.09, 95% CI [1.04-1.15], p < 0.001), with no access to improved sanitation facilities (AOR = 1.14, 95% CI [1.06-1.22], p < 0.001) and experiencing severe food insecurity (AOR = 1.07, 95% CI [1.01-1.14], p = 0.02). CONCLUSION: Child stunting in Pakistan is strongly associated with various factors, including gender, age, diarrhea, residence, maternal age and education, household size, food and wealth status, and access to sanitation. To address this, interventions must be introduced to make locally available food and nutritious supplements more affordable, improve access to safe water and sanitation, and promote female education for long-term reductions in stunting rates.

Impedance Study of Temperature-Stable Relaxor Dielectrics in the System of BCT-BMT Ceramics.

Preparation of a lead-free system (Ba0.8Ca0.2)TiO3-xBi(Mg0.5Ti0.5)O3 (BCT-BMT) with x = 0, 0.1, 0.2, 0.3, 0.4, and 0.5 was carried out using a solid-state reaction technique. X-ray (XRD) diffraction analysis confirmed a tetragonal structure for x = 0, which shifted to cubic (pseudocubic) at x ≥ 0.1. From Rietveld refinement, a single phase with a tetragonal symmetry model (P4mm) was observed for x = 0, and however, for sample x = 0.1 and sample x = 0.5, the data are modeled to cubic (Pm3m). Composition x = 0 showed a prominent Curie peak, typical of ordinary ferroelectrics with a Curie temperature (Tc) ∼130 °C, modified to a typical relaxor dielectric at x ≥ 0.1. However, samples at x = 0.2-0.5 displayed a single semicircle attributed to the bulk response of the material, whereas a slightly depressed second arc appeared for x = 0.5 at 600 °C, indicating a slight contribution to the electrical properties, ascribed to the grain boundary of the material. Finally, the dc resistivity increased with the increase of the BMT content and the solid solution increased the activation energy from 0.58 eV at x = 0 to 0.99 eV for x = 0.5. Adding the BMT content eliminated the ferroelectric behavior at compositions x ≥ 0.1 and led to a linear dielectric response and electrostrictive behavior with a maximum strain of 0.12% for x = 0.2.

Ocular complications of antineoplastic therapies.

Ocular complications of antineoplastic agents can have a profound effect on the quality of life of cancer patients. New oncologic treatments like monoclonal antibodies, immunotherapies, antibody-drug conjugates, checkpoint inhibitors and growth factor receptors have resulted in increased ocular complications. These ocular complications differs in respect to distinct mechanisms of actions and lead to significant challenges in the management of cancer patients. In this review, we reviewed literature, clinical studies and cases detailing ocular complications due to administration of antineoplastic agents and emphasized the need for communication between oncologists and ophthalmologists toward early detection and management of ocular complications.

Ocular side effects can have a large impact on the quality of life on patients with cancer. New ways to treat cancer greatly increased patient prognosis, however, it has also resulted in increased ocular complications. This paper aims to review past medical literature, clinical studies, and case reports to describe the types of ocular complications that may arise from administration of antineoplastic agents. This paper emphasizes the need for communication between oncologists and ophthalmologists toward early detection and management for better patient care.