Enhancing telehealth services development in Pakistani healthcare sectors through examining various medical service quality characteristics.

Introduction: The telehealth service increased attention both during and after the Covid-19 outbreak. Nevertheless, there is a dearth of research in developing countries, including Pakistan. Hence, the objective of this study was to examine telehealth service quality dimensions to promote the telehealth behavior intention and sustainable growth of telehealth in Pakistan. Methods: This study employed a cross-sectional descriptive design. Data were collected from doctors who were delivering telehealth services through a well-designed questionnaire. To examine the hypothesis of the study, we employed the Smart PLS structural equation modeling program, namely version 0.4. Results: The study findings indicate that medical service quality, affordability, information quality, waiting time, and safety have a positive impact on the intention to engage in telehealth behavior. Furthermore, the adoption of telehealth behavior has a significant favorable effect on the actual utilization of telehealth services, which in turn has a highly good impact on sustainable development. Conclusion: The study determined that telehealth services effectively decrease the amount of time and money spent on travel, while still offering convenient access to healthcare. Furthermore, telehealth has the potential to revolutionize payment methods, infrastructure, and staffing in the healthcare industry. Implementing a well-structured telehealth service model can yield beneficial results for a nation and its regulatory efforts in the modern age of technology.

3D Melt-Extrusion Printing of Medium Chain Length Polyhydroxyalkanoates and Their Application as Antibiotic-Free Antibacterial Scaffolds for Bone Regeneration.

In this work, we investigated, for the first time, the possibility of developing scaffolds for bone tissue engineering through three-dimensional (3D) melt-extrusion printing of medium chain length polyhydroxyalkanoate (mcl-PHA) (i.e., poly(3-hydroxyoctanoate-co-hydroxydecanoate-co-hydroxydodecanoate), P(3HO-co-3HD-co-3HDD)). The process parameters were successfully optimized to produce well-defined and reproducible 3D P(3HO-co-3HD-co-3HDD) scaffolds, showing high cell viability (100%) toward both undifferentiated and differentiated MC3T3-E1 cells. To introduce antibacterial features in the developed scaffolds, two strategies were investigated. For the first strategy, P(3HO-co-3HD-co-3HDD) was combined with PHAs containing thioester groups in their side chains (i.e., PHACOS), inherently antibacterial PHAs. The 3D blend scaffolds were able to induce a 70% reduction of Staphylococcus aureus 6538P cells by direct contact testing, confirming their antibacterial properties. Additionally, the scaffolds were able to support the growth of MC3T3-E1 cells, showing the potential for bone regeneration. For the second strategy, composite materials were produced by the combination of P(3HO-co-3HD-co-HDD) with a novel antibacterial hydroxyapatite doped with selenium and strontium ions (Se-Sr-HA). The composite material with 10 wt % Se-Sr-HA as a filler showed high antibacterial activity against both Gram-positive (S. aureus 6538P) and Gram-negative bacteria (Escherichia coli 8739), through a dual mechanism: by direct contact (inducing 80% reduction of both bacterial strains) and through the release of active ions (leading to a 54% bacterial cell count reduction for S. aureus 6538P and 30% for E. coli 8739 after 24 h). Moreover, the composite scaffolds showed high viability of MC3T3-E1 cells through both indirect and direct testing, showing promising results for their application in bone tissue engineering.

An Efficient Propagation Approach to Forcing Softwood Shoots from Epicormic Buds and Subsequent Rooting of Paulownia elongata S. Y. Hu.

The current research describes the multiplication of Paulownia elongata S. Y. Hu, a timber plant, through the forcing of softwood shoots from epicormic buds under glasshouse conditions in spring and fall seasons. Different growth media were used to compare their effect on the forcing potential of epicormic buds. For this, 25-30-cm-long and 1.2-2-cm-diameter stem segments taken from the lower juvenile portion of a mother plant were placed horizontally in flat trays containing media, i.e., sterilized well-moistened sand, peat moss, perlite, and vermiculite individually. Furthermore, 4-6-cm-long forced softwood shoots were detached and treated with various concentrations of IBA (indole-3-butyric acid) and NAA (α-naphthyl acetic acid) either individually or in combinations for subsequent rooting. The response of shoot forcing was better in spring as compared to fall in terms of shoot length (cm), and number of shoots or leaves; however, an earlier bud break was observed during fall after 30 days of the initial experiment. The use of peat moss and vermiculite proved to be equally suitable for early bud break in both seasons, whereas in terms of shoot and leaf number as well as the shoot length (cm), the best outcome was observed in sand. Best rooting was observed at 3 gL-1 IBA + 3 gL-1 NAA in terms of root number per shoot, root length (cm), and days to root initiation while using sand as the growth medium after 50 days of the rooting experiment. The successfully established plantlets were further shifted to soil at Botanical Garden, University of the Punjab, Lahore, Pakistan, exhibiting an 87.5% survival rate. On the basis of the results obtained, it may be concluded that reasonable softwood shoot forcing in P. elongata may further be exploited for its mass scale nursery propagation as well as use in future in vitro studies.

A Novel Thermal Interface Material Composed of Vertically Aligned Boron Nitride and Graphite Films for Ultrahigh Through-Plane Thermal Conductivity.

The relentless drive toward miniaturization in microelectronic devices has sparked an urgent need for materials that offer both high thermal conductivity (TC) and excellent electrical insulation. Thermal interface materials (TIMs) possessing these dual attributes are highly sought after for modern electronics, but achieving such a combination has proven to be a formidable challenge. In this study, a cutting-edge solution is presented by developing boron nitride (BN) and graphite films layered silicone rubber composites with exceptional TC and electrical insulation properties. Through a carefully devised stacking-cutting method, the high orientation degree of both BN and graphite films is successfully preserved, resulting in an unprecedented through-plane TC of 23.7 Wm-1 K-1 and a remarkably low compressive modulus of 4.85 MPa. Furthermore, the exceptional properties of composites, including low thermal resistance and high resilience rate, make them a reliable and durable option for various applications. Practical tests demonstrate their outstanding heat dissipation performance, significantly reducing CPU temperatures in a computer cooling system. This research work unveils the possible upper limit of TC in BN-based TIMs and paves the way for their large-scale practical implementation, particularly in the thermal management of next-generation electronic devices.

CO2-Free Ethylene Oxide Production via Liquid-Phase Epoxidation with Fe2O3/MSM Catalyst.

In this study, we present an approach for ethylene oxide (EO) production that addresses environmental concerns by eliminating greenhouse gas emissions. Our catalyst, Fe2O3/MSM, was synthesized using a hydrothermal method, incorporating Fe2O3 nanoparticles into a well-structured mesoporous silica matrix (MSM). We selected peracetic acid as the oxidant, enabling CO2-free EO production while yielding valuable by-products such as acetic acid, monoethylene glycol, and diethylene glycol. X-ray diffraction (XRD), X- ray photoelectron spectroscopy (XPS), and Brunauer-Emmett-Teller (BET) analyses confirmed the heteroatom structure of the catalysts and porosity, while Transmission electron microscopy (TEM) analysis provided insights into its morphology. Then, the synthesized catalyst was used in the liquid-phase epoxidation of ethylene for EO production. Our systematic experiments involved varying critical parameters such as temperature, ethylene to oxidant ratio, catalyst dosage, and solvent to optimize EO selectivity and ethylene conversion. The results of this study demonstrated an 80.2 % ethylene conversion to EO with an EO selectivity of 87.6 %. The production process yielded valuable by-products without CO2 emissions, highlighting its environmental friendliness.

Correction: Development of a chromium oxide loaded mesoporous silica as an efficient catalyst for carbon dioxide-free production of ethylene oxide.

[This corrects the article DOI: 10.1039/D3RA05858A.].

Theabrownin: a dietary nutraceutical with diverse anticancer mechanisms.

Cancer, a highly deadly disease, necessitates safe, cost-effective, and readily accessible treatments to mitigate its impact. Theabrownin (THBR), a polyphenolic pigment found in Pu-erh tea, has garnered attention for its potential benefits in memory, liver health, and inflammation control. By observing different biological activities of THBR, recently researchers have unveiled THBR's promising anticancer properties across various human cancer types. By examining existing studies, it is evident that THBR demonstrates substantial potential in inhibiting cell proliferation and reducing tumour size with minimal harm to normal cells. These effects are achieved through the modulation of key molecular markers such as Bcl-2, Bax, various Caspases, Poly (ADP-ribose) polymerase cleavage (Cl-PARP), and zinc finger E box binding homeobox 1 (ZEB 1). This review aims to provide in-depth insights into THBR's role in cancer research. This review also elucidates the underlying anticancer mechanisms of THBR, offering promise as a novel anticancer drug to alleviate the global cancer burden.

Development of a chromium oxide loaded mesoporous silica as an efficient catalyst for carbon dioxide-free production of ethylene oxide.

Ethylene oxide (EO) is a significant raw material used in many commodities for consumers, particularly ethoxylates, polymers, and certain other glycol derivatives. We synthesized a catalyst by incorporation of chromium oxide into a mesoporous silica material (Cr/MSM) via the hydrothermal method, an effective catalyst for partial ethylene oxidation for producing carbon dioxide (CO2) free EO. Subsequently, XRD, BET, XPS, and TEM were used to analyse the structural characteristics of the Cr/MSM catalyst. The catalytic performance of the synthesized catalyst was assessed in the liquid-phase epoxidation (LPE) of ethylene, utilizing peracetic acid (PAA) as an oxidant. This approach not only circumvented the generation of CO2 but also mitigated the risk of metal leaching. Confirmation of the successful production of EO was achieved through GC chromatography, where the presence of a peak with a retention time (RT) of 8.91 minutes served as conclusive evidence. We systematically explored a range of reaction parameters, including temperature, catalyst concentration, the molar ratio of ethylene to PAA, and solvent effect. This comprehensive investigation aimed to fine-tune the reaction conditions, ultimately improving ethylene conversion and enhancing the selectivity of the catalyst for EO production. This approach can effectively resolve the issues of greenhouse gas emissions and metal leaching that had been associated with previously reported catalysts.

Coronary artery complications with left bundle branch area pacing: A review of literature.

Left bundle branch area pacing (LBBAP) is an emerging technique in cardiac resynchronization therapy that shows promise in improving ventricular synchrony and clinical outcomes in patients with heart failure. However, the potential risk of coronary artery complications with LBBAP necessitates careful attention and management. This literature review explores the mechanisms, acute coronary events, and clinical implications associated with coronary artery complications in LBBAP. The mechanism of coronary injury with LBBAP involves mechanical trauma, altered coronary blood flow dynamics, and endothelial damage. Acute coronary events such as myocardial ischemia, acute coronary syndromes, and coronary artery dissection can occur during or after LBBAP, leading to significant clinical implications including the need for prompt intervention and potential impact on long-term outcomes. To avoid coronary injury and acute coronary syndrome with LBBAP, specific care strategies are recommended. These include thorough pre-procedural evaluation, expert operator technique, optimization of hemodynamics and ventricular synchrony, close monitoring for ischemic events, collaboration with cardiology specialists, and long-term follow-up. The clinical implications of coronary artery complications with LBBAP necessitate careful patient selection, informed decision-making, and a multidisciplinary approach. Future directions in this field include advancements in procedural techniques, technological innovations, risk stratification strategies, enhanced imaging modalities, research on mechanisms and prevention, and collaboration among stakeholders. By implementing these strategies and focusing on future advancements, healthcare providers can minimize the risk of coronary artery complications with LBBAP and optimize patient outcomes in cardiac resynchronization therapy.

Impact of COVID-19 pandemic on health care workers (HCWs) in Sindh Province of Pakistan.

BACKGROUND: In Pakistan, the COVID-19 outbreak posed a significant challenge for healthcare workers in the country's public hospitals. The HCWs faced several problems in terms of the COVID-19 pandemic. Therefore this study investigated how the COVID-19 pandemic has affected the medical staff at the public hospital in Sindh Province, Pakistan. METHODS: In this study, a qualitative exploratory design was used. Semi-Structure interviews (SSI) were conducted by using an open-indeed questionnaire (OIQ) for data collection. An inductive approach was used for theoretical data analysis. A total of 320 HCWs participated to complete the criteria of the study from 10 different public hospitals. RESULTS: The study result showed the Sindh public hospital's insufficient infrastructure, lack of health protective equipment, shortages of isolation rooms and beds, and emergencies during the COVID-19 pandemic caused HCWs to experience physical and psychological weariness, sleep disturbance, mental stress, and fear of infection. CONCLUSION: The study concluded that public hospitals' insufficient infrastructure, furniture, emergency wards, and safety equipment during the COVID-19 pandemic significantly damaged HCWs' physical and psychological health, generating fear of infection and sleep disturbance. Additionally, Sindh healthcare workers' fear of illness and isolation may impair family connections.

The Effects of Gestational Diabetes on Fetus: A Surveillance Study.

INTRODUCTION: Gestational diabetes is an intolerance to glucose diagnosed during pregnancy that goes away postpartum. Gestational diabetes may result in outcomes such as birth trauma, increased rates of cesarean sections, and macrosomia. This study aims to determine the outcomes of gestational diabetes mellitus (GDM) on maternal and fetal health in a tertiary care hospital setting. MATERIALS AND METHODS: This is a retrospective study of 52 patients who presented with gestational diabetes mellitus (GDM) and were treated at Tentishev Satkynbai Memorial Asian Medical Institute, Kyrgyzstan, between April 2021 and January 2022. The information was taken from the medical records of the patients. The baby's age, the mother's body mass index (BMI), history of pregnancy, deaths, birth weight, and the number of births were all taken into account. RESULTS: Out of all the cases during the study period at the Tentishev Satkynbai Memorial Asian Medical Institute, Kyrgyzstan, 52 were found to be complicated with gestational diabetes mellitus, which is 2.7% of the total deliveries. There was a significant difference found among both study groups in gestational age and history of GDM. The neonatal intensive care unit (NICU) admission rate of neonates born to GDM mothers was found to be significant with a difference of 10.9% (p < 0.0003), which is higher compared to the control group. CONCLUSION: Incidences of macrosomia, NICU admissions of preterm babies, and large for gestational age (LGA) and increased rates of hypertensive disorders were found among GDM pregnancies compared to control cases. The study shows higher rates of maternal and fetal/neonatal complications in females with GDM.

Predictors of an Active Lifestyle in Middle-Aged and Older Adults with HIV in the United States Deep South.

Background and Purpose: An active lifestyle is important for health maintenance and disease prevention. This study was to examine what factors predict an active lifestyle in HIV+ and HIV- adults from the United States Deep South. Methods: The sample included 279 participants (174 HIV+ and 105 HIV-) who completed a comprehensive assessment. An active lifestyle composite was created using variables of employment status, level of social support, level of physical activity, and diet. Correlations and regression analyses were conducted between the active lifestyle composite and possible predictors for all (HIV+ and HIV-), HIV+, and HIV- participants, respectively. Results: Lower levels of depression, higher socioeconomic status (SES), and younger age were significant predictors of a more active lifestyle for the full sample, HIV+, and HIV- participants, respectively. Conclusion: SES and depression represent important factors influencing engagement in an active lifestyle in PLWH. Such factors should be considered when developing and implementing lifestyle interventions.

Correction: CO2 free production of ethylene oxide via liquid phase epoxidation of ethylene using niobium oxide incorporated mesoporous silica material as the catalyst.

[This corrects the article DOI: 10.1039/D2RA07240H.].

CO2 free production of ethylene oxide via liquid phase epoxidation of ethylene using niobium oxide incorporated mesoporous silica material as the catalyst.

Ethylene Oxide (EO) is an essential raw material used in various consumer products like different glycol derivatives, ethoxylates, and polymers. We hydrothermally synthesize niobium oxide incorporated with mesoporous silica material (Nb/MSM), an efficient catalyst for CO2 free-ethylene oxide (EO) production via partial oxidation of ethylene. The structural properties of Nb/MSM catalysts were characterized using XRD, TEM, and N2 adsorption-desorption. The catalytic activity of synthesized materials in liquid phase epoxidation (LPE) of ethylene was evaluated in the presence of peracetic acid (PAA) as an oxidant to avoid the production of CO2 and also minimize metal leaching. GC chromatography was used to investigate the successful production of EO, and a peak with a retention time (RT) of 9.01 min served as confirmation. Various reaction parameters viz. temperature, catalyst concentration, ethylene to PAA molar ratio, and solvent effect were investigated in order to optimize the reaction conditions for enhancing the ethylene conversion and selectivity for EO production. By this approach, the challenges of greenhouse gas production and metal leaching were addressed which were associated with previously reported catalysts.

Entropy Related to K-Banhatti Indices via Valency Based on the Presence of C6H6 in Various Molecules.

Entropy is a measure of a system's molecular disorder or unpredictability since work is produced by organized molecular motion. Shannon's entropy metric is applied to represent a random graph's variability. Entropy is a thermodynamic function in physics that, based on the variety of possible configurations for molecules to take, describes the randomness and disorder of molecules in a given system or process. Numerous issues in the fields of mathematics, biology, chemical graph theory, organic and inorganic chemistry, and other disciplines are resolved using distance-based entropy. These applications cover quantifying molecules' chemical and electrical structures, signal processing, structural investigations on crystals, and molecular ensembles. In this paper, we look at K-Banhatti entropies using K-Banhatti indices for C6H6 embedded in different chemical networks. Our goal is to investigate the valency-based molecular invariants and K-Banhatti entropies for three chemical networks: the circumnaphthalene (CNBn), the honeycomb (HBn), and the pyrene (PYn). In order to reach conclusions, we apply the method of atom-bond partitioning based on valences, which is an application of spectral graph theory. We obtain the precise values of the first K-Banhatti entropy, the second K-Banhatti entropy, the first hyper K-Banhatti entropy, and the second hyper K-Banhatti entropy for the three chemical networks in the main results and conclusion.

Innovations in the synthesis of graphene nanostructures for bio and gas sensors.

Sensors play a significant role in modern technologies and devices used in industries, hospitals, healthcare, nanotechnology, astronomy, and meteorology. Sensors based upon nanostructured materials have gained special attention due to their high sensitivity, precision accuracy, and feasibility. This review discusses the fabrication of graphene-based biosensors and gas sensors, which have highly efficient performance. Significant developments in the synthesis routes to fabricate graphene-based materials with improved structural and surface properties have boosted their utilization in sensing applications. The higher surface area, better conductivity, tunable structure, and atom-thick morphology of these hybrid materials have made them highly desirable for the fabrication of flexible and stable sensors. Many publications have reported various modification approaches to improve the selectivity of these materials. In the current work, a compact and informative review focusing on the most recent developments in graphene-based biosensors and gas sensors has been designed and delivered. The research community has provided a complete critical analysis of the most robust case studies from the latest fabrication routes to the most complex challenges. Some significant ideas and solutions have been proposed to overcome the limitations regarding the field of biosensors and hazardous gas sensors.

Attention-guided multi-scale deep object detection framework for lymphocyte analysis in IHC histological images.

Tumor-infiltrating lymphocytes are specialized lymphocytes that can detect and kill cancerous cells. Their detection poses many challenges due to significant morphological variations, overlapping occurrence, artifact regions and high-class resemblance between clustered areas and artifacts. In this regard, a Lymphocyte Analysis Framework based on Deep Convolutional neural network (DC-Lym-AF) is proposed to analyze lymphocytes in immunohistochemistry images. The proposed framework comprises (i) pre-processing, (ii) screening phase, (iii) localization phase and (iv) post-processing. In the screening phase, a custom convolutional neural network architecture (lymphocyte dilated network) is developed to screen lymphocytic regions by performing a patch-level classification. This proposed architecture uses dilated convolutions and shortcut connections to capture multi-level variations and ensure reference-based learning. In contrast, the localization phase utilizes an attention-guided multi-scale lymphocyte detector to detect lymphocytes. The proposed detector extracts refined and multi-scale features by exploiting dilated convolutions, attention mechanism and feature pyramid network (FPN) using its custom attention-aware backbone. The proposed DC-Lym-AF shows exemplary performance on the NuClick dataset compared with the existing detection models, with an F-score and precision of 0.84 and 0.83, respectively. We verified the generalizability of our proposed framework by participating in a publically open LYON'19 challenge. Results in terms of detection rate (0.76) and F-score (0.73) suggest that the proposed DC-Lym-AF can effectively detect lymphocytes in immunohistochemistry-stained images collected from different laboratories. In addition, its promising generalization on several datasets implies that it can be turned into a medical diagnostic tool to investigate various histopathological problems. Graphical Abstract.

A review of synthesis, fabrication, and emerging biomedical applications of metal-organic frameworks.

The overwhelming potential of porous coordination polymers (PCP), also known as Metal-Organic Frameworks (MOFs), especially their nanostructures for various biomedical applications, have made these materials worth investigating for more applications and uses. MOFs unique structure has enabled them for most applications, particularly in biomedical and healthcare. A number of very informative review papers are available on the biomedical applications of MOFs for the reader's convenience. However, many of those reviews focus mainly on drug delivery applications, and no significant work has been reported on other MOFs for biomedical applications. This review aims to present a compact and highly informative global assessment of the recent developments in biomedical applications (excluding drug-delivery) of MOFs along with critical analysis. Researchers have recently adopted both synthetic and post-synthetic routes for the fabrication and modification of MOFs that have been discussed and analyzed. A critical review of the latest reports on the significant and exotic area of bio-sensing capabilities and applications of MOFs has been given in this study. In addition, other essential applications of MOFs, including photothermal therapy, photodynamic therapy, and antimicrobial activities, are also included. These recently grown emergent techniques and cancer treatment options have gained attention and require further investigations to achieve fruitful outcomes. MOF's role in these applications has been thoroughly discussed, along with future challenges and valuable suggestions for the research community that will help meet future demands.

The Impact of Seeding Density and Nitrogen Rates on Forage Yield and Quality of Avena sativa L.

Green forage is an excellent feed source for livestock. It is an integral part of livestock production to accomplish the demands for butter, milk, and other derivatives for human utilization. Livestock contributes 11.39% towards the gross domestic product of Pakistan and 58.33% in agricultural farming. Livestock face shortage or insufficient supply of green fodder during the winter season, which ultimately reduces milk yield. Oat (Avena sativa L.) is a major forage crop in the winter season; however, several biotic and abiotic factors negatively affect its yields. Low soil fertility, particularly nitrogen deficiency, is regarded as one of the few reasons responsible for the low forage yield of oat. Low organic matter content in the soil, suboptimal agronomic practices, and harsh climatic conditions are the other major reasons for low oat yield. Seed rate and different nitrogen rates significantly alter green forage yield and quality of oat. This study assessed the impact of different seeding densities and nitrogen (N) doses on the forage yield of oat. Three seeding densities (70, 80, and 90 kg ha-1) and five N doses (0, 40, 80, 120, and 160 kg ha-1) were included in the study. The interactive effect of seeding density and N doses significantly altered green forage yield and quality attributes of oat. The highest green forage yield (54.67 t ha-1) was noted for the interaction among 90 kg seed rate ha-1 and 160 kg N ha-1. Similarly, the highest germination count (140 m-2), number of tillers (5.97 m-2), plant height (122.97 cm), number of leaves per plant (24.50 m-2), leaf area per tiller (123.18 cm2), fresh weight (5.47 kg m-2), dry weight (1692 g m-2), dry matter yield (20.90 t ha-1), crude protein (10.54%), crude fiber (31.62%), and total ash (9.39%) were recorded for the interactive effect of 90 kg seed rate ha-1 and 160 kg N ha-1. Economic analysis revealed that interaction between 90 kg seed rate ha-1 with 120 and 160 kg N ha-1 was superior to others with higher benefit: cost ratio and net economic returns. It is recommended that the oat seed rate of forage oat crop must be kept at 90 kg ha-1 and it should be supplied 120 kg N ha-1 for higher yield, better quality, and more economic returns.

Alpinetin: a Dietary Flavonoid with Diverse Anticancer Effects.

Cancer is a global burden and mechanistically complex disease with a plethora of genetic, physiological, metabolic, and environmental alterations. The development of dietary nutraceuticals into cancer chemotherapeutics has emerged as a new paradigm in cancer treatment. Alpinetin (ALPI) is a novel flavonoid component of multiple edible and medicinal plants and possesses a wide range of biological and pharmacological activities including antibacterial, anti-hemostatic, anti-oxidative, anti-hepatotoxic, stomachic, immunosuppressive, and anti-inflammatory. Recently, ALPI has been reported as a bioactive dietary nutraceutical with promising anticancer activity in various human cancers through multiple mechanisms. The purpose of this review is to compile the data on natural sources of ALPI, and its anticancer activity including cellular targets and anticancer mechanism in various human cancers. Moreover, this review will set the stage for further design and conduct pre-clinical and clinical trials to develop ALPI into a lead structure for oncological therapy.