Aeromonas hydrophila induced necrotizing fasciitis following laparoscopic cholecystectomy.

Necrotizi ng fasciit is [NF] i s a m ultifaceted disease of the muscle fascia and body tissues which demands the earliest intervention. Past reviews have documented ver y few cases of Aeromonas Hydroph ila [AH] induced N F fol lo wing abdominal surgery. AH can cause fatal NF as seen in a 72 year old female patient reported at Liaquat National Hospital &Medical College; a ter tiary care center in Karachi, Pakistan on 2nd April, 2022. She had a k nown comorbidity of hypertension and presented with the chief complaint of symptomatic gallstones for which she unde rwent Laparoscopic Cholecystectomy (LAPCHOL). She developed NF of the lower ab domen post- oper atively. Following uneventful Laparoscopic Cholecystectomy our pati ent presented to the ER two days later with severe lower abdo minal pain and overlyi ng celluliti s. Fasc io to my revealed extensive myonecrosis with necrotizing soft tissue in fe ction. Despite u ndergoing extensive surgical debr idement and broad spectr um antibi ot ic administration; the patient died in the ICU on the fifth postoperat ive day followi ng septic complications. Histopathologica l an alysis, confirmed i nflammat ion and necrosis. Culture sensitivity of the debrided tissue revealed AH. Approach should lie towards analyzing the behaviour of such microbes in high risk patients through collective case studies. This is the first clinical case showcasing such parameters e ncountered in the General Surger y Department.

Palestinian Nursing Students' Perspective of Clinical Decision-Making.

Introduction: One of the most important aspects of nursing education and practice is clinical decision-making (CDM), which is also crucial to clinical competency. Objective: The study aimed to assess the CDM of undergraduate nursing students by using the CDM nursing scale. Method: The study was cross-sectional and involved 315 nursing student participants. Data collection utilized the Clinical Decision-Making Scale, which comprises domains such as "canvassing of objectives and values," "search for alternatives or options," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Statistical analyses included Pearson correlation, ANOVA, and independent t-tests. Data collection occurred during the second semester of 2023. Results: The results indicated that the mean age of the students was 21.69 (SD = 1.6) years. In terms of gender, the majority were males, constituting 216 (68.6%) of the participants. Among the participants, 105 (33.3%) were from the second year, 108 (34.3%) from the third year, and 102 (32.4%) from the fourth year. The analysis revealed that the average CDM score was 129.8 (SD = 17.5). Additionally, examination of the subscales of CDM showed that the highest subscale score was for "search for information and unbiased assimilation of new information" (M = 33.1, SD = 5.3), while the lowest subscale score was for "search for alternatives or options" (M = 31.8, SD = 6.0). Furthermore, the analysis demonstrated a significant difference between academic year level and the mean CDM scores (p < .05), along with a positive relationship between the CDM score and students' age (r = .67, p = .001). Conclusion: The findings revealed that nursing students exhibit a moderate level of CDM. Moreover, it was revealed that students' CDM is influenced by both their age and academic year level.

Knowledge about Breast Cancer and Barriers to Screening among Saudi Women in Al-Baha Region.

OBJECTIVE: The aim of this study was to measure the knowledge about breast cancer and to identify the barriers in screening among Saudi women in the Al-Baha region. To achieve this, a cross-sectional study was conducted, involving 468 women, to assess their understanding of breast cancer and to explore the obstacles they face in accessing breast cancer screening services. METHODS: The cross-sectional study included 468 women from Al Baha, Saudi Arabia, starting from May 17, 2022, to May 17, 2023. Participants were interviewed by well-trained team members of the research, and their responses were subsequently entered into a Google Form. This process aimed to evaluate their awareness, knowledge, and barriers to breast cancer screening. RESULTS: The majority of participants (48.9%) were in the 18-28 age group. The findings reveal a high level of awareness (96.4%) among participants regarding the significance of early breast cancer detection. For the effectiveness of breast cancer treatment, 59% believed there is an effective treatment, while 32.9% were uncertain or did not know. Knowledge about various risk factors for breast cancer varied. Smoking (73.5%), genetic factors (65.6%), and a family history of breast cancer (70.7%) were well-recognized as risk factors. Education and occupation significantly influenced knowledge about breast cancer (p-value of 0.000, and 0.035 respectively). CONCLUSION: this research highlights strong awareness of breast cancer's importance but gaps in knowledge regarding lesser-known factors. Education is crucial, requiring tailored campaigns and healthcare professional engagement.

Asymmetric role of green energy, innovation, and technology in mitigating greenhouse gas emissions: evidence from India.

The primary cause of environmental degradation, which poses a danger to the long-term viability of the ecosystem, is the emission of greenhouse gases (GHG). For this reason, the Glasgow Climate Pact (COP26) established a decarbonization goal in response to this ecological concern, for which all economic players have a responsibility. India is among the participants who have a target set for them to decarbonize their economies by the year 2060 via the use of green energy and the advancement of science and innovation. Nevertheless, the asymmetrical effect of green energy, technology, and innovation on India's decarbonization program was not sufficiently explored in the prior study; hence, this research aims to fill this literature vacuum by considering India's GHG emissions from 1990 to 2020 by leveraging the non-linear autoregressive distributed lag (NARDL) model. The findings reveal the asymmetric influences of variables of interest on GHG emissions during the short and long term and under positive and negative shocks. Regarding the positive shock, long-term findings demonstrate that innovation and technical know-how grow GHG emissions and accelerate environmental degradation. However, a negative shock in innovations and technological know-how is opposed to a positive shock and improving environmental conditions. Further, positive shocks in green energy boost environmental effectiveness by reducing GHG secretions in India. In contrast, the negative shock in green energy deteriorates the environment by triggering GHG releases. These factual findings compel the Indian government to prioritize green technologies in addition to green energy generation to decouple economic growth from greenhouse gas emissions and meet rising energy demands.

Demystifying the association between economic development, transportation, tourism, renewable energy, and ecological footprint in Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation region during globalization mode.

The Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) economies have yet to meaningfully contribute to accomplishing Sustainable Development Goals (SDG 7) affordable and clean energy, (SDG 8) decent work and economic growth, and (SDG 13) climate action. Dealing with this issue might require a shift or alteration of policy framework that is the major theme of this study. Consequently, this present research inspects the influence of economic growth, transportation, tourism sector development, and renewable energy on ecological footprint using panel time series from 1990 and 2019 for the BIMSTEC region. To evaluate this dynamic nexus between the mentioned environmental pollution drivers of ecological footprint, this study employed the augumented mean group (AMG) and common correlated effect mean group (CCEMG) regression estimators after detection of cross-sectional dependency. The empirical outcomes denote that economic growth and transportation sector of BIMSTEC countries increase the levels of ecological footprint. Conversely, tourism sector development, globalization, and renewable energy protect the ecological excellence in the region. Moreover, it is observed that a unidirectional causality exists from economic growth to ecological footprint, ecological footprint to transportation, tourism to ecological footprint, and globalization to ecological footprint, while bidirectional causality exists between renewable energy and ecological footprint. By observing the positive function of tourism, green energy, and globalization on sustainable environment progress, central authorities are capable to redesign policies concerning supportable efficient technologies and regulate globalization towards green programs and agenda to reduce global warming.

Impact of banking development and renewable energy consumption on environmental sustainability in Germany: Novel findings using the bootstrap ARDL approach.

This study examines the effects of banking development, economic growth and consumption of renewable energy on carbon dioxide (CO2) emissions and load capacity factor (LCF). Previous empirical studies have assessed the interrelationship between banking development and CO2 emissions; however, these studies have ignored supply-side ecological issues. To overcome this issue, this study evaluates the effect of banking development on LCF, which is considered to be one of the most comprehensive ecological proxies to date, including both biocapacity and ecological footprint (EF). Using the bootstrap autoregressive distributed lag model, the study reveals that renewable energy improves ecological quality in Germany. The results of the investigation demonstrate that the environmental Kuznets curve hypothesis is valid in Germany using CO2 emissions and LCF indicators. Furthermore, this study demonstrates that banking growth and renewable energy in Germany correlate with improved environmental quality. These findings provide policymakers with important insights. In this context, the study advises the banking industry and government authorities to leverage banking expansion to support green energy to achieve the national goal of zero CO2 emissions by 2045.

A challenging case of pancreaticogastric anastomotic stricture in a patient with surgically altered anatomy.

Video 1EUS-guided gastro-jejunostomy using a lumen-apposing metal stent to access the surgical pancreaticogastric anastomotic site and perform EUS-guided de novo pancreatico-gastrostomy for the management of a postsurgical pancreaticogastric anastomotic stricture with pancreatic insufficiency.

Environmental cost of natural resources, globalization, and economic policy uncertainty in the G-7 bloc: do human capital and renewable energy matter?

The panel of G-7 economies is considered one of the most prosperous economies, endowed with abundant natural and renewable energy resources. Due to their richness in these resources, most economic development and activities, including environmental and economic aspects, depend on and are determined by energy consumption and natural resource rents. However, the increasing dependence of G-7 economies on energy consumption and natural resources raises questions about their long-term growth and ecological policies towards achieving sustainable development goals (SDGs). Therefore, the main objective of this study is to examine the influence of natural resources, renewable energy, economic policy uncertainty, human capital, and globalization on the ecological footprint in the panel of G-7 economies from 1990 to 2020. After confirming the cross-sectional dependence issue, this study applied second-generation panel data approaches to estimate robust and reliable outcomes. The estimated evidence from this study discovered that natural resources, globalization processes, and economic policy uncertainty significantly increase the level of ecological footprint in the region. In contrast, renewable energy and human capital provide feasible solutions for ecological improvement in the study area. Likewise, the interactive role of renewable energy with economic policy uncertainty significantly protects the environmental quality in the study area. Based on the estimated findings, this study recommends various achievable policy options for policymakers and the governments of these economies to ensure environmental sustainability.

Statistical inferences under step stress partially accelerated life testing based on multiple censoring approaches using simulated and real-life engineering data.

Evaluating the lifespan distribution of highly reliable commodities under regular use is exceedingly difficult, time consuming, and extremely expensive. As a result of its ability to provide more failure data faster and at a lower experimental cost, accelerated life testing has become increasingly important in life testing studies. In this article, we concentrate on parametric inference for step stress partially life testing utilizing multiple censored data based on the Tampered Random Variable model. Under normal stress circumstances, the lifespan of the experimental units is assumed to follow the Nadarajah-Haghighi distribution, with and being the shape and scale parameters, respectively. Maximum likelihood estimates for model parameters and acceleration factor are developed using multiple censored data. We build asymptotic confidence intervals for the unknown parameters using the observed Fisher information matrix. To demonstrate the applicability of the different methodologies, an actual data set based on the timings of subsequent failures of consecutive air conditioning system failures for each member of a Boeing 720 jet aircraft fleet is investigated. Finally, thorough simulation studies utilizing various censoring strategies are performed to evaluate the estimate procedure performance. Several sample sizes were studied in order to investigate the finite sample features of the considered estimators. According to our numerical findings, the values of mean squared errors and average asymptotic confidence intervals lengths drop as sample size increases. Furthermore, when the censoring level is reduced, the considered estimates of the parameters approach their genuine values.

The role of monetary and fiscal policies in determining environmental pollution: Revisiting the N-shaped EKC hypothesis for China.

The equilibrium between environmental quality and economic growth is one of the contemporary objectives of fiscal and monetary policies in the case of China. In this study, we investigate the extent of the existence of the N-shaped environmental Kuznets curve (EKC) hypothesis and measure the collision of fiscal and monetary policy on carbon emissions within the economic growth perspectives that China is witnessing. This study examines the dynamic nexus between monetary supply, government expenditure, and carbon emissions in China over the spanning from 1980 to 2019. The findings demonstrate that the money supply reduces carbon emissions in the short- and long-run. Precisely, a 1-unit augmentation in monetary policy tool (money supply) will significantly reduce the pressure on the environment by 0.29332 unit in the long-run and 0.79311 unit in the short-run. In contrast, the fiscal policy instrument (government expenditure) contributes to the increase in carbon emissions. Specifically, a 1-unit increase in government expenditure will increase the carbon emission by 0.17835 and 0.48247 units in the long-run and short-run, respectively. Additionally, the result also confirmed the N-shaped EKC hypothesis. Particularly, at the initial stage of economic growth, there are 1.58659 and 4.29197 unit increas in carbon emission in the long-run and short-run, respectively. However, after taking the square of economic growth, this reduces the environmental pollution by 0.3018 and 0.81665 units in the long-run and short-run, respectively. Finally, the cubic form of economic growth shows the 0.01755 and 0.04747 units increase in the pollution level in the long-run and short-run, respectively. Moreover, the study also found the presence of a causality link between government expenditure, economic growth, and carbon emissions. These findings will aid policymakers in implementing fiscal and monetary policies that promote long-term development while lowering carbon emissions.

Region of interest (ROI) selection using vision transformer for automatic analysis using whole slide images.

Selecting regions of interest (ROI) is a common step in medical image analysis across all imaging modalities. An ROI is a subset of an image appropriate for the intended analysis and identified manually by experts. In modern pathology, the analysis involves processing multidimensional and high resolution whole slide image (WSI) tiles automatically with an overwhelming quantity of structural and functional information. Despite recent improvements in computing capacity, analyzing such a plethora of data is challenging but vital to accurate analysis. Automatic ROI detection can significantly reduce the number of pixels to be processed, speed the analysis, improve accuracy and reduce dependency on pathologists. In this paper, we present an ROI detection method for WSI and demonstrated it for human epidermal growth factor receptor 2 (HER2) grading for breast cancer patients. Existing HER2 grading relies on manual ROI selection, which is tedious, time-consuming and suffers from inter-observer and intra-observer variability. This study found that the HER2 grade changes with ROI selection. We proposed an ROI detection method using Vision Transformer and investigated the role of image magnification for ROI detection. This method yielded an accuracy of 99% using 20 × WSI and 97% using 10 × WSI for the ROI detection. In the demonstration, the proposed method increased the diagnostic agreement to 99.3% with the clinical scores and reduced the time to 15 seconds for automated HER2 grading.

Tobacco harm reduction in Afghanistan: a recipe for improving smokers' health.

Tobacco Harm Reduction (THR) offers a promising approach to addressing the significant burden of smoking in Afghanistan. Over three million Afghans smoke daily, making it a leading cause of preventable deaths in the country. While the previous Afghan government implemented various tobacco cessation policies and strategies, these measures were only partially effective in reducing the number of smokers or smoking-related deaths. In 2021, community-based initiatives in Kabul and Herat started advocating for Tobacco Harm Reduction (THR) as a novel, realistic, and practical approach proven to promote smoking abstinence and minimize tobacco harm. However, implementing THR strategies in Afghanistan faces numerous challenges, including a lack of governmental support, funding issues, unfavorable market conditions, the high cost-effectiveness of THR products, and misconceptions about these products. To effectively promote THR in Afghanistan and overcome these challenges, it will be necessary to implement THR policies that support THR products for smokers, regulate the market for these products, produce them locally with healthcare professional oversight, conduct more engaging advocacy campaigns, and secure domestic sponsors.

Singular Nuclei Segmentation for Automatic HER2 Quantification Using CISH Whole Slide Images.

Human epidermal growth factor receptor 2 (HER2) quantification is performed routinely for all breast cancer patients to determine their suitability for HER2-targeted therapy. Fluorescence in situ hybridization (FISH) and chromogenic in situ hybridization (CISH) are the US Food and Drug Administration (FDA) approved tests for HER2 quantification in which at least 20 cancer-affected singular nuclei are quantified for HER2 grading. CISH is more advantageous than FISH for cost, time and practical usability. In clinical practice, nuclei suitable for HER2 quantification are selected manually by pathologists which is time-consuming and laborious. Previously, a method was proposed for automatic HER2 quantification using a support vector machine (SVM) to detect suitable singular nuclei from CISH slides. However, the SVM-based method occasionally failed to detect singular nuclei resulting in inaccurate results. Therefore, it is necessary to develop a robust nuclei detection method for reliable automatic HER2 quantification. In this paper, we propose a robust U-net-based singular nuclei detection method with complementary color correction and deconvolution adapted for accurate HER2 grading using CISH whole slide images (WSIs). The efficacy of the proposed method was demonstrated for automatic HER2 quantification during a comparison with the SVM-based approach.

The Perception of Health Professionals in Bangladesh toward the Digitalization of the Health Sector.

Bangladesh is undertaking a major transformation towards digitalization in every sector, and healthcare is no exception. Digitalization of the health sector is expected to improve healthcare services while reducing human effort and ensuring the satisfaction of patients and health professionals. However, for practical and successful digitalization, it is necessary to understand the perceptions of health professionals. Therefore, we conducted a cross-sectional survey in Bangladesh to investigate health professionals' perceptions in relation to various socio-demographic variables such as age, gender, location, profession and institution. We also evaluated their competencies, as digital health-related competencies are required for digitalization. Additionally, we identified major digitalization challenges. Quantitative survey data were analyzed with Python Pandas, and qualitative data were classified using Valence-Aware Dictionary and Sentiment Reasoner (VADER). This study found significant relationships between age χ2(12,N=701)=82.02,p<0.001; location χ2(4,N=701)=18.78,p<0.001; and profession χ2(16,N=701)=71.02,p<0.001; with technical competency. These variables also have similar influences on psychological competency. According to VADER, 88.1% (583/701) of respondents have a positive outlook toward digitalization. The internal consistency of the survey was confirmed by Cronbach's alpha score (0.746). This study assisted in developing a better understanding of how professionals perceive digitalization, categorizes professionals based on competency, and prioritizes the major digitalization challenges.

Development of immunotherapy for high-grade gliomas: Overcoming the immunosuppressive tumor microenvironment.

The preclinical and clinical development of novel immunotherapies for the treatment of central nervous system (CNS) tumors is advancing at a rapid pace. High-grade gliomas (HGG) are aggressive tumors with poor prognoses in both adult and pediatric patients, and innovative and effective therapies are greatly needed. The use of cytotoxic chemotherapies has marginally improved survival in some HGG patient populations. Although several challenges exist for the successful development of immunotherapies for CNS tumors, recent insights into the genetic alterations that define the pathogenesis of HGG and their direct effects on the tumor microenvironment (TME) may allow for a more refined and targeted therapeutic approach. This review will focus on the TME in HGG, the genetic drivers frequently found in these tumors and their effect on the TME, the development of immunotherapy for HGG, and the practical challenges in clinical trials employing immunotherapy for HGG. Herein, we will discuss broadly the TME and immunotherapy development in HGG, with a specific focus on glioblastoma multiforme (GBM) as well as additional discussion in the context of the pediatric HGG diagnoses of diffuse midline glioma (DMG) and diffuse hemispheric glioma (DHG).

Prognostic criteria for the management of temporomandibular disorders using arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma.

Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies (TMJ hypermobility, internal disc derangement, bone changes, degenerative disorders, and ankylosis). Pain, clicking or crepitus, restricted range of motion, deranged jaw function, and deflected or deviated mouth opening and closing are the commonly observed manifestations in TMDs. Internal derangement refers to an aberrant relation of the articular disc to the condyle and fossa, respectively. Conventional therapies highlight the role of non-invasive conservative treatment strategies, namely joint unloading, anti-inflammatory drugs, and physiotherapy. Current literature has emphasized the use of corticosteroids and platelet-rich plasma (PRP) as treatment strategies in TMDs. This study aimed to evaluate whether intra-articular injection of PRP after normal saline lavage in TMJ minimizes the symptoms of TMDs, as compared to injection of normal saline. Thirty patients with TMD according to research diagnostic criteria (RDC) were selected. One group received arthrocentesis with normal saline, and the other group received arthrocentesis with PRP injection. The patients were assessed for pain, maximum inter-incisal mouth opening, bite force, and TMJ sounds. TMDs treated by PRP injection had slightly better results. More studies are required to substantiate the outcome. Injections of PRP were more effective in reducing the symptoms than arthrocentesis with normal saline.

Design, Fabrication, Structure Optimization and Pressure Sensing Demonstration of COC Piezoelectret Sensor and Sensor Array.

This study reported on the design and fabrication of a pseudo-piezoelectric material (piezoelectret) from cyclic olefin copolymer (COC) based on a micropillar structure. The fabrication feasibility of such structure was explored and piezoelectret with the good piezoelectric activity (characterized by quasi-static piezoelectric coefficient d33) was demonstrated. Response surface method with a central composite design was employed to investigate the effects of the structure parameter on the piezoelectric coefficient d33. An optimal structure design was obtained and was validated by experiments. With the optimal design, d33 can reach an exceptional high value of ~9000 pC/N under low pressure. The charging process and the electrical and electromechanical characteristics were further investigated by experimentation and modeling. We further demonstrated the scalability of the fabrication process and demonstrated the application of these sensors in position specific pressure sensing (pressure mapping).

A 2-month post-COVID-19 follow-up study on patients with dyspnea.

BACKGROUND AND AIMS: Dyspnea is one of the most common symptoms associated with the COVID-19 caused by novel coronavirus SARS-CoV-2. This study aimed to assess the prevalence of dyspnea, observe co-variables, and find predictors of dyspnea after 2 months of recovery from COVID-19. METHODS: A total of 377 patients were included in the study based on their responses and clinical findings during initial admission to the hospital with COVID-19. After excluding five deceased patients, a total of 327 patients were interviewed through telephone using a 12-point dyspnea scale and using relevant questions to gauge the patient clinically. Interviews were carried out by trained physicians, and responses were recorded and stored. All analyses were carried out using the statistical programming language R. RESULTS: Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after 2 months of COVID-19. The study demonstrated that patient oxygen saturation level SpO2 (P = .03), D-dimer (P = .001), serum ferritin (P = .006), and the presence and severity of dyspnea are significantly correlated. In addition to that, patient smoking history (P = .012) and comorbidities such as chronic obstructive pulmonary disease (COPD) (P = .021) were found to be statistically significant among groups. CONCLUSION: These findings of this study can be useful for predicting and managing long-term complications of COVID-19.

Silver Nanoparticles as Potential Antiviral Agents.

Since the early 1990s, nanotechnology has led to new horizons in nanomedicine, which encompasses all spheres of science including chemistry, material science, biology, and biotechnology. Emerging viral infections are creating severe hazards to public health worldwide, recently, COVID-19 has caused mass human casualties with significant economic impacts. Interestingly, silver nanoparticles (AgNPs) exhibited the potential to destroy viruses, bacteria, and fungi using various methods. However, developing safe and effective antiviral drugs is challenging, as viruses use host cells for replication. Designing drugs that do not harm host cells while targeting viruses is complicated. In recent years, the impact of AgNPs on viruses has been evaluated. Here, we discuss the potential role of silver nanoparticles as antiviral agents. In this review, we focus on the properties of AgNPs such as their characterization methods, antiviral activity, mechanisms, applications, and toxicity.