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Highway construction projects are known for their propensity to consume enormous quantities of materials and their susceptibility to generate considerable waste. Adequate research has been conducted on identifying the causes of waste produced in building projects, however, there are limited studies available on identifying causative factors for highway projects. This study aims to identify and evaluate the causes and factors of waste generated on highway projects using a literature review and questionnaire survey technique. Causes leading to waste in highway projects were identified from the literature as well as from highway construction experts. Subsequently, quantitative data were collected from 127 highway construction professionals using a Likert Scale questionnaire survey, which was ranked using the Relative Importance Index (RII) and further analyzed by using a very robust Factor Analysis (FA) technique. RII results highlight the most significant causes of waste in highway construction, while FA suggests the main factors contributing to the waste in highway projects. The top five most significant causes of waste revealed by this study were: (1) mistakes of surveyors, (2) faulty drawings, (3) incompetence of quantity surveyors, (4) faulty/substandard work, and (5) poor workers’ skills, whereas the seven waste factor groups evaluated by the study were: (1) design, (2) storage, (3) survey, (4) workers, (5) waste management, (6) site management, and (7) external. This study further suggested waste management and mitigation strategies for highway construction projects corresponding to each factor group. This is a novel study on waste generation in highway projects in Pakistan and will assist academia and industry practitioners in understanding and controlling construction waste generation in highway projects during various stages of project execution.

This narrative review presents a comprehensive examination of optical coherence tomography angiography (OCTA), a non-invasive retinal vascular imaging technology, as reported in the existing literature. Building on the coherence tomography principles of standard OCT, OCTA further delineates the retinal vascular system, thus offering an advanced alternative to conventional dye-based imaging. OCTA provides high-resolution visualisation of both the superficial and deep capillary networks, an achievement previously unattainable. However, image quality may be compromised by factors such as motion artefacts or media opacities, potentially limiting the utility of OCTA in certain patient cohorts. Despite these limitations, OCTA has various potential clinical applications in managing retinal and choroidal vascular diseases. Still, given its considerable cost implications relative to current modalities, further research is warranted to justify its broader application in clinical practice.

Purpose The purpose of this paper is to assess the influence of patients’ expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data (n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan’s most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients’ expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients’ expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

IntroductionIn response to the high maternal mortality in Afghanistan, the government emphasised enhancing antenatal care (ANC) coverage to improve skilled birth attendance and reduce maternal mortality. This study aimed to explain how and why ANC interventions worked, for whom, and under what circumstances in Afghanistan between 2000 and 2024.MethodsA rapid realist review was conducted to identify underlying programme theories and examine contextual factors and key mechanisms influencing ANC outcomes, with input from a panel of national experts. Data were extracted using context–mechanism–outcome (CMO) configurations to develop and refine theories for policy recommendations.ResultsFrom 3502 papers, 1860 duplicates were removed, 63 were screened for full text and 25 were included in the final review. In total, 29 CMOs were inferred across nine interventions, classified at individual, interpersonal, community and institutional levels. We found that ANC interventions could work best by empowering women and healthcare workers (HCWs), involving husbands, hiring female community health workers (CHWs), ensuring regular contact with the same HCWs, endorsing health messages by the government, incentivising CHWs and designing and implementing interventions using participatory approaches. Interventions are less successful when there is a lack of community trust in service quality or HCW qualifications, low decision-making ability among women, discomfort during travel to health facilities, adherence to traditional practices and beliefs, hiring CHWs from outside the community, chronic stress and lack of support among HCWs and unrecognised incentives.ConclusionOur evidence synthesis can inform donors, policymakers and implementers on how to design more effective ANC interventions to achieve better health outcomes in Afghanistan. By emphasising intervention evaluation and ANC quality improvement, it highlights the importance of key social elements, such as cultural norms, power dynamics, relationships, beliefs and trust, which are likely to maximise impact. Community involvement is essential for designing and implementing effective and sustainable ANC interventions.

The study aims to forecast the research output of four selected countries (USA, China, India and Pakistan) using two models of Grey System Theory—Even Model GM (1, 1) and Nonhomogeneous Discrete Grey Model (NDGM). The study also conducts publication growth analysis using relative growth rate (RGR) and the doubling time (Dt). The linear and exponential regression analyses were also performed for comparison. The study also proposes and successfully tests two novel synthetic models for RGR and Dt that facilities the comparison of the countries’ performance when actual data and forecasted data produce different sequences of performance in the given period of time. The data of documents published by the four countries from 2005 to 2016 was collected from SJR/Scopus website. Performance criterion was Mean Absolute Percentage Error. The study confirms that NDGM is a better model for forecasting research output as its accuracy level is higher than that of the Even Model GM (1, 1) and statistical regression models. The results revealed that USA is likely to continue leading in research output at least till 2025 however the research output difference between USA and China is likely to reduce. The study reveals that the less developed countries tend to possess higher relative growth rate in publications whereas the more developed countries tend to possess lower relative growth rate. Further, the more developed countries need more time for publications to double in numbers for a given relative growth rate and less developed countries need less time to do so. The study is original in term of its analysis of the problem using the models involved in the study. The study suggests that the strategies of USA and China to enhance the research output of their respective countries seem productive for the time being however in long run less developed countries have greater competitive advantage over the more developed countries because of their publication growth rate and time required to double the number of publications. The study reported nearly linear trend of growth in research output among the countries. The study is primarily important for the academic policy makers and encourages them to take corrective measures if the growth rate of their academic/publishing sector is not reasonable.

This paper adds to the existing body of knowledge by incorporating the role of fiscal decentralization (FD) in influencing CO 2 emissions. Therefore, this study looked at the effect of FD on CO 2 emissions in the presence of nonrenewable energy consumption (NRE), renewable energy consumption (REN), gross domestic product (GDP), and trade openness (TOP) for the period 1994–2018 in Japan. Thus, the current work intends to fill this knowledge gap by employing econometric techniques such as Bayer and Hanck cointegration, dynamic ordinary least squares (DOLS), fully modified ordinary least squares (FMOLS), and canonical cointegration regression (CCR). Additionally, the frequency domain causality analysis is used in the investigation to determine the causal impact of FD, NRE, REN, GDP, and TOP on CO2 emissions. The novelty of the frequency-domain approach is that it can differentiate between nonlinearity and causality levels and show causality among parameters with different frequencies. The DOLS, FMOLS, and CCR results reveal that NRE, GDP, and TOP augment CO 2 emissions in Japan, whereas FD and REN increase the quality of the atmosphere. Furthermore, the frequency causality test results show that FD, REN, GDP, and TOP have implications for CO 2 emissions in the long run, while NRE raises CO 2 emissions in the medium run. As a policy direction, the current study suggests expanding renewable energy consumption in Japan by emphasizing more on Sustainable Development Goals (7, 8, and 13).

Objective: We report a case of latent postoperative endophthalmitis caused by Staphylococcus cohnii in a 72-year-old woman.Observation: The patient was referred to the department of ophthalmology with blurry vision in her right eye 12 days after phacoemulsification. The clinical examination showed signs of endophthalmitis. A vitreous tap, with intraocular injection of ceftazidime, was performed, and topical dexamethasone and tobramycin were initiated. The postoperative follow-up showed reduction in the intraocular reaction, and the patient was afterwards discharged. After 6 months, her private ophthalmologist referred the patient again with signs of uveitis and macular edema. The clinical examination showed hypopyon and infiltrates on the posterior lens capsule which led to a vitrectomy with the removal of the posterior lens capsule infiltrate. With no signs of improvement at the postoperative follow-up, the intraocular lens was removed.Results: A pathological examination with H&E, Gram, and Periodic Acid Schiff showed gram-positive cocci in relation to the lens capsule. Polymerase chain reaction was performed, detecting DNA of Staphylococcus cohnii.Conclusion and Importance: Staphylococcus cohnii should be considered in cases of latent endophthalmitis. Staphylococcus cohnii is a gram-positive coagulase-negative bacterium that produces biofilm. Biofilm can promote adherence to implants leading to failure of therapy.

In-stent restenosis (ISR) has always been considered a conundrum for interventional cardiologists. Despite many technical advances in the past 20 years aimed at reducing its occurrence, this area of interventional cardiology remains challenging. Here, we present a novel use of intravascular lithotripsy therapy (IVL) in a patient with repeat ISR, in whom IVL treatment has provided excellent procedural and follow-up results. Here, we present a 79-year-old man with previous ISR to a left circumflex artery (LCX) stent presenting with angina. An elective coronary angiogram confirmed recurrent ISR in the LCX. This was treated by IVL, which provided an excellent procedural result. The patient made an uneventful recovery and was discharged the same day with a follow-up 90 days postprocedure, at which point they were asymptomatic from angina. IVL is a relatively simple technique to modify ISR with a short learning curve. This case presentation highlights a novel use of IVL in a subclass of patients that remains challenging for the interventional cardiology community.

This paper offers a new indulgence to the present literature by integrating the role of fiscal decentralization (FD) in affecting ecological footprint (EF). So, this study considered the effect of FD on EF in the existence of energy consumption (EC), technological innovation (TI), gross domestic product (GDP), and trade openness (TOP) from 1990 to 2018 in Pakistan. We employ econometric methods like Bayer & Hanck cointegration, fully modified ordinary least squares, dynamic ordinary least squares, and canonical cointegration regression for empirical analysis. Moreover, the frequency domain causality test is used to conclude the causal impact of FD, EC, TI, GDP, and TOP on EF. The regression results disclose that EC, GDP, and TOP boost EF in Pakistan; however, FD and TI promote the sustainability of the environment by reducing EF. Besides, the frequency causality outcomes indicate that FD, EC, TI, GDP, and TOP have insinuations for EF in the long term. As a policy recommendation, this research suggests that Pakistan could successfully integrate strategies to increase ecological quality by allowing the lower level of government to utilize eco-friendly technological innovations.

This novel research looked into the role of public-private partnership investment in energy in affecting Pakistan’s long-term environmental sustainability. Employing time series data from 1992 to 2018 and utilizing the autoregressive distributive lag model (ARDL) model, we found a long-term equilibrium association of ecological footprint with public-private partnership investment in energy, technological innovation, economic growth, and trade openness. Our outcomes showed a significant positive association between public-private partnership investment in energy and ecological footprint in the long-run and the short-run, specifying that the increase in public-private partnership investment in energy affects the environmental sustainability of Pakistan. Similarly, our study confirmed that technological innovation, economic growth, and trade openness increase the ecological footprint in Pakistan. It demonstrates that these factors are unfavorable to the sustainable environment in Pakistan. Furthermore, robustness check findings are analogous to the results of ARDL estimates, utilizing dynamic ordinary least squares and fully modified ordinary least squares. On the basis of the research conclusions, a multi-pronged sustainable development goal (SDG) model was proposed that addresses SDG 8 and SDG 13 while incorporating SDG 17 as a medium.