Search

Background: Birth injury is defined as impairment of neonate’s body function that occur due to mechanical forces during the process of delivery. Incidence of birth injury varies from place to place, with place of delivery, experience of birth attendants, and mode of delivery. Objective: To determine the incidence, characteristics of birth injury in the Special Care Baby Unit of the University of Maiduguri Teaching Hospital (UMTH). Subjects and methods: This is a prospective observational study that was conducted in a Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital. The subjects were recruited between 1st January, 2016 and 31st December, 2016. Neonatal birth injury was diagnosed based on paediatrician or senior registrar examination. Demographic variables: maternal age, maternal weight, and height, reproductive and labour variables: prenatal care, parity, gestational age, presence and duration of PROM, duration of labour, type of delivery, and skill of delivery attendance, while neonatal variables, includes: neonatal age, sex, birth weight, length, Apgar score, and type of birth injury. The treatment administered to the patients were either medical management such exchange blood transfusion in case of severe Jaundice complicating cephalhaematoma and/or simple transfusion for anaemia without complication, phototherapy, antibiotics, among others, or surgical/orthopaedic treatment in the presence of surgical injury. Statistical analysis was done using SPSS version 16 (SPSS Inc., Illinois, Chicago USA). A P-value < 0.0001. Soft tissue injury constituted the majority accounting for 37/61 (60.7%), closely followed by sub- conjunctival haemorrhages 25/61 (41.0%). Severe perinatal asphyxia also constituted significant proportion of the birth injury 24/61 (39.3%). Other central nervous system (CNS) birth injuries includes facial nerve palsy and Erb’s palsy 13.1% each. The commonest of the fractures was femoral bone fracture 9/61 (14.8%), followed by clavicular fracture 5/61 (8.2%). It was revealed that urea 2.5 mmol/L, total serum bilirubin (TSSB) 12.4 μmol/L and random blood sugar 2.6mmol/L were deranged in those neonates with three or more birth injuries and all the three parameters were statistically significant p0.05. Four patients died, two with internal organ injury were, of which one with splenic rupture and the other one with liver damage in addition to severe perinatal asphyxia died while the remaining two patients with severe perinatal asphyxia also died with mortality rate of 6.6%. Conclusion: The incidence of birth injury has decreased overtime especially in the affluent economy where obstetric and perinatal diagnosis has remarkably improved, but in the developing economy like ours as demonstrated in this study CC –BY 100 such an improvement is yet to be achieved. However education of the general populace especially the pregnant women so that they attend antenatal care and deliver at health facility with skilled health personnel will remarkably reduce birth injury.

Hadeel Abdulelah Ibrahim College of Nursing, University of Sulaimani, Kurdistan Region, Republic of IraqCorrespondence: Hadeel Abdulelah IbrahimCollege of Nursing, University of Sulaimani, Kurdistan Region, Republic of IraqTel +964(0)7703914402Email hadeel.ibrahim@univsul.edu.iqBackground: The effects of vitamin D3 (VD3) on pregnancy outcomes remain obscure. Thus, this study aims to investigate the relationship between maternal H. pylori infection, low VD3 level, and spontaneous abortion.Methods: This research is conducted in Shahid Ali Qader Consultant Clinic in Sulaimaniyah city in which 100 women with a history of abortion and 100 women with no history of miscarriage were included. Serum detection of anti-H. pyloriIgG, IgA, and VD3 were done using enzyme-linked immunosorbent assay (ELISA) technique.Results: The mean of VD3, H. pylori IgG, and IgAin patients and control group cases was determined and analyzed statistically.Conclusion: H. pylori infection and VD3 play a significant role in early pregnancy loss. Blood group A and O are more prone to spontaneous abortion.Keywords: miscarriage, bacterial infection, vitamin deficiency, antibody detection, ABO grouping

Mohamed El-Shanshory,1,2 Nahed M Hablas,2 Yasmin Shebl,2 Ahmed R Fakhreldin,3 Mohamed Attia,4 Hamdi H Almaramhy,5 Hussam Baghdadi,6 Mongi Ayat,1,6 Amal Albeihany,7 Amr El-Dardear,1,8,9 Hoda Ali Ibrahim,10 Hany Salah Mahmoud,11 Manal Mohamed Helmy Nabo,12,13 Salah Mohamed El Sayed1,6,14 1Prophetic Medicine Course and Research, Taibah College of Medicine, Medina, Saudi Arabia; 2Department of Pediatrics, Tanta University Faculty of Medicine, Tanta Gharbia, Egypt; 3Department of Pediatrics, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt; 4Department of Clinical Pathology, Tanta Faculty of Medicine, Tanta University, Tanta, Egypt; 5Department of Surgery, Taibah Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 6Department of Clinical Biochemistry and Molecular Medicine, Taibah Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 7Department of Hematology, King Fahd Hospital, Ministry of Health, Medina, Saudi Arabia; 8Department of Pediatrics, Faculty of Medicine, Taibah University, Medina, Saudi Arabia; 9Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; 10Department of Biochemistry, Tanta Faculty of Medicine, Tanta University, Tanta, Egypt; 11Scientific Center for Experimental and Research Studies, Cairo, Egypt; 12Division of Pediatric Intensive Care Unit, King Fahad Hospital, Ministry of Health, Medina, Saudi Arabia; 13Division of Pediatric Cardiology, Pediatrics Department, Sohag Teaching Hospital, Ministry of Health, Sohag, Egypt; 14Department of Medical Biochemistry, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt Background: Thalassemia is a major health problem due to iron overload, iron deposition and oxidative stress-induced tissue damage. Here, we introduce Al-hijamah (a minor surgical excretory procedure) as a novel percutaneous iron excretion therapy. Al-hijamah is a wet cupping therapy of prophetic medicine, and prophet Muhammad, peace be upon him, strongly recommended Al-hijamah, saying: “The best of your treatment is Al-hijamah”. Aim of the study: Our study aimed at investigating the safety, iron chelation, pharmacological potentiation and oxidant clearance effects exerted by Al-hijamah to thalassemic children. Patients and methods: Ethical committee’s approval and patients’ written agreement consents were obtained. We treated 20 thalassemic children (15 males and five females aged 9.07±4.26 years) with iron chelation therapy (ICT) plus Al-hijamah (using sterile disposable sets and in a complete aseptic environment) vs a control group treated with ICT only. This clinical trial was registered in the ClinicalTrial.gov registry under the name “Study of the Therapeutic Benefits of Al-hijamah in Children with Beta Thalassemia Major” (identifier no NCT 02761395) on 30 January 2016. Results: Al-hijamah was quite simple, safe, effective, tolerable (with no side effects) and time-saving procedure (30–60 minutes). A single session of Al-hijamah significantly reduced iron overload (P

Ashraf Othman Sayed,1 Nancy Selim Zeidan,2 Dalia Monir Fahmy,3 Hossam A Ibrahim4 1Department of Pediatrics, Children and Women’s University Hospital, Minia University, El-Minya, Egypt; 2Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of Diagnostic Radiology, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt Background: Diagnosis of appendicitis in children is clinically challenging. Computed tomography (CT) is the gold standard for diagnosis; however, radiation exposure early in life is a concern with this technique. Therefore, in this study, we aimed to evaluate the diagnostic reliability of low-dose CT, pediatric appendicitis score (PAS), and abdominal ultrasound (US) in children with acute appendicitis, to reach a safe diagnosis. Patients and methods: This retrospective study was conducted on 140 children who were admitted with clinically suspected acute appendicitis (45 with positive appendicitis and 95 children with negative appendicitis). Low-dose CT was performed, and PAS was retrospectively calculated for all subjects. US was initially performed for 38 subjects. All results were compared with the final diagnosis reached by an operative, histopathological analysis and follow-up. Results: Low-dose CT showed a sensitivity, specificity, and accuracy of 97.8%, 100%, and 99.3%, respectively. At a cutoff value ≥5, PAS showed a sensitivity, specificity, and accuracy of 95%, 84%, and 89%, respectively. Abdominal US examination showed sensitivity, specificity, and accuracy of 55.6%, 85%, and 71%, respectively. Implementing Poortman’s model resulted in higher accuracy (92%) of US. There was a significant difference in accuracy between a low-dose CT and PAS on one side and between Poortman’s model and US examination on the other side. A diagnostic scheme was suggested using PAS as the excluding tool (PAS ≤2 send home and ≥7 send directly to operation) followed by US examination and reserving low-dose CT for inconclusive cases. This scheme would eliminate the use of CT for at least 33.7% and in 7 cases who had initial US examination. Conclusion: Although CT remains the most accurate and less operator-dependent diagnostic tool for pediatric appendicitis, the radiation hazards could however be minimized using PAS as an excluding tool and US as the primary imaging modality followed by low-dose CT for inconclusive cases only. Keywords: acute appendicitis, children, pediatric appendicitis scoring system, PAS, computed tomography, CT, ultrasound, US

Abstract There are limited data on the effects of a high-fructose diet on the female reproductive system. Although metformin has some functional effects on female fertility, its reproductive outcome on high fructose diet-induced metabolic syndrome is unclear. The aim of the present study is to evaluate the impact of a high fructose diet on histomorphological and molecular parameters of the reproductive organs and vaginal microbiota as well as the treatment potential of metformin. Wistar albino rats were used in the study. The metabolic syndrome model was induced by a high-fructose diet in rats for 15 weeks. Metformin was orally administered once a day for the last 6 weeks. The high-fructose diet increased blood glucose, triglycerides, insulin, and ovarian testosterone levels; however, it reduced ovarian aromatase levels and follicle numbers and caused uterine inflammation. The high-fructose diet-induced molecular abnormalities on ovarian tissue were demonstrated by the downregulation of ovarian insulin signaling pathway proteins and dysregulation of ovarian mitogenic and apoptotic pathway proteins. A high-fructose diet caused vaginal dysbiosis, metformin increased probiotic bacteria in the vaginal microbiota. Our results revealed that metformin improves ovarian impairments by modulating hormonal balance, insulin level, mapk, and apoptotic signaling molecules, as well as regulating the vaginal microbiota.

According to the Ministry of National Education, 2013, children with diverse needs have the right to receive their education in environments designed to meet their needs and allow them to interact with their peers. Instructional programs that can meet all children’s needs are one of the suggested programs during the implementation of inclusive programs. The Naturalistic Teaching Process is a recommended method in this context. The Naturalistic Teaching Process is a natural instructional process that allows children to acquire and reinforce new skills. This study aims to define the perspectives of preschool teachers who have children with diverse needs in their classrooms on the Naturalistic Teaching Process. Semi-structured interviews collected the data. Fifteen preschool teachers participated in this study. The data analysis employed an inductive approach based on content analysis. The study findings indicate that preschool teachers tend to follow a child's lead when setting educational objectives for children with diverse needs and developing an individualized educational program. Additionally, the study defines preschool teachers' abilities as inadequate for collaboration with families and specialists. Preschool teachers partially use the strategies and techniques, environmental arrangements, and prompts used in the Naturalistic Teaching Process, but they do not apply them systematically, indicating a need for teacher training in these areas.

Abstract Background Ventricular tachycardia storm is a syndrome defined by the presence of at least three episodes of ventricular tachycardia over a 24-h period, requiring termination by intervention. Standard therapy consists initially of using intravenous betablockers (if left ventricular ejection fraction is preserved) and Amiodarone, in addition to intravenous Lidocaine (in case of ischemic etiology) and light sedation. In the present case, a ventricular tachycardia storm episode is terminated by Esmolol, a particular intravenous betablocker, despite acute decompensated heart failure. Case presentation We report the case of an 89-year-old patient presenting for a ventricular tachycardia storm and acute heart failure with reduced left ventricle ejection fraction of coronary ischemic origin that persisted despite coronary revascularization, oral betablocker, intravenous Amiodarone and Lidocaine, light sedation, and multiple electrical cardioversion. Emergency catheter ablation was not feasible due to meteorological conditions. We decided to use an intravenous betablocker despite the presence of acute heart failure. We favored use of intravenous Esmolol over other intravenous betablockers due to its short half-life and thus his rapid elimination, a unique characteristic for Esmolol. Intravenous Esmolol has successfully terminated the ventricular tachycardia without causing cardiogenic shock. Conclusions Intravenous Esmolol can be used safely in patients with acute decompensated heart failure to terminate an electrical storm after failure of other measures. Close monitoring of the patient remains essential.

Abstract Background Hospitalization of patients with heart failure makes it possible to optimize drug therapy, considerably improving the prognosis of this serious condition. Methods We conducted a retrospective descriptive study of patients with reduced left ventricular ejection fraction (≤ 40%) in the Cardiology Department of a community hospital center in France to measure the prescription rate of heart failure medications in hospitalized patients with reduced ejection fraction heart failure and identify their limiting factors. The primary endpoint was the prescription on the discharge prescription of the following four drug classes: beta-blockers, renin–angiotensin–aldosterone system blockers, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter inhibitors. Results From September 1, 2022, to March 31, 2023, 73 patients were included in the study. About one-third of patients were discharged with the recommended four drug classes. Those discharged with all 4 drug classes were younger and had preserved renal function. Conclusions The low rate of prescription of heart failure medications after hospitalization is a reminder of the need to develop a specialized follow-up structure to optimize the drug treatment of reduced ejection fraction heart failure, even in the most fragile patients.

Abstract Background Conus artery occlusion is a rare life-threatening event, typically secondary to iatrogenic etiology, and is treated mainly with conservative therapy and/or balloon angioplasty without stenting. However, treatment remains challenging. Case presentation We report the case of a 60-year-old man with a known history of coronary artery disease presenting with multiple internal defibrillator cardioversions due to an electrical storm (recurrent ventricular fibrillation). The coronary angiography showed an acute occlusion of the conus artery arising from the proximal segment of the right coronary artery, treated by percutaneous transluminal coronary angioplasty with stenting (drug-eluting stent) without any serious complications. Conclusions To our knowledge, this is the first case in the literature where a non-iatrogenic occlusion of the conus artery causing a ST-segment elevation myocardial infarction and electrical storm was treated with percutaneous coronary intervention with drug-eluting stenting. Graphical abstract

Optimal and cost-effective drilling operations in extended-reach horizontal wells depend on efficient solid cuttings removal from the borehole. Several solids-suspended multiphase processes such as crude petroleum transportation, separation, and processing of oil and gas streams also require the efficient removal of these solids. The terminal settling velocity (Vts) of the solid particle is a vital parameter that controls the removal efficiency of these solids. In a drilling scenario when there is a hold on fluid circulation such as connection time, the accurate estimation of Vs provides the driller with time available to prevent solid deposition. In severe conditions, this can result in a stuck pipe, especially for extended-reach horizontal wells. In this work, both spherical and non-spherical particle deposition were experimentally investigated in several fluid rheology and salinity. Two concentrations (0.1vol% and 0.05vol%.) of partially-hydrolyzed polyacrylamide (PHPA) were used as a drag-reducing additive for water-based drilling mud. The PHPA drag-reducing fluid (reduced pressure loss) acts as a turbulence inhibitor. The PHPA polymer chain suppresses any turbulence in the flow, reducing the turbulent eddy viscosity. The effects of salinity (3wt.%NaCl and 3wt.%CaCl2 contamination) on solid particle settling velocity (Vs) in drag-reducing fluids were also investigated. Terminal velocity was achieved for all experiments and seemed to increase with increased diameter/sphericity. However, cases when this trend was not consistent were observed and therefore a new parameter of Φ (sphericity index × diameter) was proposed. Vs increases with Φ value for all cases. During drilling, PHPA also aids in sealing the fracture in the formation. With and without salt in the fluid, how lowering drag affected the settling velocity of solid particles (drill cuttings) could be observed. The settling velocity tests will be improved in drag-reducing PHPA solutions with the knowledge from this study.

Abstract Background The rate of NAFLD in the general population is estimated to be 25.2%. NAFLD is affected by lifestyle, diet, and inflammation. In this study, the use of probiotics, prebiotics, and synbiotics was aimed to modulate the circadian clock in the liver and improve metabolic disorder through the gut–liver axis. Methods Six-week-old, healthy, 43 Wistar albino rats were included in the study and their average weight was determined as 140.50 g (95.00–177.00) at the beginning of the study. Before the study, the rats were randomly divided into 5 groups, 8 animals were placed in the 1st, 3rd, 4th, and 5th groups and 11 animals were placed in the 2nd group. Rats in group 1 were fed standard food for 13 weeks. Rats in the 2nd, 3rd, 4th, and 5th groups were fed with 10% fructose water during the 1-week adaptation period and then 20% fructose water. After the 7th week, probiotic treatment (2 × 109 CFU/ml Lactobacillus rhamnosus GG) was administered to rats in group 3rd via gavage for 6 weeks, and prebiotic treatment was administered to rats in group 4th with feed containing 10% grape seed extract. Rats in the 5th group were given a feed consisting of 10% grape seed extract and 2 × 109 CFU/ml Lactobacillus rhamnosus GG via gavage. Results It was determined that the use of prebiotics as a treatment option in fatty liver had a more positive effect on glucose, ALT, melatonin, and ZO-1 values. In addition, it was observed that synbiotic use had more positive effects on histopathological findings, NAS score, and the expression level of circadian clock genes. While there was no significant difference between the mRNA levels of circadian clock genes, it was observed that gene expression levels increased with fructose consumption and decreased especially with synbiotic treatment. Conclusion It has been observed that fructose modulates the circadian rhythm by affecting some biochemical and genomic pathways as a result of synbiotic use in order to prevent the negative effects of fructose on fatty liver.

Objective: The aim of this study was to investigate whether spinal cord stimulation (SCS), a neuromodulation technique, causes any changes in sleep, quality of life, anxiety and depressive symptoms before and after the procedure in patients with chronic pain.Methods: The study was completed with 14 patients who were planned to undergo SCS for treatment-resistant chronic neuropathic pain and who applied to the psychiatry outpatient clinic for pre-treatment consultation. Patients were evaluated twice, before and 1 month after treatment. Patients were evaluated with LANNS Pain Scale, Hamilton Depression Scale (Ham-D), Hamilton Anxiety Scale (HAM-A), Pittzburg Sleep Quality Inventory (PUKI), and Quality of Life Scale Short Form (WHOQOL-Bref). Scale scores before and after the treatment were compared using a two-sample dependent t-test.Results: Depressive disorder was detected in 85.8% of the cases, anxiety disorder in 71.5%, and sleep disorder in 78.6%. The cases’ LANSS pain scale scores were 19.00±5.11 pre-treatment and 7.57±4.59 post-treatment, the difference being statistically significant (P=0.001). Significant differences were observed between pre- and post-test HAM-D, HAM-A, PSQI, quality of life (QoL) general health, QoL physical health, or QoL psychological health scores (P=.002, P=.014, P=.002, P=.002, P=.002, and P=.001, respectively). However, no significant differences were determined between pre- and post-test QoL social relationships or QoL environmental health scores (P=.160 and P=.831, respectively)Conclusion: Our data in this study suggest that SCS not only effectively reduces pain in treatment-resistant chronic pain, but also mediates significant improvements in sleep quality, anxiety and depressive states.

Abstract This research introduces an advanced finite control set model predictive current control (FCS-MPCC) specifically tailored for three-phase grid-connected inverters, with a primary focus on the suppression of common mode voltage (CMV). CMV is known for causing a range of issues, including leakage currents, electromagnetic interference (EMI), and accelerated system degradation. The proposed control strategy employs a system model that predicts the inverter’s future states, enabling the selection of optimal switching states from a finite set to achieve dual objectives: precise current control and effective CMV reduction, a meticulously designed cost function evaluates the potential switching states, balancing the accuracy of current tracking against the necessity to minimize CMV. The approach is grounded in a comprehensive mathematical model that captures the dynamics of CMV within the system, and it utilizes an optimization process that functions in real-time to determine the most suitable control action at each interval, Experimental validations of the proposed FCS-MPCC scheme have demonstrated its effectiveness in significantly improving the performance and durability of three-phase grid-connected inverters, Experimental validations of the proposed (MPC with CMV) scheme have demonstrated its effectiveness in significantly improving the performance and durability of three-phase grid-connected inverters. The proposed method achieved substantial reductions in CMV, notable improvements in current tracking accuracy, and extended system lifespan compared to conventional control methods.

Hospital menus are profoundly important to meet the nourishment needs of patients. So, this study is conducted to determine the nutrient adequacy of adult patients’ normal diet menus. Methods: An evaluation of 30-day fixed menus consisting of 4 dishes was conducted in four different public hospitals in Ankara, the capital of Türkiye. Mean adequacy ratio (MAR) and nutrient adequacy ratio (NAR) were used to examine the sufficiency of nutrients and meals. Results: For all the hospitals, MAR value was found higher than %85. However, nutrient adequacy ratio of dietary fiber, calcium and magnesium were lower than the other nutrients. It was determined that total fat, saturated fat, salt and cholesterol (except hospital D) contents were high according to the recommended values. Nevertheless, these fixed menus supplied 75% daily fiber on average. Hospital A and D menus met calcium requirements by 73% and 67%, respectively. While hospital D menus met magnesium (76%) and potassium (67%) requirements moderately, other hospitals approached 100% sufficiency for potassium. It is remarkable that in all the hospitals the amount of fruits seemed very low, up to 34%. Conclusion: As the hospital meal is an essential part of in-patients’ institutional care and nutritional support, the nutrient contents of menus should be monitored for nutritional requirements and, if necessary, there should be initiatives and arrangements in standard recipes to reduce salt and fat contents.

Abstract Non-Insulin-Dependent Diabetes Mellitus (NIDDM) is a chronic health condition caused by high blood sugar levels, and if not treated early, it can lead to serious complications i.e. blindness. Human Activity Recognition (HAR) offers potential for early NIDDM diagnosis, emerging as a key application for HAR technology. This research introduces DiabSense, a state-of-the-art smartphone-dependent system for early staging of NIDDM. DiabSense incorporates HAR and Diabetic Retinopathy (DR) upon leveraging the power of two different Graph Neural Networks (GNN). HAR uses a comprehensive array of 23 human activities resembling Diabetes symptoms, and DR is a prevalent complication of NIDDM. Graph Attention Network (GAT) in HAR achieved 98.32% accuracy on sensor data, while Graph Convolutional Network (GCN) in the Aptos 2019 dataset scored 84.48%, surpassing other state-of-the-art models. The trained GCN analyzed retinal images of four experimental human subjects for DR report generation, and GAT generated their average duration of daily activities over 30 days. The daily activities in non-diabetic periods of diabetic patients were measured and compared with the daily activities of the experimental subjects, which helped generate risk factors. Fusing risk factors with DR conditions enabled early diagnosis recommendations for the experimental subjects despite the absence of any apparent symptoms. The comparison of DiabSense system outcome with clinical diagnosis reports in the experimental subjects was conducted using the A1C test. The test results confirmed the accurate assessment of early diagnosis requirements for experimental subjects by the system. Overall, DiabSense exhibits significant potential for ensuring early NIDDM treatment, improving millions of lives worldwide.

Abstract Colorectal cancer (CRC) is the third most common cancer in the United States. Recent epidemiological evidence demonstrates an increasing incidence of young-onset CRC cases, defined as CRC cases in individuals 50 years old or younger. Studies have established that alterations in both the WNT and TGF-Beta signaling pathways have contributed to CRC development. While this is well understood, the comprehensive analysis of WNT and TGF-Beta pathway alterations in young-onset CRC cases has yet to be investigated. Here, we conducted a comprehensive bioinformatics analysis of mutations associated with each of the WNT and TGF-Beta signaling pathways according to age (≤ 50 years old versus > 50 years old) utilizing published genomic data from the cBioPortal. Chi-square results demonstrated no significant difference in WNT alterations between young-onset CRC and those > 50 years old. However, across all age groups, WNT alterations were frequently found in rectal cancers. We also found that WNT alterations were associated with better outcomes. The mutations associated with TGF-beta were observed at a higher rate in older CRC patients when compared to those ≤ 50 years old. Additionally, these mutations were found more frequently in colon primaries.

Abstract In humans, blood Classical CD14+ monocytes contribute to host defense by secreting large amounts of pro-inflammatory cytokines. Their aberrant activity causes hyper-inflammation and life-threatening cytokine storms, while dysfunctional monocytes are associated with ‘immunoparalysis’, a state of immune hypo responsiveness and reduced pro-inflammatory gene expression, predisposing individuals to opportunistic infections. Understanding how monocyte functions are regulated is critical to prevent these harmful outcomes. We reveal platelets’ vital role in the pro-inflammatory cytokine responses of human monocytes. Naturally low platelet counts in patients with immune thrombocytopenia or removal of platelets from healthy monocytes result in monocyte immunoparalysis, marked by impaired cytokine response to immune challenge and weakened host defense transcriptional programs. Remarkably, supplementing monocytes with fresh platelets reverses these conditions. We discovered that platelets serve as reservoirs of key cytokine transcription regulators, such as NF-κB and MAPK p38, and pinpointed the enrichment of platelet NF-κB2 in human monocytes by proteomics. Platelets proportionally restore impaired cytokine production in human monocytes lacking MAPK p38α, NF-κB p65, and NF-κB2. We uncovered a vesicle-mediated platelet-monocyte-propagation of inflammatory transcription regulators, positioning platelets as central checkpoints in monocyte inflammation.

This study aims to provide a literature evaluation of studies that examine human resources management practices using the bibliometric analysis approach. This study used bibliometric analytic techniques to conduct scientific mapping and performance analysis. The research used the Scopus database and included open-access studies. The bibliometric study revealed a total of 1133 publications and 25,456 citations during the period spanning 2000 to 2023. The number of publications on human resource management practices has steadily risen, reaching its highest point in 2020 with 110 articles and 2278 citations. However, citation counts noticeably declined in the subsequent years. A collective of ten countries has contributed to this field, with America being the most prolific, with 127 publications and 5157. Southwestern University of Finance and Economics is the most productive university, with two publications and 493 citations. The International Journal of Human Resource Management is a highly regarded publication focusing on HRM practices. It has published 52 articles and received 3459 citations. The most often used keywords are “Human Resource Management,” “Human resource management practices,” “Human resource,” and “Resource allocation.” The study identified the existing status and made recommendations for further research.

Many applications, software, websites, and online dictionaries have been introduced thanks to the advent of computer- and mobile-assisted technologies. Recent technological advancements have resulted in more targeted apps (e.g., BoldVoice for pronunciation) or reference tools (Etymonline.com for an etymology dictionary) for language learning and practice. One such tool is Thesaurus.com, an online thesaurus freely accessible through mobile devices and computers. Given the significance of synonyms and antonyms for vocabulary learning and the problems English as a foreign language learners have with these lexical subfields, this media review evaluated the aforementioned online thesaurus. The results indicated potential pedagogical opportunities and several areas of improvement. The review concludes with suggestions for further research to corroborate the findings.

The absence of a Food and Drug Administration-approved percutaneous valve technology for the treatment of severe aortic regurgitation (AR) presents a challenge for high-risk patients. In this report, we describe the successful treatment of an 84-year-old male patient suffering from severe symptomatic AR and concomitant cardiorenal syndrome with renal failure using a 34-mm Evolut R (Medtronic) self-expanding transcatheter aortic valve replacement. This intervention resulted in the resolution of AR, cardiorenal syndrome, and congestive heart failure symptoms.

This study utilizes an Autoregressive Distributed Lag (ARDL) model to examine the effects of renewable energy, economic growth, and inflation rate on exchange rate fluctuations in Somalia from 1990 to 2019. The analysis shows that economic growth and RE positively influence the exchange rate in both the short and long run. In contrast, inflation negatively impacts the exchange rate in the short run, suggesting short-term currency appreciation, but leads to depreciation in the long term. Moreover, the study finds that a 1% increase in RE results in an 80% increase in the exchange rate, indicating significant currency depreciation. To mitigate currency depreciation, the research advocates for policies promoting local renewable energy use to reduce import dependency and stabilize the currency. This approach includes investments in renewable infrastructure, community education, and economic diversification. This study highlights the need for further research into renewable energy’s impact on exchange rates in Somalia, particularly in different economic contexts, to gain a more holistic understanding of these dynamics.

Background Hospital ‘command centres’ use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom. Objective To evaluate the impact of the Bradford Command Centre on patient care and organisational processes. Design A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention. Setting The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield. Participants Thirty-six staff members were interviewed and/or observed. Intervention The implementation of a digitally enabled hospital command centre. Main outcome measures Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality. Data sources Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews. Results The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to ‘the system’. Conclusions Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se. Limitations The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention. Future work We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes. Study registration The study is registered as IRAS No.: 285933. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information. Plain language summary Safety-critical industries like airports often use ‘command centres’ to manage operations safely and efficiently. In contrast, most National Health Service hospitals have operational management that is fragmented across many departments and poorly co-ordinated. This may pose risks to the safety and care of patients and may partially explain excessive waiting times. Bradford Royal Infirmary is one of the first National Health Service hospitals to try out a command-centre approach using new digital technologies. Hospital staff at Bradford now work together in a purpose-built Command Centre room and monitor a ‘wall of analytics’ that displays real-time data from the hospital’s information systems. This study examines the implementation at Bradford in order to learn lessons that may help the National Health Service improve the way hospitals provide safe and efficient patient care. We reviewed what is known about the approach, analysed hospital data, observed teams working in the Command Centre, interviewed staff and ran workshops with patients. We also compared Bradford with a similar hospital that did not initially have a command centre. Our results showed the Bradford Command Centre does work. Staff told us the Command Centre helped them manage the hospital through the COVID-19 pandemic. Staff described how they used the new technology to improve efficiency and safety. We observed some challenges, including tension between the central team and local departments and concerns to make sure data were good quality. We could not measure the direct impact of the Command Centre on patient flow and safety using the hospital’s data because the pandemic disrupted normal operations so much. Patients expressed strong support for what they saw as modern methods but were concerned to ensure that the National Health Service tradition of personal care was preserved. Other National Health Service hospitals are interested in following a command-centre approach and our results should help them to learn from Bradford. Scientific summary Background A hospital command centre (CC) is a new approach to the management of hospital operations based on the colocation of decision-making staff and supported by digital technology to provide these staff with close to real-time information. Recent adoption of hospital CCs in the USA predominantly has demonstrated that the approach can be applied to manage hospital operations, despite their complexity. The supporting technology often includes decision-support algorithms that trigger digital notifications and alerts that identify potential safety or flow issues. These algorithms may be based on simple rules or more complex rules generated by machine learning from historic data, and the software technology has therefore been described as AI, meaning either artificial intelligence or, more accurately, augmented intelligence. In the UK, the implementation of a CC and associated technology by Bradford Teaching Hospitals NHS Trust represents a first of type for the UK NHS. To date, there has been limited evidence of the effectiveness of the CC approach and this study aims to address that evidence gap. Bradford Teaching Hospitals NHS Trust manages Bradford Royal Infirmary, an 800-bed NHS hospital located in Bradford in northern England. The Bradford Hospital Command Centre was implemented at Bradford Royal Infirmary through a phased approach in late 2019, was operational through the COVID-19 pandemic, and remains operational to date. It is designed to integrate and centralise operational decision-making to improve patient flow and patient safety across the whole hospital. The Comand Centre (CC) is implemented in a dedicated room in which up to 30 trained non-clinical management and support staff from different operational functions can sit together in teams facing a wall on which 8 large digital display screens are mounted. Each staff member answers telephone calls and performs their operational role using Information Technology (IT) systems on their desktop computer, information on the wall of display screens and communicating with team members and other teams within the room. A senior clinician or manager supports decision-making. The CC was implemented in November 2019, several months before the COVID-19 pandemic began to have a major impact on hospitals in the UK and globally. It was operational throughout the pandemic and, to date, it is firmly established as the centre for operational management of the hospital. The implementation of the CC at Bradford Royal Infirmary presents an opportunity to evaluate the potential strengths and weaknesses of the approach and to generate learning that can inform other hospitals considering adopting the approach. Objectives We aimed to evaluate the impact of the Bradford Command Centre on patient care and organisational processes. We hypothesised that the CC would improve patient flow, reduce bottlenecks and delays, enhance situational awareness to support operational decision-making, and facilitate identification and timely mitigation of threats to patient safety. This study had four research objectives: to evaluate the impact of the CC on patient safety, hospital operational efficiency and related organisational processes to understand the process of implementation of the CC and its integration into hospital management to contextualise the findings using cross-sector and cross-industry perspectives to synthesise the research findings to inform future investment and practice. Methods We conducted a comparative mixed-method case study at two sites: Study site – the CC at Bradford Royal Infirmary. Control site – Huddersfield Royal Infirmary, a hospital in the city of Huddersfield. The control site was selected as being geographically close (15 miles) and part of a similar-sized NHS hospital trust with similar challenges serving areas of high deprivation. At the start of this study, the control site had no plans to implement a CC but, during the study, they learnt from the study site and replicated some aspects of the Bradford Command Centre as part of their own pandemic response. The study combined ethnographic observation and interviews with data analytics of time-series operational data. We accessed and analysed data in the form of anonymised electronic health records from the study and control sites between January 2018 and August 2021 to cover the period before and after implementation of the Bradford Command Centre in November 2019. We conducted 72 hours of ethnographic observations of the CC operation over a period of 9 months after implementation. We conducted 15 interviews with hospital staff at the study site and 4 interviews with staff at the control site. To evaluate the impact of the CC (Objective 1), we described (qualitatively) and evaluated (statistically) the effect on hospital operations and outcomes. We used Interrupted Time Series Analysis to analyse variation in key output indicators in patient safety, patient flow and data quality. We qualitatively investigated situational awareness, operational decision-making, risk and co-ordination/communication across organisational units, from multiple stakeholder perspectives. To understand the process of implementation (Objective 2) our interviews explored staff recall of the implementation, including critical implementation factors and exploring unintended consequences. We used the interviews with staff at the control site to understand how a similar organisation adapted and changed over the same study period. To contextualise the findings (Objective 3), we reviewed the literature on command and control processes in non-healthcare safety-critical operations to extract key principles and contextual factors that may influence transferability of these models into a hospital setting. We also searched for evidence of other hospital CC implementations in the UK and worldwide. To synthesise the research findings (Objective 4), we developed a logic model to map system preconditions, processes, technology and outcomes. Results We were unable to evaluate the impact of the CC as fully as we had planned because the study was impacted by the COVID-19 pandemic. Hospital staff were extremely busy and access on site was challenging. The additional work negotiating access and the direct impact of the pandemic on our own team meant that we had fewer resources and were unable to complete all our objectives. We were able to observe how the CC helped support the hospital manage its operations through the pandemic and received strong positive evidence of its success. Complex pandemic challenges and rapid innovation to meet these challenges made it difficult to attribute outcomes to the specific intervention of the CC. Evaluation of the impact of the Command Centre (Objective 1) Our ethnographic observations and interviews with 15 study-site staff provided documentary evidence of successful use in a complex environment. The CC made a significant impact on the management of the hospital through the pandemic including through the introduction of a COVID-19 ‘tile’ which was used to managed COVID-19-specific processes. The CC and its staff worked with the new technology to change the way that the hospital operated. We identified unintended consequences that included front-line staff developing a sense of being monitored and a fear of interventions from the CC team that were perceived as unwelcome. Linked to this were challenges keeping electronic records up to date and acting on evidence of operational issues that were seen as being under local autonomy or ownership. Data quality was a constant concern for staff working in and around the CC and there were limitations in how up to date and accurate (or complete) records were, often necessitating triangulation and verification from multiple sources and systems and discrepancy between the data in the systems and what front-line staff reported. Compromise, goodwill and a shared sense of purpose were necessary to ensure the CC was effective. We were able to extract time-series data on patient safety, patient flow and data quality from operational systems by selecting representative indicators and plotting these over time. We were able to measure changes in these indicators over time and evaluate statistically the long-term impact of the CC on these indicators. We were not able to isolate improvements in these indicators that could directly be attributed to the introduction of the CC. Similarly, we were unable to isolate noticeable improvements in these indicators between study and control site. We found improvements in mortality and reduced rates of re-admission at the study site but caution against drawing conclusions from this at a time when the pandemic was raging. Some indicators, notably data quality, worsened rather than improved. We reason that the pandemic had such a profound impact on all aspects of operation that it is not possible to separate out and measure the impact of the CC. Similarly, the later adoption of a CC approach by the control site means we cannot use it to draw strong comparisons. Understanding the process of implementation of the Command Centre (Objective 2) Our project started after the CC had been implemented so our results rely on staff recall of the implementation. We identified five phases in the implementation: (1) pre-intervention, (2) a patient flow change programme, (3) Command Centre tile roll-in, (4) Command Centre go-live and (5) post-intervention engagement. Phase 2 was an organisational change, Phase 3 represents a soft-implementation period of training and familiarisation and Phase 4 represents the hard implementation of the new technology and new ways of working. Staff interviews suggest that the overall implementation approach was effective but that they found the implementation challenging and identified some need for more training and software improvements. The intention had been for a period of post-intervention engagement to support staff in getting used to new ways of working and to adapt procedures and technologies to optimise the new approach. This was disrupted by the pandemic, which started to impact on hospital operations only a few months after Phase 4 was complete. Staff recollections are therefore mixed between the pandemic response and the new technology but there is strong evidence that staff worked well together to find ways of working that were consistent with the CC approach while solving immediate challenges. Analysis of time-series data on patient safety, patient flow and data quality at different stages of implantation revealed patterns of change in response to the implementation, but these were confounded by the impact of the pandemic on the same outcome measures. When only the technology part of the Command Centre was assumed as the intervention, there was no significant difference between the pre- and post-intervention periods in the patient safety and patient flow indicators. The data quality had largely worsened in the post-implementation phase and we attribute this to the impact of the pandemic. Qualitative results show that the Command Centre has had a long bedding-in process and that this is expected to be a long process as the hospital and its staff adapt to new ways of working. Our qualitative results suggest that major improvements in patient flow, patient safety and data quality have yet to be achieved. Contextualising the findings using cross-sector and cross-industry perspectives (Objective 3) Results from the literature review found a strong body of research to support the adoption of a CC approach as part of a successful and resilient organisation. CCs are described as supporting situational awareness, decision-making, team structure and workload with the main aim of successfully delivering safety-critical operations reliably over time and in the face of dynamic risks and variations in the operating environment and system conditions. Digital technologies need to be tailored to the work done in the respective domain and should contribute to system resilience. Most articles attribute performance improvements to the physical and functional features of the centres themselves; this often includes the use of technology to generate and display real-time and/or predictive data in the centres. The implementation process usually affects process and policy changes in the organisation, including introducing new ways of working and workload distribution, adding new roles and altering the existing hierarchy of decision-making and responsibility. The literature advises caution in attributing improvements to the physical and functional aspects of the CCs versus the process and policy changes within the organisation that often arise out of the implementation process. There is emerging evidence that a CC approach can be adopted in acute health care. Effective implementations are characterised by a strong sense of shared situational awareness within a team with a shared focus on specific focal points for intelligence and intensification of this focus as threat level increases. System resilience is maintained in these implementations through simultaneous responsive and anticipatory strategies with variable resource allocation for both proactive planning for expected deviations and events with varying timescales. One paper advised caution in using the term ‘command and control’, as it may overly restrict the exploring of new ideas and new approaches seen as important to meeting the specific needs of health care, hospitals and staff given the strong culture of autonomy on the clinical front line. Synthesis of research findings to inform future investment and practice (Objective 4) We found evidence that the approach to implementation was broadly successful but that benefits take time and significant additional innovation to realise. We consolidate our learning as an intervention logic model that can be used by other hospitals planning an implementation of a digitally enabled hospital CC. Conclusions This study has presented a case study of a successful implementation of a CC in the UK NHS. The Bradford Command Centre demonstrates that systems are available but it also reveals challenges in the reliability, timeliness and quality of these data that reduce transparency and limit confidence. Management and staff have managed to overcome many of these challenges through determination, negotiation and gradual improvements while also dealing with the pandemic. There was a strong sense that the CC had been invaluable during the pandemic but we were not able to empirically validate this. Our case study was affected by the pandemic and does not provide sufficient evidence to demonstrate major benefits on its own. We therefore recommend: Command centres are a viable approach that should be considered. Reliable, modern hospital-wide information systems are an essential foundation for command-centre technology and poor data quality will undermine implementation if not addressed. Further work should follow the evolving use of the Bradford Command Centre and disseminate learning to other hospitals considering adoption. Further studies that use our time-series approach for performance metrics would allow comparison across more hospitals and support the evaluation of other implementations. Studies should consider mixed methods rather than relying solely on qualitative or quantitative approaches to draw conclusions. Study registration The study is registered as IRAS No.: 285933. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

Vocabulary and grammar are essential to language proficiency (Richards, 2015). Some word families and grammatical categories can only be distinguished by prosodic properties such as suprafixes. In English, specific noun/adjective-verb pairs, sometimes called disyllabic words, receive primary stress on different syllables. Typically, nouns receive trochaic stress, while verbs receive iambic stress. Research shows that suprafixes are difficult for language learners from diverse linguistic and prosodic backgrounds. Given the scarcity of research in specific contexts (e.g., Turkish EFL), this study explored Turkish EFL learners’ suprafixational knowledge, perception, and production. Participants were B1-level preparatory school students of a prominent state university. Data were collected through a test of knowledge (n=110), a test of perception (n=80), and a test of production (n=50). Results showed poor knowledge, perception, and production of suprafixes among Turkish EFL learners. Minor variations in suprafixational competence were observed in males and females. Additionally, different noun-verb pairs posed a challenge for both genders. The results were discussed, and recommendations for future research were made. The study concludes that Turkish EFL learners must receive suprasegmental training focusing on suprafixes.

Aim: This nationwide survey study aimed to determine the initial and definitive treatment strategies for pilonidal abscess (PA) that are used by general surgeons in Turkey. Method: Surgeons working at centers in Turkey were sent an electronic questionnaire focusing on diagnostic, perioperative, and postoperative management options for PA. The questions were prepared based on an extensive assessment of the literature and were evaluated for usability prior to distribution. A survey consisting of 20 questions was sent to surgeons and surgical residents via email. The survey link was kept active for 1 month to give the surgeons enough time to complete it. Results: Of the 520 participants, 64% defined themselves as general surgeons and 9.5% as colorectal surgeons. The most preferred surgical approaches among the participants were as follows: day surgery unit (75.2%), local anesthesia (82.8%), and drainage through the most fluctuant location (65.1%). Irrigation of the cavity was applied by 70% of the participants (38.8% with saline and 32.3% with hydrogen peroxide). The majority (82.5%) prescribed oral antibiotics following PA drainage. Definitive treatment was scheduled within a timeframe of 4-8 weeks by 45.6%. Participants who performed concurrent phenol application were more likely to perform a definitive treatment if the patient becomes symptomatic (p

The management of the aesthetic parameter represents an important factor in the integration of removable prostheses. The current major social interest in beauty has made patients more and more demanding with regard to their appearance. [1] The main objective of this study was to assess the aesthetic expectations of patients with removable prostheses at the CHU-CNOS in Bamako. Our prospective and descriptive study having collected 78 patients was carried out over a period from March 2, 2019 to March 9, 2020 at the removable prosthesis department of the CHU-CNOS in Bamako. The female sex represented 55.1% with a sex ratio of 0.65. Removable prosthetic rehabilitation mainly concerned young adults aged 21-41 (41%) Aesthetics was the main reason for rehabilitation most represented with 60.3% of cases. The white tooth was the most requested dental shade with 70.5% of cases Bonded teeth were the most represented in our patients with 71.79% of cases. Pink gum was the shade most requested by our patients with 43.6% of cases. Obtaining a personalized prosthesis in harmony with the facial framework, giving the illusion of naturalness and restoring the smile to patients is the objective to be achieved

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) represents the most harmful clinical manifestation of coronary artery disease. Risk assessment plays a beneficial role in determining both the treatment approach and the appropriate time for discharge. Hierarchical agglomerative clustering (HAC), a machine learning algorithm, is an innovative approach employed for the categorization of patients with comparable clinical and laboratory features. The aim of the present study was to investigate the role of HAC in categorizing STEMI patients and to compare the results of these patients. Methods A total of 3205 patients who were diagnosed with STEMI at the university hospital emergency clinic between 2015 and 2023 were included in the study. The patients were divided into 2 different phenotypic disease clusters using the HAC method, and their outcomes were compared. Results In the present study, a total of 3205 STEMI patients were included; 2731 patients were in cluster 1, and 474 patients were in cluster 2. Mortality was observed in 147 (5.4%) patients in cluster 1 and 108 (23%) patients in cluster 2 (chi-square P value

A pot experiment was conducted at the soil and water laboratory of Federal University Gashua Nigeria, to assess the reaction and primary nutrients – NPK, and Organic Carbon (OC) status of three white grub-produced Vermicompost using different ingredients (Municipal Waste – MW, Typha Grass – TP, and Municipal Waste + Typha Grass – MWT0). Laid on a Completely Randomized Design (CRD), the number of live worms, worms' weight, Vermicompost weight, and worms' mortality percentage as production indices were recorded and statistically analyzed upon Vermicompost maturity. Matured Vermicompost Reaction (pH and EC) and Primary nutrients (NPK), and OC were determined in another laboratory upon taking the respective compost samples as Soil health Indices. The result of the analysis showed that MW has the highest Nitrogen (%) = 1.60, the highest available Phosphorus = 0.47 mgKg-1, and the highest Exchangeable Potassium = 720 mgKg-1, it also presented a mildly acidic reaction (pH=6.8), with the highest percentage of OC (2.80%) and the lowest basic salts EC = 0.35 dS/m. In terms of earlier determined live worm percentage, live worm weight, Vermicompost weight, and worm mortality rate, the highest findings are MW = 64.5 %, MW = 40 grams, MW = 301 grams, and TP = 66.9 % respectively. In conclusion, MW Vermicompost proves to be the best, taking into consideration its better indices. As the premier of its kind in the study area, among other recommendations, we encourage setting this study as a pilot, and the conduct of more studies on the efficiency of Vermicompost on soil health and crop production in the study area.

The causal relationship between economic growth and financial development is of great importance in terms of the dynamics of economic growth and the financial background it provides. The aim of this study is to determine the existence and direction of the relationship between financial development and economic growth in selected Asian countries. The financial development index used in the analysis is an index reported by the IMF and is based on the depth, access and efficiency of financial institutions and financial markets. In addition, gross fixed capital formation and labor force are added to the model as control variables. In this panel data analysis of 24 Asian countries covering the period 2000-2021, Cross Section Augmented Dickey-Fuller (CADF) Unit Root Test and Westerlund ECM Panel Cointegration tests are applied. Dumitrescu and Hurlin (2012) Panel Granger causality test was used for causality analysis. The heterogeneous results of the study provide evidence of a causal relationship between GDP and financial development across countries. According to the findings of the study, instead of a general policy recommendation, it would be appropriate for countries to determine policies according to their own economic and financial characteristics, considering that both variables affect each other.

Tunnelling activities in urban areas are always associated with surface and subsurface ground subsidence, which may affect the stability of nearby structures and utilities. During and after tunnel construction, the surrounding building is subjected to different.deformations and strains due to immediate settlement. The constructed buildings should be able to bear the effect of change in the total, differential settlement and bending moment of raft according to the tunneling activity. The soil settlement around the tunnel and the ground movement above the tunnel should be taken in consideration too. This study focuses on the settlement of raft foundation according to tunneling activity using single and double tunnels. 2D numerical model was conducted to simulate the excessive settlement of raft according to tunneling. The effect of tunnel depth, soil consistency and spacing between double tunnels is studied. By increasing the soil cover above the tunnel crown, the settlement and bending moment of raft increases regardless the relative density of surrounding soil.

This study examines the nexus between foreign direct investment (FDI), trade openness (TRO) and economic growth for selected 11 high-income and 22 middle- and low-income Asian countries within a model using a more recent panel dataset over the period 2000–2021. The cointegration test has been applied in this study, which shows that whether there is a long-term interrelationship between FDI and economic growth, which we focus on in particular, and then the covariance matrix estimators that are developed by Driscoll and Kraay are used. Our findings indicate that there is a positive relationship between FDI and TRO, and economic growth for high-income countries, whereas the relationship between FDI and economic growth is negative for middle- and low-income countries. This study provides insights on why governments and policy makers in developing countries should focus on prioritizing domestic investment and production strategies for sustainable economic growth rather than simply emphasizing the attractiveness of FDI and the indispensability of import-oriented trade liberalization.

Zararlı bir uyaranın algılanması sırasında savaş ya da kaç tepkisine bir adaptasyon olarak gelişen stres, bazı koşullar altında (sinir, endokrin ve bağışıklık sistemleri dahil) zararlı olabilecek bir dizi fizyolojik tepkiyi uyarır. Bu tepkiler arasında hipotalamus- hipofiz- adrenal aksının hiperaktivitesi, depresif hastalarda en yaygın görülen nörobiyolojik değişikliklerden biridir. Özellikle gebelikte depresyon, ruh sağlığını tehlikeye atan sinsi bir halk sağlığı sorunudur. Ciddiye alınmadığı durumlarda intihara kadar giden vakalar ile karşılaşılabilmektedir. Doğum öncesi depresyonun olumsuz sonuçları yalnız annede değil, ileri dönemde çocuk üzerinde de görülmektedir. Gebeliğe bağlı depresyon, genellikle birden çok sebebe bağlı olup birçok farklı fizyolojik etkenle ilişkilidir. Hamilelik sırasında ortaya çıkan fizyolojik kaymalar, maternal stres koruma mekanizmasında hipotalamus- hipofiz- adrenal aksı düzensizliği ve kortizolün aşırı salgılanması gibi değişikliklerin oluşmasına sebep olur. Vücudun strese gösterdiği tepkiyle ilişkili olan aşırı kortizol salınımı, gebelik süresince görülen depresif belirtilerle ilişkilidir. Yakın zamanda yapılan çalışmalar belirli diyet etkenlerinin özellikle diyet liflerinin, stres hormonunu zayıflattığını vurgulamaktadır. Vücuda alınan diyet lifi, bağırsak bakterileri vasıtasıyla sindirilir ve kısa zincirli yağ asitlerinin ortaya çıkarılmasını sağlar. Söz konusu metabolitlerin hipotalamus- hipofiz- adrenal aksı başta olmak üzere pek çok değişik nörolojik fonksiyonu etkilediği düşünülmektedir. Bu derleme makale, kortizol salınımnda rol oynadığı düşünülen lif tüketiminin yaptığı değişiklikleri belirlemeyi hedeflemektedir

Background/objectives: The swift appearance of asymmetry in breast size and density has been associated with an increased risk of breast cancer and other pathological changes. However, the occurrence of breast asymmetry and the factors influencing it have not been extensively studied among healthy, screened women in the Saudi population. Thus, this study aims to explore bilateral breast asymmetry in breast size and density among healthy, screened Saudi women and factors affecting the asymmetry. Methods: Data of 1048 out of 1173 eligible women screened between 2012 and 2018 were extracted from Sheikh Mohammed Hussien AL-Amoudi Center of Excellence in Breast Cancer. The Laboratory for Individualized Radiodensity Assessment (LIBRA) software was used to measure percent density, dense area, and total area of breast from mammograms. Paired t-test was used to examine asymmetry between right and left breasts, and stratified analysis was performed to investigate the factors associated with breast asymmetry. Results: No significant differences were observed between the right and left breasts in percent density, dense area, and total breast area (p ≥ 0.2). However, for participants who never breastfed, the right breast area was slightly larger (average: 207.9 cm2) than the left breast (average: 202.8 cm2); p = 0.008. Conclusion: There were no significant differences found in the density, and size of the right and left breasts. However, women who breastfed tended to have slightly larger right breasts.

We challenge the dominant technology-centric narrative around clinical AI. To realise the true potential of the technology, clinicians must be empowered to take a whole-system perspective and assess the suitability of AI-supported tasks for their specific complex clinical setting. Key factors include the AI's capacity to augment human capabilities, evidence of clinical safety beyond general performance metrics and equitable clinical decision-making by the human–AI team. Proactively addressing these issues could pave the way for an accountable clinical buy-in and a trustworthy deployment of the technology.

The electronic advertisement is an advanced means of communication, keeping pacewith the times and the ease of access to the recipient in a way that suits the communication technical developments and human orientations. On influencing the recipient through the content of the suggestive metaphor, which dependsOn the juxtaposition of two contents, each of which carries a hypothetical significance of the content of the advertisement, as the metaphor is represented by the interdependenceof two meanings, the first for the real image, and the second for the relational construction according to the designer’s vision to form a virtual design structure within the formal metaphor that the designer invents in advertising works within an artistic formula that is sufficient and influential in the recipient , In this sense, the research problem raised by the researchers is summarized in the following two questions: - How is the virtual structure of the formal metaphor formed in electronic advertising? - What are the outcomes of the virtual construction of the formal metaphor in electronic advertising and its communication effectiveness? The importance of the research lies in the fact that it establishes intellectual and practical starting points for the axes of virtual construction and formal metaphor , in addition to that it is a scientific approach in employing the virtual formal metaphor in electronic advertising. The current research aims to reveal the mechanisms of employing the virtual construction of the formal metaphor in electronic advertising.

Time management in education is very important so that the goals you want to target can be easily achieved and systematically. If there is no good management, the desired targets will be difficult to achieve. The existence of management makes the learning system more structured. This research aims to find out how the time management program in the Tahfidz Maskanulhuffadz Medan Islamic boarding school is so that it can complete memorizing 30 juz of the Al-Quran in the span of one year. Using a qualitative research approach, this research uses. The research approach taken is a qualitative approach. namely descriptive data in the form of written words taken from Maskanulhuffadz's daily guidebook as well as information obtained from people's words and behavior that can be obtained. The data collection techniques used were through interviews, observation and copying documents. The results of this research explain the good time management of the program which has been prepared and designed to utilize one year's time. Students can complete their memorization quickly and the three year program is compressed into one year.

Background: Multicentric Castleman disease (MCD) is a rare, aggressive lymphoproliferative disorder. Human herpesvirus-8 (HHV-8) has an important role in the pathogenesis of the disease and its association with Kaposi’s sarcoma has been reported, especially in people living with human immunodeficiency virus (HIV). In this report, we present the case of HHV-8 positive MCD accompanied by Kaposi’s sarcoma and multiple myeloma in an HIV-negative patient. Case Report: A 78-year-old man with Kaposi’s sarcoma presented with B symptoms, pancytopenia, lymphadenopathy, and splenomegaly. The bone marrow biopsy demonstrated 70% lambda-restricted monotypic plasma cell infiltration consistent with plasma dyscrasia. Also, the patient was diagnosed with HHV-8 positive MCD as a result of inguinal lymph node excisional biopsy. Treatment was initiated including ganciclovir and methylprednisolone and followed by rituximab. The patient passed away at the 24th hour of rituximab infusion due to shock. Conclusions: MCD and associated malignancies are difficult to treat and have a poor prognosis. More studies and data are needed to manage these patients.

This systematic review paper provides a comprehensive analysis of the recent advances in deep learning techniques for rice disease recognition. Rice is one of the most important crops in the world, providing food for more than half of the global population. However, rice diseases pose a major threat to rice production and can cause significant yield losses. In recent years, deep learning techniques have shown great potential in automating the process of rice disease recognition, which can help in early disease detection and management. This paper reviews the current trends in deep learning techniques for rice disease recognition, including various pre-processing and augmentation techniques, as well as popular deep learning models such as convolutional neural networks (CNNs) and their variants. The paper also provides an in-depth analysis of the different datasets used in the studies, along with their limitations and challenges. Furthermore, the paper discusses the future directions for research in this field, such as the need for larger and more diverse datasets, the development of novel deep learning architectures, and the integration of other data sources such as weather data and satellite imagery. The paper concludes by summarizing the key findings of the systematic review and highlighting the potential impact of deep learning techniques in rice disease recognition. In addition, the review provides a useful resource for researchers and practitioners in the field of agricultural technology and can help in the development of more accurate and efficient automated systems for rice disease detection and management.

This bibliometric analysis investigates the evolving research landscape in renewable energy supply chains. The study uses VOSviewer software to examine influential articles, authors, countries, journals, and keywords from 2015 to 2023. Notably, 2019 marked a significant shift with a surge in publications and citations, suggesting a transition toward more impactful and higher-quality research. In subsequent years, they have witnessed fluctuations in citation counts, potentially reflecting changes in research focus and publication quality. Geographically, the United States and China stand out as leading contributors, with the United Kingdom, Germany, Italy, and Iran also making substantial contributions. The analysis of journals and publishers reveals variations in research impact and influence, with Elsevier emerging as a significant publisher. The keyword analysis underscores the prevalence of "Supply chains," "renewable energy resources," and "biomass" as central themes. This study offers valuable insights into the research trends and dynamics in the renewable energy supply chain field.

Metaheuristic algorithms are commonly used in solving complex and NP-hard optimization problems in various fields. These algorithms have become popular because of their ability to explore and exploit solutions in various problem domains. Honey Badger Algorithm (HBA) is a population-based metaheuristic optimization algorithm inspired by the dynamic hunting strategy of honey badgers, utilizing honey and digging-seeking techniques. Since its introduction in 2020, HBA has garnered widespread attention and has been applied across various domains. This review aims to comprehensively survey the improvement and application of HBA in solving various optimization problems. Additionally, the survey conducts a meta-analysis of the HBA's improvements, hybridization and application since its introduction. According to the result of the survey, 52 studies presented improved HBA using chaotic maps, levy flight mechanism, adaptive mechanisms, transfer functions, multi-objective mechanism and opposition based learning techniques, 20 studies presented a hybrid HBA with other metaheuristics algorithms and 101 studies uses the original HBA for solving various optimization problems. According to the survey, the wide acceptance of the HBA within the research community stems from its straightforwardness, ease of use, efficient computational time, accelerated convergence speed, high efficacy, and capability to address different kind of optimization issues, distinguishing it from the well-known optimization approches presented.

ABSTRACT Background Myofascial pain syndrome (MPS) is a particular type of temporomandibular joint disorder. Research findings comparing various treatment approaches are scarce and controversial. Therefore, this study aimed to compare the effectiveness of ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises in reducing pain intensity and improving mandibular mobility in patients with MPS. Methods It was a single‐blind, randomized, parallel‐group, active‐controlled trial that took place between April 2023 and October 2023 at the Department of Fixed Prosthodontics, Damascus University. Patients older than 18 years old with myofascial pain accompanied by limited jaw opening and pain lasting for at least 6 months were included. Eighty patients were randomly assigned into four groups using online randomization software: ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises. Only outcome assessors were masked to treatment allocation. The exercise regimen was the exercise program for patients with TMD. The following primary outcome measures were considered at the baseline (t0), at the first (t1), second (t2), and fourth (t3) week of treatment, and at the second (t4) and fifth (t5) month of follow‐up: pain intensity using the visual analogue scale, maximum interincisal opening, right lateral movement, and left lateral movement measured in millimeters. Results The pain level changed from severe to mild at t3 in ultrasound therapy, stabilization splint, and TheraBite device groups. In the masticatory muscle exercises group, it changed to moderate, with a significant difference between ultrasound therapy (p = 0.012) and stabilization splint (p = 0.013) groups. In addition, the mandibular mobility continued to improve at the subsequent follow‐up periods (t4 and t5). Conclusions All therapies are equally effective after 5‐month follow‐up. However, ultrasound therapy and stabilization splints have the benefit of achieving rapid improvement. Trial Registration ISRCTN20833186.

IntroductionIn this retrospective study, it was aimed to evaluate effects of Toll Like Receptor 4 (TLR4) and Toll Like Receptor 2 (TLR 2) gene polymorphisms on clinical outcomes in acute non-biliary pancreatitis patients.MethodsA total of 108 acute non-biliary pancreatitis patients (ANBP) were retrospectively subjected to the study. Gender, age, number of attacks, hospitalization duration, amylase, lipase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leukocyte, C-reactive protein (CRP), total bilirubin, direct bilirubin, Atlanta score, ultrasonography (USG), Computer Tomography (CT) and patient outcome differences between TLR 4 Rs4986790, TLR 4 Rs4986791 and TLR 2 groups were evaluated.ResultsAccording to TLR 4 Rs4986790 groups, females were significantly common in AA sequence (AA) group with statistically significant difference (p0.05). there was a statistically significant correlation between TLR 4 Rs4986790 and gender (r=0.265; p

Abstract Purpose Although multiple scales exist to evaluate psychological readiness before returning to sport post‐lateral ankle sprain (LAS), no score has been validated specifically for LAS or chronic ankle instability. The main aim of the study is to evaluate the validity and reproducibility of the ankle ligament reconstruction‐return to sport injury (ALR‐RSI) scale in assessing psychological readiness after LAS and its ability to identify patients who can return to their preinjury level. Methods A total of 64 patients (35 females and 29 males; 33.8 ± 13.2 years) who recently experienced an acute LAS were included in this study. All patients participated in a predictive validation component of the study and were assessed at 2 and 4 months following an LAS. The ALR‐RSI was completed twice by 20 patients at a 7‐day interval to evaluate the reliability of the score in patients suffering from LAS. Results The ALR‐RSI was significantly (p

Two Schiff bases, (E)-N-(4-bromophenyl)-1-(2,6-dichlorophenyl)methanimine (S1) and (E)-4-(((4-bromophenyl)imino)methyl)phenol (S2) were synthesized and elucidated using basic spectroscopic methods such as Fourier-transform-infrared, Ultraviolet-visible as well as 1H & 13C-NMR while purity of the compounds was ascertained by the means of elemental analysis. The stability, chemical reactivities and electronic properties of S1 and S2 were evaluated using Density Functional Theory (DFT). Energy band gap (?E) of S1 and S2 are 2.81 eV and 3.02 eV respectively and this inferred that S1 is more reactive as well as less stable than S2. The Molecular electrostatic potential (MEP) mapping evaluation showed that both S1 and S2 are having more of the yellow, green and red region than the blue region, signifying that these structures are prone to electrophilic attack. The compounds were screened against one Gram-negative (Staphylococcus aureus) and two Gram-positive bacteria (Klebsiella pneumoniae and Psedomonas aeruginosa) to evaluate their antibacterial potential. S1 as well as S2 showed antibacterial potential against Staphylococcus aureus and exhibited less of no activity against Klebsiella pneumoniae and Escherichia coli. In silico studies of S1 and S2 against Staphylococcus aureus was carried out and the outcomes corroborate with experimental findings. Pharmacological evaluation of S1 and S2 showed that both compounds exhibited less violation of Lipinski’s rule of five (Ro5) which pose them to be less toxic and orally available.

Aim: The purpose of this study was to examine clinical and epidemiological characteristics and autoantibody status of children diagnosed with type 1 diabetes mellitus (DM) at presentation. Methods: The data retrieved from the medical records of 80 patients with type 1 DM, aged under 18 and diagnosed at the Adıyaman Education and Research Hospital, pediatric endocrinology clinic and emergency department between September 2016 and December 2021 were examined retrospectively. Patients’ symptoms at presentation and clinical and laboratory findings were recorded. Results: Thirty-four (42.5%) of the children with type 1 DM were girls and 46 (57.5%) were boys, with a mean age of 10.69±4.75 years. The presentation was most common in the 5-10 (33.8%) and 10-15 (31.3%) age groups. Diabetic ketoacidosis (DKA) was present in 36 (45%) of the children with type 1 DM at presentation, ketosis without acidosis in 30 (38%), and only hyperglycemia in 14. Sixty percent of the patients under five years of age, 48% of those in the 5-10 age group, and 33.3% of the 10-18 age group presented with DKA, and the frequency of presentation with DKA was higher among patients under five years of age than in the other age groups. Severe DKA findings were present in 13 (36%) cases, moderate findings in 10 (27.8%), and mild findings in 13 (36.1%). Anti-glutamic acid decarboxylase positivity was present in 14 cases (53.2%), islet cell antibody positivity in 37 (48%), and anti-insulin antibody positivity in 11 (14.2%). Conclusion: The incidence rate of DKA in children with newly diagnosed type 1 DM and the rate of severe ketoacidosis among them are quite high in the province of Adıyaman. This shows the need to continue diabetes awareness programs and to reach a larger number of people.

Background/Aims Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose. Methods Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours. Results The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired. Conclusions T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

Abstract Arsenic (As) is a heavy metal that is toxic to both plants and animals. Silicon nanoparticles (SiNPs) can alleviate the detrimental effects of heavy metals on plants, but the underlying mechanisms remain unclear. The study aims to synthesize SiNPs and reveal how they promote plant health in Arsenic-polluted soil. 0 and 100% v/v SiNPs were applied to soil, and Arsenic 0 and 3.2 g/ml were applied twice. Maize growth was monitored until maturity. Small, irregular, spherical, smooth, and non-agglomerated SiNPs with a peak absorbance of 400 nm were synthesized from Pycreus polystachyos. The SiNPs (100%) assisted in the development of a deep, prolific root structure that aided hydraulic conductance and gave mechanical support to the maize plant under As stress. Thus, there was a 40–50% increase in growth, tripled yield weights, and accelerated flowering, fruiting, and senescence. SiNPs caused immobilization (As(III)=SiNPs) of As in the soil and induced root exudates Phytochelatins (PCs) (desGly-PC2 and Oxidized Glutathione) which may lead to formation of SiNPs=As(III)–PCs complexes and sequestration of As in the plant biomass. Moreover, SiNPs may alleviate Arsenic stress by serving as co-enzymes that activate the antioxidant-defensive mechanisms of the shoot and root. Thus, above 70%, most reactive ROS (OH) were scavenged, which was evident in the reduced MDA content that strengthened the plasma membrane to support selective ion absorption of SiNPs in place of Arsenic. We conclude that SiNPs can alleviate As stress through sequestration with PCs, improve root hydraulic conductance, antioxidant activity, and membrane stability in maize plants, and could be a potential tool to promote heavy metal stress resilience in the field.

Abstract Background Heavy smokers are at increased risk for cardiovascular disease and may benefit from individualized risk quantification using routine lung cancer screening chest computed tomography. We investigated the prognostic value of deep learning-based automated epicardial adipose tissue quantification and compared it to established cardiovascular risk factors and coronary artery calcium. Methods We investigated the prognostic value of automated epicardial adipose tissue quantification in heavy smokers enrolled in the National Lung Screening Trial and followed for 12.3 (11.9–12.8) years. The epicardial adipose tissue was segmented and quantified on non-ECG-synchronized, non-contrast low-dose chest computed tomography scans using a validated deep-learning algorithm. Multivariable survival regression analyses were then utilized to determine the associations of epicardial adipose tissue volume and density with all-cause and cardiovascular mortality (myocardial infarction and stroke). Results Here we show in 24,090 adult heavy smokers (59% men; 61 ± 5 years) that epicardial adipose tissue volume and density are independently associated with all-cause (adjusted hazard ratios: 1.10 and 1.38; P