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Lobular neoplasia (LN) involves proliferative changes within the breast lobules. LN is divided into lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). LCIS can be further subdivided into three subtypes: classic LCIS, pleomorphic LCIS, and LCIS with necrosis (florid type). Because classic LCIS is now considered as a benign etiology, current guidelines recommend close follow-up with imaging versus surgical excision. The goal of our study was to determine if the diagnosis of classic LN on core needle biopsy (CNB) merits surgical excision. This is a retrospective, observational study conducted at Mount Auburn Hospital, Cambridge, MA, from May 17, 2017, through June 30, 2020. We reviewed the data of breast biopsies conducted at our hospital over this period and included patients who were diagnosed with classic LN (LCIS and/or ALH) and excluded patients having any other atypical lesions on CNB. All known cancer patients were excluded. Of the 2707 CNBs performed during the study period, we identified 68 women who were diagnosed with ALH or LCIS on CNB. CNB was performed for an abnormal mammogram in the majority of patients (60; 88%) while 7(10.3%) had an abnormal breast magnetic resonance imaging study (MRI), and 1 had an abnormal ultrasound (US). A total of 58 patients (85%) underwent excisional biopsy, of which 3 (5.2%) showed malignancy, including 2 cases of DCIS and 1 invasive carcinoma. In addition, there was 1 case (1.7%) with pleomorphic LCIS and 11 cases with ADH (15.5%). The management of LN found on core biopsy is evolving, with some advocating surgical excision and others recommending observation. Our data show a change in diagnosis with excisional biopsy in 13 (22.4%) of patients with 2 cases of DCIS, 1 invasive carcinoma, 1 pleomorphic LCIS, and 9 cases of ADH, diagnosed on excisional biopsy. While ALH and classic LCIS are considered benign, the choice of ongoing surveillance versus excisional biopsy should be made with shared decision making with the patient, with consideration of personal and family history, as well as patient preferences.

Background. The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives. This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods. A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results. The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion. Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.

The aim of this paper is to investigate the approximate solutions of nonlinear temporal fractional models of Gardner and Cahn-Hilliard equations. The fractional models of the Gardner and Cahn-Hilliard equations play an important role in pulse propagation in dispersive media. The time-fractional derivative is observed in the conformable framework. In this orientation, a reliable computationally algorithm is designed and developed by following a residual error and multivariable power series expansion. Basically, the approximate solutions of pulse wave function of the fractional higher-order Gardner and Cahn-Hilliard equations are obtained in the form of a conformable convergent fractional series. Relevant consequences are theoretically and numerically investigated under the conformable sense. Besides, the analysis of the error and convergence of the developed technique are discussed. Some of the unidirectional homogeneous physical applications of the posed models in a finite compact regime are tested to confirm the theoretical aspects, demonstrate different evolutionary dynamics, and highlight the superiority of the novel developed algorithm compared to other existing analytical methods. For this purpose, associated graphs are displayed in two and three dimensions. Growing and decaying modes of the fractional parameters are analyzed for several α values. From a numerical viewpoint, the simulations and results declare that the proposed iterative algorithm is indeed straightforward and appropriate with efficiency for long-wavelength solutions of nonlinear partial differential equations.

Oral anticoagulation is the most common method to decrease the risk of stroke in people with atrial fibrillation.To assess the knowledge of Jordanian nurses about anticoagulation therapy, the effectiveness of educational courses in increasing their knowledge, and the factors that affect nurses' changing knowledge following completion of an educational course.A pre/posttest quasi-experimental design was used. A total of 123 nurses participated in the study, identified by convenience sampling and recruited from five governmental hospitals in Jordan. To assess changes in knowledge between pre-and posttest, a questionnaire based on European cardiovascular nurses' knowledge of anticoagulation therapy was used. An educational course was given to improve participants' knowledge of anticoagulation therapy. The participants' knowledge was assessed before and after the educational course. For data analysis, Statistical Package for the Social Sciences version 23 was used.Nurses' knowledge of anticoagulants was poor; however, a significant improvement was achieved following the educational course (M = 25.5, SD = 3.41), as compared to before conducting it (M = 12.2, SD = 5.3, t = 42.54, p 0.001). Having an academic degree was found to affect the change in knowledge scores among participants (t = -3.52, p = 0.001).The educational course was effective in improving the nurses' knowledge. Baccalaureate degree holders achieved more improvement in their knowledge scores. Post-graduate education for nurses would help to improve their knowledge of anticoagulants. Revision of nursing curricula may be deemed necessary to improve the quality of education for nurses during their degree work, especially regarding anticoagulants.

Purpose. The aims of the study were to determine the reasons behind surgical correction delay in adult patients with strabismus, reveal motivations for seeking treatment, and study the psychosocial and functional impacts of strabismus on patients using an Arabic version of the Adult Strabismus-20 (AS-20) questionnaire. Methods and Patients. This study included 79 patients aged ≥18 years and had strabismus for at least one year prior to surgical correction and 40 controls without known visual defects. After a comprehensive ophthalmic exam during their preoperative visit, a validated questionnaire was administered to patients to collect sociodemographic data, reasons for surgery delay, and motivations for seeking treatment now. A translated version of the AS-20 questionnaire was then presented to patients and controls. Total AS-20 (and its subscales: psychosocial and function) scores were calculated and analyzed. All relationships between sociodemographic characteristics, the onset of deviation, presence of diplopia, type and size of deviation, and the changes in the scores of AS-20 (and its subscales) were investigated. Results. A total of 79 adult patients with strabismus (cases) and 40 subjects with normal vision (control group) were included in this study. The mean age (SD) was 34.10 (11.5) years for cases (range: 18–61) and 34.20 (11.2) years for controls (range: 18–65) ( p = 0.964 ). About half (55.7%, n = 44) of the patients were males compared to (57.5%, n = 23) of the controls. The reasons for strabismus surgery delay reported by the patients were the following: surgery was not offered by an ophthalmologist (35.4%), surgery was offered but declined by the patient due to fear from surgical complications (22.8%), nonaffordability (17.7%), surgery was offered but refused because patients thought they were too old for surgery or patient was not bothered by appearance (15.2%), and patient never sought care (8.9%). The reasons for seeking surgical treatment after this delay were as follows: for cosmetic issues (27.8%), a better understanding of strabismus surgery and its potential complications (20.3%), pressure from family and friends (16.5%), improved economic status (13.9%), relationship/marriage prospects (13.9%), and to improve chances of getting a job (7.6%). When compared to control, patients have significantly lower mean scores of total AS-20 (50.57 vs. 88.01) and its psychosocial (49.59 vs. 87.84) and functional (51.55 vs. 88.19) subscales. AS-20 total score was significantly lower among females and in patients with large deviation size (>25 PD). The psychosocial subscale of AS-20 was significantly lower in females, patients with younger age of onset, and those with large deviation size (>25 PD). Female gender, large deviation size, vertical deviation, and having diplopia correlated significantly with a lower functional score. Conclusion. Strabismus has a profound psychosocial and functional impact on affected individuals, especially females and patients with large deviation sizes. Many adult patients with strabismus tend to delay surgical correction; most of these delays could be avoided by better public education, increased awareness among health care providers, and changing health insurance policies to cover the costs of strabismus surgery.

The mechanical heart valve is a crucial solution for many patients. However, it cannot function on the state of blood as human tissue valves. Thus, people with mechanical valves are put under anticoagulant therapy. A good measurement of the state of blood and how long it takes blood to form clots is the prothrombin time (PT); moreover, it is an indicator of how well the anticoagulant therapy is, and of whether the response of the patient to the drug is as needed. For a more specific standardized measurement of coagulation time, an international normalized ratio (INR) is established. Clinical testing of INR and PT is relatively easy. However, it requires the patient to visit the clinic for evaluation purposes. Many techniques are therefore being developed to provide PT and INR self-testing devices. Unfortunately, those solutions are either inaccurate, complex, or expensive. The present work approaches the design of an anticoagulation self-monitoring device that is easy to use, accurate, and relatively inexpensive. Hence, a two-channel polymethyl methacrylate-based microfluidic point-of-care (POC) smart device has been developed. The Arduino based lab-on-a-chip device applies optical properties to a small amount of blood. The achieved accuracy is 96.7%.

Many phenomena in physics and engineering can be built by linear and nonlinear fractional partial differential equations which are considered an accurate instrument to interpret these phenomena. In the current manuscript, the approximate analytical solutions for linear and nonlinear time-fractional Swift-Hohenberg equations are created and studied by means of a recent superb technique, named the Laplace residual power series (LRPS) technique under the time-Caputo fractional derivatives. The proposed technique is a combination of the generalized Taylor’s formula and the Laplace transform operator, which depends mainly on the concept of limit at infinity to find the unknown functions for the fractional series expansions in the Laplace space with fewer computations and more accuracy comparing with the classical RPS that depends on the Caputo fractional derivative for each step in obtaining the coefficient expansion. To test the simplicity, performance, and applicability of the present method, three numerical problems of the time-fractional Swift-Hohenberg initial value problems are considered. The impact of the fractional order β on the behavior of the approximate solutions at fixed bifurcation parameter is shown graphically and numerically. Obtained results emphasized that the LRPS technique is an easy, efficient, and speed approach for the exact description of the linear and nonlinear time-fractional models that arise in natural sciences.

In this article, we aim to develop new k , s -fractional integral and differential operators containing S -functions as kernels in a form of generalized k -Mittag-Leffer functions. We also set up various properties of such operators. Furthermore, we consider a variety of implications of the major outcomes that will be very useful in the implementation of scientific, engineering, and technical problems.

INTRODUCTION Despitecardiac cachexia being a prevalent health problem among heart failure (HF) patients, it has been given little attention by nursing researchers. Therefore, this study aims to conduct a systematic review that investigates cardiac cachexia among patients with HF. METHODOLOGY A systematic review will be performed according to the PRISMA guidelines to assess the findings of twelve selected studies which meet the inclusion criteria of the systematic review research. The selected articles were published between 2000 and 2020 across three databases: PubMed, CINAHL, and MEDLINE. RESULTS In comparison to cancer cachexia, cardiac cachexia has been insufficiently studied and is poorly understood. No definitive diagnostic method for cardiac cachexia has been identified in the literature. Age, smoking, and hypertension have been reported to be risk factors for cardiac cachexia. Cardiac cachexia has been significantly associated with lethal structural changes in the heart and has been measured using anthropometric measures and laboratory biomarkers. A combination of pharmacological and nonpharmacological treatments has been effectively implemented to manage cardiac cachexia. CONCLUSION A focused multidisciplinary approachthat takes culture into consideration is required to set a variety of assessment and interventional strategies for the early detection and proper management of cardiac cachexia.

Background. Bladder cancer (BC) is the second most reported cancer in Lebanon and the fifth in Jordan. Its risk factors are mainly smoking and occupational exposure to aromatic amines. In these countries where smoking and bladder cancer are highly prevalent, the role of waterpipe smoking (WPS) in bladder cancer is less investigated. We aim to compare two sets of patients between Lebanon and Jordan, focusing on their smoking habits, WP use, occupational exposure, and the grade/invasiveness of their bladder cancer. Methods. This is a cross-sectional study that compares the smoking culture between two sets of populations with bladder cancer, from two different countries. We recruited 274 bladder cancer patients over the 18 years of age at the American University of Beirut Medical Center (AUBMC), and 158 bladder cancer patients over the age of 18 years at the King Hussein Cancer Center (KHCC). Results. 7.7% of Lebanese patients had significantly more positive family history of bladder cancer compared to 13.9% of Jordanian patients ( p = 0.045 ). Another significant finding is that the majority of Lebanese patients 70.7% reported being frequently exposed to secondhand smoking, mainly cigarettes, versus only 48.6% of Jordanian patients ( p < 0.001 ). The increasing smoking trend among Lebanese females is remarkably the highest in the region, which contributed to the overall increase in smoking rates in the country. 17.1% of the Lebanese smoking patients are mainly but not exclusively WP smokers of which 6.3% are daily WP smokers, similarly 17.1% of the Jordanian patients of which 3.2% are daily WP smokers. There were 71.5% of Lebanese patients who had a noninvasive BC versus 40% of Jordanian patients ( p < 0.001 ), and more than one-third reported an occupational exposure to one of the risk factors of BC in both groups. Conclusions. Bladder cancer incidence is on the rise in both Jordan and Lebanon along with different smoking types. It is necessary to impose prevention policies to prevent and control the high smoking prevalence. Bladder cancer invasiveness is higher in Jordan compared to universal data.

Background Different work environments may create different nurses' job stressors, and in turn, may need different social support behaviors to help nurses overcome these stressors. Aims This study aimed at comparing nurses' job stressors and social support behaviors in three different work environments (i.e., public, teaching, and private hospitals) in Jordan and examining the predictors of these stressors and social support behaviors. Materials & methods This was a descriptive comparative study in which data were collected using the Nursing Stress Scale and the Inventory of Social Supportive Behaviors from 139, 190, and 135 nurses from the public, teaching, and private hospitals, respectively. Descriptive and inferential statistics including comparative and multiple linear regression statistics were used. Results The results indicated that there were no significant differences in the total scores of job stressors and social support behaviors among nurses at the three types of hospitals. However, significant differences were reported in the subscales of job stressors in teaching and public hospitals and in individual items of both scales across the three kinds of hospitals. Controlling for nurses' characteristics, the scores of both scales were not predicted by the type of hospitals. Conclusion Similar to public hospitals, teaching, and private hospitals, administrators should initiate various social support behaviors in their clinical settings, and should consider the predictors of job stressors to help nurses overcome their job stressors.

Purpose. Microsatellite instability (MSI) caused by mismatch repair protein (MMRP) deficiency is detected in 15% of sporadic colorectal cancers (CRCs). Our aim is to investigate the frequency of MMRP deficiency in young CRC patients, using immunohistochemical analysis. Methods. This study targeted cases of CRC at King Hussein Cancer Center from 2004 until 2012 in patients 45 years of age or younger at the time of diagnosis. Clinicopathological data was obtained from 155 patients’ records. Immunohistochemistry for MLH1, MSH2, PMS2, and MSH6 proteins was performed on paraffin-embedded tissue containing carcinoma. Results. The median age of patient at diagnosis was 38 years. A total of 29 (19%) cases showed deficient MMRP(dMMRP)expression. Loss of expression of PMS2 was seen in 17 cases, 12 cases of which showed loss of MLH1 expression. Loss of expression of MSH6 was seen in 10 cases, 9 of which showed loss of MSH2 expression. One case (3.4%) showed loss of all four MMR proteins, and another case (3.4%) showed loss of PMS2/MLH1 and MSH6. There was a significant association between abnormal MMR protein expression and tumor location proximal to splenic flexure (p value 0.000), pathologic features suggestive of microsatellite instability (p value 0.000), P53 negativity (p value 0.000), and stage (p value 0.02). Patients with dMMRP CRC appeared to have a significantly better overall survival compared to patients with proficient MMRP(pMMRP)(p value 0.02). Loss of MSH2/MSH6 was significantly associated with positive family history of cancer (p value = 0.020). Conclusions. The prevalence of dMMRP tumors in this age group appears to be similar to international literature. dMMRP tumors tends to be associated with earlier stages and better outcomes compared to pMMRP cases. dMMRP can serve as a biomarker for better prognosis. These results are of value in directing the clinical management of young patients with CRC.

Aim. The study aimed at evaluating the incidence of dentinal defects after root canal retreatment with ProTaper Universal retreatment (PTUR) and XP-endo Shaper and Finisher R (XP). Materials and Methods. Sixty extracted single-rooted human premolars were selected and divided into 4 groups of 15 teeth each. In the negative control group, the teeth were left unprepared. In the positive control group, the teeth were prepared with ProTaper Next and obturated with no further retreatment. In the PTUR and XP groups, the teeth were prepared and obturated followed by removal of the filling material at body temperature using PTUR and XP instruments, respectively. The roots were then sectioned at 3, 6, and 9 mm from the apex and observed under a digital microscope to detect defects. Results. PTUR group showed significantly higher ( p value

In this article, we aim to develop new k,s-fractional integral and differential operators containing S-functions as kernels in a form of generalized k-Mittag-Leffer functions. We also set up various properties of such operators. Furthermore, we consider a variety of implications of the major outcomes that will be very useful in the implementation of scientific, engineering, and technical problems.