Search

Abstract Soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) is used without evidence of benefits. We investigated the relationship between lipid emulsions and brain injury in term-equivalent age magnetic resonance imaging (MRI) in 148 very preterm infants with a birth weight of

In Yemen, there is a scarcity of research and a lack of application for phonics-based instruction. Hence, the present study aimed to explore EFL teachers' perspectives on the efficiency of phonics instruction in developing reading, spelling and pronunciation fluency among Yemeni EFL learners at primary schools. The study sample comprised 33 EFL teachers from six schools in Dhamar City, Yemen. The participants were asked to give their views and share their experiences on the efficacy of phonics-based instruction in developing the above-mentioned language skills. The participants were selected based on the convenient sampling technique and asked to respond to a questionnaire consisting of 15 statements. The data obtained were analyzed using the SPSS program version 22.0 to display descriptive statistics quantitatively. The results revealed that teaching phonics is so crucial for the development and improvement of learners' reading fluency, spelling mastery, and pronunciation proficiency. In addition, phonics teaching contributes to reducing and/or eliminating the learners' errors in spelling, reading, and pronunciation. The findings highlighted the importance of integrating phonics teaching into the curricula of English in the early stages at Yemeni schools.

Abstract Organic rich sedimentary rocks of the Late Cretaceous Muwaqqar Formation from the Lajjun outcrop in the Lajjun Sub-basin, Western Central Jordan were geochemically analyzed. This study integrates kerogen microscopy of the isolated kerogen from 10 oil shale samples with a new finding from unconventional geochemical methods [i.e., ultimate elemental (CHNS), fourier transform infrared spectroscopy and pyrolysis–gas chromatography (Py–GC)] to decipher the molecular structure of the analyzed isolated kerogen fraction and evaluate the kerogen composition and characteristics. The optical kerogen microscopy shows that the isolated kerogen from the studied oil shales is originated from marine assemblages [i.e., algae, bituminite and fluorescence amorphous organic matter] with minor amounts of plant origin organic matter (i.e., spores). This finding suggests that the studied kerogen is hydrogen-rich kerogen, and has the potential to generate high paraffinic oil with low wax content. The dominance of such hydrogen-rich kerogen (mainly Type II) was confirmed from the multi-geochemical ratios, including high hydrogen/carbon atomic of more than 1.30 and high A-factor of more than 0.60. This claim agrees with the molecular structure of the kerogen derived from Py–GC results, which suggest that the studied kerogen is mainly Type II-S kerogen exhibiting the possibility of producing high sulphur oils during earlier stages of diagenesis, according to bulk kinetic modeling. The kinetic models of the isolated kerogen fraction suggest that the kerogen conversion, in coincidence with a vitrinite reflectance range of 0.55–0.60%, commenced at considerably lower temperature value ranges between 100 and 106 °C, which have produced oils during the early stage of oil generation. The kinetic models also suggest that the commercial amounts of oil can generate by kerogen conversion of up to 50% during the peak stage of oil window (0.71–0.83%) at relatively low geological temperature values in the range of 122–138 °C. Therefore, further development of the Muwaqqar oil shale successions is highly approved in the shallowly buried stratigraphic succession in the Lajjun Sub-basin, Western Central Jordan.

Abstract To enable interrogation of tumor HLA LOH as a clinical diagnostic for precision oncology, we developed and validated an assay that detects HLA LOH within the context of an FDA-approved clinical diagnostic test, Tempus xT CDx. Validation was conducted via: (1) analytical evaluation of 17 archival patient samples and 42 cell line admixtures and (2) independent clinical evaluation of LOH prevalence in the HLA-A gene (HLA-A LOH) across 10,982 patients. To evaluate the prognostic relevance of HLA-A LOH we assessed 256 immunotherapy-treated non-small cell lung cancer (NSCLC) patients. To determine the feasibility of prospectively identifying and enrolling HLA-A LOH patients into a clinical trial, we established BASECAMP-1 (NCT04981119). We observed a positive predictive agreement of 97% and a negative predictive agreement of 100% in samples with ≥ 40% tumor purity. We observed HLA-A LOH in 16.1% of patients (1771/10,982), comparable to previous reports. HLA-A LOH was associated with longer survival among NSCLC adenocarcinoma patients (HR = 0.60, 95% CI [0.37, 0.96], p = 0.032) with a trend towards shorter survival among squamous cell patients (HR = 1.64, 95% CI [0.80, 3.41], p = 0.183). In 20 months, we prospectively screened 1720 subjects using the Tempus AWARE program, identifying 26 HLA-A*02 LOH patients at 8 sites, with 14 (54%) enrolled into BASECAMP-1. In conclusion, we developed and validated an investigational assay that detects tumor HLA LOH within an FDA-approved clinical diagnostic test, enabling HLA LOH utilization in diagnostic, prognostic, and therapeutic applications.

Abstract Background Lymphoid neoplasm is a common disease, arising from lymphoid cells. It is divided into Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphoma can be intranodular or extranodular, which happens in 25% of primary cases. The most common locations of extranodular non-Hodgkin lymphoma are the skin and gastrointestinal tract. The genital tract is a rare location; most lymphomas arise from the cervix and vagina, while the uterine corpus is an extremely rare location. In our case, the patient was diagnosed with primary extranodular non-Hodgkin lymphoma in different locations of her genital tract. Case presentation A 48-year-old nonparous Syrian woman complained of diffuse abdominal pain, fatigue, debility, high fever, vomiting, and urinary retention for a week. The last menstrual period of the patient was 5 years previously. The physical examination showed periodic abdominal pain with severe fatigue and increased abdominal size. The laboratory investigations were within normal limits except for a low level of hemoglobin and a high level of cancer antigen 125. The radiological investigations showed a uterine sizable lobulated mass with irregular borders and high and heterogeneous density, extending to the right and left ovaries, enlargement lymph nodes around the abdominal aortic and right iliac vessels, and severe right pleural effusion with right inferior lobe atelectasis. A total hysterectomy and oophorectomy were done. The histopathological examination showed that the patient had non-Hodgkin lymphoma (primary tumor). Conclusion Primary non-Hodgkin lymphoma in the female genital tract is an extremely rare disease. Fast diagnosis and treatment can improve the outcomes, so this differential diagnosis should be in our minds even in the absence of systematic manifestations of lymphoma. More studies are needed to explain the pathology of this disease and to put guidelines that determine the perfect methods for diagnosis and treatment.

The incidence of chronic diseases in contemporary society has been steadily rising with the ageing population. They place a significant strain on both people and the healthcare system, and they are the leading cause of death. As a result, novel detection methods that allow for early identification of chronic diseases to manage therapy are in high demand. Modern sensing tools have emerged in the form of biosensors, which can detect biomarkers and transform them into quantifiable signals. The fields of environmental science, agriculture, drug discovery, biotechnology, food safety, and medical diagnostics might all benefit from the data they provide. The development of more precise, sensitive, and selective diagnostic tools is, nevertheless, of the utmost importance, as is the ability to identify biomarkers as disease indicators at very low concentrations. Nano biosensors are a new generation of analytical instruments that have evolved from the integration of nanomaterials with biosensors. One promising option for continuous, real-time health monitoring is nanostructured biosensors, which provide exceptional sensitivity, selectivity, and reproducibility. Nano biosensors are categorized in this extensive study according to their size, production process, and transduction mechanism. Also, talk about the latest developments and uses for nano biosensors, and cover some important elements of them, focusing on their electrochemistry and optical characteristics. Further research is needed to fully understand nano biosensors and their potential as a tool for personalized treatment, since there are still many unknowns about their biocompatibility, toxicity, stability, and integration into the human body.

This paper examines acquisition of voiced obstruents by Yemeni Arabic speaking children. In particular, it looks at the phenomenon of devoicing voiced obstruents in word-final position, a well-established phenomenon in the literature of child phonology. Children appear to devoice the voiced obstruents as a strategy to simplify production of voiced obstruents in word-final position. Six Yemeni Arabic speaking children aged 2;6, 2;8, 2;9, 2;10,2;11 and 3 have participated in this study. They have been recorded and then the data collected have been transcribed by the researchers. An OT account is then provided to explain this phonological process. Results suggest that children substitute voiced obstruents in word-final position, most of the time, with their voiceless cognates in early child language. The devoicing process might have interesting implications, both phonological and pedagogical.

Background: Cerebral arteriovenous malformations (AVMs) are complex, heterogeneous, uncommon lesions that carry a high risk of intracranial hemorrhage with subsequent disability. Aim: To evaluate the outcome of patients with cerebral AVMs treated in our center, King Faisal Specialized Hospital and Research Center (KFSH&RC) Saudi Arabia with SRS using the CyberKnife. Methods: Medical records of patients treated in the above-mentioned way in the period between 2009-2021 were retrospectively evaluated. Results: A total of 51 patients were included in this study. The median age at diagnosis was 31 (3-77) years. Neurological alteration and intracranial hemorrhage were the most common presentations in 24 (47.1%) patients. The mean maximum AVM nidus diameter and volume were 2.9 cm and 5.9 cc respectively. All the patients received SRS using CyberKnife with a median marginal dose of 20 (14-21) Gy over a single fraction. Volume staged treatment was applied in 4 (7.8%) patients. After a median follow-up of 37 (2-170) months, all patients were alive with successful obliteration of the AVM nidus occurring in 31 (60.8%) patients after a median latency period of 27 (4-68.9) months in those who achieved complete obliteration. No patients developed post-SRS hemorrhage and 11 (21.6%) patients developed post-SRS radiological radiation-induced changes of which only 3 (27.3%) patients were symptomatic (in the form of uncontrolled seizures). only SRS dose > 19 Gy was significantly correlated with the obliteration rate, as 79.3% of patients who received SRS dose > 19 Gy achieved obliteration vs 36.4 % only in those who received dose Conclusion: SRS treatment using CyberKnife is effective management for patients with cerebral AVMs without an increase in the incidence of post-SRS hemorrhage, stroke, or death.

During a 1-year study, Trichuris adults were obtained after necropsy of Arabian camels (Camelus dromedarius) from a slaughterhouse in Kuwait. Morphological and molecular identification was performed to confirm the identity of the Trichuris specimens obtained from C. dromedarius. Fifteen male Trichuris specimens were selected, and molecular identification was performed using mitochondrial cytochrome c oxidase subunit I, 12S ribosomal RNA, 16S ribosomal RNA genes and the nuclear internal transcribed spacer 2 (ITS2) region. Through phylogenetic analysis, 2 distinct groups were obtained using the mitochondrial genes, where group 1 showed a close relationship to Trichuris globulosa while group 2 showed a close relationship to Trichuris ovis, providing molecular evidence of a possible T. globulosa species complex. Additionally, the nuclear ITS2 region did not provide enough resolution to distinguish between the 2 groups of Trichuris specimens. Observation of morphological characters revealed variations in the shape of the male spicule sheath, where specimens present either a globular posteriorly truncated swelling or the absence of posteriorly truncated swelling. Moreover, the variations in male spicule sheath does not corroborate with the results of molecular data, suggesting the limited use of this character for identification of T. globulosa. In conclusion, molecular analysis suggests a possible species complex in T. globulosa, with the mitochondrial genetic markers successfully differentiating between the 2 groups. The limited use of the male spicule sheath as a diagnostic character for identification of T. globulosa is suggested.

Abstract Introduction Prolonged Length of Stay (LOS) in ED (Emergency Department) has been associated with poor clinical outcomes. Prediction of ED LOS may help optimize resource utilization, clinical management, and benchmarking. This study aims to systematically review models for predicting ED LOS and to assess the reporting and methodological quality about these models. Methods The online database PubMed, Scopus, and Web of Science (10 Sep 2023) was searched for English language articles that reported prediction models of LOS in ED. Identified titles and abstracts were independently screened by two reviewers. All original papers describing either development (with or without internal validation) or external validation of a prediction model for LOS in ED were included. Results Of 12,193 uniquely identified articles, 34 studies were included (29 describe the development of new models and five describe the validation of existing models). Different statistical and machine learning methods were applied to the papers. On the 39-point reporting score and 11-point methodological quality score, the highest reporting scores for development and validation studies were 39 and 8, respectively. Conclusion Various studies on prediction models for ED LOS were published but they are fairly heterogeneous and suffer from methodological and reporting issues. Model development studies were associated with a poor to a fair level of methodological quality in terms of the predictor selection approach, the sample size, reproducibility of the results, missing imputation technique, and avoiding dichotomizing continuous variables. Moreover, it is recommended that future investigators use the confirmed checklist to improve the quality of reporting.

The free convection of a non-Newtonian fluid in an equilateral triangular cavity containing a triangle obstruction in various positions is investigated numerically in this paper. The research is carried out using the finite element method. The sloped side walls are adiabatic, while the bottom is kept heated. At the obstacle, three positions are examined. The effects of different power law indexes on free convection have been investigated. The temperature field, fluid flow, and heat transfer are all highly influenced by the obstacle's location, Rayleigh number, and power law index. The resulting outcomes are confirmed using existing results in the literature and verified using a grid sensitivity analysis. A comparison of the current results to those found in the literature demonstrates the study's dependability and trustworthiness.

Abstract Background Patients' missed appointments can cause interference in the functions of the clinics and the visit of other patients. One of the most effective strategies to solve the problem of no‐show rate is the use of an open access scheduling system (OA). This systematic review was conducted with the aim of investigating the impact of OA on the rate of no‐show of patients in outpatient clinics. Methods Relevant articles in English were investigated based on the keywords in title and abstract using PubMed, Scopus, and Web of Science databases and Google Scholar search engine (July 23, 2023). The articles using OA and reporting the no‐show rate were included. Exclusion criteria were as follows: (1) review articles, opinion, and letters, (2) inpatient scheduling system articles, and (3) modeling or simulating OA articles. Data were extracted from the selected articles about such issues as study design, outcome measures, interventions, results, and quality score. Findings From a total of 23,403 studies, 16 articles were selected. The specialized fields included family medicine (62.5%, 10), pediatrics (25%, four), ophthalmology, podiatric, geriatrics, internal medicine, and primary care (6.25%, one). Of 16 articles, 10 papers (62.5%) showed a significant decrease in the no‐show rate. In four articles (25%), the no‐show rate was not significantly reduced. In two papers (12.5%), there were no significant changes. Conclusions According to this study results, it seems that in most outpatient clinics, the use of OA by considering some conditions such as conducting needs assessment and system design based on the patients' and providers' actual needs, and cooperating of all system stakeholders through consistent training caused a significant decrease in the no‐show rate.

BackgroundFederated learning (FL) is a technique for learning prediction models without sharing records between hospitals. Compared to centralized training approaches, the adoption of FL could negatively impact model performance.AimThis study aimed to evaluate four types of multicenter model development strategies for predicting 30-day mortality for patients undergoing transcatheter aortic valve implantation (TAVI): (1) central, learning one model from a centralized dataset of all hospitals; (2) local, learning one model per hospital; (3) federated averaging (FedAvg), averaging of local model coefficients; and (4) ensemble, aggregating local model predictions.MethodsData from all 16 Dutch TAVI hospitals from 2013 to 2021 in the Netherlands Heart Registration (NHR) were used. All approaches were internally validated. For the central and federated approaches, external geographic validation was also performed. Predictive performance in terms of discrimination [the area under the ROC curve (AUC-ROC, hereafter referred to as AUC)] and calibration (intercept and slope, and calibration graph) was measured.ResultsThe dataset comprised 16,661 TAVI records with a 30-day mortality rate of 3.4%. In internal validation the AUCs of central, local, FedAvg, and ensemble models were 0.68, 0.65, 0.67, and 0.67, respectively. The central and local models were miscalibrated by slope, while the FedAvg and ensemble models were miscalibrated by intercept. During external geographic validation, central, FedAvg, and ensemble all achieved a mean AUC of 0.68. Miscalibration was observed for the central, FedAvg, and ensemble models in 44%, 44%, and 38% of the hospitals, respectively.ConclusionCompared to centralized training approaches, FL techniques such as FedAvg and ensemble demonstrated comparable AUC and calibration. The use of FL techniques should be considered a viable option for clinical prediction model development.

The present research project aims to explore translation methods adopted by Yemeni undergraduates when translating war-related collocations from English to Arabic and vice versa. To collect the data, a translation test was given to 64 undergraduate students affiliated to the departments of English and Translation in five Yemeni public and private universities. The test consists of 20 English sentences including war-related collocations to be translated into Arabic, and 20 Arabic sentences to be translated into English. The translation methods used by the students were investigated. Excel statistical analysis software was used to analyze the selected collocations. Percentages were used to quantify the total number of Yemeni undergraduate students who translated the collocations in the translation test. The frequencies of the methods used for the selected collocations were represented as ratios. The findings revealed that the most frequent methods used by students in translating war-related collocations are modulation, paraphrasing, literal translation, and transposition. The findings of the study also highlight implications to be utilized by students and translators in the form of recommendations.

Diffusion magnetic resonance imaging (dMRI) allows for a non-invasive visualization and quantitative assessment of white matter architecture in the brain by characterizing restrictions on the random motion of water molecules. Ultra-high field MRI scanners, such as those operating at 7 Tesla (7T) or higher, can boost the signal-to-noise ratio (SNR) to improve dMRI compared with what is attainable at conventional field strengths such as 3T or 1.5T. However, wavelength effects at 7T cause reduced transmit magnetic field efficiency in the human brain, mainly in the posterior fossa, manifesting as signal dropouts in this region. Recently, we reported a simple approach of using a wireless radiofrequency (RF) surface array to improve transmit efficiency and signal sensitivity at 7T. In this study, we demonstrate the feasibility and effectiveness of the RF enhancer in improving in vivo dMRI at 7T. The electromagnetic simulation results demonstrated a 2.1-fold increase in transmit efficiency with the use of the RF enhancer. The experimental results similarly showed a 1.9-fold improvement in transmit efficiency and a 1.4-fold increase in normalized SNR. These improvements effectively mitigated signal dropouts in regions with inherently lower SNR, such as the cerebellum, resulting in a better depiction of principal fiber orientations and an enhanced visualization of extended tracts.

ABSTRACT Background: To determine the frequency and risk factors of COPD and Restrictive Lung Diseases in a Primary Care Center in Karachi. Methods: All patients coming to Primary Health Care Center presenting with cough were enrolled in the study. They were seen by Consultant Family Physician who filled the questionnaires after informed consent. Chest was examined and the patients underwent PEF. If PEF was

Background: Acute meningitis is a disease with case fatality and disability rate that is dependent on the causative agent. Objective: Determine the meningitis trend in Iraq from 2007 to 2023 using a joinpoint regression at national and sub-national levels and describe the epidemiology. Methods: Joinpoint regression model was used on surveillance data from Jan 2007 until May 2023, to calculate annual and average annual percent changes to determine the trend. Meningitis total count was modelled by year of reporting and province using the log transformation and Poisson variance. Best-fit model was chosen based on the weighted BIC criteria as the final point. Results: Bacterial meningitis was higher than viral meningitis from 2007 to 2018, then viral meningitis started to exceed till 2023. Meningococcal meningitis was lower than other bacterial and viral meningitis from 2007 to 2023. Most meningitis cases across the years were lower than 15 years, at almost 80 %, while 20 %–40 % were lower than one year. Across all years, 55 % of the cases were males; apart from 2019, 70 % were females. Conclusion: In Iraq, viral meningitis has been the predominant type since 2018. Most meningitis patients were lower than 15-year-old males. The meningitis trend in Iraq was stable from 2007 till 2023.

Post-fire analysis of a six-story square steel building under the action of dynamic wind forces in the south of Iraq is presented. The nonlinear time-history analysis using direct integration method is accomplished by SAP 2000 V16 program while geometric nonlinear parameters are included. The post fire deformations values and their configurations along building are based on available literature that related to post fire deformations of steel buildings at 550oCwith reducing of yield stress and modulus of elasticity) by 10% due to fire. In the present study, two post fire scenarios are considered, with wind speed of 42 m/s, according to Iraqi meteorological and IQS.301 standards. The aim of this study is to investigate the post-fire dynamic analysis of a multi-story steel moment-resisting building subjected to dynamic along-wind loads. Variations of base shear, base moment, drift ratio, and displacement are considered for discussion and comparison. Its concluded that the presence of deformation in building after fire and the reduction in yield stress and modulus of elasticity increased the base shear, base moment and drift ratio as average by about 12.5, 20& 64%respectively under the effect wind load. The fire deformations may be critical and the structural decision for the building safety should be done via structural analysis of the building taking into consideration different parameters related to post fire effects.

Abstract Coronavirus (COVID-19) was a pandemic disease that was affecting our medical and surgical daily practice badly. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotic treatment alone. Non-operative treatment for simple acute appendicitis (NOTA) avoids surgery, the risks of general anesthesia, and long hospital stays. It also decreases the risk of exposure to coronavirus. We aimed to study the cost-effectiveness and outcome of NOTA during the COVID-19 pandemic and compared it to single-incision pediatric endo-surgery appendectomy (SIPESA). A prospective cohort study for NOTA of patients from 6 to 12 years old in the COVID-19 pandemic period from April 1st, 2020, to April 30th, 2021, patients were divided into two groups: Group S was managed by SIPESA, and Group N was managed by NOTA. Family education and assurance with detailed explanation were done for early detection of any complications, and we continue monitoring the patients until their complete recovery. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. Six cases (17%) in group N were converted to surgical management in the first 6 months of the study. The mean cost dropped from $2736/day to $400/day. The mean psychological stress for the children improved from 4.4 in April to 2 in September. The mean follow-up was 3.5 months. NOTA is a feasible, cost-effective approach, and we recommend it, as we have learned this lesson during the COVID-19 pandemic days.

The advent of low-field nuclear magnetic resonance (LF-NMR) has revolutionized the petroleum industry by providing a swift and straightforward method for the spectroscopic characterization of crude oil. This review paper delves into the significant strides made in LF-NMR technology since its inception by Felix Bloch and Edward Purcell in 1946, particularly its application in determining the composition, viscosity, and water content of crude oil, alongside SARA (Saturates, Aromatics, Resins, and Asphaltenes) analysis. LF-NMR’s ability to noninvasively quantify the total water and oil content, differentiate between bound and mobile phases, and measure the SARA fractions underscores its superiority over traditional analysis methods, which often suffer from interference and lack of precision. This manuscript not only highlights LF-NMR’s pivotal role in enhancing crude-oil characterization but also reviews recent developments that solidify its position as an indispensable tool in the petroleum industry. The convergence of empirical studies and technological advancements points toward a pressing need for further research to fully exploit LF-NMR’s potential and refine its application, ensuring its continued contribution to the efficient and accurate analysis of petroleum products.

Abstract The distribution of aromatic hydrocarbon in sediments and oils is known to be affected by thermal maturity, source input and depositional conditions. Hence, the aromatic hydrocarbon fraction of four oil samples from different wells of the West Siberian Basin (central Russia) was investigated to determine the source of organic matter (OM), depositional environment and maturity of their source rocks. Biomarker ratios and parameters of aromatic compounds indicate that the studied oils were generated from clay-rich source rocks containing a mixed organic matter of marine and terrestrial origin, which were deposited in freshwater/deltaic to marine environmental settings under suboxic to relatively oxic conditions. Furthermore, the maturity-sensitive aromatic hydrocarbon parameters indicate that the source rocks are thermally mature, and in the peak to late maturity stage of the oil generation window. Oil–oil correlation results of various established aromatic biomarker proxies for organic matter origin, depositional environment and lithology suggests that the analyzed west Siberian Basin’s oils were generated from a variety of geological sources and can be grouped into two distinct oil families. The first oil family (group I) was generated from clay-rich source rock containing mixed organic matter with relatively high amounts of terrestrial plant input and deposited in a non-marine (freshwater/deltaic) environment under relatively oxic conditions, while the second oil family (group II) was derived from mixed organic matter with high marine OM input that was deposited in marine environment under suboxic conditions. The findings of the heterocyclic and polycyclic aromatics highlighted in this study can help for better understanding of the genetic ties between oils and their sources and have an impact on traditional hydrocarbon development in the Basin.

Abstract We aimed to assess the added predictive performance that free-text Dutch consultation notes provide in detecting colorectal cancer in primary care, in comparison to currently used models. We developed, evaluated and compared three prediction models for colorectal cancer (CRC) in a large primary care database with 60,641 patients. The prediction model with both known predictive features and free-text data (with TabTxt AUROC: 0.823) performs statistically significantly better (p

Recently, heterocyclic compounds such as pyrido [2,3-d] pyrimidinones, 1,2,4-triazolopyrimidines, pyrimidoquinazolines, and quinoline derivatives have gained attention from researchers due to their pharmacological and biological activities. To synthesize new compounds, quinoline-2-thioxopyrido [2,3-d] pyrimidinone (1) and methylthioquinoline-pyrido [2,3-d] pyrimidinones (2) were used as starting materials. The new compounds synthesized were quinoline-pyrido [2,3-d] (DeGoey et al., 2013; Gouda et al., 2020; Dangolani et al., 2018) [1, 2,4]triazolopyrimidinones (5a-d), 2-methylsulfonyl-quinoline-pyrido [2,3-d]pyrimidinone (6), pyrido [2,3-d]pyrimidine derivatives, pyridopyrimido (Gouda et al., 2020; DeGoey et al., 2013) 2,12,1-b] quinazoline (9), pyrido [(Khajouei et al., 2021; Gouda et al., 2020) 3,23,2-e]bis (1,2,4-triazole)pyrimidine (12a,b) and pyridopyrimido-diquinazoline-dione (16) derivatives. These compounds were synthesized with high efficiency, producing yields ranging from 69% to 90%, under moderate conditions, through treating (2) or (10) with various reagents such as anthranilic acid, phosphorus oxychloride, hydrazine hydrate, formic acid, glacial acetic acid, arylamine (aniline, 4-chloroaniline, or 4-methoxyaniline), and sec-amine (piperazine or morpholine). The new structures of the synthesized compounds were verified using various spectroscopic procedures, such as IR, NMR, and mass spectra. Molecular docking studies were carried out to investigate and discuss how the prepared compounds bind to amino acids such as Estrogen Receptor alpha, EGFR, and NADPH oxidase protein. Also, the synthesized products were tested for their anticancer and antioxidant activities against the (MCF-7) breast carcinoma cell line and human normal Retina pigmented epithelium cells (RPE-1). The study on the structure-activity relationship (SAR) established a correlation between the chemical structure of the newly synthesized compounds and their anticancer activity. The findings suggest that compounds 5a-d, 9,12a-b, and 16 exhibited promising anticancer activity and antioxidant effects as measured by DPPH inhibition.

Introduction: Eosinophilic colitis (EC) is an uncommon inflammatory condition with the lowest reporting rate among eosinophilic gastrointestinal disorders. EC, which is characterized by the accumulation of eosinophilic cells, is typically diagnosed by a combination of clinical, imaging, and microscopic evaluations. We present a rare case of complete colonic obstruction due to eosinophilic colitis (EC) in a neonate, which was successfully managed with surgical intervention. Case presentation: A 27-day-old female neonate presented with bloody diarrhea and anemia, followed by repeated bilious vomiting, feeding intolerance, and abdominal distention along with very limited bowel motion. Abdominal radiography showed contrast-medium retention in the colon with persistent bowel dilatation while a lower GI contrast enema indicated a cut-off sign at the level of the sigmoid colon. Subsequent colonoscopy revealed a rectosigmoid stricture with complete luminal obstruction 7 cm from the anal verge. Histopathological examination showed marked eosinophilic infiltration through all the layers of the colon. Exploratory laparotomy showed a 3-cm complete stricture with severe gross inflammation in the rectosigmoid colon. Resection of the affected segment and primary anastomosis was achieved successfully, and the patient showed an uneventful recovery with no symptoms at discharge as well as age-appropriate weight gain at the one-year follow-up examination. Conclusion: To our knowledge, this is the first reported case of rectosigmoid stricture caused by EC in a neonate, and it highlights the importance of including EC in the differential diagnosis of colonic obstruction in neonates as well as the need for surgical management in such cases.

The Internet of medical things (IoMT) is a modern technology that is increasingly being used to provide good healthcare services. As IoMT devices are vulnerable to cyberattacks, healthcare centers and patients face privacy and security challenges. A safe IoMT environment has been used by combining blockchain (BC) technology with artificial intelligence (AI). However, the services of the systems are costly and suffer from security and privacy problems. This study aims to summarize previous research in the IoMT and discusses the roles of AI, BC, and cybersecurity in the IoMT, as well as the problems, opportunities, and directions of research in this field based on a comprehensive literature review. This review describes the integration schemes of AI, BC, and cybersecurity technologies, which can support the development of new systems based on a decentralized approach, especially in healthcare applications. This study also identifies the strengths and weaknesses of these technologies, as well as the datasets they use.

This research article concentrates on process conditions in addition to improving color selections in polymer compounders and developing more accurate simulation models. The feed rate (FR), temperature (T) and screw speed (SS) are three processing variables that the research investigates using general trends (GTs) and Box–Behnken design (BBD) response surface methodology. The identical set of processing settings was tweaked at three separate phases independently of one another. This study uses the experimental design to investigate process parameters’ optimization while holding all other parameters constant. This design was given the name GT. To develop this design and its statistical optimization, this study used the software of the design expert method. A regression model was run in this design, which displayed collective as well as individual effects of the parameters on color images. The values of tri-stimulus color with the best optimization had the smallest proper color variance (dE*). To obtain information on pigment characteristics, an SEM image analysis was conducted, which aids in improving future designs and overcoming manufacturing issues that affect color fluctuation properties and waste reduction for various chemical grades, both of which enhance environmentally friendly processes.

Summary: Somatic copy number gains are pervasive across cancer types, yet their roles in oncogenesis are insufficiently evaluated. This inadequacy is partly due to copy gains spanning large chromosomal regions, obscuring causal loci. Here, we employed organoid modeling to evaluate candidate oncogenic loci identified via integrative computational analysis of extreme copy gains overlapping with extreme expression dysregulation in The Cancer Genome Atlas. Subsets of “outlier” candidates were contextually screened as tissue-specific cDNA lentiviral libraries within cognate esophagus, oral cavity, colon, stomach, pancreas, and lung organoids bearing initial oncogenic mutations. Iterative analysis nominated the kinase DYRK2 at 12q15 as an amplified head and neck squamous carcinoma oncogene in p53−/− oral mucosal organoids. Similarly, FGF3, amplified at 11q13 in 41% of esophageal squamous carcinomas, promoted p53−/− esophageal organoid growth reversible by small molecule and soluble receptor antagonism of FGFRs. Our studies establish organoid-based contextual screening of candidate genomic drivers, enabling functional evaluation during early tumorigenesis.

This study, tagged ( The Impact of the Scholars of the Islamic East in the Humanities and Mental Sciences ) included an introduction, scope of the study, a preface and two paragraphs. The study recommends paying attention to the conduct of scholars and their position in the Islamic community by getting to know them and their writings

The rock successions of the Chia Gara Formation were studied at two surface sections (Barsarin and Rania) from North-Eastern Iraq. The detailed sedimentological study reveals that the formation consists basically of thin-bedded black limestone, dolomitic limestone, marly limestone, bituminous shales, and Ammonitic limestone. The petrography results showed that the formation consists of various petrographic components as Ammonites, calcispheres, radiolarian, and silicate sponges in addition to the groundmass of micrite. Ammonite taxa are examined in the upper part of the Chia Gara Formation to find Ammonite species, of which seven species have been identified. One biozone is postulated based on the above assemblages, in order of age: Berriasella Jacobi, from a regional perspective, this biozone was connected with other Ammonite assemblages, leading to the conclusion that the Formation age is Early Cretaceous in age. The facies analysis demonstrates that the rock succession consists mainly of three microfacies. The main microfacies include lime mudstone, wackestone, and packstone. At the same time, the lithofacies comprise limestones and shales. The overall characteristics of these facies show that the Chia Gara Formation was deposited in three different environments; (1) the Lower part of the Upper bathyal (2) the Middle part of the bathyal, and (3) the Upper part of the outer shelf environment.

Background: Left bundle branch block (LBBB) is a common finding in electrocardiography, there are many causes of LBBB. Objectives: The aim of this study is to discuss the true prevalence of coronary artery disease (CAD) in patients with LBBB and associated risk factors in the form of hypertension and diabetes mellitus. Materials and Methods: Patients with LBBB were admitted to the Iraqi heart center for cardiac disease in December 2017 to the end of April 2021; all patients underwent coronary angiography and they are classified into three groups: group 1: patients with proximal left anterior descending artery (LAD) or mid-LAD and either left circumflex artery (LCX) or right coronary artery (RCA) with lesion consider significant if more than 70% stenosis of the artery, group 2: patients with either isolated LCX or RCA with lesion if more than 70% stenosis of the artery, group 3: patients with normal coronary artery. Results: The most important finding in this study is that the percentage of LAD artery lesions or two vessels disease was only 24.5%. Patients in group 1 showed a high prevalence of hypertension (77.6%), whereas in group 3, the prevalence of hypertension was 47.95%. In this study, the prevalence of diabetes mellitus in group 1 was high (62.2%), whereas in group 3, it was 32%. Conclusion: High prevalence of men with LBBB than women, and the prevalence of LBBB increases with age. Patients who had hypertension and diabetes mellitus with LBBB most likely had an ischemic cause of LBBB, but patients with LBBB had low ejection fraction (EF) 369 out of 400 patients (90%) had low EF.

Severe acute malnutrition (SAM) is a major public health concern in Yemen, particularly in areas affected by ongoing conflict war. SAM is defined as a very low weight for height, by visible severe wasting, or by the presence of nutritional edema. The prevalence of SAM in Yemen has increased dramatically since the onset of the conflict. Prior studies have focused on evaluating prevalence, but this novel study aimed to assess the risk factors associated with SAM prevalence. Five thousand two hundred and seventeen patients of SAM admitted at 12 sentinel hospitals were enrolled, and data were collected and analyzed. Marasmus was the most common form. Numerous risk factors contribute to the high prevalence of SAM in Yemen, including food insecurity. The current conflict has hampered food production, distribution, and access. Awareness of risk factors can prevent SAM in the general population.

The purpose of the paper is to select the mediating role of information integration between cloud computing and productivity. The research sample comprised 320 employees. Survey was utilized to gauge the cloud computing impact on productivity and information integration. 281 questionnaires returned for statistical analysis, adopting the quantitative approach. The study's findings indicated that productivity standards, applying information integration, and cloud computing usage were all highly prevalent. In addition, there was an impact for cloud computing on productivity and information integration. Recommendations for study were discussed.

Abstract Objective It is hypothesized that patients who are actively provided with more treatment‐related education may report increased satisfaction and have improved overall outcomes. The aim of this study was to demonstrate the feasibility of an audiovisual education platform in patients undergoing head and neck surgery and to investigate whether patients using this module reported increased satisfaction. Methods This was a prospective pilot study of patients undergoing major head and neck reconstructive surgery who were randomized to either (1) control group or (2) intervention (i.e., in‐patient audiovisual educational module). Both study groups then completed a discharge survey. Results Total 35 patients were recruited into the study (N = 16 Intervention; N = 19 Control). Patients in the intervention group reported an increased satisfaction with their overall outcome. Exactly 87.5% (14 of 16) found the intervention to be “Extremely useful,” “Quite useful,” or “Sometimes useful.” Exactly 68.8% (11 of 16) would recommend similar patients to receive the same educational intervention. However, there was no significant difference in patients' perceived level of involvement amongst the two groups. For future improvements to the intervention, patients requested further information such as how to look after themselves, postoperative radiation, course in hospital, and nutrition. Conclusion This pilot study demonstrated the feasibility of an audiovisual education platform in the postoperative setting for patients undergoing major head and neck reconstructive surgery. Although most patients found the module useful, future steps will incorporate patient feedback to further improve the educational platform and confirm the current preliminary impressions in prospective studies. Level of Evidence 1b

Artificial intelligence (AI) has emerged as a transformative force in various sectors, including medicine and healthcare. Large language models like ChatGPT showcase AI’s potential by generating human-like text through prompts. ChatGPT’s adaptability holds promise for reshaping medical practices, improving patient care, and enhancing interactions among healthcare professionals, patients, and data. In pandemic management, ChatGPT rapidly disseminates vital information. It serves as a virtual assistant in surgical consultations, aids dental practices, simplifies medical education, and aids in disease diagnosis. A total of 82 papers were categorised into eight major areas, which are G1: treatment and medicine, G2: buildings and equipment, G3: parts of the human body and areas of the disease, G4: patients, G5: citizens, G6: cellular imaging, radiology, pulse and medical images, G7: doctors and nurses, and G8: tools, devices and administration. Balancing AI’s role with human judgment remains a challenge. A systematic literature review using the PRISMA approach explored AI’s transformative potential in healthcare, highlighting ChatGPT’s versatile applications, limitations, motivation, and challenges. In conclusion, ChatGPT’s diverse medical applications demonstrate its potential for innovation, serving as a valuable resource for students, academics, and researchers in healthcare. Additionally, this study serves as a guide, assisting students, academics, and researchers in the field of medicine and healthcare alike.

This review article discusses the recent progress in synthesizing seven-membered ring 1,3,5-triazepine and benzo[f][1,3,5]triazepine derivatives. These derivatives can be either unsaturated, saturated, fused, or separated. This review covers strategies and procedures developed over the past two decades, including cyclo-condensation, cyclization, methylation, chlorination, alkylation, addition, cross-coupling, ring expansions, and ring-closing metathesis. This review discusses the synthesis of 1,3,5-triazepine derivatives using nucleophilic or electrophilic substitution reactions with various reagents such as o-phenylenediamine, 2-aminobenzamide, isothiocyanates, pyrazoles, thiazoles, oxadiazoles, oxadiazepines, and hydrazonoyl chloride. This article systematically presents new approaches and techniques for preparing these compounds. It also highlights the biological importance of benzo[f][1,3,5]triazepine derivatives, which have been used as drugs for treating nervous system diseases. This review aims to provide researchers with the necessary information to create and develop new derivatives of these compounds as quickly as possible.

Abstract Background Medication non-adherence is a prevalent health problem in people with type 2 diabetes mellitus (T2DM). Interventions have previously been developed to improve medication adherence, but inconsistent outcomes have been reported. A potential explanation for this inconsistency is a ‘one size fits all’ approach, with interventions not tailored to the needs and preferences of individuals. Therefore, the aim of this study is to evaluate the effectiveness of a personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with T2DM. Methods A parallel-group randomised controlled trial will be conducted in 40–50 community pharmacies in the Netherlands and the United Kingdom (UK). A total of 300 participants will be included and followed up for a period of 6 months. Participants will be people with T2DM identified as non-adherent to oral antidiabetic and/or antihypertensive medication, aged 35–75 years and mobile phone users. The intervention group will receive a personalised intervention programme that is based on one or more of the participants’ pre-defined non-adherence profile(s), namely (I) Knowledge and perceptions, (II) Practical problems, (III) Side effects and (IV) Negative mood and beliefs. The intervention comprises of one or more supporting modules, namely (I) Brief messaging, (II) Clinical medication review, (III) Medication schedule, (IV) Reminding messaging, (V) Medication dispensing systems, (VI) Smart messaging, (VII) Referral to general practitioner and (VIII) Unguided web-based Self Help Application for low mood. The control group will receive usual care including access to a publicly available informative diabetes website. The primary study outcome is medication adherence measured with a telephone pill count. Secondary outcomes are systolic blood pressure, HbA1c level, self-reported medication adherence, attitude and beliefs toward medication, satisfaction with diabetes treatment, health status and medical consumption and productivity cost. In addition, a process evaluation will be undertaken to establish the fidelity, reach and the extent to which intervention delivery is normalised in the daily practice of community pharmacy teams. Discussion The study can lead to a personalised intervention programme that improves medication adherence in people with T2DM that are non-adherent to oral antidiabetic and/or antihypertensive medication. Trial registration Dutch Trial Register, Trial NL8747 , registered 02 July, 2020; ISRCTN Registry, ISRCTN36009809 , registered 05 February, 2020.

Objective: Our study aimed to characterize clinical, hematological and Immunophenotyping patterns in Sudanese patients with Chronic Lymphocytic Leukemia. Methods: A cross-sectional study was conducted in Khartoum state, Sudan, during the period from April 2017 to April 2018, involved 110 CLL patients. Physical examination, Complete Blood Count and Immunophenotyping were performed for all patients to confirm the diagnosis. Clinical staging such as Rai and Binet stages were applied. The statistical analysis was performed by using SPSS version 23.0. Results: In this study, 71.8% were males and 28.2% were females. Lymphadenopathy, splenomegaly, hepatomegaly, leukocytosis, thrombocytopenia, and anemia were seen in 71%, 49%, 13%, 60.9%, 39% and 34.5% of patients respectively. However, about 90% of patients displayed an advanced Rai risk stage and 70% were at Binet stage B or C. All CLL samples expressed CD45, CD19 and CD20. All the CLL cases were negative for the T-cell marker CD3.CD5 was expressed in 80% patients; CD23 was expressed in 92.7% patients. CD22, CD79b and FMC7 were negative in 91.8%, 77.3%, and 96.4% of patients respectively. Conclusions: CLL in Sudan is a disease of the elderly and more frequently in males than females. The incidence at young patients was higher than those reported by Western studies. Most of our patients presented advanced Rai and Binet stages. CD22 may be a highly specific marker for diagnosing CLL in Sudanese patients and should be included in all diagnostic panels used to differentiate CLL from other B cell lymphoproliferative disorders in Sudan.

Some cancer patients with impaired HLA-I still respond to immunotherapy. Here the authors combine a cytotoxic gene signature from CD4+ and CD8+ T cells with tumor mutational burden to predict immunotherapy response in NSCLC patients, including those with HLA-LOH.

الأهداف: هدفت الدراسة إلى معرفة درجة امتلاك معلمات الصفوف الثلاثة الأولى في الأردن لاستراتيجيات التدريس القائمة على التعلم الإلكتروني واتجاهاتهن نحوه من وجهة نظرهن. المنهجية: اتبعت الدراسة المنهج الوصفي المسحي. وتكونت عينة الدراسة من (160) معلمة من معلمات الصفوف الثلاثة الأولى في محافظة معان بالأردن. وقد تم اختيار عينة الدراسة بالطريقة العشوائية الطبقية. ولغايات تحقيق أهداف الدراسة، فقد تم إعداد أداتين: الأولى استبانة مكونة من (18) فقرة تقيس درجة امتلاك معلمات الصفوف الثلاثة الأولى في الأردن لاستراتيجيات التدريس القائمة على التعلم الإلكتروني. والثانية مقياس للاتجاهات نحو التعلم الإكتروني وتكونت من (16) فقرة. النتائج: وأظهرت نتائج الدراسة أن درجة امتلاك معلمات الصفوف الثلاثة الأولى في الأردن لاستراتيجيات التدريس القائمة على التعلم الإلكتروني واتجاهاتهن نحوه كانت مرتفعة. التوصيات: وفي ضوء نتائج الدراسة أوصى الباحث بمجموعة من التوصيات.

Background: Various mortality prediction models for Transcatheter Aortic Valve Implantation (TAVI) have been developed in the past years. The effect of time on the performance of such models, however, is unclear given the improvements in the procedure and changes in patient selection, potentially jeopardizing the usefulness of the prediction models in clinical practice. We aim to explore how time affects the performance and stability of different types of prediction models of 30-day mortality after TAVI. Methods: We developed both parametric (Logistic Regression) and non-parametric (XGBoost) models to predict 30-day mortality after TAVI using data from the Netherlands Heart Registration. The models were trained with data from 2013 to the beginning of 2016 and pre-control charts from Statistical Process Control were used to analyse how time affects the models' performance on independent data from the mid of 2016 to the end of 2019. The area under the Receiver Operating Characteristics curve (AUC) was used to evaluate the models in terms of discrimination and the Brier Score (BS), which is related to calibration, in terms of accuracy of the predicted probabilities. To understand the extent to which refitting the models contribute to the models’ stability, we also allowed the models to be updated over time. Results: We included data from 11,291 consecutive TAVI patients from hospitals in the Netherlands. The parametric model without re-training had a median AUC of 0.64 (IQR 0.54–0.73) and BS of 0.028 (IQR 0.021–0.035). For the non-parametric model, the median AUC was 0.63 (IQR 0.48–0.68) and BS was 0.027 (IQR 0.021–0.036). Over time, the developed parametric model was stable in terms of AUC and unstable in terms of BS. The non-parametric model was considered unstable in both AUC and BS. Repeated model refitting resulted in stable models in terms of AUC and decreased the variability of BS, although BS was still unstable. The refitted parametric model had a median AUC of 0.66 (IQR 0.57–0.73) and BS of 0.027 (IQR 0.020–0.035) while the non-parametric model had a median AUC of 0.66 (IQR 0.57–0.74) and BS of 0.027 (IQR 0.023–0.035). Conclusions: The temporal validation of the TAVI 30-day mortality prediction models showed that the models refitted over time are more stable and accurate when compared to the frozen models. This highlights the importance of repeatedly refitted models over time to improve or at least maintain their performance stability. The non-parametric approach did not show improvement over the parametric approach.

Abstract Objective Laryngeal verrucous carcinoma (LVC) comprises 1% to 4% of all laryngeal tumors. Although controversial, surgery has been the mainstay of treatment, due to concern about anaplastic transformation with radiotherapy. We aimed to study LVC patients to identify treatment patterns for primary and recurrent diseases. Study Design Retrospective cohort study. Setting Tertiary referral center. Methods Patients with a pathological diagnosis of LVC treated over a 28‐year period were included. Baseline demographics, and treatment outcome measures including 5‐year laryngeal preservation rates (LPR), overall survival (OS), and recurrence‐free survival (RFS) were included. A literature review of published studies within the same study period was also completed. Results Thirty‐two patients were included in the analysis (median age 61.5 years, 93.8% [30/32] male). Twenty‐three patients had T1 disease, and 9 had T2 disease with no evidence of regional or metastatic disease. The most common presenting symptom was hoarseness (93.8%) and the majority within the glottis 81.3% (26/32). Twenty‐nine patients underwent primary surgery only (28 local excisions, 1 vertical partial laryngectomy) meanwhile 3 underwent local excision with postoperative radiotherapy. LPR, OS, and RFS at 5 years were 95.8%, 90.1%, and 80.6%, respectively. Our literature review identified 23 previous studies, mostly single‐institution retrospective case series. Our study was the largest Canadian study in the literature to date. Conclusion All LVC patients were treated with primary surgery, consistent with the current literature with excellent 5‐year OS and LPR. There was no consensus on the treatment of recurrent disease. Future prospective multicenter studies are warranted to further study this rare disease population.

The Ground Penetrating Radar survey can increase the amount and quality of the information when applied to archaeological prospection. In comparison to other geophysical methods, the Ground Penetrating Radar method's effectiveness rests in its applicability to a wide variety of site variables as well as the complementary nature of the data. One more benefit of the use of Ground Penetrating Radar for this investigation is that an archaeological location is usually ‎shallow, which facilitates the Ground Penetrating Radar with an enhancement in the resolution achieved. An area with dimensions of 31×19 m dimensions was taken in cooperation with the Heritage and Antiquities Authority. This area was regularly divided into a group of lines in North-South and West-East, representing the radar device’s path. The Tall Abo_Al-Za’ar district was surveyed using Seventy-two parallel and two antennas, 450 and 750 MHz, used respectively, for each survey. The results of this research showed the presence of several zones, the first represented by the upper layer, which ranges from 0.5-1 m, which is the burial area, as is evident in the Ground Penetrating Radar Image, interspersed with broken parts of the materials from which the walls of the area made. The second zone is located directly below the burial layer, and it is clear that there are archaeological walls made of clay at different depths. The last zone, located below the depth between 4-5m, represents the water-saturated area, which decreased the specific resistance, which caused loud noises and the inability to know what was in this range. The 2D view of the Tall Abo_Al-Za’ar district shows that the archaeological anomalies are distributed randomly and with different widths, and it was not possible to know the thickness of the walls in the area due to the high humidity

Abstract The FAIR Data Principles are being rapidly adopted by many research institutes and funders worldwide. This study aimed to assess the awareness and attitudes of clinical researchers and research support staff regarding data FAIRification. A questionnaire was distributed to researchers and support staff in six Dutch University Medical Centers and Electronic Data Capture platform users. 164 researchers and 21 support staff members completed the questionnaire. 62.8% of the researchers and 81.0% of the support staff are currently undertaking at least some effort to achieve any aspect of FAIR, 11.0% and 23.8%, respectively, address all aspects. Only 46.6% of the researchers add metadata to their datasets, 39.7% add metadata to data elements, and 35.9% deposit their data in a repository. 94.7% of the researchers are aware of the usefulness of their data being FAIR for others and 89.3% are, given the right resources and support, willing to FAIRify their data. Institutions and funders should, therefore, develop FAIRification training and tools and should (financially) support researchers and staff throughout the process.

Abstract Background Colorectal cancer (CRC) consensus molecular subtypes (CMS) have different immunological, stromal cell, and clinicopathological characteristics. Single-cell characterization of CMS subtype tumor microenvironments is required to elucidate mechanisms of tumor and stroma cell contributions to pathogenesis which may advance subtype-specific therapeutic development. We interrogate racially diverse human CRC samples and analyze multiple independent external cohorts for a total of 487,829 single cells enabling high-resolution depiction of the cellular diversity and heterogeneity within the tumor and microenvironmental cells. Results Tumor cells recapitulate individual CMS subgroups yet exhibit significant intratumoral CMS heterogeneity. Both CMS1 microsatellite instability (MSI-H) CRCs and microsatellite stable (MSS) CRC demonstrate similar pathway activations at the tumor epithelial level. However, CD8+ cytotoxic T cell phenotype infiltration in MSI-H CRCs may explain why these tumors respond to immune checkpoint inhibitors. Cellular transcriptomic profiles in CRC exist in a tumor immune stromal continuum in contrast to discrete subtypes proposed by studies utilizing bulk transcriptomics. We note a dichotomy in tumor microenvironments across CMS subgroups exists by which patients with high cancer-associated fibroblasts (CAFs) and C1Q+TAM content exhibit poor outcomes, providing a higher level of personalization and precision than would distinct subtypes. Additionally, we discover CAF subtypes known to be associated with immunotherapy resistance. Conclusions Distinct CAFs and C1Q+ TAMs are sufficient to explain CMS predictive ability and a simpler signature based on these cellular phenotypes could stratify CRC patient prognosis with greater precision. Therapeutically targeting specific CAF subtypes and C1Q + TAMs may promote immunotherapy responses in CRC patients.

Abstract Purpose The study was aimed to assess the prognostic power The Pediatric Risk of Mortality-3 (PRISM-3) and the Pediatric Index of Mortality-3 (PIM-3) to predict in-hospital mortality in a sample of patients admitted to the PICUs. Design and methods The study was performed to include all children younger than 18 years of age admitted to receive critical care in two hospitals, Mashhad, northeast of Iran from December 2017 to November 2018. The predictive performance was quantified in terms of the overall performance by measuring the Brier Score (BS) and standardized mortality ratio (SMR), discrimination by assessing the AUC, and calibration by applying the Hosmer-Lemeshow test. Results A total of 2446 patients with the median age of 4.2 months (56% male) were included in the study. The PICU and in-hospital mortality were 12.4 and 16.14%, respectively. The BS of the PRISM-3 and PIM-3 was 0.088 and 0.093 for PICU mortality and 0.108 and 0.113 for in-hospital mortality. For the entire sample, the SMR of the PRISM-3 and PIM-3 were 1.34 and 1.37 for PICU mortality and 1.73 and 1.78 for in-hospital mortality, respectively. The PRISM-3 demonstrated significantly higher discrimination power in comparison with the PIM-3 (AUC = 0.829 vs 0.745) for in-hospital mortality. (AUC = 0.779 vs 0.739) for in-hospital mortality. The HL test revealed poor calibration for both models in both outcomes. Conclusions The performance measures of PRISM-3 were better than PIM-3 in both PICU and in-hospital mortality. However, further recalibration and modification studies are required to improve the predictive power to a clinically acceptable level before daily clinical use. Practice implications The calibration of the PRISM-3 model is more satisfactory than PIM-3, however both models have fair discrimination power.

Shared mobility is one of the smart city applications in which traditional individually owned vehicles are transformed into shared and distributed ownership. Ensuring the safety of both drivers and riders is a fundamental requirement in shared mobility. This work aims to design and implement an adequate framework for shared mobility within the context of a smart city. The characteristics of shared mobility are identified, leading to the proposal of an effective solution for real-time data collection, tracking, and automated decisions focusing on safety. Driver and rider safety is considered by identifying dangerous driving behaviors and the prompt response to accidents. Furthermore, a trip log is recorded to identify the reasons behind the accident. A prototype implementation is presented to validate the proposed framework for a delivery service using motorbikes. The results demonstrate the scalability of the proposed design and the integration of the overall system to enhance the rider’s safety using machine learning techniques. The machine learning approach identifies dangerous driving behaviors with an accuracy of 91.59% using the decision tree approach when compared against the support vector machine and K-nearest neighbor approaches.

For over two decades in India, the technical industry's unique selling proposition (USP), with its wide infrastructure of technical institutes, has been capable of supplying best-in-class engineers. But recently, this claim does not hold water. According to the All India Council for Technical Education (AICTE), about 2.6 lakh mechanical engineers graduate every year in India. But the real count of industry ready mechanical engineers is approximately 7%. Hence, there is a need to assess the quality of engineering education in India to reduce the flaws in higher education. The purpose of the paper is to identify the various defects associated with technical education and eliminate those defects using various quality tools. This research is based on the six sigma technique, which is used to assess the quality criteria proposed by the National Board of Accreditation India (NBA). The proposed model is then applied to a typical tier II Indian engineering college located in south India. Six Sigma has two main methodologies: DMAIC and DFSS. The DMAIC (Define, Measure, Analyze, Improve, and Control) methodology is implemented for existing systems, whereas DFSS (Design for Six Sigma) is for assuring quality in new products. In this project, the conclusion is driven by the DMAIC methodology. Various statistical and non-statistical tools are employed in this research. The tools used are CTS-CTQ, SIPOC, Pareto chart, normal process capability analysis, one-way ANOVA, Ishikawa diagram, FMEA, RCBD, and SPC chart. All the statistical processes are done using Minitab analytical software. From the results, it is identified that the factors that have a risk priority number (RPN) greater than 300 need improvement, such as versatility in program curriculum, laboratories and workshops, and credibility among universities. Six Sigma can be achieved by developing proper strategies for mitigating these defects. Doi: 10.28991/HIJ-2022-03-02-07 Full Text: PDF

أصبح إيجاد استراتيجيات وطرائق وأساليب حديثة في تعليم المهارات الرياضية من ضرورات نجاح العملية التعليمية، حيث ترتكز أساليب التعلم الحديثة على جعل المتعلم أكثر نشاطاً وإيجابية، ويهدف البحث إلى التعرف على أثر استخدام نموذج مكارثي في تعلم مهارة التمرير والسيطرة على الكرة بكرة القدم. واشتملت فروض البحث على أن هناك تأثير إيجابي لنموذج مكارثي في تعليم مهارتي التمرير والسيطرة على الكرة بكرة القدم. واستخدم الباحث المنهج التجريبي بتصميم (المجموعتان المتكافئتان ذات الاختبار القبلي والبعدي ) وذلك لملاءمته طبيعة المشكلة وتحقيق أهداف البحث. أما عينة البحث فاشتملت على طلاب السنة الأولى كلية التربية الرياضية جامعة تشرين والبالغ عددهم (40) طالب. وكانت أهم نتائج البحث تفوق المجموعة التجريبية التي استخدمت نموذج مكارثي على المجموعة الضابطة والتي استخدمت الأسلوب الأمري في تعلم مهارتي التمرير والسيطرة على الكرة بكرة القدم، وكان هناك أفضلية لنموذج مكارثي على الأسلوب الأمري في الاختبارات البعدية بالنسبة لمهارتي التمرير والسيطرة على الكرة. وأوصى الباحث على التأكيد على أهمية نموذج مكارثي في تعليم المهارات الأساسية بكرة القدم، وضرورة عمل ندوات علمية لكيفية تطبيق هذا النموذج في تعليم المهارات.

PurposeOnly few studies have assessed the preventive effect of the STOPP/START criteria on adverse events. We aim to quantify 1) the association between nonadherence to STOPP/START criteria and gastrointestinal bleedings, and 2) the association between exposure to the potentially harmful START-medications and gastrointestinal bleedings.DesignA retrospective cohort study using routinely collected data of patients aged ≥ 65 years from the electronic health records (EHR) of 49 general practitioners (GPs) in 6 GP practices, from 2007 to 2014. The database is maintained in the academic research network database (AHA) of Amsterdam UMC, the Netherlands.MethodsGastrointestinal bleedings were identified using ICPC codes and free text inspections. Three STOPP and six START criteria pertaining to gastrointestinal bleedings were selected. Cox proportional hazards regression with time-dependent covariate analysis was performed to assess the independent association between nonadherence to the STOPP/START criteria and gastrointestinal bleedings. The analysis was performed with all criteria as a composite outcome, as well as separately for the individual criteria.ResultsOut of 26,576 participants, we identified 19,070 Potential Inappropriate Medications (PIM)/Potential Prescribing Omission (PPO) instances for 3,193 participants and 146 gastrointestinal bleedings in 143 participants. The hazard ratio for gastrointestinal bleedings of STOPP/STARTs, taken as composite outcome, was 5.45 (95% CI 3.62-8.21). When analysed separately, two out of nine STOPP/STARTs showed significant associations.ConclusionThis study demonstrates a significant positive association between nonadherence to the STOPP/START criteria and gastrointestinal bleeding. We emphasize the importance of adherence to the relevant criteria for gastrointestinal bleeding, which may be endorsed by decision support systems.

BackgroundFalls are the leading cause of injury-related mortality and hospitalization among adults aged ≥ 65 years. An important modifiable fall-risk factor is use of fall-risk increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs.MethodsA multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged ≥ 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient's consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression.DiscussionThe findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries.Trial registrationClinicalTrials.gov NCT05449470 (7-7-2022).