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BACKGROUND: Central vein stenosis (CVS) is a common complication in hemodialysis patients following tunneled central venous catheter (CVC) insertion. Little is known about its incidence, association with patient characteristics, or relationship with duration of CVC placement. We systematically evaluated central vein stenosis in hemodialysis patients receiving their first CVC exchange at a large medical center. METHODS: All new hemodialysis patients underwent an ultrasound before their internal jugular tunneled CVC placement, to exclude venous stenosis or thrombosis. After the initial CVC insertion, if the patients were referred for CVC exchange due to dysfunction, a catheterogram/venogram was performed to assess for hemodynamically significant (≥50%) central vein stenosis. During a 5-year period (January 2016 to January 2021), we quantified the incidence of CVS in patients undergoing CVC exchange. We also evaluated the association of central vein stenosis with patient demographics, comorbidities, and duration of CVC dependence before exchange. RESULTS: During the study period, 273 patients underwent exchange of a tunneled internal jugular vein CVC preceded by a catheterogram/venogram. Hemodynamically significant CVS was observed in 36 patients (13%). CVS was not associated with patient age, sex, race, diabetes, hypertension, coronary artery disease, peripheral artery disease, or CVC laterality. However, the frequency of CVS was associated with the duration of CVC dependence (26% versus 11% for CVC duration ≥6 versus

The aging population worldwide is expected to increase the prevalence of Alzheimer’s disease. As there is no medical curative treatment for this disease to date, alternative treatments have been applied to improve the patient’s brain and general health. One of these efforts includes providing Alzheimer’s patients with proper food and nutrition. In this paper, we propose a knowledge-powered personalized virtual coach to provide diet and nutrition assistance to patients of Alzheimer’s and/or their informal caregivers. The virtual coach is built on top of an ontology-enhanced knowledge base containing knowledge about patients, Alzheimer’s disease, food, and nutrition. Semantics-based searching and reasoning are performed on the knowledgebase to get personalized context-aware recommendation and education about healthy eating for Alzheimer’s patients. The proposed system has been implemented as a mobile application. Evaluation based on use cases has demonstrated the usefulness of this tool.

Purpose This study aims to prepare low-cost biomaterials from renewable natural resources (rosin). Design/methodology/approach Preparation of different biomaterials, ethylene glycol maleic rosin (EGMR), glycerol maleic rosin, pentaerythritol maleic rosin and sorbitol maleic rosin (SMR) esters, then evaluated by stability studies, moisture absorption, swelling index parameters, thermogravimetric analysis and skin irritation studies. Findings The prepared rosin derivatives had excellent moisture safety, according to the results. From EGMR to SMR, the swelling indices increase. Research limitations/implications These rosin biomaterials were used in coating, especially in the field of pharmaceutical coating, and good results were obtained in this study. Practical implications As these biomaterials rosin derivatives have excellent moisture resistance, they are recommended for use as coating materials for moisture-sensitive drugs. Originality/value There has recently been a lot of interest in researching the effects of rosin derivatives in various drug delivery systems.

AIM: The aim of this study was to compare the remineralization ability, ion release, microshear bond strength and wear resistance of a claimed bioactive restorative material (ACTIVA BioACTIVE Restorative, Pulpdent Corporation, Watertown, USA) with the conventional resin composite (​Filtek Z350 XT, 3M ESPE Elipar, Germany). MATERIALS AND METHODS: The remineralization ability was evaluated after 28 days using Energy Dispersive X-Ray (EDX) analysis. Ion release was investigated at three-time intervals: 1, 14 and 28 days. Calcium and phosphate ions release were determined by using ion chromatography system. Microshear bond strength was assessed using Universal Testing Machine. A wear test was conducted using a dual axis chewing simulator. RESULTS: ACTIVA™ was found to induce remineralization to the demineralized dentin. Results revealed that ACTIVA™ released Ca2+ and PO4-3 ions, whilst Filtek Z350 XT did not. Concerning microshear bond strength ACTIVA™ without adhesive application showed unacceptable failure. Regarding wear resistance there was no statistically significant difference between them. CONCLUSION: ACTIVA™ bioactive restorative material seems promising bioactive restorative materials. Clinical trials are recommended to compare clinical performance of ACTIVA™ with the other restorative materials.

Background and Objective:The behavior of COVID-19, clinical symptoms, and mortality rate are not the same in different regions. Due to lack of knowledge about the cited issues, we aimed to investigate the clinical symptoms, case fatality rate, and some risk factors of COVID-19. Materials and Methods:This longitudinal study was started from the late February 2020 and lasted to the mid-July 2020 in Jiroft, Kerman province, Iran. The course of the disease, clinical signs and symptoms, underlying diseases, patients' exposure history, travel history, adherence to health instructions, and the fatality rate of the disease were evaluated in the patients. The descriptive statistics and frequency were analyzed in different groups using IBM SPSS statistics version 20. Results:In this study, 2977 definitive cases of COVID-19 were detected using RT-PCR test. The frequent clinical symptoms were fever (45.2%), body aches and bruises (38.8%), and cough (36.4%), respectively. The fatality rate of the disease was 4%. Evaluation of the patients’ exposure history showed that almost 50% of the cases had no exposure. Among the studied individuals, 33% had the history of exposure to a definite COVID-19 case. Conclusion:Personal hygiene, social distancing, and use of face mask are of great importance in reducing the disease morbidity and mortality. Public awareness about COVID-19 should also be increased, especially in the elderly individuals with the history of underlying and chronic diseases. Keywords:Coronavirus,COVID-19,Epidemiology,Mortality,Patient

In a multi-tenant business environment, tenants share the same applications and databases to store their data. Due to the widespread use of a multi-tenant environment, the service providers face difficult challenges daily. These challenges are condensed in how to guarantee the quality of service provided to tenants, which are documented in a formal document known as a Service Level Agreement (SLA). In addition, SLA should consider the irregular patterns of workload of tenants which may affect the level of guarantee. In this research, an Enhanced Multi-Tenant Database Management System (EMT DBMS) is proposed. In addition, an Enhanced Multi-tenant Migration Algorithm called EMT-M is presented, which aims to migrate the violated tenants depending on both the number of SLA violations and the variance rate. Experimental results prove that the proposed EMT-M algorithm is ideal for migrating violated tenants, as it reduces the number of SLA violations compared to previous migration algorithms.

Background: Neck pain (NP) is regarded as a chronic episodic condition characterized by persistent, recurrent, or fluctuating pain and disability. Low back pain (LBP) is social and economic health problem that affects population of all ages globally. Objective: To evaluate the prevalence and associated risk factors of neck and low back pains among students at Faculty of Medicine, Zagazig University. Patients and Methods: This was a cross sectional study that included 360 students at Faculty of Medicine, Zagazig University through the period from September 2018 to April 2019. Assessment of presence or absence of neck pain and back pain by Standardized Nordic Musculoskeletal questionnaire. Results: 96 of the students were males (26.6%) and 264 were females (73.3%), their ages ranged from 18-25 years with a mean of 20.68 ± 1.92 years old, where 162 students of them ≤ 20 (45%) & 198 of them > 20 years old (55%). Prevalence of neck pain and/or low back pain among the studied group of students was 81.1%, while 18.9% of students were free from neck & low back pain. NP presented in 74.4% of students and LBP presented in 73.1% of all studied students. 66.4% of participants reported both NP & LBP. There was statistical significant association between reading hours (> 3 hours/ day) and NP & LBP. Conclusion: High prevalence of NP and/or LBP 81.1% among medical students. Students complaining from NP and/or LBP had longer studying and reading time, presented mostly in clinical years in addition they had ergonomic problems and poor psychological studying environments.

Background Although many environmental factors play an important role in bone mass density (BMD) variation, genetic influences account for 60–85% of individual variance. The aim of this study was to find the interaction between some dietary ingredients, vitamin D, estrogen, and obesity polymorphic receptor genes, among a sample of obese Egyptian women. This was a cross sectional study included 97 women (aged 25–60 years). Data on anthropometry, dietary intake, BMD, biochemical, and genetic analyses were collected. Results Osteoporosis was high among women had dominant Taq1 vitamin D receptor gene while osteoporosis was less common among the homozygous Apa1 receptor gene women. Both genes in their two forms did not show any effect on serum vitamin D. Heterozygous types of osteoporotic women carried both genes revealed a slight but significant decrease in level of serum calcium. Xba1 estrogen receptor gene was identified only in a homozygous type while the heterozygous Pvu11 estrogen receptors gene has been identified among both osteoporotic and non-osteoporotic women, this gene was associated with higher BMI in both groups compared to the homozygous receptor gene. Mutant types of genotype FTOrs99 and FTOrs80 obesity receptors genes were less common (4.44%, 11%) among participants. Both of these genes were associated with the highest value of BMI and caloric daily intake, fat, and saturated fatty acid that were more prominent among osteoporotic women. Conclusion There is significant association between vitamin D, estrogen, obesity receptors genes, special nutrients, and osteoporosis. Increased BMI, calories, and fat intake lead to rise of genetic predisposition and susceptibility to osteoporosis.

Introduction Routine diabetes care changed during the COVID-19 pandemic due to precautionary measures such as lockdowns, cancellation of in-person visits, and patients’ fear of being infected when attending clinics. Because of the pandemic, virtual clinics were implemented to provide diabetes care. Therefore, we conducted this study to assess the impact of these virtual clinics on glycaemic control among high-risk patients with type 2 diabetes mellitus (DM). Methods A prospective single-cohort pre-/post telemedicine care intervention study was conducted on 130 patients with type 2 DM attending a virtual integrated care clinic at a chronic Illness center in a family and community medicine department in Riyadh, Saudi Arabia during the COVID-19 pandemic. Results The mean age of the participants was 57 years (standard deviation (SD) = 12) and the mean (SD) duration of diabetes was 14 (7) years. Over a period of 4 months, the HbA1c decreased significantly from 9.98 ± 1.33 pre-intervention to 8.32 ± 1.31 post-intervention (mean difference 1.66 ± 1.29; CI = 1.43–1.88; P Discussion The current study found a significant positive impact of telemedicine care on glycaemic control among high-risk patients with DM during the COVID-19 pandemic. Moreover, it showed that telemedicine could be integrated into diabetic care to successfully replace many of the usual in-person care visits. Consequently, health policy makers need to consider developing comprehensive guidelines in Saudi Arabia for telemedicine care to, ensure the quality of care and address issues such as financial reimbursement and patient information privacy.

The objective of this study was to investigate whether the combination of miR-224-5p, miR-199-3p, and let-7d-3p is a suitable diagnostic panel for endometriosis. Twenty-five women with endometriosis (case) and twenty-five women without any sign of endometriosis (controls) were included. Peripheral blood specimens were collected from all these women who were a proper candidate for laparoscopy before surgery. Total RNA was isolated to synthesize complementary DNA. Expression of miR-199b-3p, miR-224-5p, and let-7d-3p was analyzed by RT-qPCR. To estimate the performance of the identified miRNAs for endometriosis diagnosis, we performed ROC curves analysis. There was an upregulation of miRNAs 199b-3p (P value < 0.001) and down-regulation of 224-5p (P value < 0.001) and miRNA let-7d-3p (P value < 0.05) in women with endometriosis compared to non-endometriosis women. The diagnostic accuracy of miRNAs 199b-3p, 224-5p, and let-7d-3p was measured by AUC which was 0.843 (sensitivity = 96% and specificity = 80%), 0.914 (sensitivity = 84% and specificity = 80%), and 0.696 (sensitivity = 80% and specificity = 56%) for miRNAs 199b-3p, 224-5p, and let-7d-3p, respectively. In combination, they showed the highest accuracy with the AUC 0.992 (sensitivity = 96% and specificity = 100%). In conclusion(s) the levels of miRNAs 199b-3p, 224-5p, and Let-7d-3p in plasma are potential diagnostic biomarkers for endometriosis patients.

With the rapid adoption of multi-tenant databases, the cloud provider consolidates multiple tenants’ database on server machines, where the tenants share a common application and database instances. To ensure the quality of service (QoS) for the leased resources, both sides (i.e., the user and the provider) create a Service Level Agreement (SLA). Higher SLA violations result in high SLA contractual penalties and increase the possibility of losing the tenant. In addition, the unusual workload patterns of each tenant transactions require seamless adjustments due to the sudden burden changes and variability. As a result, to satisfy simultaneously availability and performance tenant requirements, it is necessary to perform reliable tenant migration and replication to distribute the workload to a flexible set of sites and avoid SLA violations. In this research, a cluster-based multi-tenant database management system (CB-MT DBMS) is proposed, which takes the migration and replication decisions in advance by monitoring and acting before the violation of the SLA occurs. In addition, a dynamic proactive multi-tenant database migration and replication MTDB-MR algorithm is proposed to reduce collisions and inconsistencies between migration and replication decisions for a group of violated tenants. Experimental results show that the proposed MTDB-MR algorithm is the ideal candidate for migration and replication of the violated multi-tenant databases, as it minimizes the total number of SLA violations, the number of multi-tenant clients SLA violations, client sites average response time and total execution time of each multi-tenant client site as compared to the previous algorithms.

Introduction: Animal bites are one of the health threats that can cause transmission of zoonotic diseases such as rabies to humans. The aim of this study was to determine the incidence of animal bites and related ecological factors in Jahrom county. Materials and Methods: This retrospective descriptive study was performed on 3913 cases of people with animal bites from April 2014 to March 2016 in Jahrom county. The collected data were analyzed using chi-square test and Pearson correlation coefficient. The Cochran–Armitage test was also performed to evaluate the trend changes in the incidence rate using Winpepi software. Results: The mean age of the victims was 31.4 ± 1.7 years and the frequency of men (79.6%) was significantly higher than women (p

To enable CMOS-compatible GaN HEMTs for the next generation of communication systems (5G and beyond), a low gate resistance is of great importance since it directly affects the RF power gain and ${f}_{\text {MAX}}$ of the transistor. In this article, the impact of various gate-metal stacks on the gate resistance and RF performance of the devices is studied. The optimized Ti-free gate-metal process leads to ${f}_{\text {MAX}}$ enhancement up to ~50% for devices scaled down to 0.32- $\mu \text{m}$ gate lengths. The gate resistance for the T-shaped gate is modeled from the S-parameters and validated on various gate field plate geometries. The tradeoff between the gate resistance and the parasitic capacitance in GaN HEMTs is highlighted in this case.

Arabic datasets that have two or more records for the same world entity (i.e. person, object, etc.) make institutions suffer from low quality and degraded performance due to duplication in their Arabic datasets without having any mechanism for detecting these duplicates. The operation that distinguishes records for the same real-world entity is called Entity Resolution (ER). It is considered as a tool for linking records across databases as well as for matching query records with existing databases in real-time. Indexing is a major step in the ER process that aims at reducing the search space. Several indexing techniques are available for use with the ER process in general for English Databases. However, such techniques are not validated if they work well with other languages, such as Arabic. The Dynamic Similarity Aware Inverted Index (DySimII) is one of the indexing techniques that are utilized with dynamic databases to match query records in real time and is demonstrated to work well with English language. In this paper, we propose a framework—Arabic Real Time Entity Resolution (ARTER)—that uses DySimII with Arabic databases to perform real time ER. We also examine using different string similarity functions required for comparing records in the matching process for the aim of evaluating which similarity function is more suitable for comparing Arabic strings. A real-world Arabic database is used to conduct our experimental evaluation where two stemmers and three similarity functions are used to see the effect on DySimII with Arabic dataset. The results represent that matching accuracy is improved using Asem stemmer when the number of corrupted attributes is increased, also testing the three similarity functions show that using winkler similarity function provides better matching accuracy while N-gram provides better results when used with Asem stemmer.

Sentence similarity determines whether two sentences are close in their structure and meaning. The detection of sentence similarity can be affected by several factors such as sentence representation, similarity measure, and words weighting function. In this study, the impact of three factors that influence similarity detection and paraphrasing identification is evaluated using clustering algorithms. In the evaluation of the impact of these factors, we tried different word embedding models, clustering algorithms, and weighting methods for the context words. The clustering algorithms are applied to an Arabic paraphrasing benchmark that consists of 1010 pairs of Arabic sentences constructed on the basis of Arabic transformation rules and labeled for similarity and paraphrasing. Experimental results show that pre-trained embedding, weighting context words with part of speech, and labeling sentence pairs by the majority of experts provides better recall and precision.

Systemic sclerosis (SSc) is a chronic connective tissue disease affecting all quality of life (QoL) parameters. In addition to clinical assessment, QoL measures should be included in patient assessment. There is no Arabic tool specific for assessing QoL in Arabic SSc patients; therefore, this work was designed to translate the SScQoL questionnaire, culturally adapt and check its reliability and validity. Based on the principle of translation and cross-cultural adaptation in other language, the SScQoL questionnaire was translated into Arabic. Correlation of SScQoL scores for 50 patients with Short Form Health Survey (SF-36) scores has been tested for convergent validity and discriminate validity evaluated by stratifying clinical parameters of patients and disease subtypes. The intraclass correlation coffee (ICC) was used to assess reliability by interviewing patients twice 14 days apart. Correlations were present between SScQoL scores and physical and mental component scores of SF-36 questionnaire. We found strong negative correlation between the physical component of SF-36 and QoL function, QoL emotion, QoL total scores (r = − 0.654**, r = − 0.512**, r = − 0.540**) and moderate negative correlation present between SF-36 mental component and QoL function, QoL emotion, QoL social, and QoL total (r = − 0.314*, r = − 0.486**, r = − 0.357*, r = − 0.433*). Also, significant association (P

Background To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear. Results Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed. Conclusion Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.

Background: Hemorrhage is the most serious potential complication of percutaneous kidney biopsy. Patients are typically observed for at least 6-8 hours after a kidney biopsy, with serial measurements of vital signs and hemoglobin to monitor for major hemorrhage. This study assessed whether an immediate post-biopsy ultrasound can reliably exclude delayed major hemorrhage. Methods: We retrospectively evaluated the clinical outcomes in 147 patients undergoing an outpatient native kidney biopsy with an 18-gauge needle at a large medical center during a 2.5 year period (January 2017 to June 2019). All patients underwent a standardized post-biopsy ultrasound to assess for active extravasation of blood. We extracted from the medical records vital signs and hemoglobin values obtained before the biopsy and at 2, 4, and 6 hours after the procedure. We ascertained whether any patients with a negative post-biopsy ultrasound developed a delayed major hemorrhage. Results: Each patient underwent 2 or 3 biopsy passes. The mean patient age was 48±17 years, 49% were female, 37% were black, 53% had hypertension and 16% had diabetes. Of the 142 patients without evidence of active extravasation on ultrasound, the blood pressure, heart rate, and hemoglobin remained stable during 6 hours of observation. All were discharged after 6 hours, and none had a late bleeding complication. Conclusions: If the immediate post-kidney biopsy ultrasound does not show active bleeding, the patient is extremely unlikely to develop a late major hemorrhagic complication (negative predictive value, 100%). Such patients can be discharged home safely after a 2-hour observation, thereby simplifying their management.

Objective (s): Measles is a severe acute respiratory viral infection. The single-stranded RNA morbillivirus from the Paramixoviridea family is easily transmitted among humans through coughing or sneezing droplets. Methods: This was a case-control study that was carried out among people living in cities under coverage of Jiroft University of Medical Sciences, Jiroft, Iran in 2014-2015. Seventy-five patients with confirmed measles (case group) and 150 healthy individuals (control group) were selected for the study. The case group included entered into the study through census method. The control group was randomly selected by simple random sampling from the people who had the inclusion criteria. To control the confounding factors, each case was matched with two persons from the control group for age and gender. Conditional logistic regression was used to analyze the data. Results: After adjusting for confounding variables, a significant relationship between measles and, not receiving the vaccine (OR=14.35, CI 95%=7.03-29.27), the history of contact with the definite cases of measles (OR=1.9, CI 95%=1.09-3.43), non-native residents (OR=5.46, CI 95%=1.88-15.78), motherchr('39')s age of older than 30 years at birth (OR=2.8, CI 95%=1.23-6.38) were identified. Conclusion: Based on the findings independent risk factors for developing measles disease were not having measles vaccine, non-native people, history of contact with definite cases of measles and, motherchr('39')s age at birth.

Public eagerness to use Transjakarta as a transport mode has been increasing over the past few years as the ridership growth consistently. To keep the growth up, stakeholders need to understand the passenger behavior by creating an effective operational system so that the passenger satisfaction maintained. An understanding of passenger behavior can be obtained by identifying its pattern and trend which recorded as passenger transaction data. This project uses passenger transaction data which contains information about time and space to produce interactive visualization as a means to identify passenger behavior. Interactive visualization created in this project depicts the trend of bus stop occupancy and passenger movement from one stop to another. The visualization consists of a map and diagrams which relate to each other as one integrated analytical dashboard system. The visualization design process combines Tableau 2019.2 and Mapbox GL JS to create powerful visualization supported by a 3D map view that facilitates analytical reasoning work. Geovisual analytics dashboard as a result of this project is intended for PT. Transportasi Jakarta staff to make decisions. Some staff was asked to examine the usability of the dashboard regarding its effectiveness, efficiency, and accessibility aspects. The usability test pointed out that the analytical dashboard can generate new information about the patterns and trends of Transjakarta passengers.

Introduction: Many countries have introduced policies and strategies to limit pharmaceutical expenditures. These include pharmaceutical pricing policies and related strategies to control medicine prices and to ensure appropriate and stable prices. The aim of this study was to provide an overview of the current pharmaceutical pricing policy for medicines in Saudi Arabia and to provide an evaluation of the impact of this policy on medicine prices. Methods: A description of the current pharmaceutical policy is presented by reviewing the current official documents and regulations related to pharmaceutical pricing in Saudi Arabia. A price comparison between the original brand medicines and their generic versions was conducted for the top six selling medicines in Saudi Arabia during the period of 2010–2015. Results: The findings showed that Saudi pharmaceutical pricing policy takes into consideration several factors including an international price benchmark, internal price referencing, and the price of the medicine in the country of origin when determining medicine prices. Based on this policy, there were large differences in the prices of generic medicines compared to original brand medicines. The generic medicine to original brand medicine price ratio was 0.87–0.30. However, the price of the first generic medicine was close to the price of original brand medicine, with the first generic medicine-to-original brand medicine price ratio was 0.87–0.81. In this study, there were large differences in the prices of generic medicines for the same molecule. In fact, price ratio among the generic medicines for the same molecule was between 0.96 and 0.18. However, some generic medicines imported from high income countries were cheaper than the medicines manufactured locally or manufactured in other countries in the Middle East. Conclusion: Medicine prices are strictly controlled through the pharmaceutical pricing policy in Saudi Arabia. Overall, the current policy has resulted in significant price differences among medicines, including medicines of the same molecule. Due to this large difference, the cost savings will depend on the product prescribed or procured by the health organization.

The Actual and the Rational: Hegel and Objective Spirit, by Jean-François Kervégan. Translated by Daniela Ginsburg and Martin Shuster. Chicago: University of Chicago Press, 2018. xxiii + 384 pp.Avicenna and the Aristotelian Left, by Ernst Bloch. Translated by Loren Goldman and Peter Thompson. New York: Columbia University Press, 2019. xxvi +109 pp.Critique of Forms of Life, by Rahel Jaeggi. Translated by Ciaran Cronin. Cambridge, MA: Belknap Press of Harvard University Press, 2018. xx + 395 pp.

The photoplethysmographic (PPG) waveform, also widely known as the pulse oximeter waveform, is a noninvasive low-cost optical technique that can be used to detect blood volume changes in the microvascular bed of tissue. The pulsatile component of PPG waveform (AC) is attributed to cardiac synchronous changes in the blood volume with each heartbeat and is superimposed on a slowly varying baseline (DC) component that is attributed to respiration, sympathetic nervous system activity, and thermoregulation. In current pulse oximetry devices, the PPG signal is optimized (amplified and highly filtered) to accentuate its pulsatile component. Pulse oximeters have been used in commercially available medical devices for measuring oxygen saturation and heart rate. The utilization of powerful methods of digital signal processing allows for uncovering the true potential of the PPG waveform in order to guide early goal-directed therapeutic interventions (fluid, vasopressors, and inotropes), to assess of vascular compliance and autonomic function, and to estimate of respiratory rate, blood pressure, and cardiac output.

Introduction: Hepatitis A (HA) is a common infectious disease caused by the HA virus that primarily affects the liver. We need to determine the safety status and infection rate in the community. Therefore, we decided to study the Seroepidemiological of HA in medical students of Mazandaran University of Medical Sciences in 2019.Material and Methods: This was a cross-sectional descriptive-analytical study prospectively examining anti-HAV antibodies in medical students of Mazandaran University of Medical Sciences in 2019. Patient demographic data, laboratory results of anti-HAV IgG and vaccination history were recorded. Four cc of blood were drawn from each student for the anti-HAV IgG test and after the test was performed. Data were analyzed using SPSS 24 software.Results: One hundred and fifty-five students were interviewed. The mean age (standard deviation) of the students in this study was 23.81 (1.47) years. Ninety-nine (63.9%) of the students were male. Therefore, it was caused by previous infection with HAV and 120 (77.4%) cases were considered susceptible individuals whose serum anti-HAV IgG was negative. This was not seen to be statistically significant (P=0.754). According to the test, 77.4% of the predictions were correct. None of the variables of sex, age, history of underlying disease, place of residence, and history of travel had a significant effect on the incidence and positivity of anti-HAV IgG.Conclusion: This study showed that the incidence of anti-HAV IgG was positive in 22.6% of the students, which is much lower than previous studies. This may be due to the higher level of health in this segment of the population.

Processor power management exploiting Dynamic Voltage and Frequency Scaling (DVFS) plays a crucial role in improving the data-center’s energy efficiency. However, we observe that current power management policies in Linux (i.e., governors) often considerably increase tail response time (i.e., violate a given Service Level Objective (SLO)) and energy consumption of latency-critical applications. Furthermore, the previously proposed SLO-aware power management policies oversimplify network request processing and ignore the fact that network requests arrive at the application layer in bursts. Considering the complex interplay between the OS and network devices, we propose a power management framework exploiting network packet processing mode transitions in the OS to quickly react to the processing demands from the received network requests. Our proposed power management framework tracks the transitions between polling and interrupt in the network software stack to detect excessive packet processing on the cores and immediately react to the load changes by updating the voltage and frequency (V/F) states. Our experimental results show that our framework does not violate SLO and reduces energy consumption by up to 35.7% and 14.8% compared to Linux governors and state-of-the-art SLO-aware power management techniques, respectively.

Energy router (ER), as the core equipment of energy internet (EI), can realize the regulation, conversion, and storage of multiple energy carriers. The conversion efficiency of ERs is important which is affected by load or temperature varying with actual operating environment. But, the efficiencies of conversion devices are assumed to be constant in the conventional ER model, which results in unreasonable operation schemes. Then, the key factors affecting the economic dispatch of the ER is the accuracy of the model. Therefore, an improved energy hub (EH) dynamic model is proposed for representing complex power flows of the physical layer, where conversion efficiency varies with temperature or load rate. Besides, to further improve the flexibility of the model, energy storage and region exchange matrix are added to the proposed model. Finally, the feasibility and effectiveness of the proposed model are verified based on the general algebraic modeling system (GAMS) in a residential area.

In this paper, Gallium Nitride (GaN) Metal-Insulator-Semiconductor (MIS)-HEMTs are compared with conventional Schottky Metal-Semiconductor HEMTs in terms of DC and ESD performance. Measurement results indicate TLP failures are highly related to 2DEG channel driving capability. The impacts of different gate interfaces in the GaN (MIS)-HEMTs on failure mechanisms are the key factor of final ESD robustness.

Background: There are very few animal models of balloon angioplasty injury in arteriovenous fistula (AVF), hindering insight into the pathophysiologic processes following angioplasty in AVF. The objective of the study was to develop and characterize a rat model of AVF angioplasty injury. Methods: Balloon angioplasty in 12- to 16-week-old Sprague-Dawley rats was performed at the arteriovenous anastomosis 14 days post-AVF creation with a 2F Fogarty balloon catheter. Morphometry and protein expression of endothelial nitric oxide synthase (eNOS), monocyte-chemoattractant protein-1 (MCP-1), alpha-smooth muscle actin (α-SMA), CD68 (macrophage marker), and collagen expression in AVFs with and without angioplasty were assessed. Results: In AVFs with angioplasty versus without angioplasty: (1) angioplasty increased AVF-vein and artery intimal hyperplasia, (2) angioplasty decreased eNOS protein expression in AVF-vein and artery at 21 days post-AVF creation and remained decreased in the AVF-vein angioplasty group at 35 days, (3) angioplasty increased AVF-vein and artery α-SMA expression within the intimal region at 35 days, (4) angioplasty increased the expression of AVF-vein MCP-1 at 21 days and CD68 at 21 and 35 days, and (5) angioplasty increased AVF-vein and artery collagen expression at 35 days. Conclusion: Our findings describe a reproducible rat model to better understand the pathophysiologic mechanisms that ensue following AVF angioplasty.

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes. Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios. Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively. Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.

Background: Tuberculosis is a major public health concern in Yemen. Recurrence of tuberculosis complicates the situation further, and has severe negative economic and health consequences. This stud...

Background: Multidrug-resistant Tuberculosis (MDR-TB) has an appreicable socioeconomic impact and threatens global public health leading to initiatives across countries to address this. There is a need to assess treatment outcomes of MDR-TB and predictors of poor treatment outcomes in Sudan given current high prevalence of resistance. Methods: Combined retrospective and prospective cohort study at Abu-Anga hospital (TB specialized hospital in Sudan). All patients with MDR-TB between 2013-2017 were targeted and all confirmed MDR-TB cases received an 18-month standardized regimen in two phases: 8-month intensive and 10-month continuation phase. Results: 156 patients were recruited as having good records, 117 (75%) were male, and 152 (97.4%) had pulmonary TB (PTB). Patients were followed for a median of 18 months and a total of 2108 person-months. Overall success was 63.5% (cure or completed treatment) and the mortality rate was 14.1%. Rural residency (P

The Joint Workshop on Induced Special Regions convened scientists and planetary protection experts to assess the potential of inducing special regions through lander or rover activity. An Induced Special Region is defined as a place where the presence of the spacecraft could induce water activity and temperature to be sufficiently high and persist for long enough to plausibly harbor life. The questions the workshop participants addressed were: (1) What is a safe stand-off distance, or formula to derive a safe distance, to a purported special region? (2) Questions about RTGs (Radioisotope Thermoelectric Generator), other heat sources, and their ability to induce special regions. (3) Is it possible to have an infected area on Mars that does not contaminate the rest of Mars? The workshop participants reached a general consensus addressing the posed questions, in summary: (1) While a spacecraft on the surface of Mars may not be able to explore a special region during the prime mission, the safe stand-off distance would decrease with time because the sterilizing environment, that is the martian surface would progressively clean the exposed surfaces. However, the analysis supporting such an exploration should ensure that the risk to exposing interior portions of the spacecraft (i.e., essentially unsterilized) to the martian surface is minimized. (2) An RTG at the surface of Mars would not create a Special Region but the short-term result depends on kinetics of melting, freezing, deliquescence, and desiccation. While a buried RTG could induce a Special Region, it would not pose a long-term contamination threat to Mars, with the possible exception of a migrating RTG in an icy deposit. (3) Induced Special Regions can allow microbial replication to occur (by definition), but such replication at the surface is unlikely to globally contaminate Mars. An induced subsurface Special Region would be isolated and microbial transport away from subsurface site is highly improbable.

Background Understanding community perspectives on antibiotics and antibiotic resistance (ABR) is a key component in designing educational interventions to combat ABR at the community level in Malaysia. Therefore, this study aimed to explore community residents’ knowledge, attitudes and perceptions regarding antibiotics and ABR in Jelutong District, Penang, Malaysia. Moreover, it intended to identify areas of focus to be addressed when designing an educational intervention to increase residents’ knowledge and change their attitudes and perceptions. Methods A qualitative approach was adopted to gain a deeper understanding of community residents’ knowledge, attitudes and perceptions regarding antibiotics and ABR. A purposive sampling was employed. Twenty-two residents (aged ≥18 years) were interviewed with the aid of a semi-structured interview guide. All interviews were audio recorded, transcribed verbatim and thematically analysed. Results The majority of the participants asserted that antibiotics could be effective against viral infections. Moreover, many participants were unaware that antibiotics have adverse effects. Some acquired antibiotics from a community pharmacy without a prescription, took antibiotics given to them by their family or friends, or took leftover antibiotics prescribed for a previous illness. A few indicated that they would request antibiotics from their physician when they had viral infections. More than half of the participants discontinued taking antibiotics when their symptoms improved. The majority stated that ABR occurs when the body becomes used to antibiotics. Most participants were unaware of the causes, consequences and prevention of ABR. In fact, they were not concerned about it. As a result, only a few perceived themselves as having responsibility for preventing this problem. Conclusions The community residents had misconceptions about antibiotics and ABR, negative attitudes towards antibiotics and negative perceptions of ABR. The areas of focus that need to be addressed when designing an educational intervention to increase the general public knowledge and change their attitudes and perceptions are the appropriate use of antibiotics and their adverse effects; the importance of adhering to antibiotic therapy; and the definition, causes, consequences and prevention of ABR.

This paper presents the design, development, and measurement results of a low-cost integrated circularly polarized (CP) active phased-array antenna (CP-APAA) technology with sidelobe level (SLL) control, operating at $Ka$ -band, for high throughput land-mobile satellite communication. The proposed CP-APAA is comprised of ( $4\times 16$ ) 64 elements in a rectangular grid array configuration. Eight commercial monolithic monolithic microwave/millimeter-wave integrated circuit. (MMICs) with eight-RF output channels have been used to control the phase and amplitude over the antenna aperture. For simplicity, the array antenna was designed in three metal layers and fabricated by a low-cost printed circuit board (PCB) technology as a proof-of-concept for a modular and scalable $Ka$ -band PAA with a wide steering angle. Measured radiation pattern shows a right-hand CP (RHCP) pattern with an axial-ratio (AR) level < 3 dB and low pointing error ≤1.5° over a scanning angular range of 0° to ±40°. Moreover, the amplitude excitation of the CP-APAA was tapered exponentially to control and reduce the SLL from 11 to 25 dB in boresight direction. Finally, toward a multibeam array implementation, two RHCP beams have been simultaneously generated at −30° and +20° scan angles.

BACKGROUNDOne of the main weaknesses and problems in the field of road accident management is the lack or non-use of appropriate information systems. The overall aim of this study is to reduce the impact of road accidents in the west, southwest, and south routes of Tehran Province, Iran, by designing Management Database responsible for road accidents.METHODSThis was an applied study performed using the descriptive-analytical method in which the data entry and analysis were conducted in the Geographic Information System (GIS) environment in line with the objectives. Then, according to different requirements of the various users, an appropriate analysis was performed on the layers and the software spatial analysis was applied in line with the main objective of the study. In the next step, the desired outputs were extracted from the system and the main output, i.e. the comprehensive database of spatial data required to manage road accidents, was provided to the management levels of various organizations for planning.FINDINGSIn this study, the accident-prone areas in the studied routes were identified using the kernel density estimation (KDE) method.CONCLUSIONPerforming various analyses on geographical and descriptive information and providing appropriate outputs and also sharing them can play an effective role in reducing injuries caused by road accidents.

Background Trans-radial approach for cardiac catheterisation procedures has long been associated with high operator and patient radiation dose. The aim of the present study was to determine the effect of pelvic and radial shields on decreasing coronary procedure radiation doses. Methods A total of 418 patients randomly underwent diagnostic and therapeutic cardiac procedures with and without the pelvic and rad-board lead shields during the procedures. The operator and patient doses were then determined by means of a personal dosimeter and dose area product (DAP), respectively. Results The shields decreased the operator radiation dose by 40% in coronary angiography (CA) and by 45% during angioplasty (PCI). These results were achieved at the cost of increased patient radiation dose. Conclusion Pelvic lead shields combined with rad-board shields are highly effective in reducing operator radiation dose in trans-radial approach, but it is only achieved at the cost of increased patient DAP.

The COVID-19 outbreak began in December 2019 and has dreadfully affected our lives since then. More than three million lives have been engulfed by this newest member of the corona virus family. With the emergence of continuously mutating variants of this virus, it is still indispensable to successfully diagnose the virus at early stages. Although the primary technique for the diagnosis is the PCR test, the non-contact methods utilizing the chest radiographs and CT scans are always preferred. Artificial intelligence, in this regard, plays an essential role in the early and accurate detection of COVID-19 using pulmonary images. In this research, a transfer learning technique with fine tuning was utilized for the detection and classification of COVID-19. Four pre-trained models i.e., VGG16, DenseNet-121, ResNet-50, and MobileNet were used. The aforementioned deep neural networks were trained using the dataset (available on Kaggle) of 7232 (COVID-19 and normal) chest X-ray images. An indigenous dataset of 450 chest X-ray images of Pakistani patients was collected and used for testing and prediction purposes. Various important parameters, e.g., recall, specificity, F1-score, precision, loss graphs, and confusion matrices were calculated to validate the accuracy of the models. The achieved accuracies of VGG16, ResNet-50, DenseNet-121, and MobileNet are 83.27%, 92.48%, 96.49%, and 96.48%, respectively. In order to display feature maps that depict the decomposition process of an input image into various filters, a visualization of the intermediate activations is performed. Finally, the Grad-CAM technique was applied to create class-specific heatmap images in order to highlight the features extracted in the X-ray images. Various optimizers were used for error minimization purposes. DenseNet-121 outperformed the other three models in terms of both accuracy and prediction.

Background: The first endovascular arteriovenous fistula (endoAVF) device (WavelinQ), a novel percutaneous technique of AVF creation, was approved by the Food and Drug Administration in 2018, and has been placed in a small number of U.S. hemodialysis patients. It is unknown how often patients with advanced chronic kidney disease have vascular anatomy suitable for WavelinQ creation. The goal of the present study was to determine the proportion of patients with vascular anatomy suitable for WavelinQ creation, and to assess patient characteristics associated with such suitability. Methods: All patients referred for vascular access placement at a large academic medical center underwent standardized preoperative sonographic vascular mapping to assess suitability for an AVF. During a two-year period (March 2019 to March 2021), we assessed the suitability of the vessels for creation of a WavelinQ. We then compared the demographic characteristics, comorbidities, and vascular mapping measurements between patients who were or were not suitable for a WavelinQ. Results: During the study period 437 patients underwent vessel mapping. Of these, 51% of patients were eligible for a surgical AVF and 32% were eligible for a WaveLinq AVF. 63% of those suitable for a surgical AVF were also suitable for a WaveLinQ AVF. Patients with a vascular anatomy suitable for a WavelinQ were younger (age 55±15 vs 60±14 years, p=0.01), but similar in sex, race, diabetes, hypertension, coronary artery disease, and peripheral artery disease. Conclusions: Among patients with chronic kidney disease with vascular anatomy suitable for a surgical AVF, 63% are also suitable for an WavelinQ endoAVF. Older patients are less frequently suitable for a WavelinQ.

Bhuvan KC,1,2 Alian A Alrasheedy,3 Bey Hing Goh,4,5 Ali Blebil,1 Nida Sajid Ali Bangash,1 Mohamed Izham Mohamed Ibrahim,6 Inayat Ur Rehman7 1School of Pharmacy, Monash University Malaysia, Selangor, 47500, Malaysia; 2College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia; 3Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Qassim, Saudi Arabia; 4Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Malaysia; 5College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, People’s Republic of China; 6College of Pharmacy, QU Health, Qatar University, Doha, Qatar; 7Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, PakistanCorrespondence: Bhuvan KCSchool of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, MalaysiaTel +60142271852Email bhuvan.kc@monash.eduPurpose: The aims of this study are to explore the types and patterns of use of health mobile apps among pharmacy clients in Selangor, Malaysia, and to explore the users’ experiences and views regarding the benefits of and issues with the use of the health apps.Patients and Methods: A cross-sectional survey was conducted with 278 pharmacy clients who were using health apps on their smartphones. A survey was developed, piloted, and rolled out, comprised of socio-demographic characteristics, information regarding the common types and the pattern of health app use, the benefits of health apps, and issues that users faced while using these apps. Statistical analysis was performed using IBM SPSS version 21.Results: The mean (±SD) age of health app users was 29.8 (± 11.74) years old, and over half of them (51.8%) were male, while less than half were female (48.2%). There were 48 different types of mobile health apps used by the participants in this study. The two most common were multi-purpose general health apps (53.6%) and fitness apps (38.1%). In terms of pattern of use, 33.5% of the participants reported using their health apps daily, 36.7% at least once weekly, and 25.2% monthly. The main benefits reported by the users were tracking of health status (47%), motivation (41%), and knowledge about health and fitness (9%). The main issues reported by the participants included inaccuracy of the app (24%), inconvenience (20.7%), and not being user-friendly (18.5%).Conclusion: The study showed that the participants used many different types of mobile health apps for several purposes, including general health, wellness, fitness, and self-management of diseases. These apps helped the participants to track their health-related activities and motivated them to maintain their wellness and fitness. Further areas of improvement were identified to ensure evidence-based and effective utilization of apps to achieve required health outcomes.Keywords: digital health, digital patients, health apps, Malaysia, mobile health

In modern server CPUs, last-level cache (LLC) is a critical hardware resource that exerts significant influence on the performance of the workloads, and how to manage LLC is a key to the performance isolation and QoS in the cloud with multi-tenancy. In this paper, we argue that in addition to CPU cores, high-speed I/O is also important for LLC management. This is because of an Intel architectural innovation - Data Direct I/O (DDIO) - that directly injects the inbound I/O traffic to (part of) the LLC instead of the main memory. We summarize two problems caused by DDIO and show that (1) the default DDIO configuration may not always achieve optimal performance, (2) DDIO can decrease the performance of non-I/O workloads that share LLC with it by as high as 32%. We then present IAT, the first LLC management mechanism that treats the I/O as the first-class citizen. IAT monitors and analyzes the performance of the core/LLC/DDIO using CPU's hardware performance counters and adaptively adjusts the number of LLC ways for DDIO or the tenants that demand more LLC capacity. In addition, IAT dynamically chooses the tenants that share its LLC resource with DDIO to minimize the performance interference by both the tenants and the I/O. Our experiments with multiple microbenchmarks and real-world applications demonstrate that with minimal overhead, IAT can effectively and stably reduce the performance degradation caused by DDIO.

Vascular access is the Achilles’ heel of dialysis therapy among patient with end stage kidney disease. The development of neointimal hyperplasia and subsequent stenosis is common in vascular access and is associated with significant morbidity. Percutaneous transluminal angioplasty using balloon inflation was the standard therapy of these lesions. However, the balloon-based approaches were associated with poor vascular access patency rate necessitating new inventions. It is within this context that different types of stents were developed in order to improve the overall dialysis vascular access functionality. In this article, we review the available literature regarding the use of stents in treating dialysis vascular access stenotic lesions. Further, we review the major clinical trials of stent use in different anatomic locations and in different clinical scenarios.

Background Understanding tuberculosis (TB) treatment programs' process and the outcome is one of the critical strategies to prevent the disease's occurrence and accelerate achieving sustainable development goals to reduce TB cases. The present study aimed to evaluate directly observed treatment short-course (DOTs) for tuberculosis. Methods The present cross-sectional, descriptive-analytical study extracted information from the tuberculosis surveillance system's recorded data by a researcher-made checklist with questions from patients and health system staff. We analyzed the data by SPSS version 20. Results The outcome of patients' treatment was 85.39% improved, and the rest were death and failure of treatment and absence from treatment. The mean and standard deviation of the onset of the first symptom and diagnosis and detection of the disease was 117 and 126 days, respectively. The mean and standard deviation of the interval between diagnosis and treatment was 5.53 and 8.03 days, respectively. Regarding the treatment length, 95.5% of the cases followed the treatment length, and the rest were not observed. The history of hospitalization was 45.3% among patients, and the rest had no history of hospitalization, and the mean and standard deviation of the day of hospitalization were 6.68 ± 9.50 days. Conclusions The existence of an appropriate program for early diagnosis of tuberculosis, observing the length of treatment, training private and public centers to strengthen the care system, and strengthening the DOTs program to control tuberculosis seems to be necessary.

Purpose The accuracy of magnetic resonance neurography (MRN) for quantitative assessment of nerve injury gap is unknown. We tested the hypothesis that presurgical MRN predicts the final surgical gap size after neuroma resection at the time of surgery. Materials and Methods This was a retrospective, single-blinded, nonrandomized cohort study on 43 patients with Sunderland Class IV and V injuries of the inferior alveolar (IAN) or the lingual nerve (LN). The MRN maxillofacial protocol was performed on a 3T scanner and was read by 2 musculoskeletal radiologists to determine the maximum size of neuroma and the abnormal nerve segment. Two independent variables were recorded during surgery: 1) the length of neuroma from histologic specimens since only 9 of the 43 neuroma size measurements were accurately measureable at the time of surgery; and 2) the length of nerve gap size after the neuroma was removed and normal fascicles were identified. Results There were 7 IAN and 36 LN cases analyzed. The mean time in months from injury to MRN was 6.97 ± 9.18 and MRN to surgery was 1.21 ± 1.4. The mean length of the neuroma at surgery was 7.22 ± 2.78 mm and mean nerve gap size was 12.02 ± 4.41 mm. Intraclass coefficient (ICC) agreement was fair for abnormal nerve thickness and neuroma length (ICC = 0.28, 0.39) while it was moderate for neuroma thickness and abnormal nerve length (0.50, 0.59). There was no significant correlation between MRN based measurements and surgical gap size for both readers (P > .05). Conclusions Abnormal nerve and neuromas of the peripheral trigeminal nerve as identified on MRN imaging demonstrates no correlation of the assessed MRN findings with the final surgical gap after neuroma removal.

In late December 2019, a global outbreak (pandemic) of the coronavirus was reported, which WHO named 2019-nCoV. The virus is now spreading rapidly and has affected manycountries, including Iran. There is no definitive and effective treatment for this virus yet. This report aimed to define the effect of Tocilizumab in patient with COVID-19. This case report isabout a 52-year-old man with COVID-19 that has been treated with tocilizumab. The reported patient had an acceptable improvement in oxygen saturation but no significant change inlung CT scan. After 3 days treatment patient with Tocilizumab, extensive bilateral lungs involvement still exist but SPO2 level iimprovement up to 90%. According to the results, thisdrug had a positive impact on oxygen saturation. However, we cannot be certain whether this drug positively affected the patient’s coronavirus disease.

The GaN-on-Si technology for the upcoming RF/6G/mm-Wave applications requires a robust buffer design for enhanced device performance and improved reliability. The defect states present in the various layers of the buffer stack can have a detrimental impact on both the DC and the AC performance of the device, as they can interact with the 2DEG channel carriers and/or contribute to buffer leakage mechanisms. An important reliability concern is the dynamic-R ON , arising from the interaction of the 2DEG channel with the defects in the buffer stack and/or the defects in the barrier layer or barrier/cap interface. In this work, an improved and more robust current transient spectroscopy technique is used to extract the time constant spectra and the activation energies of various buffer defects. A thinner GaN channel layer is shown to increase the dynamic-R ON , while a specific buffer stack configuration is shown to have a considerable impact the dynamic-R ON .