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BACKGROUND: Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties. OBJECTIVE: The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England. METHOD: We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes. RESULTS: We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest “wrong implants” (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 “wrong-site surgery” incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each. CONCLUSION: We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.

Summary Purpose To report glans and penile dimensions in 1023 consecutive boys with hypospadias. Patients & methods Boys admitted for hypospadias surgery between 2016 and 2018 were included in this study. Age ranged between 6 and 36 months. Boys who underwent previous surgery, received hormone therapy or older than 36 months were excluded. The hypospadias was classified according to ICD and WHO classification into glanular (Grade I), distal (Grade II), proximal (Grade III) and perineal (Grade IV). The flaccid penile length (PL), the dorsal glans length (DGL), the ventral glans length (VGL) and the glans width (GW) were measured in the operating room under anaesthesia just before operative correction. Small (GW) in this study was defined as less than 14 mm. Results 1023 boys were included. 273 had glandular, 468 distal, 194 proximal and 88 perineal hypospadias. The mean glans width was 14 mm with a range of 8 to 20 mm. The mean glans width for glanular hypospadias was 14.0 mm (range 9–19 mm), 14.0 mm (range 10–20 mm) for distal hypospadias (p > 0.05), 13.1 mm (range 9–19 mm) for proximal hypospadias (p 0.2), but there was a difference when compared to patients older than 25 months (p Conclusions A small glans is found in about a third of distal, two thirds in proximal and more than 90% of perineal hypospadias. Download : Download high-res image (211KB) Download : Download full-size image Summary Figure . A 9 month old child with proximal hypospadias and 50° penile curvature; A. the Glans Width (GW) was 9 mm. B. The Dorsal Glans Length (DGL) was 9 mm. C. The Ventral Glans Length (VGL) was 4 mm. D. The flaccid Penile Length (PL)was 18 mm.

Background: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. Methods: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. Results: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. Conclusion: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications. Résumé: Introduction: Les grandes lignes directrices sociétales recommandent une interruption de cinq jours avant l’intervention chirurgicale du cœur des patients atteints d’un syndrome coronarien aigu qui prennent du clopidogrel. Toutefois, comme il s’agit pour plusieurs d’entre eux de patients de haute acuité, le chirurgien penche vers l’utilisation d’une interruption plus courte. Par conséquent, la présente étude avait pour objectif de déterminer les conséquences de la durée et du moment de la cessation du clopidogrel sur les événements hémorragiques indésirables. Méthodes: La présente étude de cohorte rétrospective portait sur les patients qui avaient subi une intervention chirurgicale au cœur entre 2009 et 2016 dans un centre de soins tertiaires. Nous avons utilisé les modèles multivariés de régression logistique ajustés à l’interruption du clopidogrel, à l’âge, à l’urgence de l’intervention chirurgicale et au type d’intervention chirurgicale pour quantifier les effets des caractéristiques démographiques initiales cliniquement pertinentes sur la fréquence des transfusions massives ainsi que sur les issues des complications hémorragiques. Résultats: Un total de 5 748 patients ont subi une intervention chirurgicale au cœur. Dans cette cohorte, parmi les 1 743 patients (30,3 %) qui avaient reçu du clopidogrel avant l’opération, 884 (50,7 %) avaient cessé le clopidogrel cinq jours avant leur admission à la salle d’opération. L’administration du clopidogrel un à deux jours avant l’intervention chirurgicale (ratio d’incidence approché 1,97; intervalle de confiance [IC] à 95 % : de 1,18 à 3,29) était un prédicteur indépendant des transfusions massives et des complications hémorragiques (ratio d’incidence approché 1,85; [IC] à 95 % : de 1,01 à 3,37). Le groupe de l’interruption de trois à quatre jours n’a pas montré de risque accru de complications hémorragiques graves. Le risque de transfusions massives et de complications hémorragiques a aussi contribué à l’augmentation de l’urgence et de la complexité de l’intervention chirurgicale. Conclusion: Une interruption du clopidogrel de trois à quatre jours avant l’opération n’a pas été associée à un risque accru de complications hémorragiques graves.

Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response., Quantitative MRI techniques provide biophysical measures of the microstructural integrity of the CNS. Granziera et al. review the information provided by qMRI in the field of multiple sclerosis research and the potential for translation of qMRI techniques into clinical practice.

In today’s world using data mining and classification is considered to be one of the most important techniques, as today’s world is full of data that is generated by various sources. However, extracting useful knowledge out of this data is the real challenge, and this paper conquers this challenge by using machine learning algorithms to use data for classifiers to draw meaningful results. The aim of this research paper is to design a model to detect diabetes in patients with high accuracy. Therefore, this research paper using five different algorithms for different machine learning classification includes, Decision Tree, Support Vector Machine (SVM), Random Forest, Naive Bayes, and K- Nearest Neighbor (K-NN), the purpose of this approach is to predict diabetes at an early stage. Finally, we have compared the performance of these algorithms, concluding that K-NN algorithm is a better accuracy (81.16%), followed by the Naive Bayes algorithm (76.06%).

PurposeDespite the growing unforeseen and catastrophic events that disrupt business operations, empirical studies on the impact of operational disruption (OD) on small and medium enterprises' (SMEs) performance dimensions are limited. The study aims to investigate the moderating effect of disruption orientation (DO) and government support (GS) on the relationship between coronavirus disease (COVID-19) OD and SMEs' performance.Design/methodology/approachQuantitative survey method was used to collect data from 170 SMEs in Nigeria, through hand-delivery questionnaires. Partial least square (PLS) structural equation modeling (SEM) was employed to analyze the data.FindingsThe result shows no significant relationship between COVID-19 OD, DO and GS with SMEs' financial performance (FP). However, the relationship between COVID-19 OD and non-financial performance (NFP) is negatively significant. The relationship between DO and NFP is positively significant. DO and GS have insignificant relationship with FP. Finally, DO and GS does not moderate any of the relationships between COVID-19 OD and the dimensions of SMEs' performance.Practical implicationsThe result implies that health-related disruptions such as COVID-19 affect only the NFP of SMEs. However, supply chain managers and SMEs are encouraged to adopt DO to enhance NFP of firms.Originality/valueThe current study is the first to evaluate the impact of health-related disruptions on the two major dimensions of SMEs' performance (FP and NFP) by incorporating the moderating role of internal (DO) and external (GS) factors in to a single framework. However, the paper revealed new theoretical and practical knowledge by illuminating the absence of significant relationship between COVID-19 OD and SMEs' FP, implying that COVID-19 disruption does not significantly affect SMEs' FP.

In this paper, a new classification approach based on swarm-optimization is introduced to investigate the various effects of the ammonia concentration on the protein level and bioactivity that directly affect the Egyptian Nile’s fish health and mortality rate (i.e. Tilapia fish “O. Niloticus”). This approach enhances the Support Vector (SVM) Machines to classify the fish based on the protein level by Moth-Flame Optimization (MFO) algorithm. The experiment was divided into sub-phases: lab experiments and computational experiments. The primary purposes of the proposed approach, guiding decision-makers to review the pathophysiological status of the fish. The proposed MFO-SVM approach utilizes physical and chemical measurements to finally show revolutionary advances against the classic SVM and other well-known optimizers and classifiers. By achieving 99.983% of classification accuracy, the proposed approach outperforms other machine learning approaches on the same dataset. We believe that such an approach could be useful for many other real-world challenging tasks.

Manygrowth monitoring programmes at health facilities and in communities in Pakistan weigh children with their clothes on. The nutritional status of infants at the Rawalpindi General Hospital was estimated from weight without clothes on and showed that about 8% of malnourished children were being missed. This underestimation mostly affected children with grade II and grade III malnutrition. Generally, more boys have normal nutritional status than girls. Accordingly, weight with clothes on was found to underestimate the malnutrition status of girls more than that of boys. Children should be weighed without clothes on so as estimate their nutritional status and risk accurately

Introduction Regenerative solutions of the skin represent a hope for burn victims with extensive skin loss and chronic wound patients. The development of xeno-free workflow is crucial for clinical application in compliance with the directives of the European Medicines Agency. This study aimed at evaluating the outcome of the xeno-free isolation workflow of keratinocytes from human skin biopsy. Methods Skin biopsies were obtained from volunteers. The epidermis was digested with TrypLE™ Select, which was deactivated by dilution or with trypsin, deactivated by media with fetal bovine serum. Freshly isolated cells were compared for total cell number, viability, activity of caspase 3, gene expression and the presence of the keratinocyte surface markers cytokeratin 14. The cells were cultured in xeno-free conditions for one week and characterized regarding the number and viability as well as the metalloproteinase secretion. Results The number of obtained cells was similar in both workflows. The cell viability was less in the TrypLE group, with slight reduction of the cell surface marker cytokeratin 14. Caspase 3 activity was comparable as well as the gene expression of the apoptotic markers BAX, BCL2 and SLUG, as well as the keratinocyte markers cytokeratin 14, stratifin and filaggrin. Upon culture, the number of keratinocytes, their viability and secretion of matrix metalloproteinases 1 and 10 were equal in both groups. Conclusion This study reports the possibility of isolating functioning and viable keratinocytes through a xeno-free workflow for clinical application., Highlights • The xenofree workflows are essential for clinical application of regenerative medicine. • TrypLE based digestion of skin biopsies can be deactivated by dilution in a xenofree workflow to isolate keratinocytes. • Although the xenofree workflow was efficient, keratinocytes viability was better with the classical trypsin-based workflow. • The cell characteristics were equivalent upon culturing the cells.

This paper presents an experimental study on the shear performance of reinforced concrete (RC) beams provided with pre-prepared steel trusses in the shear span zone. Those steel trusses were assembled using electrical welding for steel strips of 2 mm thickness. For comparison purpose, corresponding steel trusses were assembled from equivalent rounded steel bars and used to reinforce the shear span zone of corresponding reinforced concrete beams, and then the shear behavior of beams reinforced with either trussed strips or trussed bars was compared. Accordingly, an experimental program consisted of fifteen reinforced concrete beams included one control beam have been prepared where the shear span-to-depth ratio was the same for all beams (2.3). Experimental test results showed that the beams reinforced with trussed steel strips showed better shear performance from the viewpoint of both the ultimate capacity and the developed major shear crack width compared with those of the beams reinforced with equivalent trussed bars. That is because the internal trussed strips have higher surface area than that of the equivalent rounded bars, which enabled the reinforced beam to maintain the confinement of the concrete core inside the section thus decreased the major shear crack width and increased the ultimate strength of reinforced concrete beam. Consequently, the ultimate capacity for reinforced concrete beams reinforced with internal trussed strips was higher than the corresponding capacity of beams reinforced with equivalent trussed bars by an average value of about 16%. Besides, the internal steel strips hindered the appearance of shear cracks and decreased the major shear crack width compared to the case of using equivalent rounded bars. Moreover, the experimental findings showed comparable results against the available analytical models from the viewpoints of ultimate shear capacity and maximum shear crack width.

We present a case of atypical recurrent optic neuritis. A man in his 50s presented with right optic neuritis and profound visual loss, associated with elevated inflammatory markers. Lymph‐node biopsy was consistent with sarcoidosis. Aquaporin‐4 antibodies were also present. Three months following corticosteroid treatment, his right optic neuritis relapsed, again with raised inflammatory markers. He was started on azathioprine and prednisolone with good effect. A dual diagnosis of sarcoidosis and neuromyelitis optica with aquaporin‐4 antibodies is very rare. Long‐term immunosuppression is required. The case highlights the importance of identifying the features and cause of atypical optic neuritis.

The task of network security is to keep services available at all times by dealing with hacker attacks. One of the mechanisms obtainable is the Intrusion Detection System (IDS) which is used to sense and classify any abnormal actions. Therefore, the IDS system should always be up-to-date with the latest hacker attack signatures to keep services confidential, safe, and available. IDS speed is a very important issue in addition to learning new attacks. A modified selection strategy based on features was proposed in this paper one of the important swarm intelligent algorithms is the Meerkat Clan Algorithm (MCA). Meerkat Clan Algorithm has good diversity solutions through its neighboring generation conduct and it was used to solve several problems. The proposed strategy benefitted from mutual information to increase the performance and decrease the consumed time. Two datasets (NSL-KDD & UNSW-NB15) for Network Intrusion Detection Systems (NIDS) have been used to verify the performance of the proposed algorithm. The experimental findings indicate that, compared to other approaches, the proposed algorithm produces good results in a minimum of time.

Male infertility has a complex etiopathology, which mostly remains elusive. Although research has claimed that oxidative stress (OS) is the most likely underlying mechanism of idiopathic male infertility, the specific treatment of OS-mediated male infertility requires further investigation. Coenzyme Q10 (CoQ10), a vitamin-like substance, has been found in measurable levels in human semen. It exhibits essential metabolic and antioxidant functions, as well as playing a vital role in mitochondrial bioenergetics. Thus, CoQ10 may be a key player in the maintenance of biological redox balance. CoQ10 concentrations in seminal plasma directly correlate with semen parameters, especially sperm count and sperm motility. Seminal CoQ10 concentrations have been shown to be altered in various male infertility states, such as varicocele, asthenozoospermia, and medical or surgical regimens used to treat male infertility. These observations imply that CoQ10 plays an important physiological role in the maintenance and amelioration of semen quality. The present article thereby aimed to review the possible mechanisms through which CoQ10 plays a role in the regulation of male reproductive function, and to concisely discuss its efficacy as an ameliorative agent in restoring semen parameters in male infertility, as well as its impact on OS markers, sperm DNA fragmentation, pregnancy, and assisted reproductive technology outcomes.

Objective: Oxidative stress (OS) plays a key role in the etiology of unexplained male infertility. Coenzyme Q10 (CoQ10) is a potent antioxidant that may improve semen quality and OS in infertile men with idiopathic oligoasthenoteratospermia (OAT), but the underlying mechanism is unknown. Therefore, the present study was undertaken to investigate the effect of CoQ10 on OS markers and sperm DNA damage in infertile patients with idiopathic OAT. Methods: This prospective controlled study included 50 patients with idiopathic OAT and 50 fertile men who served as controls. All patients underwent a comprehensive medical assessment. Patients and controls received 200 mg of oral CoQ10 once daily for 3 months. Semen and blood were collected and analyzed for sperm parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity, catalase, sperm DNA fragmentation (SDF), and serum hormonal profile. Results: The administration of CoQ10 to patients with idiopathic OAT significantly improved sperm quality and seminal antioxidant status and significantly reduced total ROS and SDF levels compared to pre-treatment values. Conclusion: CoQ10, at a dose of 200 mg/day for 3 months, may be a potential therapy for infertile patients with idiopathic OAT, as it improved sperm parameters and reduced OS and SDF in these patients.

Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups. Patients and Methods: We conducted a retrospective analysis of 257 consecutive hospitalized adult patients with acute cholangitis due to endoscopic retrograde cholangiopancreatography–confirmed choledocholithiasis between January 1, 2015, and December 31, 2019. Patients were divided into 3 age groups: less than 65 years, 65 to 79 years, and 80 years or older. Symptoms, vital signs, and laboratory data on admission were collected. Outcomes included length of hospitalization, intensive care unit stay, and 3-month mortality. Nominal variables were tested with the Pearson χ2 test, and continuous variables were tested with the Wilcoxon rank sum test. Results: Charcot triad decreased with older ages. In the group that was age 80 years or older, malaise was the most common symptom; 33.6% (37 of 110) presented with altered sensorium, 9.1% (10 of 110) had no pain, fever, or jaundice, and positive blood culture results were more frequent. Tokyo cholestasis criterion was present in 96.0% (247 of 257), while inflammation (considered essential for diagnosis) was present in 75.9% (195 of 257). Patients 80 years or older had significantly higher mean length of hospital stay (P

Mitral regurgitation can have varying hemodynamic parameters dependent on factors such as pressure gradients, exercise, and/or provocative maneuvers. We present a case of unusual dynamic mitral regurgitation resolved by coughing in a patient with hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.), Central Illustration

OBJECTIVE To determine the predictors of postoperative acute kidney injury (AKI) following nonemergent cardiac surgery among patients with variable preoperative estimated glomerular filtration rate (eGFR) levels. METHODS A retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures was performed between January 2006 and November 2015. The procedures included isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG and AVR. The primary outcome AKI (any stage) following nonemergent cardiac surgery utilizing the 2012 Kidney Disease-Improving Global Outcomes (KDIGO) criteria. Patients were categorized based on the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3), and postoperative dialysis. Patients with G5 preoperative kidney function (including dialysis patients) were excluded. RESULTS A total of 6675 patients were included in our study. The mean age was 66.8 years (SD ± 10.4), with 76.3% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (67.2%), while 1960 patients were in the G3 category (29.4%). Only 228 patients (3.4%) had G4 renal function. A total of 1453 (21.7%) patients experienced postoperative AKI. The need for postoperative dialysis occurred in 3.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.2% vs. 0.5%; p

This paper proposes a novel high voltage gain structure of DC-DC converter with soft-switching ability for photovoltaic (PV) applications. A small size coupled inductor with one magnet core is utilized to improve the voltage conversion ratio in the proposed converter. The converter has one active MOSFET with low conducting resistance ( $R_{DS}-_{ON}$ ), which in turn reduces the conduction losses and complexity of the control section. Due to the low input current ripple, the lifetime of the input PV panel is increased, and the maximum power point (MPP) of the PV panel can be easily tracked. The MOSFET’s zero-voltage and zero-current switching and diodes are the other countenance of the proposed converter, which improve its efficiency. Additionally, an improved Perturb and Observe MPP tracking (IP&O MPPT) algorithm is introduced to boost the extracted power of the input PV sources. To validate the performance of this converter, the operation modes principle, steady-state and efficiency survey, and comparison results with other same family converters are carried out. Finally, an experiential prototype is built with 20 V input, 200 V output, power rate of 200 W, and 50 kHz operating frequency to validate the mathematical analysis and effectiveness of the proposed structure. The efficiency of the proposed converter was estimated by over 95% at various power levels.

Background Ketamine, a glutamate N-methyl-d-aspartate receptor antagonist, has shown rapid antidepressant effects in treatment-resistant depression. We conducted a systematic review of studies evaluating the efficacy of intravenous ketamine augmentation in treatment-resistant depression patients with bipolar disorder. Methods Major databases were searched for open-label and randomized controlled trials (RCT). Two independent reviewers screened and selected the studies that met the inclusion criteria. Studies were selected following the standard Cochrane methodology, and the findings are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodological quality of the included studies was assessed using standardized measures. Results A total of 1442 articles were screened. Five studies were included in the systematic review (3 RCTs and 2 open-label studies) enrolling 110 subjects (mean age, 45.54 ± 12.65 years; 68.18% female). All the RCTs and open-label studies showed improvement in depressions symptoms after receiving a single infusion of ketamine. Included studies also suggested improvement in suicidal ideation and anhedonia after ketamine infusion. Dissociation and transient increase in blood pressure were the most common reported adverse effects with ketamine. Ketamine infusions did not increase mania symptoms. Conclusions Limited data show efficacy and feasibility of intravenous racemic ketamine in treatment-resistant bipolar depression. Further studies with larger sample size are required to strengthen the evidence.

Sentiment analysis is an emerging research field that can be integrated with other domains, including data mining, natural language processing and machine learning. In political articles, it is difficult to understand and summarise the state or overall views due to the diversity and size of social media information. A number of studies were conducted in the area of sentiment analysis, especially using English texts, while Arabic language received less attention in the literature. In this study, we propose a detection model for political orientation articles in the Arabic language. We introduce the key assumptions of the model, present and discuss the obtained results, and highlight the issues that still need to be explored to further our understanding of subjective sentences. The main purpose of applying this new approach based on Rough Set (RS) theory is to increase the accuracy of the models in recognizing the orientation of the articles. We present extensive simulation results, which demonstrate the superiority of the proposed model over other algorithms. It is shown that the performance of the proposed approach significantly improves by adding discriminating features. To summarize, the proposed approach demonstrates an accuracy of 85.483%, when evaluating the orientation of political Arabic datasets, compared to 72.58% and 64.516% for the Support Vector Machines and Naïve Bayes methods, respectively.

Named Entity Recognition (NER) is a vital step in medical information extraction, especially Electronic Health Records (EHRs). Proper extraction of medical entities such as disease and medications can automate the process of EHR coding as well as considerably improve the filtering of EHR resulting in better extraction of medical information. NER systems are generally trained and evaluated on relatively small standard datasets. However, they are applied on real-world applications, they exposed to different collection of texts, varying in topic, entity distribution, and text type (e.g. abstract vs. full text). This mismatch between the internal structure and application can cause drop in performance and consequently, unreliability. In this paper, we propose Med-Flair, an NER tagger covering mainly multiple entity types, medications and diseases. Med-Flair is mainly based on the Flair NLP framework, in addition, it’s integrated by adding Bidirectional A Long Short Term Memory network (BiLSTM) and Conditional Random Fields (CRF) for sequence tagger. To validate the performance of Med-Flair, it is tested on 4 benchmark datasets, two for medications entities and two for diseases entities. Med Flair successfully achieves high performance, as it achieves 92%, 88%, 92% and 95% of F1-score which are mostly highest compared to state of the art deep neural network architectures such as BioBERT, DTranNER, BERT and BioNerFlair.

This work aims to provide a state-of-the-art review of the performance of combined cycle power plant (CCPP) based on several proposed inlet air cooling systems. Investigators strive to meet the significant need to promote and develop inlet air cooling technologies to recover heat from the wasted energy in the exhaust gasses of the CCPP and diminish the environmental impacts. Various types of cooling systems mainly offer a boost for electric power generation during the peak load hours. The output power of the CCPP directly depends on the mass flow rate of air that flows through the air compressor. Therefore, during extremely hot weather conditions, subsequently, the air density drops, and this leads to a drastic decrease in the power output. This paper reviews available studies investigated the impacts of inlet air cooling systems on the performance of the CCPP. The fogging cooling system contributed by up to 17% in improving the total performance of the CCPP; however, with the use of the evaporative cooling, the performance was enhanced by only 4%. The energy consumption of mechanical chiller compared to that of evaporative cooling is high due to the effectiveness of the evaporative cooler which depends on the humidity of inlet airflow. Further, the mechanical cooling system can provide the CCPP with a cooling effect for around 7-hour on-peak periods. This method increases the gain of the CCPP performance by 13.6%. Ultimately, the CCPP equipped with an absorption chiller demonstrates the best solution to increase the performance by up to 23%.

Background: In this study, we hypothesized that clinically isolated syndrome–optic neuritis patients may have disturbances in neuropsychological functions related to visual processes. Methods: Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision. Results: At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics. Conclusion: Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.

Purpose The deregulation of the Hippo pathway results in translocation ofYes-associated protein-1 (YAP1) to the nucleus to exert an oncogenic effect. This effect has been demonstrated in several malignancies, yet, in breast cancer (BC), it remains controversial. The present study aimed to investigate the significance of YAP1 expression in BC, its relation to cancer stem cells (CSCs), and the effect of its inhibition on tumor cell survival. Patients and methods We evaluated the expression of YAP1 protein and gene using immunohistochemistry (IHC) and RT-qPCR in FFPE tissue from normal and breast cancer cases. We also studied its association with CSC expression (OCT4, NANOG, and SOX2) and with different clinicopathologic characteristics. Two BC cell lines (MCF7 and MDA-MB-231) were exposed to different concentrations of YAP1 inhibitor "verteporfin" and cell viability was subsequently assessed. Results YAP1 mRNA was higher in BC compared to the normal breast tissue (p-value=0.040) and was higher in luminal tumors compared to triple-negative breast cancer (TNBC) (p-value= 0.017). Its expression in tumors was significantly associated with the expression of pluripotency markers (OCT4 and NANOG) (p-value= 0.030 and 0.035, respectively) and its inhibition resulted in a significant reduction of CSC expression in both MCF-7 and MDA-MB-231 cells. YAP1 nuclear expression by IHC, which signifies its activation, was more evident in invasive carcinomas compared to normal breast tissue and in-situ foci where the expression was limited to the cytoplasm. The pretreatment of BC cells (MCF7 and MDA-MB-231) with YAP1 inhibitor "verteporfin" resulted in their sensitization to the effect of tamoxifen and doxorubicin, respectively, and significantly decreased tumor cell proliferation and survival. Conclusion Our results imply that YAP1 is highly expressed and activated in BC and its inhibition could represent a possible novel therapeutic strategy that should be further explored and investigated to improve the outcome of breast cancer patients.

Vitamin D (Vit-D), an essential nutrient, interacts with different drugs including chemotherapeutic agents like busulphan, an alkylating agent used for conditioning prior to stem cell transplantation. The correlation between Vit-D plasma levels and busulphan clearance was investigated in an uncontrolled prospective study in patients and mice. Plasma 25(OH)D levels were measured and busulphan pharmacokinetics calculated in 81 patients. Adults received oral busulphan (n = 34) while children received busulphan orally (n = 19) or intravenously (n = 28). Patients received no Vit-D supplementation. To confirm our findings, pharmacokinetics after a single dose of busulphan (oral or intravenous) were evaluated in two groups of mice (n = 60) receiving high or standard-level Vit-D supplementation. Both busulphan clearance (P < 0.0001) and 25(OH)D levels (P = 0.0004) were significantly higher in adults compared to children. A significant negative correlation (P = 0.041) was found between busulphan clearance and 25(OH)D levels in children treated orally. No such correlation was observed in adults or in children receiving intravenous busulphan. In addition, no significant effect of Vit-D levels on busulphan pharmacokinetics in mice regardless of the administration route. In conclusion, 25(OH)D can affect oral busulphan pharmacokinetics in children and its level should be considered when personalizing oral busulphan treatment. Further studies are warranted to confirm the underlying mechanisms.

The aim of this work is to study the thermal performance of four configurations of absorber plates of solar air collectors under three levels of air mass flow rates (0.0199, 0.047 and 0.120kg/s) and fabricate an efficient and cheap solar air collector from recyclable aluminum cans. Solar air collectors were manufactured and tested under prevailing weather conditions of Shebin El-Kom city (30˚.54'N and 31 E), Egypt. Comparisons between the temperature difference of air across the collector and thermal efficiencies of the flat, aluminum cans, and v-corrugated plate solar air collectors were presented. The results revealed that the maximum thermal efficiency was obtained at mass flow rate of 0.047kg/s for an solar air collector with an absorber plate made of single layer of recyclable aluminum cans) type-I), whereas the lowest thermal efficiency was obtained for the solar air collector without cans (flat plate). The thermal efficiency of the solar air collectors depends principally on the solar radiation, surface geometry of the collectors and air mass flow rate.

Objectives: The aim of this work is to evaluate the differentmodalities of post-bariatric breast reshaping in females andtheir aesthetic outcomes and rate of complications.Background: The post-bariatric breast is a real problemafter massive weight loss especially in females. Differentmodalities for the reshaping of post-bariatric breast were used.Patients and Methods: This a prospective cohort studystatistical technique, descriptive statistics as numbers andpercentages were used, conducted over 20 post-bariatric breastpatients requesting breast contouring in the period fromJanuary 2016 to January 2019. Operations were done inMenoufia University and Railways Hospitals. Patient's ageranged from 21-49 years. A total of 20 procedures wereperformed; reduction mammoplasty in 5 patients, auto augmentationin 8 patients, augmentation mastopexy in 5 patients,and implant augmentation in 2 patients.Results: Patient's satisfaction was measured by aestheticrating scale as follow; 1- Very satisfied, 2- Satisfied, 3- Fair,and 4- Dissatisfied regarding improvement in size, shape,and quality of scar. 14 patients were very satisfied (70%), 4patients were satisfied (20%), and 2 patients were fairlysatisfied (10%). And out of the 20 patients, the overall complicationrate was 30%.Conclusion: Breast auto augmentation for breast reshapingin post bariatric patients is an ideal and long life techniquecomparable to other techniques used to address this issue.

Background: Central venous stenosis or occlusion (CVSO) is a major complication in hemodialysis patients that significantly affects morbidity and failure of the peripheral arteriovenous fistula (AVF). However, the best treatment is still unknown (surgical or endovascular). Endovascular treatment is a widely accepted option that includes percutaneous transluminal angioplasty (PTA) with or without stenting. The optimal endovascular treatment is still undetermined. Aim: To study the success rate and effect of endovascular intervention as angioplasty alone or with stenting, in patients with CVSO as optimal endovascular treatment still undetermined. Patients and Methods: this is uncontrolled clinical trial was conducted in Suez Canal University Hospital in the period between July 2017 to July 2019 and follow-up for 12 months. Thirty-four patients with compromised upper limb arteriovenous fistula due to CVSO were included to assess the patency rate of primary angioplasty with or without stenting. Any patients with (mediastinal lesion invading central veins, ipsilateral peripheral vein stenosis, or infected AVF) were excluded. Results: The mean age of studied patients was 53.06±8.49 with a slightly larger number (19) of females (56%). Pre-intervention, the innominate vein was the highest affected with lesion by 41%. Occlusion was in 9 patients (26%), while; 25patients (74%) had stenotic lesion. The success rate of primary patency was 55%, follow-up of the successful cases at 3, 6, and 12 months with patency rate 91%,77%, and 59% respectively. There was no significant difference in the patency rate during one-year follow-up regarding the use of angioplasty alone or with stenting. Conclusion: percutaneous transluminal angioplasty with or without stenting according to our results is successful, safe, and effective in managing central venous lesions in compromised AVF in hemodialysis patients.

This paper presents the experimental findings for different strengthening techniques applied on defected reinforced-concrete cantilever slabs to restore lost flexural capacities owing to insufficient bond length of the main tensile steel. The restoration technique was based on compensation of the main tensile steel by near-surface mounted steel bars, externally bonded steel plates or externally bonded carbon fibre-reinforced polymer sheets. In addition, new hybrid techniques are presented, which merge the traditional techniques with a 20 mm thick ultra-high-performance strain-hardening cementitious composites (UHP-SHCC) layer. It was found that the strengthening technique based on the embedded steel bars on the UHP-SHCC overlay enabled the strengthened slab to restore its lost capacity and outperformed it by about 5% compared to that of the properly detailed slab. Nevertheless, this restoration was at the expense of the exhibited ductility. Conversely, the strengthening technique based on the application of externally bonded steel plates on a transition layer of the UHP-SHCC material enabled the strengthened slab to restore the lost capacity by about 96% as well as to outperform its ductility by more than 29% compared to those of the properly detailed slab.

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in COVID-19, accounting for 7-23% of cases, and is associated with a higher morbidity and mortality. There is a discrepancy in the literature about myocarditis as the etiology of myocardial injury in COVID-19; although many anecdotal reports of myocarditis have been noted, there are only a handful of case reports in the literature about myocarditis related to COVID-19. This review summarizes the most up-to-date literature around the association between COVID-19 and myocarditis and gives clinicians a practical framework about the clinical manifestations, diagnostic tools and treatment options currently available. Importantly, this review will heighten suspicion for myocarditis as an etiology of myocardial injury in COVID-19 patients, therefore improving clinical outcomes and encouraging shared clinical decision-making. This will also open the door for further research to build around this review. Emergent treatment options for COVID-19 are in clinical trials and may be of benefit to COVID-19 patients with myocarditis in addition to current guideline-based recommendations., COVID-19 is responsible for hundreds of thousands of deaths worldwide. Myocarditis as a possible sequela of COVID-19 infection is a likely underestimated cause of mortality and morbidity in critically ill COVID-19 patients. Investigations for suspected myocarditis among COVID-19 patients should include high-sensitivity troponin, ECGs, and echocardiography. Treatment options are currently limited to guideline-directed heart failure therapy, supportive care and/or mechanical circulatory support. Physicians should have a high index of suspicion to ensure a timely diagnosis and subsequent consultation with multidisciplinary subspecialists for ongoing management.

Oxidative stress (OS) is a key contributing factor in 30–80% of male infertility cases. To date, several antioxidant treatments have been put forth to manage OS-induced male infertility. This study intended to elucidate the impact of coenzyme Q10 (CoQ10) and selenium on seminal fluid parameters and antioxidant status in infertile men with idiopathic oligoasthenoteratospermia (OAT). In this prospective study, 70 patients with idiopathic OAT were randomly allocated to receive CoQ10 (200 mg/day) or selenium (200 μg/day) for 3 months. Semen quality parameters (following WHO guidelines, 5th edition), total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD) activities were compared before and after the treatment. The results of the study showed an increase in sperm concentration with CoQ10 treatment (p

Obesity and the brain are linked since the brain can control the weight of the body through its neurotransmitters. The aim of the present study was to investigate the effect of high-fat diet (HFD)-induced obesity on brain functioning through the measurement of brain glutamate, dopamine, and serotonin metabolic pools. In the present study, two groups of rats served as subjects. Group 1 was fed a normal diet and named as the lean group. Group 2 was fed an HFD for 4 weeks and named as the obese group. Markers of oxidative stress (malondialdehyde, glutathione, glutathione-s-transferase, and vitamin C), inflammatory cytokines (interleukin [IL]-6 and IL-12), and leptin along with a lipid profile (cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein levels) were measured in the serum. Neurotransmitters dopamine, serotonin, and glutamate were measured in brain tissue. Fecal samples were collected for observing changes in gut flora. In brain tissue, significantly high levels of dopamine and glutamate as well as significantly low levels of serotonin were found in the obese group compared to those in the lean group (P > 0.001) and were discussed in relation to the biochemical profile in the serum. It was also noted that the HFD affected bacterial gut composition in comparison to the control group with gram-positive cocci dominance in the control group compared to obese. The results of the present study confirm that obesity is linked to inflammation, oxidative stress, dyslipidemic processes, and altered brain neurotransmitter levels that can cause obesity-related neuropsychiatric complications.

Now day’s text Classification and Sentiment analysis is considered as one of the popular Natural Language Processing (NLP) tasks. This kind of technique plays significant role in human activities and has impact on the daily behaviours. Each article in different fields such as politics and business represent different opinions according to the writer tendency. A huge amount of data will be acquired through that differentiation. The capability to manage the political orientation of an online article automatically. Therefore, there is no corpus for political categorization was directed towards this task in Arabic, due to the lack of rich representative resources for training an Arabic text classifier. However, we introduce political Arabic articles dataset (PAAD) of textual data collected from newspapers, social network, general forum and ideology website. The dataset is 206 articles distributed into three categories as (Reform, Conservative and Revolutionary) that we offer to the research community on Arabic computational linguistics. We anticipate that this dataset would make a great aid for a variety of NLP tasks on Modern Standard Arabic, political text classification purposes. We present the data in raw form and excel file. Excel file will be in four types such as V1 raw data, V2 preprocessing, V3 root stemming and V4 light stemming.

Cardiac CTA is an indispensable imaging tool for TAVR procedure planning. Post-processing of the dual-energy CT utilizing dual-source and kV-switching approach enables an increase in the density ...

Introduction: Nasal reconstruction is a difficult problembecause it entails reconstruction of skin, cartilage, osseousframe work and lining mucous membrane [1]. The result mustbe satisfactory both cosmetically and functionally [2].The anatomical reconstruction depends on the principleof subunit divisions of the nose. Which states: If the reconstructionis less than the defective subunit the result willappear patchy. On the other hand, if the reconstruction exceedsthe limits of the subunit the nose will appear unnatural [3,4].Local and regional flaps are used in nasal reconstructioneach type has its own advantages, disadvantages and donorsite morbidity [5-9]. The aim of this work is to demonstratethe advantages and disadvantages of expanded forehead flap in nasal reconstruction.Material and Methods: A retrospective review of 25consecutive cases of total or nasal dorsum reconstruction whowere operated upon in a single clinic by 3 separate surgeonsadopting the same principle of expanded forehead flap, betweenJanuary 2010 and January 2017.In this technique the median forehead skin is expandedwith a 200-ml envelope for 6-8 weeks, and then a foreheadflap is incised to match the nasal defect [10].Results: Surgical follow-up varied from a minimum of 6months to a maximum of 2 years with average follow-up of1 year. Among a total of 25 patients, 23 patients (92%)complied with follow-up, and 21 (91%) of these patients weresatisfied. One case only complicated and the expander extrudedand had to be removed.Conclusion: The tint of forehead skin is similar to nasalskin. Forehead flap is well vascularized and is lying adjacentto the nose. Forehead is a multilaminar structure which allowthe usage of skin grafts as inner lining and because of its highvascularity all types of structural support can be used.Expanded forehead flap provides large, excess forehead skinand primary closure of donor site is applicable. During theprocess of expansion, the skin is thinned out so do not needde-fattening and re-contracture do not occur. Therefore,forehead flap is always a good reconstructive option in largenasal defects.

Objectives To systematically review and synthesize literature on 1) the overall prevalence of depression and anxiety in SLE patients in identified studies, and 2) the pooled prevalence per metrics of depression and anxiety in adult SLE patients. Methods This review used (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines and in-depth searches in four databases (1954-2016; Ovid-based Medline, Embase, PsycINFO and CINAHL) to identify articles on the prevalence of depression and/or anxiety in adult SLE patients. Included studies were critically appraised and analyzed. The prevalence of depression and anxiety was studied for all included studies, and whenever possible, pooled prevalence (PP) was determined for more commonly used metrics. Statistical and publication bias was assessed using funnel plots. Result A total of 3103 references were identified, 226 were selected for detailed review and 72 were included in the final analysis. Overall Prevalence The depression PP, obtained from 69 studies representing 23,386 SLE patients, was 35.0% (95% CI: 29.9%-40.3%). The anxiety PP, obtained from 38 studies representing 4439 SLE patients, was 25.8% (95% CI: 19.2%-32.9%). Prevalence per metrics used The more commonly used instruments included the Centre for Epidemiological Studies - Depression (CES-D), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scales (HADS-A/D), and Hamilton Rating Scales for Depression/Anxiety (HAM-D/A)]. The CES-D was utilized in 13 studies including 1856 SLE patients; depression PP was 41.5% (95% CI: 35.1%-48.1%). The BDI was utilized in 14 studies including 1355 SLE patients and the BAI in 3 studies including 489 patients; depression PP was 39.9% (95% CI: 31.1%-49.1) and anxiety PP was 38.4% (95% CI: 34.2%-42.8%). The HADS-D was utilized in 14 studies including 1238 SLE patients and the HADS-A in 12 studies including 1099 patients respectively; it's depression PP was 24.4% (95% CI: 19.1%-30.1%) and anxiety PP was 38.3% (95% CI: 29.1%-47.9%). The HAM-D was utilized in 4 studies including 267 SLE patients and the HAM-A in 4 studies including 213 patients respectively; its depression PP was 40.0% (95% CI: 23.0%-59.0%) and anxiety PP was 39.0% (95% CI: 32.0%-45.0%). Conclusion There was high variability in the prevalence of depression and anxiety, ranging from 8.7%-78.6% and 1.1%-71.4%, respectively. This could be attributed to the lack of consistency in the metrics used and its definition for depression and anxiety in SLE. Studies that used a specific metric, such as the CES-D, BDI or HAM-D, yielded similar depression prevalence. The HADS-D had the lowest prevalence. All metrics of anxiety yielded similar anxiety prevalence.

Flue gas from gas fired power plants contains 10–16% (w/w) water vapor with considerable amount of latent heat. Although CO2 capture and utilization have received great attention, water capture from power plant has received limited attention. The power plants in Qatar exhaust 33 Million m3 of water per year. This paper explores selected alternative technologies namely absorption, compression & cooling, and quenching, to enable the recovery of water vapor contained in a base case 750 MW power plant flue gas streams. The alternatives for water capture were modeled and optimized over a wide range of operating conditions (pressure, temperature, and flow rate). Using data from an actual gas fired power plant in the state of Qatar, simulation studies were carried out and optimized for all modeled technologies to minimize production cost using Aspen HYSYS V8.6. The results show that the quench unit, operated at pertinent water circulation temperature (50 °C), pressure (6 atm), and flowrate of 3500 m3/h (recyclable), can extract up to 80.7% of the water in the flue gas. Apart from production cost and water capture percentage, criteria used to screen the alternative technologies were payback period, CO2e emission and brine reduction rate. The research work determined that the quench alternative had the lowest payback period (8.8 years), lowest CO2 emission rate (13 kg CO2/m3 H2O) and highest brine reduction (3.44%) among all the tested alternatives. The proposed quench water-recovery technology will have added value to Qatar and other nations with limited water resources, specifically those with access to natural gas resources.

Background We present a case of a 83-year-old man with a prior history of coronary artery bypass who presented to his family physician with progressive symptoms that raised concern for heart failure exacerbation. A chest X-ray was performed, which showed a fractured topmost sternal wire in the lateral projection and indicated that the sternal wire had migrated into the anterior mediastinum. An emergent electrocardiogram-gated flash computed tomography angiography confirmed the location of the fractured wire to be in close proximity to the main pulmonary artery. A discussion of migrated sternal wires with a literature review of cases is provided as well. Aims To present a case of a migrated sternal wire and a literature review. Methods An extensive literature review using pubmed and medline with relevant keywords was preformed. Results 11 known cases of migrated sternal wires with various complications, as detailed in the review table. The mortality rate is low but can be associated with significant morbidity. Discussion Fractured wires are quite common and are usually a benign radiographic finding. However, migration of sternal wires is an extremely rare phenomenon. Only a few reported cases in the literature were sternal wires have migrated beyond the sternum, leading to catastrophic clinical consequences, as detailed in the review table. Conclusion Sternal wire complications secondary to migration beyond the sternum are rare but potentially fatal. Precise wire location and risk assessment with CT are more appropriate when wire location cannot be clearly delineated by plain film radiography.

Impact loading could impair the entire structure or a part of it, thus making the human life at stake. In this study, to improve the impact resistance of reinforced concrete slabs under drop-weight loading, a thin layer of strain-hardening cementitious composites was added at either tension or compression side of the slab. The main parameter of this study was the three contact surface conditions, namely grinding, grinding plus steel dowels, and grinding plus epoxy adhesive, between the substrate slab and the strain-hardening cementitious composites layer. Therefore, 63 reinforced concrete slabs were prepared and tested under the effect of drop-weight falling from three different heights: 1, 1.5, and 2 m. In addition, for comparison purposes, additional seven slabs were tested under central incremental static loading until failure is presented. It was found that the strain-hardening cementitious composites–strengthening layer enhanced the impact and static response of the strengthened slabs when added at either tension or compression side. Besides, to achieve the outermost impact resistance showing ductile performance, it is better to provide a thin layer of the strain-hardening cementitious composites at the tension side of the slab connected to the substrate slab by epoxy resin applied on pre-prepared grinded surface.

Aim To evaluate the effect of the differences in the dimensions of maxillary lateral incisor on the esthetic perception of smile among dental professionals and the general population. Materials and methods Two sets of photographs where the maxillary incisor dimensions were modified using computer software (Adobe Photoshop) were created. In the first set, six images were included where the maxillary lateral incisor width was modified. The second set included five images where only the maxillary lateral incisor length was modified keeping the gingival margins same. Three groups of participants formed the sample. Hypodontia patients formed the first group, non-hypodontia patients formed the control group, while the dentists constituted to the third group. A total of 156 participants were recruited, 36 patients with radiographically confirmed hypodontia out of which 22 were female and 14 were male, 54 non-hypodontia "control" patients out of which 29 were female and 24 were male, and 66 dentists out of which 39 were female and 27 were male. Every participant had 15 seconds to view each photograph along with 30 seconds at the end for confirmation. Results The "most attractive smile" was the ones with 77% lateral incisor to central incisor width proportion according to 25.0% of the hypodontia group and 40.8% of the dentist's group, while only 4.2% of the control group agreed that it was the most attractive. However, the "least popular" was the 52% lateral incisor to central incisor width proportion according to 40.0% of patients who are hypodontic, 20.8% of participants from control group, and 49.0% of dentists. Conclusion The golden proportion was not considered as the most attractive among all groups. The esthetic perceptions of the patients might not be same as that of the dentists. In general, reductions in the maxillary lateral incisor width were not all acceptable. Clinical significance This study will help us understand the different perceptions of the patients and the dentists on esthetics, which would further help us in planning the treatment accordingly.

Introduction: Rhinoplasty is challenging procedure as itsone of the aesthetic procedures where the patient and all hisacquaintances are constantly seeing and judging the plasticsurgeon outcome. Osteotomy is one of the most crucial steps;in order to have good results; it is needed to narrow nasalwidth. Osteotomy is also one of the difficult steps in rhinoplastyas it is blind and meticulous [1].Material and Methods: Retrospective study from 2010to 2014, including 450 patients. Pre-operative data weredocumented and tabulated. Intraoperative data were documentedand tabulated. Post-operative data were documentedand tabulated. Follow-up for 6 months and evaluation sheetwas filled. 200 patients complied to follow-up, the rest (250patient) were excluded from the study. Comparative evaluationof the resultswas done and statistically analyzed.Results: 13% (26 cases) was total complication rate.Complication varied from;asymmetry: 4.5%, residual hump:6%, nasal bone collapse: 2%, extensive displacement: 0.5%.Conclusion: Osteotomy is one of the most crucial stepsin rhinoplasty. In this study we did retrospective analysis of450 rhinoplasty patients and their osteotomy results. Weconcludedthat lateral green stick osteotomy with or withoutmedian osteotomy is the safest osteotomy.

In order to reduce scaling in a multistage flash (MSF) desalination plant, the brine reject can be diluted using forward osmosis (FO) before recycling. In this FO process, the brine is used as the draw solution (DS) and seawater is used as the feed solution (FS). However, the FO process suffers from low water flux owing to membrane fouling. The water flux in FO can be enhanced by reduc-ing the foulant concentration in the FO feed solution (FS). Thus, in this paper seawater, multimedia sand filtered seawater, and ultrafiltrated seawater is being used as feed solution for the FO process. The flowrate of the feed solution was kept constant at 2.0 L/min. However, the flowrate of the draw solution (DS) were tested at 2.0 and 0.8 L/min. When the flowrate of the DS was 0.8 L/min, the highest initial flux of 44.1 L/m2 h were obtained using ultrafiltrated seawater as FS. After the initial run, the membrane was cleaned and during the second run, 83% of the initial flux was recovered using the ultrafiltrated seawater as FS. For ultrafiltrated seawater, the water recovery rate and specific energy consumption was 36.2% and 0.065 kWh/m3, respectively. 2020 Desalination Publications. All rights reserved. This research is made possible by NPRP award (NPRP10-0117-170176) from the Qatar National Research Fund (QNRF). The statements made herein are solely the responsibility of the authors. In addition, the authors wish to thank Qatar Foundation for the financial support pro-vided to one of the co-authors through a graduate sponsorship research award (GSRA6-1-0509-19021). The authors also wish to thank Qatar Electricity and Water Company (QEWC) for the supply of brine. Also, the authors would like to thank the Central Laboratories Unit (CLU) at Qatar University for generating the SEM images. Scopus