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Background: The benefit of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) is well established; its efficacy in patients with heart failure preserved ejection fraction (HFpEF) is less clear. Objective: The objective of the study was to compare AF and heart failure (HF) rehospitalizations after PVI in patients with HFpEF vs HFrEF. Methods: The IBM MarketScan Database was used to identify patients undergoing PVI for AF. Patients were categorized by HF status: absence of HF, presence of HFrEF, or presence of HFpEF. Primary outcomes were HF and arrhythmia hospitalizations after PVI. Results: A total of 32,524 patients were analyzed: 27,900 with no HF (86%), 2948 with HFrEF (9%), and 1676 with HFpEF (5%). Compared with those with no HF, both patients with HFrEF and HFpEF were more likely to be hospitalized for HF (hazard ratio [HR] 7.27; P < .01 for HFrEF and HR 9.46; P < .01 for HFpEF) and for AF (HR 1.17; P < .01 for HFrEF and HR 1.74; P < .01 for HFpEF) after PVI. In matched analysis, 23% of patients with HFrEF and 24% patients with HFpEF demonstrated a reduction in HF hospitalizations (P = .31) and approximately one-third demonstrated decreased arrhythmia rehospitalizations (P = .57) in the 6 months after PVI. Compared with those with HFrEF in longer-term follow-up (>1 year), patients with HFpEF were more likely to have HF (HR 1.30; P < .01) and arrhythmia (HR 1.19; P < .01) rehospitalizations. Conclusion: Reductions in HF and arrhythmia hospitalizations are observed early after PVI across all patients with HF, but patients with HFpEF demonstrate higher HF rehospitalization and arrhythmia recurrence in longer-term follow-up than do patients with HFrEF.

Background Plastic surgery has developed to benefit in a variety of challenging areas formerly handled by other disciplines. Medical students do not have a clear picture of plastic surgery as a career due to lacking scope, clinical practice, and understanding of plastic surgery as a clinical area of expertise, including general practitioners, nursing staff, medical trainees, and the general public, and misconceptions about the extent of reconstructive and plastic surgery.

Accents, or changes in how different people speak the same word/sentence in the same language, pose substantial communication issues in most spoken languages. This is a well-known fact, but how does the accent of one language affect learning/speaking another? In this paper, we look at how Arab accents influence the English language. To that end, we built a deep machine-learning system for Arabic accent recognition that was learned from an in-house English speech database of four Arabic accents collected from Jordan, Iraq, Saudi Arabia, and Tunisia. The proposed system employs Mel spectrograms of an English-spoken paragraph to train an LSTM neural network to recognize the accent in each sound signal. Although the collected data was extremely difficult to learn due to the presence of both males and females and fluent speakers in each class, the proposed system could recognize speakers with various accents by up to 79%. This answers the study’s main question, demonstrating that speakers with an Arabic accent have their way of speaking English, which varies by country. As a result, if trained on appropriate and adequate data, the proposed system can also be used to recognize accents in any language.

Cadmium (Cd) is among the most widespread and toxic heavy metal in several part of the world. Its toxicity in soil is becoming a severe threat to living organism worldwide. It is one of the main pollutants in paddy fields near industrial areas and highly toxic to plant growth and development of the plants. Cd can be easily taken up by plants and enter the food chain. Therefore, precautionary measurements should be done to reduce accumulation of Cd in crops to alleviate the risk of health hazards in response to Cd-polluted soils. Several strategies have been proposed for the successful management of the Cd-contaminated in crops. One approach, applicable on slightly contaminated soils, is selection of plant genotypes with high ability to repress root uptake and shoot transport of Cd which could be a reasonable approach to alleviate adverse effects of Cd toxicity in crops. Moreover, the toxic effect of Cd can be decreased by proper application of essential nutrients such as Zn, S and N fertilizers Cd contaminated soil.

In this study, TiO2 supported over embryonic Beta zeolite (BEA) was prepared for the photocatalytic degradation of Tetracycline (TC) antibiotic under visible light. The immobilization of sol-gel TiO2 over the zeolite increased its surface area from 33 (m2/g) to 226 (m2/g) and enhanced its adsorption efficiency from 8 % to 18 %. In order to expand the photocatalytic activity of TiO2 towards the visible light region (i.e. λ > 380 nm), two different metal sensitization techniques with Iron ions from aqueous solution of FeCl3 were explored. In the ion-exchange method, the substitutional cations within the TiO2/BEA structure were exchanged with Fe3+. Whereas, in the doping technique, solgel TiO2 was doped with Fe3+ during its synthesis and before its immobilization over Zeolite. Four different samples with 20, 40, 60, and 100 % w/w of TiO2/BEA ratio were prepared. After testing the various ion-exchanged photocatalysts under blue and white lights, only Fe–60%TiO2/BEA showed better activity compared to pure TiO2 under white light at TC initial concentration, Co = 20 ppm. For the doped immobilized Titania with 60 wt% TiO2/BEA, three different doped photocatalysts were prepared with 3 %, 7 %, and 10 % per mole Fe/TiO2. All the Fe-doped TiO2/BEA photocatalysts showed better activity compared to pure TiO2 under white light. Under solar irradiations, the 3 % Fe-doped TiO2/BEA was able to degrade all TC within 120 min, while Fe–60%TiO2/BEA needed 200 min, and TiO2 needed more than 300 min. This enhanced performance was a result of both increased surface area due to immobilization over BEA as well as iron doping by Fe3+ that simultaneously increased the visible light absorption of TiO2 and minimized the charge carrier recombination effect.

Background: Little is known about de novo human luekocyte antigen (HLA) antibody development with Impella 5.5 temporary mechanical circulatory assist support and downstream effects following heart transplantation in the new heart allocation system. Methods: Thirteen Impella and 17 control patients without device support were prospectively enrolled between December 2020 and June 2022. HLA antibodies with calculated panel reactive antibodies (cPRA) were assessed pre and postdevice implantation and within 1-year postheart transplantation. Results: Baseline prevalence of HLA antibodies and median cPRA were similar between groups. Patients in the study arm were on Impella support for a median of 7 days. No significant differences in HLA antibodies were observed postdevice or postheart transplant. One patient in the Impella arm developed rejection and required treatment. One Impella patient died due to infection and 1 control patient died due to primary graft dysfunction. Conclusions: Short-term use of Impella 5.5 in the new heart allocation system does not appear to increase risk of de novo HLA antibody development. Further studies are needed to validate these preliminary findings.

The aim of this study is to revisit the important question of how human drivers steer in straight and curved roads. We review the two-point and the tangent point models and suggest a new perspective by introducing the center point model. An eye tracking platform was used to investigate the driver’s gaze direction in real-time driving. Extensive data was collected in an urban environment via integration of the eye tracking system and a scene camera. The objectives of the experiments were to investigate the driver gaze behaviour in two scenarios in real traffic settings. In the first set of trials, the driver followed the tangent method whereas in the second set of tests, the driver focused on the perceived center of the road during driving in straight and curved roads. Moreover, the distance between the driver and the gaze point is found to be lower when turning left compared to turning right. This study underpins the improved performance of the center point model over the tangent point model. Furthermore, our analysis reveals correlation between gaze strategy and vehicular control, offering a deeper comprehension of visuomotor coordination essential for safe and efficient driving.These findings provide valuable insight into human driving behavior and can be utilized to develop more effective driver assistance systems and enhance lateral control mechanisms for driverless cars.

Introduction The effects of COVID-19 lockdowns and the discontinued face-to-face clinical practicum had negative consequences on nursing and midwifery students at many levels. The clinical learning environment includes all the training and learning experiences that nursing students undergo during their clinical practicum. Objectives This study aimed to assess the effects of the COVID-19 lockdowns on the nursing and midwifery students’ practicum training in governmental and private universities and academic faculties of nursing in Jordan. Methods A descriptive cross-sectional study of 1025 nursing and midwifery students from academic faculties of nursing of both governmental and private Jordanian universities was conducted in September 2021. The research group from two Jordanian universities designed and validated a 13-item survey to determine and evaluate the impact of mass lockdowns on nursing and midwifery students’ practicum training. The responses were assessed using descriptive and inferential analyses. Results The findings revealed that the lockdown had a negative impact on nursing and midwifery students’ self-confidence and competency in performing nursing procedures. The academic year of the students was a significant independent predictor of their self-confidence and competency levels in performing nursing procedures. Conclusion The study concluded that nursing and midwifery students were dissatisfied with their clinical education during the COVID-19 pandemic, which led to poor self-confidence in performing nursing procedures. The study group recommended repeating the clinical practicum, incorporating extensive laboratory and hospital courses, and implementing a one-year internship for newly graduated nurses and midwives to address the training gap and enhance self-confidence in clinical procedures.

With the rapid growth of information and communication technologies, governments worldwide are embracing digital transformation to enhance service delivery and governance practices. In the rapidly evolving landscape of information technology (IT), secure data management stands as a cornerstone for organizations aiming to safeguard sensitive information. Robust data modeling techniques are pivotal in structuring and organizing data, ensuring its integrity, and facilitating efficient retrieval and analysis. As the world increasingly emphasizes sustainability, integrating eco-friendly practices into data management processes becomes imperative. This study focuses on the specific context of Pakistan and investigates the potential of cloud computing in advancing e-governance capabilities. Cloud computing offers scalability, cost efficiency, and enhanced data security, making it an ideal technology for digital transformation. Through an extensive literature review, analysis of case studies, and interviews with stakeholders, this research explores the current state of e-governance in Pakistan, identifies the challenges faced, and proposes a framework for leveraging cloud computing to overcome these challenges. The findings reveal that cloud computing can significantly enhance the accessibility, scalability, and cost-effectiveness of e-governance services, thereby improving citizen engagement and satisfaction. This study provides valuable insights for policymakers, government agencies, and researchers interested in the digital transformation of e-governance in Pakistan and offers a roadmap for leveraging cloud computing technologies in similar contexts. The findings contribute to the growing body of knowledge on e-governance and cloud computing, supporting the advancement of digital governance practices globally. This research identifies monitoring parameters necessary to establish a sustainable e-governance system incorporating big data and cloud computing. The proposed framework, Monitoring and Assessment System using Cloud (MASC), is validated through secondary data analysis and successfully fulfills the research objectives. By leveraging big data and cloud computing, governments can revolutionize their digital governance practices, driving transformative changes and enhancing efficiency and effectiveness in public administration.

To increase global recognition and quality education, universities in Indonesia establish English-mediated International University Programs (IUPs). Within different capacities and resources, however, internationalisation sometimes preserves inequalities among Indonesian higher education institutions (IHEIs). This study investigates how the practice of English-mediated internationalisation may not only support global recognition and quality education but also perpetuate linguistic hegemony. Framed by Canagarajah's (1999b) Linguistic Imperialism (LI) and Pennycook's (2017) critical perspective of English as an international language, government document analysis and semi-structured interviews with lecturers and students reveal different international programs, ranging from deliberation to initial emergence. Most IUPs are deliberately designed to cater for international students by providing high-standard infrastructure, international curriculum and quality human resources in order to increase international admissions and partnerships which are essential for international recognition. Despite these attempts, several have not been successful in attracting international enrolments and recognition. In contrast, other programs are not deliberate but are initially emerging to become international and attract overseas students. The study also discusses some emerging linguistic hegemony between English and maintenance of national language in the internationalisation of the Indonesian tertiary sector.

Heterogeneous photocatalysis operated under visible light is considered an efficient and ecofriendly method to remove pharmaceuticals from water streams. However, the recovery of the nano-sized catalyst particles limits this technology to small-scale applications. In this study, we prepared Fe-doped P25 TiO2 photocatalysts and immobilized them over PVDF-HFP electrospun membranes for the photocatalytic degradation of Tetracycline antibiotic under visible light. To ensure uniform distribution of the nanoparticles on the fibers, the electrospinning voltage and the weight percentage of TiO2 were varied, and two preparation methods were applied to disperse the catalyst in the polymeric solution. In order to maximize the visible light exposure of the membranes, 3D printed membrane holders with square and circular shapes were designed to immerse the membrane in Tetracycline solution. The results showed that immobilizing P25 catalysts on the fibers of the membranes limited their visible light absorption when the light source was assembled on the top of the aqueous reaction medium. This occurred due to the membrane's opacity limited light penetration, resulting in uneven irradiation throughout its depth. Based on this, a new photocatalytic reactor design was proposed with immersed light illumination source to reduce the distance between the membrane and the light source for improved activation of the P25 particles. In this design, a 3D-printed vertical membrane holder was also included to accommodate a larger membrane surface area and therefore minimize the required spatial area for large industrial applications.

Abstract Background Immunotherapies have changed the landscape of late‐stage melanoma; however, data evaluating timely access to immunotherapy are lacking. Methods A retrospective cohort study utilizing the National Cancer Database was conducted. Stage III and IV melanoma cases diagnosed between 2011 and 2018 that received systemic treatment with either immunotherapy or chemotherapy were included. Chemotherapy included BRAF/MEK inhibitors. Multivariable logistic regression models were utilized to evaluate factors associated with the likelihood of receiving immunotherapy as primary systemic treatment relative to chemotherapy; additionally, Cox proportional hazards models were utilized to incorporate time from diagnosis to primary systemic therapy into the analysis. Results The study population was comprised of 14,446 cases. The cohort included 12,053 (83.4%) immunotherapy and 2393 (16.6%) chemotherapy cases. In multivariable logistic regression analysis, factors significantly associated with immunotherapy receipt included population density, circle distance, year of diagnosis, Breslow thickness, and cancer stage. Immunotherapy timing was evaluated using multivariable Cox regression analysis. Minorities were less likely to receive timely immunotherapy than non‐Hispanic Whites (HR 0.83, CI 0.74–0.93, p = 0.001). Patients at circle distances of 10–49 miles (HR 0.94, CI 0.89–0.99, p = 0.02) and ≥50 miles (HR 0.83, CI 0.77–0.90, p