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Abstract This research investigates the significance of improving cross-cultural communicative competence (ICC) in undergraduate English instruction. ICC involves the ability to communicate effectively and appropriately with people of other cultures. This goal emphasizes the growing relevance of language competence, cross-cultural awareness, and knowledge of global challenges for students in the context of higher education. This research, therefore, underlines the importance of strengthening students’ critical thinking and communication abilities through studying English at the university level. Additionally, this study investigates the challenges and controversies when instructors and students from various backgrounds attempt to understand and implement cross-cultural communicative competence skills. The study aims to discover how teachers define and understand intercultural communication competence, how telecollaboration influences the development of this competency, how English as a Foreign Language (EFL) teachers assess their students’ intercultural communication skills, and what motivates these teachers to incorporate intercultural communication competence ideas into their lessons. EFL teachers, who are responsible for teaching English in countries where English is not the primary language, face unique challenges and opportunities. Their role extends beyond language instruction to include fostering an understanding of cultural nuances and preparing students to communicate effectively in diverse international settings. The findings highlight the importance of nurturing ICC abilities within collegiate English courses, revealing inadequacies and recommending future study areas.

Abstract Background Endogenous substances of krill oil (KO) are lipophilic in nature and have clinical significance viz. DHA/EPA, phospholipids and astaxanthin. To improve the nanodispersibility of endogenous substances of KO, a self-nanoemulsifying system (SNE) was developed. Results Ternary phase behaviour of KO was explored in ethanol (ET); propylene glycol, (PG); and PEG600 using Tween80 and Tween20 as surfactants. PEG600 induced the self-nanoemulsification of KO and yielded one phase region (OPR); dilution lines (KO/Smix fraction containing PEG600) traversed across OPR, produced a fully dilutable nanoemulsion system. PEG600-based nanoformulations (NFs) of KO underwent phase transformation via percolation behaviour in nanostructure domains (86–207 nm). PEG600 induced ternary phase behaviour of KO as revealed from rheological data (higher eta values), refractive index (nonlinear) and conductivity (bimodal) patterns. Induced phase transformation could be an interaction between aqueous phase and KO/Tween20 in PEG600 environment; generating highly viscous domains of low electrical conductivity. NFs offered antioxidant activity over corresponding coarse systems (p

Spectrometers have a wide range of applications ranging from optical to non-optical spectroscopy. The need for compact, portable, and user-friendly spectrometers has been a focus of attention from small laboratories to the industrial scale. Here, the Czerny Turner configuration-based optical spectrometer simulation design was carried out using ZEMAX OpticStudio. A compact and low-cost optical spectrometer in the visible range was developed by using diffraction grating as a dispersive element and a USB-type webcam CCD (charge-coupled device) as a detector instead of an expensive commercial diffraction grating and detector. Using National Instruments LabVIEW, data acquisition, processing, and display techniques were made possible. We employed different virtual images in LabVIEW programs to collect the pixel-to-pixel information and wavelength-intensity information from the image captured using the webcam CCD. Finally, we demonstrated that the OpticStudio-based spectrometer and experimental measurements with the developed spectrometer were in good agreement.

The inherent single narrow emission peak and fast anion exchange process of cesium lead halide perovskite CsPbX3 (X = Cl, Br, I) nanocrystals severely limited its application in white light-emitting diodes. Previous studies have shown that composite structures can passivate surface defects of NCs and improve the stability of perovskite materials, but complex post-treatment processes commonly lead to dissolution of NCs. In this study, CsPb(Cl/Br)3 NCs was in-situ grown in TiO2 hollow shells doped with Eu3+ ions by a modified thermal injection method to prepare CsPb(Cl/Br)3/TiO2:Eu3+ composites with direct excitation of white light without additional treatment. Among them, the well-crystalline TiO2 shells acted as both a substrate for the dopant, avoiding the direct doping of Eu3+ into the interior of NCs to affect the crystal structure of the perovskite materials, and also as a protection layer to isolate the contact between PL quenching molecules and NCs, which significantly improves the stability. Further, the WLED prepared using the composites had bright white light emission, luminous efficiency of 87.39 lm/W, and long-time operating stability, which provided new options for the development of perovskite devices.

We report the design simulation of the Raman spectrometer using Zemax optical system design software. The design is based on the Czerny–Turner configuration, which includes an optical system consisting of an entrance slit, two concave mirrors, reflecting type diffraction grating and an image detector. The system’s modeling approach is suggested by introducing the corresponding relationship between detector pixels and wavelength, linear CCD receiving surface length and image surface dimension. The simulations were carried out using the POP (physical optics propagation) algorithm. Spot diagram, relative illumination, irradiance plot, modulation transfer function (MTF), geometric and encircled energy were simulated for designing the Raman spectrometer. The simulation results of the Raman spectrometer using a 527 nm wavelength laser as an excitation light source are presented. The present optical system was designed in sequential mode and a Raman spectrum was observed from 530 nm to 630 nm. The analysis shows that the system’s image efficiency was quite good, predicting that it could build an efficient and cost-effective Raman spectrometer for optical diagnostics.

Metakaolinite has been used as a silica and alumina precursor to synthesise kalsilite via the hydrothermal method with the addition of potassium hydroxide (KOH) as the potassium source. The effects of the KOH concentrations and reaction temperatures have been investigated. X-ray diffraction (XRD) diffractograms and field emission scanning electron microscope (FESEM) images showed the formation of hexagonal kalsilite after the hydrothermal reaction of metakaolinite at 190 ° C in 1.25 M KOH for 24 hours. Kalsilite formed as a minor crystalline phase at a KOH concentration of less than 1.0M KOH, while, at a higher KOH concentration, the crystallinity of the product increases. On the other hand, 190 ° C was sufficient to convert metakaolinite to kalsilite. Besides, zeolite F and muscovite have been found as the dominant products at a lower KOH concentration and temperature, respectively.

OBJECTIVES:. To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN:. Prospective observational study. SETTING:. One hundred seventy-nine hospitals in 24 countries within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry. PATIENTS:. Hospitalized adults with laboratory-confirmed SARS-CoV-2 infection. INTERVENTIONS:. None. RESULTS:. Of 16,225 patients enrolled in the registry with hospital discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations of COVID-19 were older with median (interquartile range) age 72 years (61.0–81.0 yr) versus 61 years (48.0–72.0 yr) and had higher prevalence of chronic medical conditions, including vascular risk factors. Adjusting for age, sex, and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (odds ratio [OR], 1.49; p < 0.001) as defined by the World Health Organization ordinal disease severity scale for COVID-19 infection. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR, 1.45; p < 0.001) and require critical care interventions (extracorporeal membrane oxygenation: OR, 1.78; p = 0.009 and renal replacement therapy: OR, 1.99; p < 0.001). Hospital, ICU, and 28-day mortality for patients with neurologic manifestations was higher (OR, 1.51, 1.37, and 1.58; p < 0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (estimated difference in days, –0.84, –1.34, and –0.84; p < 0.001). CONCLUSIONS:. Encephalopathy at admission is common in hospitalized patients with SARS-CoV-2 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.

IMPORTANCE:. At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. OBJECTIVES:. To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS:. Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. MAIN OUTCOMES AND MEASURES:. Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. RESULTS:. Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. CONCLUSIONS AND RELEVANCE:. Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.

A low-cost medium-power carbon dioxide (CO2) laser system is designed, constructed, and characterized to produce coherent, monochromatic laser radiation in the infrared region. The laser cavity is simulated and designed by using ZEMAX optic studio. A switch-mode high-tension pump source is designed and constructed using a flyback transformer and simulated using NI Multisim to study the voltage behavior at different node points. A prototype cooling system/chiller is designed and built using thermo-electric coolers (TEC) to remove the excess heat produced during laser action. Various parameters, such as pumping mechanism, chiller stability, efficiency, output power, and current at different applied voltages, are studied. The chiller efficiency at different output powers of the laser is analyzed, which clearly shows that the chiller’s cooling rate is good enough to compensate for the heat generated by the laser system. The center wavelength of the carbon dioxide laser is 10.6 μm with an FWHM of 1.2 nm simulated in the ZEMAX optic studio. The output beam penetration through salt rock (NaCl), wood, and acrylic sheet (PMMA) at various output powers is analyzed to measure the penetration depth rate of the CO2 laser.

IMPORTANCE:. Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population. OBJECTIVES:. To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical illness and mortality in hospitalized young adults. DESIGN, SETTINGS, AND PARTICIPANTS:. A retrospective cohort study of the Society of Critical Care Medicine’s Viral Infection and Respiratory Illness Universal Study registry. Patients 18–40 years old, hospitalized from coronavirus disease 2019 from March 2020 to April 2021, were included in the analysis. MAIN OUTCOMES AND MEASURES:. Critical illness was defined as a composite of mortality and 21 predefined interventions and complications. Multivariable logistic regression was used to assess associations with critical illness and mortality. RESULTS:. Data from 4,005 patients (152 centers, 19 countries, 18.6% non-U.S. patients) were analyzed. The median age was 32 years (interquartile range, 27–37 yr); 51% were female, 29.4% Hispanic, and 42.9% had obesity. Most patients (63.2%) had comorbidities, the most common being hypertension (14.5%) and diabetes (13.7%). Hospital and ICU mortality were 3.2% (129/4,005) and 8.3% (109/1,313), respectively. Critical illness occurred in 25% (n = 996), and 34.3% (n = 1,376) were admitted to the ICU. Older age (p = 0.03), male sex (adjusted odds ratio, 1.83 [95% CI, 1.2–2.6]), and obesity (adjusted odds ratio, 1.6 [95% CI, 1.1–2.4]) were associated with hospital mortality. In addition to the above factors, the presence of any comorbidity was associated with critical illness from coronavirus disease 2019. Multiple sensitivity analyses, including analysis with U.S. patients only and patients admitted to high-volume sites, showed similar risk factors. CONCLUSIONS:. Among hospitalized young adults, obese males with comorbidities are at higher risk of developing critical illness or dying from coronavirus disease 2019.

The study aims to investigate the issue of growing extremism with reference to the wider theme of societal factors as a reason for this growing menace. Society is responsible for developing particular behaviours amongst dwellers. Their attitudes are shaped up by multiple influencing factors around; it may be political, economic, or it may be merely an influence supported by culture. This study explores the said factors within two dimensions; 1. the effects of cultural and social identity on human behaviour; and 2. the influence of uncertainty on growing extremism and crimes. Quantitative data was collected from a highly educated segment of society from all over Pakistan. To obtain the data, a Likert scale was administered amongst research participants; who are working as educational leaders, teachers, scholars and tertiary level students. The findings of the research are thought-provoking and setting a direction to work forward and to dig up more.

This paper reports an experiment in which production of English plosives by advanced Pakistani learners was studied in the light of predictions of speech learning model (SLM). The results show that the learners equate aspirated and unaspirated allophones of English labial and coronal stops with the unaspirated stops of their L1. However, they maintain a difference between two allophones of English velar stop. Some participants also increase VOT of the unaspirated allophones of English stops to a level which is larger than the native VOT range. The directionality of learning is from dorsal to labial to coronal. The acquisition of accurate VOT of English coronal stops is found to be more difficult for Pakistani learners because they substitute English alveolar stops with retroflex stops of their L1. The findings of this study also points out some gaps in the SLM on the basis of which revisions are suggested in the SLM

This work aimed to analyze the heat transfer of micropolar fluid flow in a constricted channel influenced by thermal radiation and the Lorentz force. A finite difference-based flow solver, on a Cartesian grid, is used for the numerical solution after transforming the governing equations into the vorticity-stream function form. The impact of various emerging parameters on the wall shear stress, axial velocity, micro-rotation velocity and temperature profiles is discussed in this paper. The temperature profile is observed to have an inciting trend towards the thermal radiation, whereas it has a declining trend towards the Hartman and Prandtl numbers. The axial velocity profile has an inciting trend towards the Hartman number, whereas it has a declining trend towards the micropolar parameter and Reynolds number. The micro-rotation velocity escalates with the micropolar parameter and Hartman number, whereas it de-escalates with the Reynolds number. The Nusselt number is observed to have a direct relationship with the Prandtl and Reynolds numbers.

This article presented an analysis of the pulsatile flow of non-Newtonian micropolar (MP) fluid under Lorentz force’s effect in a channel with symmetrical constrictions on the walls. The governing equations were first converted into the vorticity–stream function form, and a finite difference-based solver was used to solve it numerically on a Cartesian grid. The impacts of different flow controlling parameters, including the Hartman number, Strouhal number, Reynolds number, and MP parameter on the flow profiles, were studied. The wall shear stress (WSS), axial, and micro-rotation velocity profiles were depicted visually. The streamlines and vorticity patterns of the flow were also sketched. It is evident from the numerical results that the flow separation region near constriction as well as flattening of the axial velocity component is effectively controlled by the Hartmann number. At the maximum flow rate, the WSS attained its peak. The WSS increased in both the Hartmann number and Reynolds number, whereas it declined with the higher values of the MP parameter. The micro-rotation velocity increased in the Reynolds number, and it declined with increment in the MP parameter.

Background: Medical field has experienced a constant rise in the induction of female students in medical colleges across the globe. This makes their future career preferences highly significant as they are ultimately going to shape out the fate of various specialties. Keeping in view the prevailing trend of gender distribution in medical colleges of the whole country, it will not be wrong to say that females have become the stake holders of the future of the health care in Pakistan. Thereby, it is the need of the hour to chalk out the future preferences of these female medical students Methods: This is a descriptive cross-sectional study which was done on 150 female medical students of 3rd, 4th and final year MBBS of Rawalpindi Medical University. Data was collected with the help of a questionnaire on which variables such as age, year of study, parents' occupation, plan and reason of going abroad, plan and reason of studying in Pakistan and preferable field for specialization were entered. Data was analysed by using Statistical Package for Social Sciences (SPSS) version 22.0 respectively are the specialties of choice among female medical students of RMU. Career counselling sessions should be organized and admission policy can be changed to prevent overcrowding of one field and tailor needs of the country. Results: The study showed that among 93.3% of the respondents who were interested in doing post-graduation 61.4% wanted to stay in Pakistan and 38.6% wanted to go abroad. The most frequently opted field of specialty was Medicine (39.3%) followed by Surgery (28%) and Gynaecology and Obstetrics (22%) Conclusion: Our study concluded that medicine, followed by surgery and gynaecology and obstetrics

Gold nanorods (AuNRs) have attracted great interest due to their excellent plasmonic properties which makes them a promising candidate for many applications. However, most of the applications require control over the position and concentration of nanorods (NRs) by processes that are fast, reliable and scalable. The focus of this work is to study the effects of variation of various parameters, such as applied voltage, frequency, solvents and drying time on the concentration of dielectrophoresis (DEP) -assisted deposition of AuNRs. We have seen that the concentration of AuNRs within the electrodes can be considerably increased by increasing the applied voltage and deposition time, and by choosing a more volatile solvent. Furthermore, the applied frequency also strongly influences the deposition of AuNRs. At lower frequencies, the electro-osmotic flows drag AuNRs to the top of electrodes, while at higher frequencies NRs are deposited close to the electrode edge where the electric field and the field gradient are maximum. We have also carried out simulations using the finite element method to generate the electric field patterns for coplanar electrodes. Our results provide insight into ways in which the concentration of AuNRs can be controlled during DEP-assisted deposition.

This is a pure qualitative research study based on the understanding of a Facilitator with the Psychology of Students and its impact on teaching and learning process. This research study was a qualitative and exploratory in nature , based on the grounded approach where the facts were explore in multi-dimensional framework This study provides the theme for infrastructure used in classes and what a facilitator understands about the mental level and credibility of the each student in the class, whereas the class consists of around fifty students and subsequently different pedagogies were used which make understanding of the subject for students easier and ultimately makes the teacher more preferable as well.

In this paper, synthesis and results of the low temperature sensing of carbon monoxide (CO) gas and room temperature UV sensors using one dimensional (1-D) ZnO nanostructures are presented. Comb-like structures, belts and rods, and needle-shaped nanobelts were synthesized by varying synthesis temperature using a vapor transport method. Needle-like ZnO nanobelts are unique as, according to our knowledge, there is no evidence of such morphology in previous literature. The structural, morphological and optical characterization was carried out using X-ray diffraction, scanning electron microscopy and diffused reflectance spectroscopy techniques. It was observed that the sensing response of comb-like structures for UV light was greater as compared to the other grown structures. Comb-like structure based gas sensors successfully detect CO at 75 °C while other structures did not show any response.

Importance: Perforated peptic ulcer disease (PUD) affects 4 million people annually worldwide, with a lifetime prevalence of 5% to 10%. Of those affected, 5% will progress to the point of perforation. Despite advances in the understanding and treatment, perforated PUD continues to have a high rate of morbidity (50%) and mortality (30%). This review summarizes the current evidence on management of perforated PUD, including management of failed repairs., Observations: Approaches for repair include primary closure and omental patch closure. Omental patch may be most useful in large perforations with friable tissue. Minimally invasive surgery is the preferred approach in perforated PUD, with improved outcomes compared with open techniques. Leak from the ulcer after repair is seen in approximately 12% to 17% of cases. Approaches to releak include expectant management, radiologic and/or endoscopic intervention, and repeat surgery. Morbidity and mortality after releak are especially high, and complete healing of the leak may take time., Conclusions and Relevance: Despite advances in medical management and surgical techniques, perforated PUD continues to have a relatively high rate of morbidity and mortality. Minimally invasive surgery is the current preferred treatment approach.

Layer-by-Layer (LbL) technique is the simplest and inexpensive method for preparartion of nano-dimensional thin films for tailoring material behavior having wide range of applications including sensors. Here, spectroscopic behavior of two laser dyes Acriflavine (Acf) and Rhodamine B (RhB) assembled onto LbL films have been investigated. It has been observed that both Acf and RhB form stable LbL films. Polyanion polyacrylic acid (PAA) was used to incorporate the Acf or RhB onto the LbL films. Adsorption of Acf and RhB onto PAA were completed within 45 min and 30 min respectively. During LbL film, material loss occurred in case of Acf. It has been demonstrated that such material loss can be minimized by incorporating clay laponite onto the LbL films. Temperature and pH dependant studies indicate that Acf and RhB assembled onto LbL films can be used to design temperature as well as pH sensors. Fluorescence Resonance Energy Transfer (FRET) between Acf and RhB has also been investigated. Interestingly, it has been demonstrated that the energy transfer efficiency can be manipulated using spacer molecules within the Acf and RhB LbL films. Laponite clay can be used to enhance the FRET efficiency, whereas stearic acid (SA) can be used to lower the efficiency. FRET efficiency linearly changes upon exposure of a pesticide pretilachlor at varying concentration. This study indicated that with proper calibration, proposed sensing system can be used to design FRET based pesticide sensor with detection limit of 0.22 ppm., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: One anastomosis gastric bypass (OAGB) is an American Society for Metabolic and Bariatric Surgery (ASMBS)-endorsed bariatric surgery. As utilization of OAGB increases, it is important that the safety profile of OAGB be rigorously assessed., Objectives: We studied the 30-day safety of OAGB compared to a similar gastro-jejunal anastomotic procedure, Roux-en-Y gastric bypass (RYGB)., Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating bariatric centers in the United States., Methods: A matched case-control study was conducted of patients who underwent primary gastric bypass surgery 2021-2022, identified in the MBSAQIP database. Each patient who underwent OAGB was matched to 4 controls who underwent RYGB on age (±10), sex, race, body mass index (BMI) (±5 kg/m 2 ), preoperative functional status, American Society of Anesthesiologists (ASA) classification, and 13 comorbidities. Univariate and multivariate regression analyses were performed., Results: A total of 1569 patients who underwent OAGB were matched to 6276 controls. Matched baseline characteristics were similar between groups. Operative time, length of stay (LOS), and overall complication rate were lower in the OAGB cohort (P < .001) with higher 30-day BMI loss percentage (P = .048). Specifically, OAGB was associated with a significantly lower bowel obstruction rate, as compared to RYGB (.1% versus 1.0%, P < .001). On logistic regression adjusting for all variables used in matching, OAGB was associated with a 27% decrease in overall complication rate (odds ratio [OR] .73, 95% confidence interval [CI] .62-.87, P < .001)., Conclusions: Although OAGB is minimally utilized, the 30-day safety profile appears favorable. As compared to RYGB, OAGB was associated with shorter operative time and LOS, and a lower complication rate, partially due to minimization of small bowel obstructions with a loop anatomy. Further evidence in the comparative long-term safety profile is still needed., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Middle Eastern countries, such as the United Arab Emirates and Oman, are affected by frequent dust storms and extreme hot climatic conditions, which can exacerbate respiratory conditions. These environmental factors are particularly injurious to asthmatic patients, as they can aggravate small airway disease (SAD), leading to increased morbidity and healthcare challenges. The evaluation of maximal mid-expiratory flow (MEF-25) as a diagnostic and therapeutic tool for early-stage small airway dysfunction is of significant clinical importance, particularly in hot and arid metropolitan environments where dusty conditions exacerbate pulmonary issues. This study assesses the value of MEF-25 in clinical practice for detecting SAD and investigates the effectiveness of inhaled bronchodilator therapy with extra-fine particles augmented by a spacer in helping to manage the symptoms of these patients. This retrospective, single-center study was conducted at King's College Hospital Dubai, including 225 patients aged 18 and above, who presented with MEF-25 values less than 80%. Data were collected from the Electronic Medical Record system, including demographics, spirometry findings, and treatment outcomes. MEF-25 values were categorized into moderate (51-80%), severe (35-50%), and very severe (1-34%) grades. Statistical analysis was performed using IBM SPSS software. Results revealed significant correlations between MEF-25 severity and various clinical parameters. Notably, Immunoglobulin E (IgE) and Fractional Exhaled Nitric Oxide (FeNO) levels showed an inverse relationship with decreasing MEF-25 values. Symptoms such as wheezing were more prevalent as MEF-25 values decreased, indicating that MEF-25 is a sensitive indicator of small airway dysfunction (SAD). Additionally, treatment with an inhaled corticosteroid (ICS) combined with a long-acting beta-agonist (LABA), using an inhaler with a fine particle size and augmented by a spacer device, demonstrated substantial and prompt improvement of symptoms. Follow-up data showed a high rate of symptom resolution within one to six weeks after treatment initiation. This study underscores the importance of MEF-25 in the early detection of SAD in the setting of dusty, humid, and hot climatic conditions, and supports the use of beclomethasone-formoterol with a spacer as an effective treatment strategy in optimizing clinical outcomes. The findings advocate for the integration of MEF-25 in routine spirometry evaluation to enhance the diagnosis and management of SAD, particularly in environments prone to high amounts of respiratory allergens., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. King's College Hospital Research Ethics Committee issued approval KCH/MOI/740. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shaikh et al.)

Within fluid mechanics, the flow of hybrid nanofluids over a stretching surface has been extensively researched due to their influence on the flow and heat transfer properties. Expanding on this concept by introducing porous media, the current study explore the flow and heat and mass transport characteristics of hybrid nanofluid. This investigation includes the effect of magnetohydrodynamic (MHD) with chemical reaction, thermal radiation, and slip effects. The nanoparticles, copper, and alumina are combined with water for the formation of a hybrid nanofluid. Using the self-similar method for the reduction of Partial differential equations (PDEs) to the system of Ordinary differential equations (ODEs). These nonlinear equation systems are solved numerically using the bvp4c (boundary value solver) technique. The effect of the different physical non-dimensional flow parameters on different flow profiles such as velocity, temperature, concentration, skin friction, Nusselt and mass transfer rate are depicted through graphs and tables. The velocity profiles diminish with the effect of magnetic and slip parameters. The temperature and concentration slip parameters reduce the temperature and concentration profile respectively. The higher values of magnetic factor lessened the skin friction coefficient for both slip and no-slip conditions. An elevation in the thermal slip parameter reduced the boundary layer thickness and the heat transfer from the surface to the fluid. The Nusselt number amplified with the climbing values of the radiation parameter. The mass transfer rate depressed with the solutal slip parameter. Comparison is made with the published work in the literature and there is excellent agreement between them., (© 2024. The Author(s).)

The co-occurrence of active tuberculosis (TB) in patients with moderate to severe asthma presents unique therapeutic challenges, particularly with the advent of biologics like dupilumab, which targets the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways in asthma treatment. Despite the general safety of biologics, concerns about immunosuppression and susceptibility to infections like TB persist. This case report discusses a male with severe, uncontrolled type 2 allergic asthma, who experienced multiple exacerbations despite maximal bronchodilator therapy and then concomitantly developed pulmonary TB. This case demonstrates a potential clinical scenario for co-administering dupilumab with anti-TB treatment, suggesting a beneficial approach for similar clinical scenarios and contributing to the literature on this topic., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shaikh et al.)

Introduction: Reliance on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes may misclassify perforated appendicitis with resultant research, fiscal, and public health implications. We aimed to improve the accuracy of administrative data for perforated appendicitis classification relying on ICD-10-CM codes from 2015 to 2018., Methods: We conducted a retrospective study of randomly sampled patients aged ≤18 years diagnosed with acute appendicitis from eight children's hospitals. Patients were identified using the Pediatric Health Information System, and true perforation status was determined by medical record review. We developed two algorithms by leveraging Pediatric Health Information System data elements and data mining (DM) approaches. The two developed algorithm performance was compared against algorithms that exclusively relied on ICD-10-CM codes using area under the curve and other measures., Results: Of 1051 clinically validated encounters that were included, 383 (36.4%) patients were identified to have perforated appendicitis. The two algorithms developed using DM approaches primarily leveraged ICD-10-CM codes and length of stay. DM-developed algorithms had a significantly higher accuracy than algorithms relying exclusively on ICD-10-CM (P value < 0.01): sensitivity and specificity for DM-developed algorithms were 0.86-0.88 and 0.95-0.97, respectively, which were overall higher than algorithms that relied on only ICD-10-CM., Conclusions: This study provides an algorithm that can improve the accuracy of perforated appendicitis classification using commonly available elements in administrative data. We recommend that this algorithm is used in future appendicitis classification to ensure valid reporting, hospital-level benchmarking, and fiscal or public health assessments., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: A pilot randomized controlled trial (RCT) conducted in children (2-17 ​y) with perforated appendicitis demonstrated an 89% probability of reduced intra-abdominal abscess (IAA) rate with povidone-iodine (PVI) irrigation, compared with no irrigation (NI). We hypothesized that PVI also reduced 30-day hospital costs., Methods: We conducted a retrospective economic analysis of a pilot RCT. Hospital costs, inflated to 2019 U.S. dollars, were obtained for index admissions and 30-day emergency visits and readmissions. Cost differences between groups were assessed using frequentist and Bayesian generalized linear models., Results: We observed a 95% Bayesian probability that PVI reduced 30-day mean total hospital costs ($16,555 [PVI] versus $18,509 [NI]; Bayesian cost ratio: 0.90, 95% CrI, 0.78-1.03). The mean absolute difference per patient was $1,954 less with PVI (95% CI, -$4,288 to $379)., Conclusions: PVI likely reduced the IAA rate and 30-day hospital costs, suggesting the intervention is both clinically superior and cost saving., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Appropriate education and information are the keystones of patient autonomy. Surgical societies support this goal through online informational publications. Despite these recommendations, many of these sources do not provide the appropriate level of reading for the average patient. Multiple national organizations, including the AMA and NIH, have recommended that such materials be written at or below a 6 th -grade level. We therefore aimed to evaluate the readability of patient information publications provided by the American Society of Metabolic and Bariatric Surgery (ASMBS)., Methods: Patient information publications were collected from the ASMBS webpage (https://asmbs.org/patients) and evaluated for readability. Microsoft Office was utilized to calculate Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. Flesch Reading Ease (FRE) is a 0-100 score, with higher scores equating to easier reading (≥80 = 6 th -grade reading level). Flesch-Kincaid Grade Level (FKGL) rates text on a US grade school level. Qualitative and univariate analyses were performed., Results: Eleven patient information publications were evaluated. None of the publications achieved an FRE score of 80 or an FKGL of a 6th-grade reading level. The average FRE score was 35.8 (range 14.9-53.6). The average FKGL score was 13.1 (range 10.1-17.5). The publication with the highest FRE and lowest FKGL (best readability) was that for benefits of weight loss. The brochure with the lowest FRE and highest FKGL (worst readability) was that for Medical Tourism., Conclusions: Although the ASMBS patient information publications are a trusted source of patient literature, none of the 11 publications met the recommended criteria for patient readability. Further refinement of these will be needed to provide the appropriate reading level for the average patient., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Biocompatibility and transient nature of electronic devices have been the matter of attention in recent times due to their immense potential for sustainable solutions toward hazardous e-wastes. In order to fulfill the requirement of high-density data-storage devices due to explosive growth in digital data, a resistive switching (RS)-based memory device could be the promising alternative to the present Si-based electronics. In this research work, we employed a biocompatible enzymatic protein lysozyme (Lyso) as the active layer to design a RS memory device having a device structure Au/Lyso/ITO. Interestingly the device showed transient, WORM memory behavior. It has been observed that the WORM memory performance of the device was very good with high memory window (2.78 × 10 2 ), data retention (up to 300 min), device yield (∼73.8%), read cyclability, as well as very high device stability (experimentally >700 days, extrapolated to 3000 days). Bias-induced charge trapping followed by conducting filament formation was the key behind such switching behavior. Transient behavior analysis showed that electronic as well as optical behaviors completely disappeared after 10 s dissolution of the device in luke warm water. Cytotoxicity of the as-prepared device was tested by challenging two environmentally derived bacteria, S. aureus and P. aeruginosa , and was found to have no biocidal effects. Hence, the device would cause no harm to the microbial flora when it is discarded. As a whole, this work suggests that Lyso-based WORM memory device could play a key role for the design of transient WORM memory device for sustainable electronic applications., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Background Coronaviruses are viral agents that commonly infect animals, but have the ability to cause respiratory illness in humans, exemplified by the ongoing novel coronavirus outbreak (COVID-19). Due to the sparse literature on the effects of COVID-19 on the respiratory system, and the possible development of persistent asthma-like symptoms after infection, this cross-sectional analysis was performed in order to compare the clinical and investigative parameters between post-COVID patients and asthmatic patients. Methods A retrospective cross-sectional study was conducted on patients with prior history of COVID-19 infection that presented to the pulmonology or respiratory outpatient clinics with asthma-like symptoms and were subsequently compared to known asthmatic patients with absent history of prior COVID-19 infection, in order to evaluate the degree of similarity between both cohorts. In this study, asthma-like symptoms were defined as: (i) cough, (ii) wheezing, (iii) chest tightness, and (iv) shortness of breath. Moreover, comparisons of investigative parameters were also performed, including (i) fractional exhaled nitric oxide (FeNO), (ii) serum immunoglobulin E (IgE), (iii) absolute eosinophil counts, and (iv) qualitative spirometry results. All statistical analyses were conducted via chi-squared testing for categorical variables, and independent t-test for continuous variables. Results In this study, there were a total of 76 patients included that conformed to the eligibility criteria, including 39 patients with post-COVID symptoms with absent history of asthma or other respiratory illnesses, and 37 patients with known asthma with absent history of prior COVID-19 infection or other respiratory illnesses. Overall, this study revealed the similarities between both cohorts with respect to the incidence of cough, chest tightness, and shortness of breath. Moreover, there were similarities between the serum IgE and spirometry results. However, there were differences within the complaint of wheeze, FeNO values, and eosinophil counts between both cohorts. The placement of post-COVID patients on bronchodilator therapy involving inhaled corticosteroids and long-acting beta-agonists revealed improvement in all follow-up patients. Conclusion In conclusion, there was considerable similarity in the complaint of asthma-like symptoms after COVID-19 infection, associated with an improvement after the use of bronchodilator therapy, indicating the potential role of anti-asthma therapy (e.g., bronchodilator therapy) in managing post-COVID asthma-like symptoms. In order to validate our conclusion, further comprehensive studies with robust methodologies and larger sample populations are encouraged., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Husain et al.)

Background Cough is one of the most common presenting complaints for physicians across the world, with the potential to result in a significant influence on one's daily life. It is typically categorized into acute cough (<3 weeks), subacute cough (three to eight weeks), and chronic cough (>8 weeks). The lack of specific treatment guidelines and evidence-based recommendations for resolving cough creates reasonable controversy in the medical field. This retrospective study aims to identify the clinical features of cough and evaluate the comparative efficacy between different anti-asthmatic treatment modalities in the urban city of Dubai, United Arab Emirates. Methods A retrospective cross-sectional study was performed on patients presenting to pulmonology or respiratory outpatient clinics with complaints of cough in the absence of any known history of chronic respiratory illness (e.g., asthma). Analysis was conducted via chi-squared and analysis of variance (ANOVA) testing. Results A total of 308 patients were eligible for inclusion, with 273 patients presenting for follow-up. Overall, patients with acute, subacute, and chronic coughs had similar clinical presentations, with no statistically significant differences noted. However, patients with pets were more likely to develop an acute cough (p = 0.04). Moreover, the follow-up outcomes of acute, subacute, and chronic cough were similar, with no significant statistical difference noted. Furthermore, patients receiving dual therapy using budesonide and montelukast, and patients receiving triple therapy using budesonide, montelukast, and tiotropium/ipratropium were most likely to gain complete relief of their symptoms, although triple therapy treatment was also associated with the highest rate of null improvement (p = 0.012). Additionally, chronic cough patients were more likely to be subject to higher C-reactive protein (CRP) levels in comparison to other cohorts (p = 0.26). Conclusion The comparative superiority of dual therapy using budesonide and montelukast, and triple therapy using budesonide, montelukast, and tiotropium/ipratropium were highlighted in this study. In the sparseness of specific treatment guidelines and evidence-based recommendations for cough, the use of anti-asthmatic therapy for cough patients has shown favorable results. Moreover, the lack of clinical differences between acute, subacute, and chronic cough may result in difficulties with the treatment of cough patients. To arrive at a valid conclusion, further comprehensive studies with larger and more diversified sample populations are encouraged., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Husain et al.)

Non-volatile memory devices using organic materials have attracted much attention due to their excellent scalability, fast switching speed, low power consumption, low cost etc. Here, we report both volatile as well as non-volatile resistive switching behavior of p -di[3,3'-bis(2-methylindolyl)methane]benzene (Indole2) and its mixture with stearic acid (SA). Previously, we have reported the bipolar resistive switching (BRS) behavior using 1,4-bis(di(1 H -indol-3-yl)methyl)benzene (Indole1) molecules under ambient conditions [Langmuir 37 (2021) 4449-4459] and complementary resistive switching (CRS) behavior when the device was exposed to 353 K or higher temperature [Langmuir 38 (2022) 9229-9238]. However, the present study revealed that when the H of -NH group of Indole1 is replaced by -CH 3 , the resultant Indole2 molecule-based device showed volatile threshold switching behaviour. On the other hand, when Indole2 is mixed with SA at a particular mole fraction, dynamic evolution of an Au/Indole2-SA/ITO device from volatile to non-volatile switching occurred with very good device stability (>285 days), memory window (6.69 × 10 2 ), endurance (210 times), data retention (6.8 × 10 4 s) and device yield of the order of 78.5%. Trap controlled SCLC as well as electric field driven conduction was the key behind the observed switching behaviour of the devices. In the active layer, trap centers due to the SA network may be responsible for non-volatile characteristics of the device. Observed non-volatile switching may be a potential candidate for write once read many (WORM) memory applications in future., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Introduction: Surgical repair of pectus excavatum is a painful procedure requiring multimodal pain control with historically prolonged hospital stay. This study aimed to evaluate the impact of cryoanalgesia during minimally invasive repair of pectus excavatum (MIRPE) on hospital days (HDs), total hospital costs (HCs), and complications. We hypothesized that cryoanalgesia would be associated with reduced HDs and total HCs with no increase in post-operative complications., Methods: We conducted a retrospective review of pediatric patients who underwent MIRPE from 2011 to 2021. MIRPE details and post-operative outcomes within 90 days were abstracted. Total HDs included the index MIRPE admission and readmissions within 90 days. HCs were obtained from the hospital accounting system, retroactively adjusting for medical inflation. Bayesian generalized linear models with neutral prior assuming no effect were used. Differences between treatment groups were assessed using gamma distribution (HDs and HCs) and poisson (post-operative complications). All models used log link and controlled for age, gender, race, and Haller index., Results: Forty-four patients underwent MIRPE during the study period. Cryoanalgesia was utilized in 29 (66%) patients. The probability of a reduction with cryoanalgesia vs. no cryoanalgesia was 99% for HDs (3.0 vs. 5.4 days; Bayesian RR: 0.6, 95% CrI: 0.5-0.8), 89% for HCs ($18,787 vs. $19,667; RR: 0.9, 95% CrI: 0.8-1.1), and 70% for postoperative complications (17% vs 33%; RR: 0.8, 95% CrI: 0.3-1.9)., Conclusion: Cryoanalgesia use in MIRPE likely reduced HDs, HCs, and post-operative complications. Further research is warranted to confirm these findings in large prospective studies., Level of Evidence: Level III., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE)., Background: MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS)., Materials and Methods: A multicenter retrospective cohort study of 20 US children's hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant., Results: Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33-0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50-0.87). Complications were similar between groups (29.8% vs 22.1, P =0.07), including a similar rate of emergency department visit, readmission, and/or reoperation., Conclusions: Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Platelet aggregation contributes to the pathogenesis of cardiovascular diseases. After activation it leads to dense granule secretion and 5-HT release. The question arises; how platelet aggregation is endogenously controlled during blood circulation. In preliminary studies, we observed that human platelets aggregate more rapidly when suspended in buffer as compared to those suspended in plasma (PRP). These observations point to the presence of an endogenous substance that may inhibit arachidonic acid- induced platelet aggregation. An analysis of plasma Cohn fractions demonstrated that most of the plasma inhibitory activity was associated with albumin-rich and α-globulin rich protein fractions. The identity of plasma endogenous inhibitors of platelet aggregation (EIPA) was established by affinity chromatography on Cibacron Blue F3G-A for specific removal of albumin. The association of α-globulins to EIPA activity was recognized as due to haptoglobin by affinity chromatography on a column of hemoglobin-sepharose. In addition, we also found that the distribution of EIPA activity varies according to sex and physiological state. These findings reveal that EIPA may act by modulation of arachidonic acid metabolism or sequestering the fatty acid substrate.

Complementary resistive switching (CRS) devices are more advantageous compared to bipolar resistive switching (BRS) devices for memory applications as they can minimize the sneak path problem observed in the case of BRS having a crossbar array structure. Here, we report the CRS behavior of 1,4-bis(di(1 H -indol-3-yl)methyl)benzene (Indole1) molecules. Our earlier study revealed that Au/Indole1/Indium tin oxide (ITO) devices showed BRS under ambient conditions. However, the present investigations revealed that when the device is exposed to 353 K or higher temperatures, dynamic evolution of the Au/Indole1/ITO device from BRS to CRS occurred with a very good memory window (∼10 3 ), data retention (5.1 × 10 3 s), stability (50 days), and device yield (∼ 60%). This work explores the application possibility of indole derivatives toward future ultradense resistive random access memory.

Increased traffic volumes worldwide have resulted in an increased number of road accident injuries and mortalities. This global phenomenon motivated the United Nations (UN) to initiate a decade-long global road safety plan in 2010. In response, Saudi Arabia concurrently initiated a comprehensive road safety program, supported by detailed and comprehensive road safety data for the Eastern Province (EP) of Saudi Arabia. The contributed EP-Traffic-Mortality-and-Policy-Interventions Dataset provides multidimensional road safety data for 2010-2020 via two primary and five secondary data subsets. The first primary subset provides road accident mortality data. The five secondary data subsets reflect road accident mortalities at different time scales and administrative (provincial or governorate) levels. The second primary subset provides details of traffic safety policy interventions implemented during the same period. Researchers and policymakers can use this comprehensive dataset to study accident mortality patterns across various geospatial and time scales and analyze the effectiveness of policies intended to mitigate road accident mortalities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Intra-abdominal abscess, the most common complication after perforated appendicitis, is associated with considerable economic burden. However, costs of intra-abdominal abscesses in children are unknown. We aimed to evaluate resource utilization and costs attributable to intra-abdominal abscess in pediatric perforated appendicitis., Methods: A single-center retrospective analysis was performed of children (<18 years) who underwent appendectomy for perforated appendicitis (2013-2019). Hospital costs incurred during the index admission and within 30 postoperative days were obtained from the hospital accounting system and inflated to 2019 USD. Generalized linear models were used to determine excess resource utilization and costs attributable to intra-abdominal abscess after adjusting for confounders., Results: Of 763 patients, 153 (20%) developed intra-abdominal abscesses. Eighty-one patients with intra-abdominal abscesses (53%) underwent percutaneous abscess drainage. Intra-abdominal abscess was independently associated with a nearly 8-fold increased risk of 30-day readmission (adjusted risk ratio, 7.8 [95% confidence interval, 4.7-13.0]). Patients who developed an intra-abdominal abscess required 6.1 excess hospital bed days compared to patients without intra-abdominal abscess (95% confidence interval, 5.3-7.0). Adjusted mean hospital costs for patients with intra-abdominal abscess totaled $27,394 (95% confidence interval, $25,688-$29,101) versus $15,586 (95% confidence interval, $15,102-$16,069) for patients without intra-abdominal abscess. Intra-abdominal abscess was associated with an incremental cost of $11,809 (95% confidence interval, $10,029-$13,588). Hospital room costs accounted for 66% of excess costs., Conclusion: Postoperative intra-abdominal abscess nearly doubled pediatric perforated appendicitis costs, primarily due to more hospital bed days and associated room costs. Intra-abdominal abscesses resulted in estimated excess costs of $1.8 million during the study period. Even small reductions in intra-abdominal abscess rates or hospital bed days could yield substantial health care savings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

In the present communication, we have investigated the interaction between a biomembrane component 1,2-dioleoyl- sn -glycero-3-phosphocholine (DOPC) and a coagulating protein protamine sulfate (PS) using the Langmuir-Blodgett (LB) technique. The π- A isotherm, π- t characteristics, and analysis of isotherm curves suggested that PS strongly interacted with DOPC, affecting the fluidity of the DOPC layer. Electrical characterization indicates that PS as well as the PS-DOPC film showed resistive switching behavior suitable for Write Once Read Many (WORM) memory application. Trap-controlled space charge-limited conduction (SCLC) was the key mechanism behind such observed switching. The presence of DOPC affected the SCLC process, leading to lowering of threshold voltage ( V Th ), which is advantageous in terms of lower power consumption., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Background: Postoperative pain control is challenging after pectus excavatum repair. We aimed to understand the impact that cryoanalgesia had on opioid utilization and outcomes of pediatric patients undergoing minimally invasive repair of pectus excavatum (MIRPE)., Methods: A single-center retrospective cohort study was conducted of all patients (< 18 y) who underwent MIRPE (2011-2019). Patients receiving cryoanalgesia were compared to those who did not. The primary outcome was total postoperative, inpatient, opioid use, measured as milligrams of oral morphine equivalents per kilogram (OME/kg). Univariate and multivariable analyses were performed., Results: Of 35 patients, 20 received cryoanalgesia (57%). Baseline characteristics were similar. Patients who received cryoanalgesia had a lower opioid requirement: median 2.3 mg OME/kg (IQR 1.2-3.1), versus 4.9 mg OME/kg (IQR 2.9-5.8), P < 0.001. Accounting for receipt of cryoanalgesia, epidural, and/or patient-controlled analgesia, cryoanalgesia was associated with a 3.3 mg OME/kg reduction in opioid use (P < 0.001). Median length of stay (LOS) was shorter in cryoanalgesia patients: 3.1 d (IQR 2.3-3.4), versus 5.1 d (IQR 4.3-5.4), P < 0.001. Complications within 90 d were similar between groups., Conclusions: Cryoanalgesia is an effective adjunctive pain control modality for patients undergoing MIRPE. Use of cryoanalgesia was associated with lower postoperative opioid requirements and shorter LOS, without increased short-term complications, and should be considered for enhanced recovery after MIRPE., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background/purpose: Comprehensive opioid stewardship programs require collective stakeholder alignment and proficiency. We aimed to determine opioid-related prescribing practices, knowledge, and beliefs among providers who care for pediatric surgical patients., Methods: A single-center, cross-sectional survey was conducted of attending physicians, residents, and advanced practice providers (APPs), who managed pediatric surgical patients., Results: Of 110 providers surveyed, 75% completed the survey. Over half of respondents (n = 43, 52%) reported always/very often prescribing opioids at discharge, with residents reporting the highest rate (66%). Provider types had varying prescribing patterns, including what types of opioids and non-opioids they prescribed. There was a lack of formal training, particularly among residents, of which only 42% reported receiving formal opioid prescribing education. Finally, although only 28% of providers felt that the opioid epidemic affects children, 48% believed pediatric providers' prescribing patterns contributed to the opioid epidemic as a whole, and 80% reported changing their prescribing practices in response., Conclusions: Significant variability exists in opioid prescribing practices, knowledge, and beliefs among providers who care for pediatric surgical patients. Effective opioid stewardship requires comprehensive policies, pediatric specific guidelines, and education for all providers caring for children to align provider proficiency and optimize prescribing patterns., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care., Material and Methods: We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3., Results: The search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD=-3.71 [-4.46, -2.96]; p<0.00001; I 2 =88%). Placenta previa (OR=9.54 [7.23, 12.59]; p<0.00001; I 2 =88%), placental abruption (OR=6.77 [5.25, 8.73]; p<0.00001; I 2 =72%), emergency C-section (OR=1.92 [1.42, 2.60]; p<0.0001; I 2 =75%), general anesthesia (OR=8.43 [7.90, 9.00]; p<0.00001; I 2 =72%), multiple gestations (OR=1.60 [1.24, 2.06]; p=0.0003; I 2 =85%), preterm labor (OR=3.34 [2.75, 4.06]; p<0.00001; I 2 =85%), prolonged labor (OR=1.68 [1.44, 1.96]; p<0.00001; I 2 =78%), unbooked cases (OR=2.42 [1.22, 4.80]; p=0.01; I 2 =80%), hypertensive disorders of pregnancy (OR=1.81 [1.72, 1.90]; p<0.00001; I 2 =71%), and fibroids (OR=2.32 [1.55, 3.47]; p<0.0001; I 2 =72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR=0.67 [0.29, 1.55]; p=0.36; I 2 =90%), maternal age (MD=0.09 [-0.27, 0.45]; p=0.62; I 2 =50%), maternal body mass index (MD=-0.14 [-0.81, 0.53]; p=0.67, I 2 =86%), diabetes (OR=0.93 [0.75, 1.15]; p=0.51; I 2 =52%), and malpresentation (OR=0.65 [0.38, 1.11]; p=0.13; I 2 =64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups., Conclusion: Placenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion., (Copyright © 2021 Société française de transfusion sanguine (SFTS). Published by Elsevier Masson SAS. All rights reserved.)

Background/purpose: We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates., Methods: A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant., Results: Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6]., Conclusions: Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions., Level of Evidence: Level III., Type of Study: Retrospective comparative treatment study., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Almost all measures of loneliness have been developed without discussing how to best conceptualize and assess the severity of loneliness. In the current study, we adapted the four-item UCLA, so that it continued to measure frequency of loneliness, but also assessed intensity and duration, providing a measure of other aspects of loneliness severity. Using data from participants resident in the UK who completed the BBC Loneliness Experiment (N = 36,767; F = 69.6%) and Latent Class Profile Analyses, we identified four groups of people who scored high on loneliness on at least one of the three severity measures. Duration of loneliness often over months or years seemed to be particularly important in distinguishing groups. Further, group membership was predicted by important demographic and psychological variables. We discuss the findings in terms of implications for research and practice. We highlight the need to explore these profiles longitudinally to investigate how membership predicts later mental and physical health, and well-being.

Objective: To estimate the probability of human immunodeficiency virus (HIV)-1 transmission from different key HIV population groups using probabilistic modelling., Methods: This study was conducted in December 2020. A probabilistic model was used to estimate the probability of HIV-1 transmission from different key HIV population groups in Larkana. Our model was run on three probabilistic assumptions: 1) each replication gave two conceivable results: 'true' or 'false'; 2) the chance of giving a 'true' result is the same for each replication; and 3) the replications are independent - 'true' in one will not impact the likelihood of 'true' in another., Results: The results estimated the probability of HIV transmission in key HIV population groups in Larkana to range between 0.42-0.54 per trial, where the highest probability of transmission was predicted for men who have sex with men (MSM; 0.54 per trial), followed by transgender (TG; 0.46 per trial) and people who inject drugs (PWID; 0.457 per trial)., Conclusions: Our results suggest that there is a high likelihood of HIV transmission by key population groups in Larkana, such as MSM, TG, and PWID. Mathematic models, such as one proposed in our study can aid the HIV and acquired immunodeficiency syndrome (AIDS) control programmes in evaluating and optimising the strategies in controlling transmission of HIV from the key population groups.

Purpose: Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis., Methods: We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019). Multivariate linear regression was performed to analyze variations in opioid use., Results: Among 30 patients with gastroschisis, 33% were managed by primary suture-less closure, 7% by primary sutured closure, 40% by spring silo, and 20% by handsewn silo. The proportion of pain medication used was: morphine (89%), acetaminophen (8%), and fentanyl (3%). Opioids were used for a median of 6.5 days (range 0-20) per patient. Median total opioid administered across all patients was 2.2 morphine milligram equivalents (MME)/kg (IQR 0.7-3.3). Following definitive closure, median opioid use was 0.2 MME/kg (IQR 0.1-0.8). With multivariate regression, 45% of the variation in MME use was associated with the type of surgery after adjusting for weight, gestational age, and gender, p = 0.02. After definitive fascial closure, there was no significant variations in opioid use., Conclusion: There is a significant variation in the utilization of opioid, primarily prior to fascial closure. Understanding pain needs and standardization may improve opioid stewardship in infants with gastroschisis. 197/200 LEVEL OF EVIDENCE: Level III., (Copyright © 2021. Published by Elsevier Inc.)

Purpose: Pain control is challenging after minimally invasive repair of pectus excavatum (MIRPE). Cryoanalgesia, which temporarily ablates peripheral nerves, improves pain control and may accelerate post-operative recovery. We hypothesized that cryoanalgesia would be associated with shorter length of stay (LOS) in children undergoing MIRPE., Methods: A matched cohort study was conducted of children (<18 years) who underwent MIRPE 2016-2018, using the National Surgical Quality Improvement Program-Pediatric database. Each patient who received cryoanalgesia during MIRPE was matched to four controls (no cryoanalgesia). Univariate and multilevel regression analyses were performed., Results: Thirty-five patients who received cryoanalgesia during MIRPE were matched to 140 controls. Patients who received cryoanalgesia had a LOS reduction with similar secondary outcomes (operative time, rates of complication, reoperation, and readmission). On multilevel regression adjusted for matched groups, cryoanalgesia was associated with a 1.3-day reduction in LOS (95% CI -1.8 to -0.8, p < 0.001). On sensitivity analysis excluding patients with complications, cryoanalgesia remained associated with a LOS reduction., Conclusions: Cryoanalgesia is a promising adjunct in the care of pediatric patients undergoing MIRPE. Utilization is associated with a shorter LOS without an increase in operative time or complications. Cryoanalgesia should be considered for inclusion in enhanced recovery strategies for patients undergoing MIRPE., Competing Interests: Declarations of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Bipolar resistive switching using organic molecule is very promising for memory applications owing to their advantages, such as simple device structure, low manufacturing cost, stability, and flexibility. Herein we report Langmuir-Blodgett (LB) and spin-coated-film-based bipolar resistive switching devices using organic material 1,4-bis(di(1 H -indol-3-yl)methyl)benzene (Indole1). The pressure-area per molecule isotherm (π- A ), Brewster angle microscopy (BAM), atomic force microscopy (AFM), and scanning electron microscopy (SEM) were used to formulate an idea about the organization and morphology of the organic material onto thin films. On the basis of the device structure and measurement protocol, it is observed that the device made up of Indole1 shows nonvolatile resistive random access memory (RRAM) behavior with a very high memory window (∼10 6 ), data sustainability (5400 s), device yield (86.7%), and repeatability. The oxidation-reduction process and electric-field-driven conduction are the keys behind such switching behavior. Because of very good data retention, repeatability, stability, and a high device yield, the switching device designed using compound Indole1 may be a potential candidate for memory applications.

Background/purpose: Prophylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis., Methods: A 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (age < 18) perforated appendicitis patients. QI patients were compared to controls admitted during the preceding 8 months and following 4 months. The primary outcome was 30-day IAA rate. Univariate and multivariate analyses were performed., Results: Two hundred seventy QI patients were compared to 109 controls. There was 100% compliance during 21 of 27 months of the QI initiative; only 7 QI patients did not receive drains. IAA occurred in 20.0% of QI patients and 22.9% of control (p = 0.52). After adjustment, the QI initiative was not associated with reduced odds of IAA (OR 0.83, 95% CI 0.48-1.44). Median length of stay was longer in QI patients during the index admission (p = 0.03) and over 30 postoperative days (p = 0.03), but these relationships did not persist after adjustment., Conclusions: A QI initiative investigating prophylactic, intraabdominal drain placement in perforated appendicitis did not reduce the IAA rate. We recommend against routine drain placement in pediatric perforated appendicitis., Level of Evidence: Level III., (Copyright © 2020 Elsevier Inc. All rights reserved.)

In this study, we designed and synthesised a series of coumarin derivatives appended with a long alkoxy chain on the seventh position of the coumarin-3-carboxylate/carboxylic acid core to make thin film materials. Synthesised compounds were characterized by their UV and fluorescence spectra in solutions as well as their films prepared by both LB and spin-coated methods. The surface morphology and electrical behaviour of thin films were judged by AFM, SEM and I - V characteristic mapping respectively. Isotherm, UV-Vis absorption and fluorescence spectroscopic investigations revealed the formation of aggregates on thin films. The result of SEM and AFM images provides the information about the length and height of aggregates on the thin films of coumarin derivatives. From I - V characteristics, it was found that at room temperature, the spin-coated films of coumarin derivatives containing an ester functional group exhibited a threshold switching behaviour, whereas derivatives containing the carboxylic acid functional group showed both threshold and bipolar switching behaviours. We also noticed that the I - V characteristic features of synthesized materials depended on the length of the alkyl chain of individual series., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)