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Supply chains are one of the key tools in optimizing production and distribution simultaneously. However, information uncertainty is always a challenge in production and distribution management. The main purpose of this paper is to design a two-echelon supply chain in a multi-cycle state and in conditions of demand uncertainty. The task includes determining the number and location of distribution centers, planning capacity for active distribution centers, and determining the amount of shipments between different levels so that the total costs of the chain are minimized. Uncertainty is applied through discrete scenarios in the model and the problem is formulated by multi-stage stochastic programming method in the form of a mixed integer linear model. The results acquired using two indicators called VMS and VSS demonstrated that modeling the supply chain design problem with the multi-stage stochastic approach can result in significant costs reduction. Plus, utilizing mathematical expectation can generate misleading results, therefore resulting in the development of supply chain designs incapable of satisfying demand due to its overlooked limitations.

This detailed study examines the complex role of the SOX family in various tumorigenic contexts, offering insights into how these transcription factors function in cancer. As the study progresses, it explores the specific contributions of each SOX family member. The significant roles of the SOX family in the oncogenic environment are well-recognized, highlighting a range of regulatory mechanisms that influence tumor progression. In brain, lung, and colorectal cancers, SOX types like SOX2, SOX3, and SOX4 promote the migration, proliferation, and angiogenesis of cancer cells. Conversely, in pancreatic, gastric, and breast cancers, SOX types, including SOX1, SOX9, and SOX17 inhibit various cancer cell activities such as proliferation and invasion. This thorough investigation enhances our understanding of the SOX family’s complex role in cancer, establishing a foundation for future research and potential therapeutic strategies targeting these versatile transcription factors. [ABSTRACT FROM AUTHOR]

This study explores the critical role of inhibitors targeting the mammalian target of rapamycin (mTOR) signaling pathway in breast cancer research and treatment. The mTOR pathway, a central regulator of cellular processes, has been identified as a crucial factor in the development and progression of breast cancer. The essay explains the complex molecular mechanisms through which mTOR inhibitors, such as rapamycin and its analogs, exert their anticancer effects. These inhibitors can stop cell growth, proliferation, and survival in breast cancer cells by blocking critical signaling pathways within the mTOR pathway. Furthermore, the essay discusses the implications of using mTOR inhibitors as a comprehensive therapeutic strategy. It emphasizes the potential benefits of combining mTOR inhibitors with other treatment approaches to enhance the effectiveness of breast cancer treatment. The evolving landscape of breast cancer research underscores the significance of mTOR as a therapeutic target and highlights ongoing efforts to improve and optimize mTOR inhibitors for clinical use. In conclusion, the essay asserts that inhibitors of the mTOR signaling pathway offer a promising approach in the fight against breast cancer. These inhibitors provide a focused and effective intervention targeting specific dysregulations within the mTOR pathway. As research advances, the integration of mTOR inhibitors into customized combination therapies holds excellent potential for shaping a more effective and personalized approach to breast cancer treatment, ultimately leading to improved outcomes for individuals affected by this complex and diverse disease. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF), a frequently occurring heart rhythm disorder, is linked to a higher likelihood of mortality, heart failure, and stroke. Patients with AF often have poor illness perceptions and suboptimal self-care behaviors, leading to adverse health outcomes. This research has aimed to evaluate the impact of a psychoeducational intervention on illness perceptions and self-care behaviors in patients with AF. Methods: A randomized controlled trial (RCT) was conducted between March 2023 and March 2024 at three tertiary care hospitals in Baghdad, Iraq. Participants were recruited using purposive sampling from March 2023 to June 2023. The 6-week psychoeducational intervention was delivered from July 2023 to August 2023. Illness perceptions were assessed employing the Brief Illness Perception Questionnaire (B-IPQ; Broadbent et al., 2006), and self-care behaviors were measured using the European Heart Rhythm Association (EHRA) Self-Care Questionnaire (Hendriks et al., 2014). SPSS software (version 26.0) was employed to analyze the data, using mixed-design analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Statistical significance was set at P < 0.05. Results: The mixed-design ANOVA revealed a significant interaction effect between time and group for illness perceptions (F(3, 456) = 29.7, P < 0.001, partial μ = 0.163) and selfcare behaviors (F(3, 456) = 41.2, P < 0.001, partial q2 = 0.213). The intervention group showed a 31.1% improvement in illness perception scores and a 40.5% improvement in self-care behavior scores from baseline to post-intervention (P < 0.001). These improvements were sustained at the 3- and 6-month follow-ups (P < 0.001). Conclusion: The psychoeducational intervention significantly improved illness perceptions and self-care behaviors among patients with AF in Iraq. These improvements were sustained at the 3- and 6-month follow-ups. Healthcare providers should consider incorporating psychoeducational interventions into standard AF management to promote better patient outcomes. Policymakers should support the implementation of similar interventions to reduce the burden of this chronic condition. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare in Egypt has undergone significant reforms since the 1990s, including the pioneering Family Health Program (FHP). However, limited evaluation exists regarding the FHP's impact on enhancing the delivery of primary healthcare services. The primary objective of this study was to analyze and understand the efficiency and effectiveness of the FHP in altering the delivery of primary healthcare in Egypt. We aimed to outline the fundamental characteristics of the primary healthcare system, compare them between the conventional and the newly reformed FHP centers, and gauge the awareness level of these variances among key decision-makers, focusing specifically on Cairo, Egypt. Methods: This cross-sectional study employed a mixed methods approach to evaluate and compare the quality of care between conventional clinics and FHP clinics in Cairo using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) tool. The study population consisted of healthcare providers and municipal health authorities in Cairo. A purposive sampling method was used to select 19 FHP clinics and 12 conventional clinics, representing 75% of the total government primary care clinics in Cairo. Surveys were conducted among healthcare providers at these clinics, and interviews were conducted with 8 carefully selected municipal health authorities in supervisory roles. Descriptive statistics were used to summarize the survey responses. The chi-square (y2) test was employed to examine variations in scores between FHP and conventional clinics, with significance attributed to differences at the P < 0.05 level. Cronbach's alpha was used to assess the reliability of the scales used within each primary care dimension. Results: FHP clinics scored significantly higher on continuity of care (4.17 ± 0.37 vs. 3.68 ± 0.51, P = 0.05), family-centered approach (4.28 ± 0.59 vs. 2.97 ± 0.44, P = 0.01), and provider competency (4.29 ± 0.39 vs. 3.42 ± 0.99, P = 0.01) compared to conventional clinics. FHP clinics were more likely to offer domestic violence services (2.76 ± 1.49 vs. 1.80 ± 1.74, P = 0.02), tuberculosis treatment (2.73 ± 2.11 vs. 0.12 ± 0.34, P = 0.029), and prenatal care (4.75 ± 0.00 vs. 4.01 ± 1.56, P = 0.014). Conclusion: While FHP clinics demonstrate benefits in continuity, family-focus, and provider competency, quality improvements are still required in both conventional and FHP clinics to achieve comprehensive, continuous, integrated, and patient-centered primary healthcare aligned with community needs. Further evaluations are warranted given the continued expansion of the FHP program. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that metabolic syndrome (MetS) accelerates the aging process, potentially contributing to the development of age-related complications. Available studies examining the relation of MetS to telomere length (TL), a putative biological marker of aging, have yielded inconclusive findings. This meta-analysis was performed to investigate the association between MetS and TL. Methods: A comprehensive systematic search was conducted in PubMed and Scopus databases to identify relevant literature published up to February 2024. Standard mean difference (SMD) and standardized beta coefficient (β) with their 95% confidence intervals (CI) were used as effect sizes to measure the associations using the random effects model. Results: A total of nine studies, comprising a total sample size of 8,606 participants, were eligible for the meta-analysis. No significant difference in mean TL was found between patients with and without MetS (SMD = -0.03, 95%CI = -0.17 to 0.10), with a significant heterogeneity across the studies (I² = 89.7.0%, p ≤ 0.001). In contrast, it was revealed that MetS is negatively related to TL (β = -0.08, 95%CI = -0.15 to -0.004). In the subgroup analysis, this finding was supported by the International Diabetes Federation (IDF) definition of MetS. Conclusion: This meta-analysis highlighted that MetS may be linked to a shorter TL. Additional studies are required to confirm this finding. [ABSTRACT FROM AUTHOR]