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Muhammed A Saad,1,2 Noha M Eissa,2 Mohammed A Ahmed,3 Aliaa N ElMeshad,3,4 Götz Laible,5– 7 Ahmed S Attia,8 Medhat A Al-Ghobashy,9,10 Rania M Abdelsalam,1,2 Muhammad Y Al-Shorbagy1,11 1Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 2School of Pharmacy, Newgiza University, Giza, Egypt; 3Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 4Faculty of Nanotechnology for Postgraduate Studies, Cairo University, Giza, Egypt; 5AgResearch, Ruakura Research Centre, Hamilton, New Zealand; 6School of Medical Sciences, University of Auckland, Auckland, New Zealand; 7Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand; 8Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 9Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 10Bioanalysis Research Group, School of Pharmacy, Newgiza University, Giza, Egypt; 11Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman, United Arab EmiratesCorrespondence: Ahmed S Attia, Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt, Email ahmed.attia@pharma.cu.edu.egIntroduction: Rituximab (RTX) and recombinant human myelin basic protein (rhMBP) were proven to be effective in ameliorating the symptoms of multiple sclerosis (MS). In this study, a nanoformulation containing rhMBP with RTX on its surface (Nano-rhMBP-RTX) was prepared and investigated in comparison with other treatment groups to determine its potential neuro-protective effects on C57BL/6 mice after inducing experimental autoimmune encephalomyelitis (EAE).Methods: EAE was induced in the corresponding mice by injecting 100 μL of an emulsion containing complete Freund’s adjuvant (CFA) and myelin oligodendrocyte glycoprotein (MOG). The subjects were weighed, scored and subjected to behavioural tests. After reaching a clinical score of 3, various treatments were given to corresponding EAE-induced and non-induced groups including rhMBP, RTX, empty nanoparticle prepared by poly (lactide-co-glycolide) (PLGA) or the prepared nanoformulation (Nano-rhMBP-RTX). At the end of the study, biochemical parameters were also determined as interferon-γ (IFN-γ), myeloperoxidase (MPO), interleukin-10 (IL-10), interleukin-4 (IL-4), tumor necrosis factor alpha (TNF-α), nuclear factor kappa B (NF-kB), brain derived neurotrophic factor (BDNF), 2’, 3’ cyclic nucleotide 3’ phosphodiesterase (CNP) and transforming growth factor beta (TGF-β) along with some histopathological analyses.Results: The results of the Nano-rhMBP-RTX group showed promising outcomes in terms of reducing the clinical scores, improving the behavioural responses associated with improved histopathological findings. Elevation in the levels of IL-4, CNP and TGF-β was also noticed along with marked decline in the levels of NF-kB and TNF-α.Conclusion: Nano-rhMBP-RTX treated group ameliorated the adverse effects induced in the EAE model. The effectiveness of this formulation was demonstrated by the normalization of EAE-induced behavioral changes and aberrant levels of specific biochemical markers as well as reduced damage of hippocampal tissues and retaining higher levels of myelination.Keywords: multiple sclerosis, experimental autoimmune encephalomyelitis, nanoparticle, rituximab, recombinant human myelin basic protein

BackgroundHuman immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA.MethodsWe analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units.ResultsWe found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group.ConclusionsAs the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

Applications such as agriculture, hydrology, and environmental management need the mapping of soil texture. In a research region near the Great Zab River in Iraq, this study assessed machine learning models for predicting important soil texture qualities using Sentinel-1A radar and digital elevation data. 75 soil samples in all were gathered, and their percentages of clay, silt, gravel, sand, and moisture content were determined. The models that were examined were Artificial Neural Network (ANN), Decision Tree (DT), Random Forest (RF), Support Vector Regression (SVR), and Logistic Regression (LR) (ANN). Based on test data, results indicated that RF had the lowest Root Mean Squared Error (RMSE) in terms of forecasting clay (0.994 percent), specific gravity (0.012), gravel (10.802 percent), and sand (9.894 percent) (0.094 percent). Additionally, it had the greatest R2 values for clay (0.68), silt (0.68), sand (0.474), specific gravity (0.764), and gravel (0.639). (0.826). When it came to predicting moisture content, ANN excelled (RMSE 2.515, R2 0.776). According to the RF feature significance scores, elevation was determined to be the most significant input variable. The study showed that precise maps of soil texture prediction may be obtained by utilizing RF machine learning in conjunction with Sentinel-1A data and digital elevation models. This provides an effective way for mapping soil properties in remote places with minimal effort.

Background: Aortic dissection is the most common acute aortic syndrome in the United States. Type B aortic dissection (TBAD) can be managed medically, through open surgical repair, or with thoracic endovascular repair (TEVAR). The present study sought to assess contemporary trends in the use and timing of TEVAR. Methods: Adult nonelective TBAD admissions were identified in the 2010 to 2020 Nationwide Readmissions Database. Patients were categorized as medical management (Medical Management), TEVAR at initial hospitalization (Early), or TEVAR during readmission (Delayed). Multivariable models were developed to assess associations with clinical outcomes and resource utilization. Results: Of 85,753 patients, 8.7% underwent TEVAR at index hospitalization (Early). From 2010 to 2020, the proportion undergoing TEVAR decreased significantly (from 11.3% to 9.6%; nptrend

Objective: Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade. Methods: All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year. Results: Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (P

Background: Multiagent neoadjuvant chemotherapy (NAT) has been linked with improved survival for locally advanced (LA) or borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC). However, the existence of disparities in its utilization remains to be elucidated. Methods: All adults with PDAC were tabulated from the 2011–2017 Nationwide Cancer Database. Tumor vascular involvement was determined using the clinical T stage and CS_EXTENSION variables. The significance of temporal trends was calculated using Cuzick's non-parametric test. A Cox proportional hazard model was used to assess the impact of NAT utilization on hazard of two-year mortality. A logistic regression model was developed to determine factors associated with receipt of NAT. Results: Of 3811 patients meeting inclusion criteria, 50.8 % received NAT. NAT utilization significantly increased over the study period, from 31.7 % in 2011 to 81.1 % in 2017 (p

Background: Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event. Methods: All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016–2020 National Readmissions Database. Patients undergoing trauma-related operations or procedures ≤2 days of admission were excluded. FTR was defined as in-hospital death following acute kidney injury requiring dialysis (AKI), myocardial infarction, pneumonia, respiratory failure, sepsis, stroke, or thromboembolism. Multilevel mixed-effect models were developed to assess factors linked with FTR. Results: Among 826,548 EGS operations satisfying inclusion criteria, 298,062 (36.1 %) developed at least one MAE. Of those experiencing MAE, 43,477 (14.6 %) ultimately did not survive to discharge (FTR). Following adjustment for fixed hospital level effects, only 3.5 % of the variance in FTR was attributable to center-level differences. Relative to private insurance and the highest income quartile, Medicaid insurance (AOR 1.33; 95%CI, 1.23–1.43) and the lowest income quartile (AOR 1.22; 95%CI, 1.17–1.29) were linked with increased odds of FTR.A subset analysis stratified complication-specific rates of FTR by insurance status. Relative to private insurance, Medicaid coverage and uninsured status were linked with greater odds of FTR following perioperative sepsis, pneumonia, and AKI. Conclusion: Our findings underscore the need for increased screening and vigilance following perioperative complications to mitigate disparities in patient outcomes following high-risk EGS.

Background: Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis. Methods: The 2016–2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH). Results: Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission. Conclusions: We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.

Background: Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race. Methods: The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality. Results: Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]). Conclusions: We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.

Background: Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC). Methods: Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017–2020 Nationwide Readmissions Database. Patients were stratified by obesity class; class 1 (Body Mass Index [BMI] = 30.0–34.9), class 2 (BMI = 35.0–39.9), and class 3 (BMI ≥ 40.0). Multivariable regression models were developed to assess factors associated with CTO and its association with perioperative complications and resource utilization. Results: Of 89,476 patients undergoing LC, 40.6 % had BMI ≥ 40.0. Before adjustment, class 3 obesity was associated with increased rates of CTO compared to class 1–2 (4.6 vs 3.8 %; p

In line with the United Nation's sustainable development goals (SDGs), the unsustainable use of scarce natural resources and worldwide environmental degradation call for the immediate implementation of green behaviors across all organizations. As environmental issues originate from human activities, they necessitate the realization and execution of employees' workplace pro-environmental behaviors (WPEB) and their stimulators. Drawing on social exchange and social identity theories, this study first investigates the mediating role of green organizational climate in the relationship between various forms of perceived corporate social responsibility (CSR) and employees' WPEB. It further examines the mediated moderation via green shared vision. An adapted survey questionnaire was distributed to senior-level and middle-level managers of large and medium-sized manufacturing firms in Pakistan, and 349 responses were gathered. The partial least-squares technique was used for data analysis. The findings indicate that all forms of perceived CSR positively correlate with a green organizational climate, which further significantly leads to employees' WPEB. The results also show that a strong shared green vision among employees can improve the relationship between the green organizational climate and employees' WPEB and vice versa. Moreover, multi-group analysis shows that the relationship between customer-centric perceived CSR and green organizational climate was stronger for medium-sized firms than large ones. Thus, to ensure the implementation of SDGs such as decent work and climate action, firms' top management must recognize the importance of investing in both internal and external CSR initiatives to foster a green organizational climate leading to employees' WPEB. Companies should communicate their participation in CSR activities to all stakeholders through public platforms to increase inspiration. Policymakers should further introduce CSR excellence awards and non-compliance penalties to encourage firms' extensive participation.

Background: With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations. Methods: We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016–2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge. Results: Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, OD were older (66 [57–73] vs 64 [54–72] years, p

Background: Racial disparities in access to preoperative evaluation for colorectal cancer remain unclear. Emergent admission may indicate lack of access to timely care. The present work aimed to evaluate the association of admission type with race among patients undergoing colorectal cancer surgery. Methods: All adults undergoing resection for colorectal cancer in 2011–2020 National Inpatient Sample were identified. Multivariable regression models were developed to examine the association of admission type with race. Primary outcome was major adverse events (MAE), including mortality and complications. Secondary outcomes included costs and length of stay (LOS). Interaction terms between year, admission type, and race were used to analyze trends. Results: Of 722,736 patients, 67.6 % had Elective and 32.4 % Emergent admission. Black (AOR 1.38 [95 % CI 1.33–1.44]), Hispanic (1.45 [1.38–1.53]), and Asian/Pacific Islander or Native American (1.25 [1.18–1.32]) race were associated with significantly increased odds of Emergent operation relative to White. Over the study period, non-White patients consistently comprised over 5 % greater proportion of the Emergent cohort compared to Elective. Furthermore, Emergent admission was associated with 3-fold increase in mortality and complications, 5-day increment in LOS, and $10,100 increase in costs. MAE rates among Emergent patients remained greater than Elective with a widening gap over time. Non-White patients experienced significantly increased MAE regardless of admission type. Conclusion: Non-White race was associated with increased odds of emergent colorectal cancer resection. Given the persistent disparity over the past decade, systematic approaches to alleviate racial inequities in colorectal cancer screening and improve access to timely surgical treatment are warranted.

This dataset integrates and helps examine the impact of green intellectual capital (GIC) which comprises of green human capital (GHC), green structural capital (GSC), and green relational capital (GRC) on green organizational culture (GOC). Secondly, it enables the investigation of GOC as a mediation phenomenon between GIC and sustainable business model innovation (SBMI). Moreover, it highlights the moderation of frugal innovation (FGL) on GOC and SBMI relationship. An online survey was designed using Google forms to collect data from 345 middle/ senior management employees working in medium and large manufacturing firms in Pakistan. Unit of analysis is the organization; thus, each response represents one firm. SPSS and Smart PLS 4 were used for data analysis. Dataset demonstrates that GHC, GSC, and GRC positively impact GOC, which subsequently enhances SBMI. Moreover, effective implementation of FGL can bolster the effect of GOC on SBMI. The dataset is valuable as it can be reproduced and reanalyzed. It offers insights for professionals to revolutionize their innovation for environmental initiatives particularly in the manufacturing sector and train their staff to use modern eco-friendly ingenuities leading to enhanced business performance as well as sustainable development goals. Furthermore, the dataset holds significance for policymakers involved in implementing green economic revitalization programs, enabling them to offer incentives or penalties to encourage compliance.

In optical communication systems, the Q-factor is an important performance metric to evaluate the performance of an optical link. In this paper, a deep learning-based eye diagram analyzer is proposed to estimate the Q-factor. CNN architectures such as LeNet, Wide ResNet, and Inception-v4 are used for ON-Off Keying (OOK) and Pulse Amplitude Modulation (PAM) formats’ eye diagrams. The performance of these architectures is evaluated in terms of accuracy, Mean Squared Error (MSE), and error tolerance. This work shows that Wide ResNet demonstrates better performance in both OOK and PAM4 transmission schemes, achieving MSE values of 0.00188 and 0.00036, respectively. Additionally, it attains a high R-squared (R2) value of 0.9998. This deep learning-based eye diagram analyzer may be a promising approach for analyzing and optimizing optical communication systems without extensive human intervention.

Objective: Frailty has been repeatedly associated with inferior outcomes after surgical hospitalizations. However, a thorough evaluation of the impact of frailty on the clinical and financial outcomes of patients undergoing solid-organ thoracic transplantation is sparse in the literature. We evaluated the association of frailty, as determined by an administrative tool, with postoperative outcomes and healthcare resource use after heart or lung transplantation. Methods: The Nationwide Readmissions Database was used to identify all adult hospitalizations for heart or lung transplant from 2014 to 2020. Patients were grouped as frail or nonfrail using International Classification of Diseases codes associated with conditions in the Johns Hopkins Adjusted Clinical Groups cluster. Multivariable regression models were developed to evaluate the association of frailty status on in-hospital mortality, complications, length of stay, costs, and unplanned readmissions. Results: Of an estimated 35,862 heart or lung transplant recipients, 7316 (20.4%) were considered frail. After multivariable adjustment, frailty in heart transplantation was associated with greater odds of in-hospital mortality (adjusted odds ratio, 1.54; 95% CI, 1.19-1.99) and infectious complications (adjusted odds ratio, 1.77; 95% CI, 1.45-2.15; P

The primary aim of the current study is to investigate the influence of input parameters of near dry electric discharge machine (ND-EDM) upon the output performances including the MRR, EWR, SR and WLT for the fabricated new metal matrix composite (MMCs) of aluminum A7075 matrix nanocomposites by adding 8% of Microscopic Slide Glass Nanoparticles (MSGNPs) as reinforcements to improve the metallurgical and mechanical properties of Al-7075/MSGNP composites using stir-casting method. In (ND-EDM), the dielectric medium plays a significant role in the procedure responses. In the current work, the vegetable oil with gases, such as air, Ar, mix (Ar+N2), and Freon were used as a dielectric media. The obtained results show that the highest MRR achieved when using the vegetable oil + Freon gas, reached 29.425 mm3/min, and then 26.943 mm3/min when using the vegetable oil + Air as a dielectric. The lowest EWR achieved when employing the vegetable oil + Argon gas, reached 0.120 mm3/min, and then 0.175 mm3/min. The lowest SR values obtained for all the designed experiments reached 3.287 µm when using Ip (10 A), Ton (1600 µsec), and Ar additive gas, followed by 4.567 µm when adding Freon gases to the dielectric. In the ND-EDM, the average of recast white layer thickness in the case of vegetable oil + air, vegetable oil + Ar, vegetable oil + mix (Ar-N2), and vegetable oil + Freon was 1.505, 1.180, 0.456, and 0 μm, respectively. These unique results can be used to increase the service and fatigue life of parts and machines that are exposed to sudden dynamic mechanical or thermal loads, without the need for additional operations to remove this brittle layer, which causes the failure of these parts with a short service life. The created mathematical models displayed a higher value of R-Square and the adjusted R-square, which manifest a better fit. Normal probability plots of the residuals for MRR, EWR, and SR elucidated an obvious pattern (i.e., the points were stabilized in a straight line) which indicates that every factor affects the mentioned responses and the outcomes of these responses from the regression model (predicted value by factorial) and the true values (from the experiments).

Foreign direct investment is considered one of the most important sources of capital flows. It is also considered one of the basic pillars that enable the investment of the country’s human and natural resources. Foreign investment can play an important role in this process, as it is intended to use the investor’s surplus funds in investment tools and opportunities available in the markets. Foreign investments outside the borders of the resident investor’s country. These investments differ from local investments in terms of the nature of the investment instruments used, the currencies traded, and the degree of risks to which the investor is exposed. This study aims to measure the impact of foreign direct investment on exports for the period (1990 - 2020) in developing countries using a sample of middle-income developing countries. The results showed that at the level of middle-income countries, there was a direct relationship between inward foreign direct investment and exports, with a ratio of (0.218), while outward foreign direct investment had a direct relationship with exports, with a ratio of (0.232). The study suggested directing foreign investments towards export industries, especially industries that can replace imports, with the aim of improving the balance of payments. It also recommends directing investments away from local investments to avoid competition with local investments. The study suggests diversifying foreign investments into various industrial, agricultural, and service sectors, and getting rid of investments linked to one sector, such as oil. We should also benefit from modern technology accompanying these investments and partnering with local investment sectors to gain skills and stimulate them. In this way, the impact of foreign investments in improving the country’s economic structure and achieving Long-term benefits at the economic level. It will also contribute to developing local industries and increasing the competitiveness of the national economy in global markets.

Cystic echinococcosis (CE), or hydatid disease, is a parasitic infection caused by Echinococcus granulosus endemic to areas with considerable pastoral farming and animal husbandry. Typical presentations include hydatid cyst formation in the liver, lungs, brain, kidneys, or bones. An isolated splenic hydatid cyst is an extremely rare occurrence, accounting for only 0.5%-4% worldwide incidence rates, and recurrent cases are even more infrequent. Globalization, cross-border travel, and altered immigration patterns over time have shifted some of the burden of CE from the developing to the developed world, making the diagnosis challenging for these nonendemic areas. Judicious use of imaging modalities for prompt diagnosis and effective intervention is necessary to treat the initial disease and prevent a recurrence. Herein, we present the case of a 13-year-old male with recurrent isolated splenic hydatid cyst. The patient presented with chronic and nonradiating pain in his left hypochondrium. Physical examination revealed splenomegaly. Ultrasonography showed multiple cysts. Computerized tomography (CT) scan showed cystic lesions in splenic parenchyma with numerous internal enhancing septae. Surgical evacuation was performed for the management of disease.

The paper presented a new type of double helical-winding tubular induction motor (DHWTIM). The proposed motor consists of double- layer helical windings primary arranged on the same circumference with a common secondary. By controlling the phase sequence of supply voltage for each of primary winding layers, the secondary conductor would be capable of producing pure rotary motion, pure linear motion, or helical motion. An appropriate multi-layer analysis using cylindrical geometry is presented. This has been used to study the effect of iron presence in the magnetic circuit of the machine on its performance.

Objective: To compare the level of awareness towards orthodontic treatment among parents and teachers of middle school children. Method: The cross-sectional study was conducted from July 2021 to May 2022 in the middle schools of Rawalpindi and Islamabad, Pakistan, after approval from the ethics review committee of the Foundation University College of Dentistry and Hospital, Foundation University, Islamabad. Those included were middle school teachers and parents of students studying in middle schools. Data was collected using a validated questionnaire that had 6 demographic and 5 survey questions. The form was digitized for easy dissemination among parents. Data was analysed using SPSS 23. Results: Of the 240 subjects, 120(50%) each were parents and teachers. Overall, there were 165(68.75%) females and 75(31.25%) males. Level of education and professional exposure were not significantly different between teachers and parents (p>0.05). There was no difference in the level of education and professional work experience between the parents and teacher (p>0.05). Teachers showed a higher level of awareness than parents towards the role of orthodontist in tooth alignment (p=0.013), associated habits with malalignment of teeth (p=0.003), and that the most appropriate age for treatment was 10-15 years (p 0.001).Teachers were more likely of the opinion that facial disharmony is treatable than parents (odds ratio: 1.599, 95% confidence interval: 0.572-4.467). Conclusion: Teachers showed a higher level of awareness than parents regarding orthodontic treatment of children. Key Words: Awareness, Orthodontics, Middle school teachers, Parents, Attitude.

BackgroundFor dental graduates, internships are a vital transitional phase that gives them the invaluable opportunity to close the gap between their academic studies and the reality of professional dentistry. Research on dental internships remains limited and most of the existing studies focus on the clinical aspects of dental internships with little attention given to dental interns' experiences overall. This study aims to bridge this gap in the literature by gaining an in-depth understanding of Saudi dental graduates' range of experiences as dental interns.MethodsTo achieve the research objective, this study adopted a qualitative approach. Using purposive and snowball sampling, the study recruited 23 dental interns from Riyadh Province, Saudi Arabia, who had completed at least nine months of their internship. Data was gathered across three months via diaries and virtual semi-structured interviews based on participants' preferences. The data was then analysed thematically using an inductive analytical strategy.ResultsThe data analysis revealed three major themes and four sub-themes regarding the experiences of dental interns. The core three themes were "activities", "autonomy" and "transitioning to a balanced life" whereby interns have the time and freedom to explore their interests, rekindle their social lives and focus on self-care, resulting in a better work-life balance.ConclusionThis study suggests that dental interns will benefit from the retention and strengthening of key internship activities such as research, community work and clinical rotations. Additionally, the experiences of dental interns can be improved by encouraging interns to progress in their clinical training with a high level of autonomy. Also, due to the limited research in this area, further studies are required to improve our understanding of the lived experiences of dental interns and dental internships in general.

In the context of the United Nations Sustainable Development Goals (UN-SDGs), this study accentuates the role of the tourism and hospitality sector in promoting sustainability. The primary purpose is to unravel the relationship between corporate social responsibility (CSR) and energy-specific sustainable behavior of employees (ESBE), with particular emphasis on the mediating roles of green intrinsic motivation and personal environmental norms. Utilizing a three-wave data collection approach, we secured 325 valid responses from sector employees at various levels (manager-non managers) and applied Structural Equation Modeling through the SMART-PLS tool to assess the hypothesized relationships. The findings highlight a pronounced interconnection between CSR, ESBE, and the designated mediating variables. These results not only augment the academic literature by illustrating the psychological underpinnings bridging CSR to ESBE, but also equip the tourism and hospitality industry with actionable insights. Through informed CSR initiatives aligned with employee values, the sector can galvanize sustainable behaviors and create business models that resonate with the aspirations of the UN-SDGs, pointing the way to a more sustainable industry.

IntroductionLiterature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs.MethodsAll adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy.ResultsOf an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations.ConclusionIn this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.

BackgroundTranscatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes.MethodsAdults undergoing isolated redo mitral valve replacement were identified in the 2016-2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints.ResultsOf an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrendConclusionsIn this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.

BackgroundWhile insurance reimbursements allay a portion of costs associated with cardiac operations, uncovered and additional fees are absorbed by patients. An examination of financial toxicity (FT), defined as the burden of patient medical expenses on quality of life, is warranted. Therefore, the present study used a nationally representative database to demonstrate the association between insurance status and risk of financial toxicity (FT) among patients undergoing major cardiac operations.MethodsAdults admitted for elective coronary artery bypass grafting (CABG) and isolated or concomitant valve operations were assessed using the 2016-2019 National Inpatient Sample. FT risk was defined as out-of-pocket expenditure >40% of post-subsistence income. Regression models were developed to determine factors associated with FT risk in insured and uninsured populations. To demonstrate the association between insurance status and risk of FT among patients undergoing major cardiac operations.ResultsOf an estimated 567,865 patients, 15.6% were at risk of FT. A greater proportion of uninsured patients were at risk of FT (81.3 vs. 14.8%, pConclusionUninsured patients demonstrated higher FT risk after undergoing major cardiac operation. Hispanic race, longer lengths of stay, and combined CABG-valve operations were independently associated with increased risk of FT amongst the uninsured. Conversely, non-income factors did not impact FT risk in the insured cohort. Culturally-informed reimbursement strategies are necessary to reduce disparities in already financially disadvantaged populations.

Below-knee prosthetics are used to restore the functional activity and appearance of persons with lower limb amputation. This work attempted to design and manufacture a low-cost, novel, comfortable, lightweight, durable, and flexible smart below-knee foot prosthesis prototype. This prosthesis foot was designed according to the natural leg measurement of an adult male patient. The foot is composed of rigid PVC layers interspersed with elastic strips of PTFE, and the axis of the ankle joint is flexible and consists of metal layers and a composite of polymeric damping strips with different mechanical properties, making it flexible and allowing it to absorb shocks and store and release energy. The design, modeling, and simulation of the manufactured prosthetic foot were performed via the ANSYS 18.0 software and the finite element method (FEM), where a large number of parallel and oblique planes and sketches were created. This work included four adult patients weighing 50, 75, 90, and 120 kg with different walking cycles. The results show that the highest equivalent von Mises stress and total deformations for the prosthetic limb occur at the beginning of the walking step, while the highest equivalent elastic strains and strain energy release rates are observed at the end of the walking step, regardless of the weight. This prototype can satisfactorily perform the biomechanical functions of a natural human foot, and it can be produced in attractive sizes, models, and shapes to suit different levels of below-knee amputations for different ages and weights, especially for patients with limited income.

Medical laboratory workers handle clinical specimens, which are a threat of exposure to infectious agents. Notably, medical laboratory science students report for internships with only theoretical knowledge of biosafety and biorisk management practices, predisposing them to a higher risk of laboratory hazards. In this study, we assessed the influence of entry-level students' adherence to practices and attitudes towards biosafety and biorisk management during the Internship. An online survey tool was used to explore the practices and attitudes towards laboratory biosafety and risk management. Of the 96 students, 60 (62.5%) anonymous responses were received, and of these, 60.3% were direct entrants, and 32.8% were diploma entrants. Most (91.7%) of the students attended hospital internships, with 60.2% in Biosafety Level (BSL)-2 laboratories and 70.2% rotating in all the core areas of laboratory medicine. The 8.3% who did not attend any internship were under the direct entry category. Exposure to biohazards was not significantly associated with laboratory safety level and student entry category (P> 0.05). Recommended laboratory biosafety practices were not significantly associated with the safety level of the laboratory and student entry category (P> 0.05). Poor attitudes towards certain laboratory biosafety practices were not significantly associated with the biosafety level of the training laboratory (P> 0.05), whereas training (P = 0.021) and clean-up procedures (P = 0.048) were associated with laboratory safety levels, respectively. The direct entrants had no access to BSL-3 laboratories, and this category of students had a negative attitude towards internship attendance. Therefore, there is a need to create a multi-channel full range laboratory biosafety and biorisk management teaching reforms based on practical application, real case studies, and laboratory simulation to be incorporated into the curriculum to benefit the direct entrant.

Abstract Reservoir inflow (Q flow) forecasting is one of the crucial processes in achieving the best water resources management in a particular catchment area. Although physical models have taken place in solving this problem, those models showed a noticeable limitation due to their requirements for huge efforts, hydrology and climate data, and time-consuming learning process. Hence, the recent alternative technology is the development of the machine learning models and deep learning neural network (DLNN) is the recent promising methodology explored in the field of water resources. The current research was adopted to forecast Q flow at two different catchment areas characterized with different type of inflow stochasticity, (semi-arid and topical). Validation against two classical algorithms of neural network including multilayer perceptron neural network (MLPNN) and radial basis function neural network (RBFNN) was elaborated and discussed. The research was further investigated the potential of the feature selection algorithm “genetic algorithm (GA)”, for identifying the appropriate predictors. The research finding confirmed the feasibility of the developed DLNN model for the investigated two case studies. In addition, the DLNN model confirmed its capability in solving daily scale Q more accurately in comparison with the monthly scale. The applied GA as feature selection algorithm was reduced the dimension and complexity of the learning process of the applied predictive model. Further, the research finding approved the adequacy of the data span used in the current investigation development of computerized ML algorithm.

هدف البحث إلى معرفة مستوى وجود العدالة التنظيمية ومدى علاقتها وتأثيرها بظاهرة الاحتراق الوظيفي للعاملين في المنظمة المبحوثة، تكونت عينة البحث من (80) موظف بمختلف المستويات والتخصصات وتم اعداد استبانة لمتغيرات البحث وأبعاده وتم استخدام منهج الوصفي التحليلي واستخدام البرنامج الاحصائي (SPSS) وتم التأكد من صدق وثبات مفردات الاستبانة وأظهرت نتائج البحث وجود هذه العدالة مع وجود علاقة الارتباط والتأثير بين العدالة التنظيمية وأبعادها والاحتراق الوظيفي وأبعاده كما أظهر البحث أن مستوى العدالة التنظيمية الموجودة في هذه المنظمة متوسطا ومستوى الاحتراق الوظيفي أكثر من المتوسط وفي ضوء هذه النتائج أوصى الباحثان بمجموعة من التوصيات لتكون هنالك عدالة تنظيمية يدعمها مناخ تنظيمي فاعل يقلل من مستوى ظاهرة الاحتراق الوظيفي.

Around the world, the COVID-19 pandemic quickly led to the closure of educational institutions in the hope of reducing infections and fatalities due to this disease. Distant education is becoming a policy priority, although institutions and teachers are neither experienced nor accustomed to its use.The purpose of this study is to determine secondary school teachers' perceptions and requirements of distance education during confinement. To our knowledge, none of the similar studies conducted in this area has approached this issue in Morocco. To determine teachers' perceptions regarding distance education, we conducted an analytical and descriptive survey among secondary school teachers in May, June, and July 2020.The chi-square test has been used to test the association between all variables. The association was considered significant when the p-value < 0.05. The calculation of the chi² (X²) and the p-value is performed using R software.The grouping of responses show that most teachers have been teaching remotely during confinement using Whatsapp. They confirmed that this is a useful way to ensure pedagogical continuity during the break from classroom teaching, and they also indicated a preference for both face-to-face and hybrid tutoring.Statistical analysis showed a significant correlation between the subjects taught and distance education (X2= 67.4 with p = 0.01), and a low correlation between training follow-up and distance education during the confinement period r = 0.12.This national study, focused in the secondary school teachers, is pertinent and has showen the extent of the problems of continuous teacher training, as well as strategies that are not evaluated and which do not take into account the perceptions of the actors, including the teacher. This data will be valuable and can be used to establish appropriate measures for improving distance learning tools and the quality and competencies of the actors.

Abstract Background Hearing loss can greatly affect the overall quality of life. Several studies have reported that patients with SLE may suffer from audio-vestibular manifestations. The aim of this study is to evaluate the influence of systemic lupus erythematosus (SLE) on hearing and association of hearing impairment with severity and duration of SLE. Results Pure-tone audiometry (PTA) (air conduction and bone conduction) thresholds showed significant elevation in SLE group than controls (P ≤ 0.05). It was observed also that there is a significant association between SLE severity and duration with sensorineural hearing loss (SNHL) and its degree. Conclusion SLE can lead to hearing loss, and there is a positive association of SLE severity and duration with degree of hearing loss.

Abstract Accurate and reliable optimization and simulation of the dam reservoir system to ensure optimal use of water resources cannot be achieved without precise and effective models. Providing insight into reservoir system operation and simulation modeling through a comprehensive overview of the previous studies and expanding research horizons can enhance the potential for accurate and well-designed models. The current research reviews previous studies that have used optimization methods to find optimal operating policies for a reservoir system over the past 20 years. Indeed, successful operating policies cannot be obtained without achieving accurate predictions of the main hydrological parameters in the reservoir system, which are inflow and evaporation. The present study focuses on giving an overview of the applications of AI-based models for predicting reservoir inflow and evaporation. The advantages and disadvantages of both optimization algorithms and predictive models have been summarized. Several recommendations for future research have also been included in the present review paper.

BackgroundDespite advances in endoscopic techniques for management of benign colonic neoplasms, a rise in rates of surgical treatment has been reported. We used a nationally representative cohort to characterize temporal trends, patient characteristics, and outcomes associated with colectomy for colonic neoplasms.MethodsAll patients undergoing elective partial colectomy for benign or malignant colonic neoplasms were identified using the 2012-2019 National Inpatient Sample. Those presenting with inflammatory bowel disease, or experiencing intestinal perforation were excluded. Patients with benign neoplasms were classified as the Benign cohort (others: Malignant). Trends, characteristics, and outcomes were assessed between groups.ResultsOf 569,280 colectomy procedures included for analysis, 153,435 (27.0%) were performed for benign lesions. The proportion of Benign operations decreased from 28.6% in 2012 to 23.7% in 2019 (P for trendConclusionsThe present national study identifies a decrease in colectomy for benign polyps from 2012-2019. Future investigations should identify patients who would most benefit from surgical resection and address persistent inequities in access to screening and treatment for colonic neoplasms.