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Nicola Luigi Bragazzi,1– 4 Hicham Khabbache,5 Khalid Ouazizi,6 Driss Ait Ali,6 Hanane El Ghouat,6 Laila El Alami,6 Hisham Atwan,7 Ruba Tuma,8– 10 Nomy Dickman,10 Raymond Farah,10,11 Rola Khamisy-Farah9,10 1Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Parma, Italy; 2Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada; 3Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; 4United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair, Health Anthropology Biosphere and Healing Systems, University of Genoa, Genoa, Italy; 5Director of the UNESCO Chair “Lifelong Learning Observatory” (UNESCO/UMSBA), Fez, Morocco; 6Department of Psychology, Faculty of Arts and Human Sciences Fès-Saïss, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 7Department of Internal Medicine, Kaplan Medical Centre, Hebrew University, Rehovot, Israel; 8Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Galilee, Israel; 9Clalit Health Services, Akko, Israel; 10Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; 11Department of Internal Medicine B, Ziv Medical Center, Safed, IsraelCorrespondence: Nicola Luigi Bragazzi, Human Nutrition Unit (HNU), Department of Food and Drugs University of Parma, Via Volturno 39, Parma, 43125, Italy, Tel +39 0521 903121, Email nicolaluigi.bragazzi@unipr.itPurpose: Sex and Gender-Based Medicine (SGBM) addresses the influence of sex and gender on health and healthcare, emphasizing personalized care. Integrating SGBM into medical education is challenging. This study examines the implementation of an SGBM course in an Israeli university during the first year of the medical school.Methods: The course integrated lectures, group work, online gender studies resources, workshops, teacher training, and essential literature. The curriculum spanned pre-clinical and clinical aspects, featuring seven 90-minute sessions. Surveys assessed course structure, content, and lecturers using a 5-point Likert scale and qualitative feedback. Quantitative analysis involved descriptive statistics, and thematic analysis was used for qualitative data.Results: Of the 84 students surveyed, 35 (41.7%) responded to the first part, and 30 (35.7%) to the second. The SGBM course received high satisfaction with an average score of 3.63, surpassing other first-year courses (average 3.21). Students appreciated the supportive academic atmosphere (mean score 4.20) and diverse teaching methods (mean score 4.03), while the development of feminist thinking was less appreciated (average score 3.49). Lecturers received high ratings (average score 4.33). Qualitative feedback highlighted the value of group work, the significance of the subject matter, and the helpfulness of supplementary videos. Students requested more content on contemporary issues like gender transition and patient perspectives. The feminist medicine aspect was contentious, with students seeking better gender balance and scientific evidence.Conclusion: Introducing SGBM into the first-year curriculum yielded positive results with high student satisfaction for content and lecturers. An expanded course module is planned, to be assessed at the end of the next academic year.Keywords: sex- and gender-based medicine, medical education, medical training, curriculum integration

Abstract Modern advancements in targeted therapy and immunotherapy have significantly improved survival outcomes for advanced melanoma; however, there remains a need for novel approaches to overcome disease progression and treatment resistance. In recent years, PARPi therapy has shown great promise both as a single regimen and in combination with other therapeutics in melanoma. Here, we describe three unique cases of advanced BRAF V600 mutated melanoma that progressed on targeted BRAF/MEK agents that subsequently exhibited partial to near-complete responses to combinatory PARPi and BRAF/MEK inhibitors. This highlights both a potential synergy underlying this combinatory approach and its efficacy as a treatment option for patients with advanced melanoma refractory to targeted and/or immunotherapies. Prospective clinical trials are needed to explore this synergic effect in larger melanoma cohorts to investigate this combination for treating refractory advanced melanoma.

Abstract Background Treatment cost and high prevalence of Poly Cystic Ovarian Syndrome (PCOS) is a very challenging issue globally. Due to this reason; current study was conducted to determine pharmaco-economy of conventional and non-conventional treatments for the management of PCOS. Methods Prospective Cross-Sectional study was conducted in the metropolitan city of Karachi from January – December 2019. Primary data of 200 PCOS patients were collected from different hospitals and clinics. An instrument was used to collect data pertaining to the direct and indirect cost associated with the disease management. Collected data was analyzed by the tools for cost analysis and software called Statistical Package of Social Sciences (SPSS) – 22. Results In Cost Minimization Analysis (CMA); Allopathic treatment [Mean cost/month: PKR:4479.32 ± 350.95 (USD:27.46 ± 2.15)], Herbal treatment [Mean cost/month: PKR:1527.78 ± 78.15 (USD:9.37 ± 0.48)], Combination treatment [Mean cost/month: PKR:2803.09 ± 654.22 (USD:17.18 ± 4.01)], and Homoeopathic treatment [Mean cost/month: PKR:976.95 ± 46.19 (USD:5.99 ± 0.28)]. Incremental cost/month for Allopathic treatment is 358%, Herbal treatment is 56%, Combination treatment is 187%. In Cost Effectiveness Analysis (CEA); Allopathic treatment (Incremental cost-effectiveness ratio/month: 1334.24), Herbal treatment (Incremental cost-effectiveness ratio/month: 936.41), Combination treatment (Incremental cost-effectiveness ratio/month: 1017.09). Due to lowest cost of Homeopathic treatment, cost of Homeopathic treatment was considered as a threshold value. In-direct cost/month of Allopathic treatment is PKR:593.33 ± 24.00 (USD:3.64 ± 0.15), Herbal treatment is PKR:307.84 ± 26.69 (USD:1.89 ± 0.16), Combination treatment is PKR:409.09 ± 45.63 (USD:2.51 ± 0.28) and Homoeopathic treatment is PKR:300.00 ± 26.39 (USD:1.84 ± 0.16). Conclusion The most cost-effective is treatment is Homeopathic; Herbal treatment is second most cost-effective option for the treatment of PCOS. Lowest direct and indirect costs and short treatment duration collaboratively lessen the %incremental cost per year and incremental cost effectiveness ratio per year.

Abstract Introduction Liver cancer (LC) is frequently preceded by cirrhosis and poses a significant public health challenge in the United States (US). Recent decades have seen notable shifts in the epidemiological patterns of LC, yet national data guiding the optimal allocation of resources and preventive efforts remain limited. This study aims to investigate the current trends, risk factors, and outcomes of LC in the US. Methods This study utilized the Global Burden of Disease (GBD) dataset to collect data on the annual incident cases, deaths, Disability-Adjusted Life Years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized DALY rates of primary LC and its etiologies and risk factors, between 1990 and 2019. Percentage changes in incident cases, DALYs, and deaths and the estimated annual percentage change (EAPC) in ASIR and deaths rates of LC were calculated to conduct temporal analysis. Linear regression was applied for the calculation of EAPCs. Correlations of EAPC with socio-demographic index (SDI) were separately evaluated by Pearson correlation analyses. Results We observed a marked increase in the ASIR of LC, increasing from 2.22 (95% CI: 2.15–2.27) per 100,000 people in 1990 to 5.23 (95% CI: 4.28–6.29) per 100,000 people in 2019, a percentage change of 135.4%. LC due to hepatitis C followed by alcohol use were the primary factors driving this increase. The ASIR and age-standardized death rates of LC showed a significant average annual increase of 3.0% (95% CI: 2.7–3.2) and 2.6% (95% CI: 2.5–2.8), respectively. There was a significant negative correlation between the SDI and the EAPC in ASIR (ρ = -0.40, p = 0.004) and age-standardized death rates (ρ = -0.46, p

Abstract Since public support is critical for implementing carbon pricing policies, we conduct a systematic review and meta-analysis to examine the survey-based literature on change in public support for direct and indirect carbon pricing policies with and without revenue recycling options. Following a comprehensive and transparent machine-learning assisted screening of the literature, our dataset comprises 35 studies containing 70 surveys across 26 countries with over 100,000 respondents. We find that the introduction of any type of revenue recycling option increases public support for carbon pricing. Results from our meta-regression indicate that green spending (i.e. using revenues for climate-friendly projects) is the only revenue recycling option associated with a statistically significant increase in public support. Our findings moreover suggest that the effects may depend on which region the survey was carried out, highlighting the need for additional research in countries in the regions of Africa and Latin America and the Caribbean.

Controlled/slow-release fertilizers (CSRF) continue to be developed because of the need to increase agricultural productivity and reduce the economic, social, and environmental impacts of conventional fertilizers leaching into nature. Additionally, the use of biodegradable polymers as CSRF materials continues to be a priority in CSRF development. Therefore, this review synthesizes the current research on lignin- and polysaccharide-based CSRFs and emphasize their compatibility and performance in agricultural applications. Lignin, an abundant and renewable biopolymer, was evaluated for its effectiveness as a slow-release agent in CSRF. Studies have demonstrated the potential of lignin to improve nutrient release profiles and environmental sustainability when used alone or in combination with other polymers. Polysaccharides, which are known for their biocompatibility and biodegradability, have also been explored. The incorporation of lignin into polysaccharide-based CSRFs has been highlighted, particularly in starch, cellulose, chitosan, and sodium alginate matrices. These composites offer improved mechanical properties, controlled nutrient release, and enhanced soil water retention. The challenges and future directions regarding lignin- and polysaccharide-based CSRF are also reviewed. These findings underscore the importance of developing sustainable fertilizer technologies to meet future food demands while mitigating environmental impacts.

This study introduces a lead-free alternative for enhanced radiation protection. While lead aprons effectively attenuate ionizing radiation, concerns regarding flexibility, weight, and environmental hazards persist. In response, the present research is focused on producing an innovative sheet shielding comprised of carefully selected dense metal oxide microparticles (DMOs-MPs) and liquid silicone rubber (LSR). To evaluate the efficacy of the LSR samples, the current study uses rigorous testing procedures, such as microstructure characterization using EDX and FESEM. Furthermore, the study investigated key attenuation parameters within the LSR samples. Radiation protection was greatly and effectively supplied using DMOs-MPs filler (Bi-1 to Bi-7) in LSR samples; this protection reached 99.9% in the X-ray energy range. Due to the unique characteristics of the Bi-7, the results demonstrated that the samples’ shielding efficiency improved with the addition of high atomic number and high-density fillers. It had the greatest attenuation coefficient and density. At 60 keV, Bi-7’s density was 2.980 gcm−3, and its LAC and MAC were 19.2621 cm−1 and 6.4638 cm2/g, respectively. It also had the lowest half-value layer values in the energy range of 60–120 keV. The LSR samples showed effective radiation absorption for different energy levels, indicating that LSR can enhance the flexibility and comfort of the apron while providing adequate radiation protection. The incorporation of the DMOs-MPs with LSR represents an effective contribution and a noteworthy stride to enhance the safety and well-being of medical professionals routinely exposed to ionizing radiation.

The Spatiotemporal variability of air quality is influenced by various factors over time. The objectives of this research are to create prediction models for Carbon monoxide (CO) and Nitrogen dioxide (NO2) and determine the factors which that most impact CO and NO2 monthly using Random Forest Prediction. The methodology relies on Random Forest Prediction to predict air quality monthly in 2021, incorporating eight variables land surface temperature (LST), normalized difference built-up index (NDBI), built-up index (BU index), normalized difference vegetation index (NDVI), digital elevation model (DEM), relative humidity (RH), wind speed (WS), and wind direction (WD). The results indicate that RH, elevation, WD, and LST are the most significant factors influencing CO concentrations, representing 33%, 24%, 12%, and 10% respectively at annual level in 2021. Similarly, WD, WS, RH, elevation and LST are the most importance factors impacting NO2 concentrations, representing 24%, 21%, 18%, 12%, and 10% respectively at an annual level in 2021. Furthermore, NDBI and BU index had the lowest impact in on both CO and NO2, with BU index showing a slightly higher percentage in NO2 models compared to CO models. Regarding cross-validation, the MAE values in CO models range from 0.11 to 0.18, and the RMSE values range from 0.14 to 0.23. Additionally, the MAE values in NO2 models ranges from 3.78 to 7.30, and RMSE values range from 4.93 to 9.23.

In this study, mesoporous silica nanoparticles (MSNs) with a hexagonal structure and large surface area were synthesized via a sol-gel method. The properties of the synthesized MCM-41 catalyst were characterized using BET, EDX, XRD, and FTIR analyses. The results showed that the MCM-41 had a high surface area of 966 m2/g and large pore volume of about 0.91 cm3/g. Sunflower oil was converted to biodiesel in a batch reactor at different temperatures (40, 50, 60 °C), methanol-to-oil molar ratios (6:1, 9:1, 12:1), catalyst loadings (0.7, 0.9, 1.25 wt%), and reaction times (up to 80 min) using the prepared catalyst under atmospheric pressure. The biodiesel yield was found to reduce when the reaction time exceeded 1 hour despite maintaining the catalyst. The maximum biodiesel yield of 45% was obtained under optimal conditions of a 9:1 methanol-to-oil ratio, 1.25 wt% catalyst loading, 60 °C temperature, and 60 min reaction time. GC-MS analysis characterized the biodiesel composition and properties. The synthesized biodiesel showed improved properties compared to conventional fuels, with linoleic acid methyl ester (C17H34O2, 25.93%) as the main component. The MCM-41 catalyst exhibited remarkable catalytic activity and could be recovered, regenerated, and reused, reducing reaction costs. This makes it a potential alternative to homogeneous catalysts that complicate product separation.

This section of the article consists of three analytic discussions (“Illusion,” “Unemployment,” “Absence of a Father Figure”) and further probes into social and cultural factors that make the protagonist of Williams’s play precarious in Butlerian sense of the term. This survey attributes five reasons to Laura’s precariousness, which also involve, and at times are generated or intensified by her mother, her brother, and her suitor. These precarity agencies, which are in one way or another interrelated, include gender (in a patriarchal society), lameness, pipe dreams, inability to work (in a capitalist milieu), and the absence of an authoritative and supportive man. Laura is a misfit both domestically and socially in the sense that physically, financially, and sexually, she fails to abide by the social norms set by the normative power which privileges men over women and those who can work and pay tax over those who cannot.

The brain plays a central role in controlling and regulating bodily activities. Given its significance, the brain needs to remain in optimal condition to function properly. Neurodegenerative diseases arise when the mechanisms maintaining brain homeostasis fail, resulting in prolonged and uncontrolled activation of cell death pathways. Increasingly, researchers are focusing on specific types of cell death, such as ferroptosis and pyroptosis, due to their potential as targets for preventing and treating neurodegenerative diseases. Brain-derived neurotrophic factor (BDNF) is a crucial growth factor for neurogenesis, neuronal survival, and maintenance, and is thus implicated in cell death mechanisms. This review aims to elucidate the role of BDNF in the ferroptosis and pyroptosis mechanisms that impact brain health. To achieve this, three databases – PubMed, Scopus, and Web of Science – were searched for relevant studies, yielding 95 articles, of which only 14 were aligned with the study’s aim. Ferroptosis (iron-dependent cell death) and pyroptosis (inflammatory cell death) are distinct modes of cell death; however, this review found both mechanisms are associated with oxidative stress. Consequently, the findings suggest that ferroptosis and pyroptosis collectively impact brain health conditions such as depression, cognitive deficiencies, and anxiety, which are notably linked to reduced BDNF levels.

Abstract Background Hypodontia is the most prevalent dental anomaly in humans, and is primarily attributed to genetic factors. Although genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNP) associated with hypodontia, genetic risk assessment remains challenging due to population-specific SNP variants. Therefore, we aimed to conducted a genetic analysis and developed a machine-learning-based predictive model to examine the association between previously reported SNPs and hypodontia in the Saudi Arabian population. Our case–control study included 106 participants (aged 8–50 years; 64 females and 42 males), comprising 54 hypodontia cases and 52 controls. We utilized TaqManTM Real-Time Polymerase Chain Reaction and allelic genotyping to analyze three selected SNPs (AXIN2: rs2240308, PAX9: rs61754301, and MSX1: rs12532) in unstimulated whole saliva samples. The chi-square test, multinomial logistic regression, and machine-learning techniques were used to assess genetic risk by using odds ratios (ORs) for multiple target variables. Results Multivariate logistic regression indicated a significant association between homozygous AXIN2 rs2240308 and the hypodontia phenotype (ORs [95% confidence interval] 2.893 [1.28–6.53]). Machine-learning algorithms revealed that the AXIN2 homozygous (A/A) genotype is a genetic risk factor for hypodontia of teeth #12, #22, and #35, whereas the AXIN2 homozygous (G/G) genotype increases the risk for hypodontia of teeth #22, #35, and #45. The PAX9 homozygous (C/C) genotype is associated with an increased risk for hypodontia of teeth #22 and #35. Conclusions Our study confirms a link between AXIN2 and hypodontia in Saudi orthodontic patients and suggests that combining machine-learning models with SNP analysis of saliva samples can effectively identify individuals with non-syndromic hypodontia.

Abstract Background Piezocision is a minimally invasive surgical method aiming to accelerate tooth movement. However, its effect was found to be transient, appertaining to the regional acceleratory phenomenon (RAP). Hence, the aim of the study was to evaluate the effect of single and multiple piezocisions on the rate of orthodontic tooth movement (OTM). Moreover, the impact of both protocols on canine tipping and orthodontically induced inflammatory root resorption (OIIRR) has been assessed. Methods Thirty indicated patients for the therapeutic extraction of maxillary first premolars were enlisted in this split-mouth study, and they were randomly split into two equal groups, each including 15 subjects. In the Single Application Group (SAG), one side of the maxillary arch arbitrarily received a single piezocision before the onset of canine retraction, whereas in the Multiple Application Group (MAG), piezocisions were randomly performed on one side, three times on a monthly basis, over the 12-week study period. The contralateral sides of both groups served as the controls. Canine retraction was carried out bilaterally using nickel-titanium closed-coil springs, delivering 150 g of force, and the rate of tooth movement, as well as canine tipping were evaluated on a monthly basis, over a 3-month period. Cone-bean computed tomography scans were also conducted pre- and post- canine retraction, and OIIRR was assessed using Malmgren Index. Results The reported outcomes revealed a significant increase in the amount of canine retraction, canine tipping, as well as root resorption scores on the experimental sides in both groups SAG and MAG post-retraction (p 0.05). Conclusions Single and multiple piezocisions effectively accelerate OTM in comparison to conventional orthodontic treatment, with relative outcomes reported by both intervention frequencies. Accordingly, single piezocision is recommended as an adjunct to OTM. Furthermore, significant tooth tipping as well as a significantly higher root resorption risk accompanies both single and multiple piezocision applications in conjunction with OTM. Name of the Registry Clinicaltrials.gov Trial Registration Number NCT05782088 Date of Registration 23/03/2023 “Retrospectively registered”. URL https://clinicaltrials.gov/ct2/show/NCT05782088

Health-care workers are on the front line of the COVID-19 pandemic. In this occupational group, infection is of great concern due to the risk of nosocomial spread of the disease and significant reduction in the number of employees, it also endanger patient safety and compromise the capacities of health care workers. This is a cross-sectional study conducted among healthcare workers of university hospital of Farhat Hached Sousse who were affected by COVID 19 during September 1, 2020 to February 28, 2021. Data collection was carried out using an anonymous questionnaire about socio-professional and medical characteristics. Severity level of the SARS-CoV-2 infection was assessed according to the criteria of the National Authority for Health Assessment and Accreditation guideline (INEAS). Of the 555 healthcare workers with COVID-19, 477 participated. The factors associated with residual symptoms of COVID- 19 were: age (p=0.002), female gender (p=0.001), marital status (p=0.015), cardiovascular (p=0.001), endocrine (p=0.002) comorbidities, obesity (p=0.004), work position (p=10-3), professional work seniority (p=0.022), duration of confinement (p=10-3) and hospitalization (p=0.037).The use of antibiotics(p=10-3), anticoagulants (p=0.010) and corticosteroids (p=0.004) were significantly associated with the persistence of symptoms. After binary logistic regression, the factors associated with persistent symptoms were female gender, para-medical category, antibiotic and corticosteroid use. Long-term follow-up of HCWs with COVID-19 is recommended to understand and treat persistent symptoms after recovery. Protective equipment should be provided as well as vaccination for prevention and management.

The present study was to investigate the efficacy of acceptance and commitment therapy in the context of infertile women’s emotional expression and sexual function. The study was a quasi-experimental design with pretest-posttest and control group design, with a two-month follow-up period. The statistical population included infertile women who submitted referrals to the infertility clinics at Mother and Child Hospital and Samar infertility clinic in Shiraz during the winter of 2021. The experimental and control groups were randomly assigned to 36 infertile women who were selected through the voluntary sampling procedure. Over the course of two and a half months, the experimental group was subjected to ten sessions of acceptance and commitment therapy. In this study, the Emotional Expression Questionnaire (EEQ) (King, Emmons, 1990) and the Sexual Function Questionnaire (Keraskian, Mojembari, and Kaiballah, 2014) were implemented. The SPSS23 software was used to analyze the collected data using mixed ANOVA. The findings indicated that acceptance and commitment therapy has a substantial impact on the emotional expression and sexual function of infertile women (p

Abstract The aim of this study was to compare the changes in the sagittal pharyngeal airway dimension (SPAD) in adolescents with Class II mandibular retrusion treated with Invisalign Mandibular Advancement (IMA), prefabricated Myobrace (MB), and Twin block (TB). For this retrospective study, the pre-treatment and post-treatment lateral cephalograms of 60 patients who underwent myofunctional treatment, using either one of the tested appliances were gathered from the files of treated patients. Changes in the SPAD were measured in each group, and comparisons were carried out between the three study groups. Additionally, sagittal skeletal measurements were carried out. Comparisons of the study variables at T0 and T1 between the three groups were performed using one-way ANOVA, while comparisons of the difference (T1–T0) were performed using Kruskal Wallis test. A significant SPAD increase has been reported using the three tested appliances (p 0.05). The IMA, MB, and TB generated significant SPAD and sagittal changes, with both IMA and TB surpassing MB in the airway area improvement post-treatment. Moreover, the three tested Class II functional appliances did not affect the vertical dimension.

Abstract Background Childhood obesity is a growing concern, and non-alcoholic fatty liver disease (NAFLD) is a significant consequence. Currently, there are no approved drugs to treat NAFLD in children. However, a recent study explored the potential of vitamin E enriched with tocotrienol (TRF) as a powerful antioxidant for NAFLD. The aims of the present study were to investigate the effectiveness and safety of TRF in managing children with obesity and NAFLD. Methods A total of 29 patients aged 10 to 18 received a daily oral dose of 50 mg TRF for six months (January 2020 to February 2022), and all had fatty liver disease were detected by ultrasonography and abnormally high alanine transaminase levels (at least two-fold higher than the upper limits for their respective genders). Various parameters, including biochemical markers, FibroScan, LiverFASt, DNA damage, and cytokine expression, were monitored. Results APO-A1 and AST levels decreased significantly from 1.39 ± 0.3 to 1.22 ± 0.2 g/L (P = 0.002) and from 30 ± 12 to 22 ± 10 g/L (P = 0.038), respectively, in the TRF group post-intervention. Hepatic steatosis was significantly reduced in the placebo group from 309.38 ± 53.60 db/m to 277.62 ± 39.55 db/m (p = 0.048), but not in the TRF group. Comet assay analysis showed a significant reduction in the DNA damage parameters in the TRF group in the post-intervention period compared to the baseline, with tail length decreasing from 28.34 ± 10.9 to 21.69 ± 9.84; (p = 0.049) and with tail DNA (%) decreasing from 54.13 ± 22.1to 46.23 ± 17.9; (p = 0.043). Pro-inflammatory cytokine expression levels were significantly lower in the TRF group compared to baseline levels for IL-6 (2.10 6.3 to 0.7 1.0 pg/mL; p = 0.047 pg/mL) and TNF-1 (1.73 5.5 pg/mL to 0.7 0.5 pg/mL; p = 0.045). Conclusion The study provides evidence that TRF supplementation may offer a risk-free treatment option for children with obesity and NAFLD. The antioxidant and anti-inflammatory properties of TRF offer a promising adjuvant therapy for NAFLD treatment. In combination with lifestyle modifications such as exercise and calorie restriction, TRF could play an essential role in the prevention of NAFLD in the future. However, further studies are needed to explore the long-term effects of TRF supplementation on NAFLD in children. Trial registration The study has been registered with the International Clinical Trial Registry under reference number (NCT05905185) retrospective registration on (15/06/2023).

Abstract Altered functioning of the bed nucleus of the stria terminalis (BNST) may play a critical role in the etiology of posttraumatic stress disorder (PTSD). Chronic stressors such as racial discrimination and lifetime trauma are associated with an increased risk for PTSD, but it is unknown whether they influence the relationship between BNST functioning and PTSD. We investigated acute post-trauma BNST resting-state functional connectivity (rsFC) as a predictor of future PTSD symptoms in Black trauma survivors. We also examined whether racial discrimination and lifetime trauma moderated the relationship between BNST rsFC and PTSD symptoms. Black adults (N = 95; 54.7% female; mean age = 34.04) were recruited from an emergency department after experiencing a traumatic injury (72.6% were motor vehicle accidents). Two-weeks post-injury, participants underwent a resting-state fMRI scan and completed questionnaires evaluating their PTSD symptoms as well as lifetime exposure to racial discrimination and trauma. Six-months post-injury, PTSD symptoms were reassessed. Whole brain seed-to-voxel analyses were conducted to examine BNST rsFC patterns. Greater rsFC between the BNST and the posterior cingulate cortex, precuneus, left angular gyrus, and hippocampus prospectively predicted six-month PTSD symptoms after adjusting for sex, age, education, and baseline PTSD symptoms. Acute BNST rsFC was a stronger predictor of PTSD symptoms in individuals who experienced more racial discrimination and lifetime trauma. Thus, in the acute aftermath of a traumatic event, the BNST could be a key biomarker of risk for PTSD in Black Americans, particularly for individuals with a greater history of racial discrimination or previous trauma exposure.

Emerging clinical observations underscore the correlation between interleukin-8 (IL-8) and rosacea. Increased IL-8 expression has been detected in rosacea samples, particularly in moderate to severe manifestations. This phenomenon has prompted the exploration of IL-8 as a prospective therapeutic target for rosacea treatment. To this end, a selection of compounds sourced from the ZINC database, encompassing six small molecules, was made with the intent of identifying promising lead candidates that exhibit drug-like characteristics against IL-8. Through an integrated in silico approach involving structure-guided drug design, encompassing molecular docking, molecular dynamics (MD) simulation, molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) analysis, protein-peptide docking, and scrutiny of toxicity profiles, it was ascertained that the small molecule ZINC000022339916 effectively inhibits IL-8 activity. These findings present a novel lead compound that warrants further validation through in vitro, in vivo, and ongoing clinical investigations to confirm its potential for therapeutic management of rosacea.

Abstract The vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important public health strategy to prevent people from the pandemic. Vaccines are a game-changing tool, it is essential to understand the adverse events after COVID-19 vaccination. This study explored the adverse events of COVID-19 Vaccination Oxford–AstraZeneca, Pfizer-BioNTech, Moderna, Johnson and Johnson on Guillain–Barré Syndrome (GBS). In this study, initially 128 documents were identified from the databases, including Pub-Med, Web of Science-Clarivate Analytics, Scopus, and Google Scholar. The articles on COVID-19 vaccination and GBs were searched using the keywords “SARS-CoV-2, COVID-19, Vaccination, and Guillain Barré Syndrome, GBS”, finally, 16 documents were included in the analysis and synthesis. After administering 1,680,042,214 doses of COVID-19 vaccines, 6177 cases were identified with 10.5 cases per million vaccine doses. A significant positive risk was found between COVID-19 vaccine administration and GBS with a risk rate of RR 1.97 (95% CI 1.26–3.08, p = 0.01). The mRNA vaccines were associated with 2076 cases, and 1,237,638,401 vaccine doses were linked with 4.47 GBS events per million vaccine doses. The first dose of the m-RNA vaccine was associated with 8.83 events per million doses compared to the second dose with 02 events per million doses. The viral-vector vaccine doses 193,535,249 were linked to 1630 GBS cases with 11.01 cases per million doses. The incidence of GBS after the first dose was 17.43 compared to 1.47 cases per million in the second dose of the viral-vector vaccine. The adverse events of the Oxford–AstraZeneca vaccine were linked to 1339 cases of GBS following 167,786,902 vaccine doses, with 14.2 cases per million doses. The Oxford–AstraZeneca vaccine significantly increased the risk of GBS RR: 2.96 (95% CI 2.51–3.48, p = 0.01). For the Pfizer-BioNTech vaccine, there were 7.20 cases per million doses of the vaccine, and no significant association was identified between the Pfizer-BioNTech vaccine and GBS incidence RR: 0.99 (95% CI 0.75–1.32, p = 0.96). Moderna vaccine was related with 419 cases of GBS after administering 420,420,909 doses, with 2.26 cases per million doses. However, Johnson and Johnson's vaccination was linked to 235 GBS after 60,256,913 doses of the vaccine with 8.80 cases per million doses. A significant association was seen between the risk of GBS and Ad.26.COV2. S vaccine, RR: 2.47 (95% CI 1.30–4.69, p

Abstract Background A logbook system is essential to ensure standardized competency in medical education. This survey will provide the first overview of our current logbook and can serve as an initial proposal for improvement to a more relevant and valuable tool to assess our postgraduate training programme. Methods This survey was conducted among all Universiti Kebangsaan Malaysia (UKM) anaesthetic trainees. The data for this survey was collected by using Google Forms. A link to the form was distributed to all UKM anaesthetic trainees. The survey questionnaire consisted of five sections, demographic data, strengths and weaknesses of logbook content, evaluation of logbook usage experience, perception of the feedback received regarding the logbook performance, and potential improvements that can be made. Results 107 anaesthetic trainees participated in this study. All of the sections in the logbook were deemed relevant by more than 60% of the trainees except for the on-call section which was seen as relevant only by 37.4% of them. 53.3% agreed that the logbook is useful for learning during the course. However, only 43.9% of them perceived that the logbook was easy and convenient to use. Only 59 respondents received feedback regarding their logbook performance. The analysis of open-ended answers highlights the necessity of transitioning to a fully digitalized logbook system for easy accessibility. It also reveals the need to re-evaluate specific logbook contents and incorporate additional teaching and learning tools to enhance the overall training process. Moreover, the findings emphasize the importance of effectively implementing feedback mechanisms within the logbook system to optimize student learning. Conclusion Serving as a foundational step towards developing a more efficient and structured educational tool, this research provides valuable insights for future advancements in medical education, particularly in anaesthesiology.

Abstract Background Despite the extensive use of community-based participatory research (CBPR) in health-related projects, there is limited work on how CBPR processes result in outcomes, especially in household and ambient air pollution (HAAP) research. This study explores the reflections of key informants on factors that shape the implementation and outcomes of CBPR in HAAP projects. Methods We conducted semi-structured interviews with 13 key stakeholders, including academic researchers, non-governmental organisation administrators, a policymaker, and community members. All interviewees have experience in CBPR projects. Interviews were analysed using framework analysis, and findings were mapped to Wallerstein et al.’s CBPR conceptual model, which consists of four constructs: context, partnership processes, intervention and research, and outcomes. Results The findings are described under two main categories: ‘barriers to participation’ and ‘good practices for effective CBPR design and implementation’. Relevant sub-categories were barriers at the structural, research, community, and individual levels. Suggestions for good practices included respect, cultural humility, trust, effective communication, suitable and affordable interventions such as improved cookstoves, appropriate participatory research tools, and gratuity for the community’s time. Conclusion Key informants’ perspectives identified factors supported by the CBPR model to inform the design and implementation of the CBPR approach. The add-ons to some of the model’s factors, such as intra-community dynamics, give value to the informants’ knowledge to support community-research partnerships and improve outcomes in HAAP intervention projects. Addressing these factors at the design stage and reporting CBPR evaluation could deepen the understanding of community-research partnerships.

Abstract In this paper, a ( p , q ) $\left ( p,q\right ) $ -fractional nonlinear difference equation of different orders is considered and discussed. With the help of ( p , q ) $\left ( p,q\right ) $ -calculus for integrals and derivatives properties, we convert the main integral boundary value problem (IBVP) to an equivalent solution in the form of an integral equation, we use the upper–lower solution technique to prove the existence of positive solutions. We present an example of the IBVP to apply and demonstrate the results of our method.

Abstract piRNAs are crucial for transposon silencing, germ cell maturation, and fertility in male mice. Here, we report on the genetic landscape of piRNA dysfunction in humans and present 39 infertile men carrying biallelic variants in 14 different piRNA pathway genes, including PIWIL1, GTSF1, GPAT2, MAEL, TDRD1, and DDX4. In some affected men, the testicular phenotypes differ from those of the respective knockout mice and range from complete germ cell loss to the production of a few morphologically abnormal sperm. A reduced number of pachytene piRNAs was detected in the testicular tissue of variant carriers, demonstrating impaired piRNA biogenesis. Furthermore, LINE1 expression in spermatogonia links impaired piRNA biogenesis to transposon de-silencing and serves to classify variants as functionally relevant. These results establish the disrupted piRNA pathway as a major cause of human spermatogenic failure and provide insights into transposon silencing in human male germ cells.

Person identification through chest X-ray radiographs stands as a vanguard in both healthcare and biometrical security domains. In contrast to traditional biometric modalities, such as facial recognition, fingerprints and iris scans, the research orientation towards chest X-ray recognition has been spurred by its remarkable recognition rates. Capturing the intricate anatomical nuances of an individual's rib cage, lungs and heart, chest X-ray images emerge as a focal point for identification, even in scenarios where the human body is entirely damaged. Concerning the field of deep learning, a paradigm is exemplified in contemporary generations, with promising outcomes in classification and image similarity challenges. However, the training of convolutional neural networks (CNNs) requires copious labelled data and is time-consuming. In this study, we delve into the rich repository of the NIH ChestX-ray14 dataset, comprising 112,120 frontal-view chest radiographs from 30,805 unique patients. Our methodology is nuanced, employing the potency of Siamese neural networks and the triplet loss in conjunction with refined CNN models for feature extraction. The Siamese networks facilitate robust image similarity comparison, while the triplet loss optimizes the embedding space, mitigating intra-class variations and amplifying inter-class distances. A meticulous examination of our experimental results reveals profound insights into our model performance. Noteworthy is the remarkable accuracy achieved by the VGG-19 model, standing at an impressive 97%. This achievement is underpinned by a well-balanced precision of 95.3% and an outstanding recall of 98.4%. Surpassing other CNN models utilized in our research and outshining existing state-of-the-art models, our approach establishes itself as a vanguard in the pursuit of person identification through chest X-ray images.

Abstract Introduction Amidst the challenges posed by Covid-19, assessing healthcare quality in India is crucial, particularly through patient satisfaction levels. Methodology A cross-sectional survey of 277 participants in Jammu and Kashmir was conducted, utilizing a semi-structured questionnaire and PSQ-18. Data analysis was performed using SPSS (v25) including Chi-Square tests and Descriptive analysis. Results Out of 277 participants, 70.8% expressed high satisfaction with medical care. Majority (70%) agreed that doctors explained medical tests well. Additionally, 70% strongly agreed that their doctor’s office was well-equipped. Dissatisfaction factors were notably low. Significant associations were found between age and alcohol use (p = 0.041), gender and alcohol use (p = 0.007), gender and tobacco use (p = 0.032), and education level and vaccination (p = 0.001). Conclusion The study highlights high patient satisfaction during the pandemic. Improving accessibility and quality of primary healthcare and community centres is essential to meet patient needs effectively.

Context: The chronic diabetes mellitus (DM) condition may lead to diabetic wounds that increase morbidity in patients. Ipomoea reptans Poir leaves have been widely reported to possess anti-diabetic activity due to their flavonoid contents. To enhance drug penetration, a nanoemulgel preparation was formulated. Aims: This study aimed to evaluate the activity of nanoemulgel preparations of Ipomoea reptans Poir leaf extract on diabetic and non-diabetic wound-healing using male Wistar rats. Settings and Design: This research was an experimental study with a post-test only control group design. Materials and Methods: The rats (n = 32) were randomly divided into two groups: diabetic (induced by 40 mg/kg BW STZ) and non-diabetic model. Each model consisted of four groups: normal, positive control, I. reptans leaf extract (IRLE), and nanoemulgel of I. reptans leaf extract (NIRLE). All the animals studied were shaved from the back, and a 2.5 × 0.5 cm full-thickness excision wound was made. IRLE and NIRLE were administered daily and observed for the wound-healing process. Statistical Analysis Used: The one-way analysis of variance with the Tukey post-hoc test was used for the statistical analysis. Results: A NIRLE formulation has been developed to produce a preparation that meets the physical requirements. IRLE and NIRLE possessed wound-healing activity in normal and diabetic rat models. However, the wound-healing process in diabetic rats treated with NIRLE was faster than those with IRLE. Conclusions: NIRLE increased the activity of wound-healing effect of I. reptans leaves on diabetic rats in comparison with the extract form.

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10−8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels.

Purpose– This study aims to investigate social media marketing activities and electronic word of mouth (EWOM) on consumer behavior (purchase intention and loyalty intention) through quality relationships. Methodology – This study used a quantitative approach, where the source of data used was primary data in the form of questionnaires. The distribution of questionnaires is carried out online. Respondents in this study amounted to 108 respondents, where respondents were individuals who had shopped using social media. The sampling technique uses purposive sampling. The analytical tool used is the structural equation model, and is tested using PLS-SEM. Findings – This research shows that social media activities have an effect on relationship quality, but electronic word of mouth has no effect. In addition, the results of this study show that relationship quality mediates the influence of social media activities and EWOM on customer behavior (purchase intention and loyalty intention). Originality/Novelty – The findings of this study can provide a reference for the Company to carry out social media marketing and EWOM activities intensely in order to improve the quality of the relationship between producers and consumers, which in turn will increase consumer buying interest. Implications – The practical implication of this research is that companies can be more intense in carrying out activities with social media. This is because doing so can improve

BACKGROUND: The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. OBJECTIVES: Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. DESIGN: Retrospective cohort SETTING: Tertiary care center in Riyadh PATIENTS AND METHODS: All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. MAIN OUTCOME MEASURES: Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. SAMPLE SIZE: 25 AN patients RESULTS: Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. CONCLUSIONS: The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. LIMITATIONS: Data collected retrospectively, a single institution, and a small population.

Abstract Background Most rural populations experience significant health disadvantage. Community-engaged research can facilitate research activities towards addressing health issues of priority to local communities. Connecting scholars with community based frontline practices that are addressing local health and medical needs helps establish a robust pipeline for research that can inform gaps in health provision. Rural Health Projects (RHPs) are conducted as part of the Doctor of Medicine program at the University of Queensland. This study aims to describe the geographic coverage of RHPs, the health topic areas covered and the different types of RHP research activities conducted. It also provides meaningful insight of the health priorities for local rural communities in Queensland, Australia. Methods This study conducted a retrospective review of RHPs conducted between 2011 and 2021 in rural and remote Australian communities. Descriptive analyses were used to describe RHP locations by their geographical classification and disease/research categorisation using the International Classification of Diseases and Related Health Problems – 10th Revision (ICD-10) codes and the Human Research Classification System (HRCS) categories. Results There were a total of 2806 eligible RHPs conducted between 2011 and 2021, predominantly in Queensland (n = 2728, 97·2%). These were mostly conducted in small rural towns (under 5,000 population, n = 1044, 37·2%) or other rural towns up to 15,000 population (n = 842, 30·0%). Projects mostly addressed individual care needs (n = 1233, 43·9%) according to HRCS categories, or were related to factors influencing health status and contact with health services (n = 1012, 36·1%) according to ICD-10 classification. Conclusions Conducting community focused RHPs demonstrates a valuable method to address community-specific rural health priorities by engaging medical students in research projects while simultaneously enhancing their research skills.

Abstract High Mobility Group A2 (HMGA2) oncofetal proteins are a distinct category of Transcription Factors (TFs) known as “architectural factors” due to their lack of direct transcriptional activity. Instead, they modulate the three-dimensional structure of chromatin by binding to AT-rich regions in the minor grooves of DNA through their AT-hooks. This binding allows HMGA2 to interact with other proteins and different regions of DNA, thereby regulating the expression of numerous genes involved in carcinogenesis. Consequently, multiple mechanisms exist to finely control HMGA2 protein expression at various transcriptional levels, ensuring precise concentration adjustments to maintain cellular homeostasis. During embryonic development, HMGA2 protein is highly expressed but becomes absent in adult tissues. However, recent studies have revealed its re-elevation in various cancer types. Extensive research has demonstrated the involvement of HMGA2 protein in carcinogenesis at multiple levels. It intervenes in crucial processes such as cell cycle regulation, apoptosis, angiogenesis, epithelial-to-mesenchymal transition, cancer cell stemness, and DNA damage repair mechanisms, ultimately promoting cancer cell survival. This comprehensive review provides insights into the HMGA2 protein, spanning from the genetic regulation to functional protein behavior. It highlights the significant mechanisms governing HMGA2 gene expression and elucidates the molecular roles of HMGA2 in the carcinogenesis process. Graphical Abstract

Abstract Background Spinal muscular atrophy (SMA) is a group of motor neuron diseases. In 95% of SMA patients, the telomeric copy of the SMN gene (SMN1) is homozygously deleted. Due to the autosomal recessive pattern of SMA inheritance, individuals with a family history of SMA are at risk of being carriers. A total of 622 individuals from SMA families, including parents, siblings, and first, second, and third-degree relatives, were recruited to the neuro-genetic clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. SMA cases and suspected carriers were referred to the genetic laboratory. Pregnant women underwent amniocentesis and chorionic villi sampling at 12–14 gestational weeks. RFLP-PCR and real-time PCR were performed for symptomatic and asymptomatic individuals (possible carriers), respectively. RFLP and real-time PCR were performed for amniotic fluid and chorionic villi samples. Results The study enrolled 622 subjects from SMA-affected families, including 159 fetuses and 463 non-fetuses. Two samples were missing. A total of 268 individuals (43.2%) were healthy (wild type), 187 individuals (30.1%) were heterozygous for exon deletion of SMN1, and 143 individuals (23%) were homozygous for exon deletion of SMN1. Four individuals (0.6%) showed three copies of the SMN1 gene. Conclusion The frequency of carriers with two SMN1 copies on a single chromosome (cis) was estimated at 2.9% (18/622), and the total rate of carriers was approximately 21.8%. Considering the high rate of SMA carriers in this study, genetic counseling and definitive prenatal diagnosis are of utmost importance for reducing the psychosocial burden of the SMA disease among Iranian families.

Abstract Background To evaluate the efficacy of SIMBA as an educational intervention for both HCPs and people with either PCOS or adrenal conditions and to study the change in knowledge of people with PCOS or adrenal conditions about the conditions and expectations from the HCPs involved in their care following SIMBA-PPI sessions. Methods Two SIMBA-PPI sessions (SIMBA-PPI Polycystic ovary syndrome (SIMBA-PCOS) and SIMBA-PPI Adrenal conditions (SIMBA-Adrenal conditions)) were conducted in September 2021 and March 2022. In both sessions, HCPs interacted with moderators on patient management through WhatsApp. Patients with respective conditions underwent workshop-style learning in the same cases. SIMBA-PCOS transcripts were also translated into Brazilian Portuguese and workshops were held in both Brazilian Portuguese and English. The two groups (HCPs and patients) were then brought together to discuss exploring gaps in knowledge and expectations. The Wilcoxon Signed-Rank test compared differences in pre- and post-SIMBA self-reported confidence levels in HCPs and patients. Qualitative data from the online recordings were transcribed and analysed with inductive thematic analysis to identify gaps in knowledge and expectations from managing the cases. Results 48 HCPs and 25 patients participated in our study. When compared to pre-SIMBA confidence levels, SIMBA-PPI sessions effectively improved clinicians’ confidence in managing PCOS (40.5%, p

Abstract As delays are common, persistent, and ingrained in daily life, it is imperative to take them into account. In this work, we explore the averaging principle for impulsive Atangana–Baleanu fractional stochastic delay differential equations driven by Lévy noise. The link between the averaged equation solutions and the equivalent solutions of the original equations is shown in the sense of mean square. To achieve the intended outcomes, fractional calculus, semigroup properties, and stochastic analysis theory are used. We also provide an example to demonstrate the practicality and relevance of our research.

Abstract Background The motivation of caregivers plays a crucial role in the treatment, follow-up, and care of children with intellectual and developmental disabilities. Previous studies have focused on the older people and end-stage diseases, while giving less attention to the motivation of mothers caring for children with special needs. This study aimed to explore the motivations of mothers caring for children with intellectual and developmental disabilities in Iran. Methods This study employed a qualitative approach, guided by the Self-Determination Theory. Purposeful sampling was initially used, followed by theoretical sampling until data saturation was achieved. Data were collected through semi-structured interviews with 26 mothers of children with intellectual and developmental disabilities. Mayring’s seven-step directed content analysis approach was utilized for coding and categorization. The research adhered to ethical standards and ensured data trustworthiness through credibility, dependability, confirmability, and transferability measures. Results The findings revealed that mothers’ caregiving motivations could be classified into four main categories: (I) intrinsic, (II) identified-extrinsic, (III) introjected-extrinsic, and (IV) external-extrinsic. Additionally, twelve sub-categories were identified within these four main categories. Conclusion The findings revealed that mothers demonstrated varying levels of intrinsic and extrinsic motivations in caring for children with intellectual and developmental disabilities. By recognizing and enhancing the diverse sources of motivation, healthcare providers and policymakers can better support mothers in their caregiving roles, ultimately contributing to improved outcomes for both the mothers and their children.

Abstract Background Identifying the risk indicators of parental dental anxiety (PDA) and oral health literacy (OHL) can help oral healthcare professionals recognise challenges in this field. Armed with the appropriate information, they can effectively engage with parents to build trust and promote early and regular child dental visits. Objectives This study aimed to investigate the association between PDA and OHL with the sociobehavioural characteristics of families, self-reported child oral health (presence of ≥ 1 untreated decayed teeth) and the dental visit patterns amongst children living in Al Jouf Province, Kingdom of Saudi Arabia. Subjects and methods A total of 430 parents with children aged ≥ 14 years were invited using a systematic random sampling method. PDA was assessed using the Dental Anxiety Scale-Revised (DAS-R) scale, and parents’ OHL was measured using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30). The relationships amongst participant characteristics, PDA and OHL were evaluated through the Chi-square and ANOVA. Additionally, binary regression analysis was conducted to identify predictor variables associated with PDA and OHL. A P value of 12 months ago (AOR = 34.94; P

Abstract Background Multiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians’ waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics. Methods It was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar’s Chi-square test. Results Total 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25–36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p

Abstract The coronavirus disease 2019 (COVID-19) pandemic and respective shutdowns dramatically altered human activities, potentially changing human pressures on urban-dwelling animals. Here, we use such COVID-19-induced variation in human presence to evaluate, across multiple temporal scales, how urban birds from five countries changed their tolerance towards humans, measured as escape distance. We collected 6369 escape responses for 147 species and found that human numbers in parks at a given hour, day, week or year (before and during shutdowns) had a little effect on birds’ escape distances. All effects centered around zero, except for the actual human numbers during escape trial (hourly scale) that correlated negatively, albeit weakly, with escape distance. The results were similar across countries and most species. Our results highlight the resilience of birds to changes in human numbers on multiple temporal scales, the complexities of linking animal fear responses to human behavior, and the challenge of quantifying both simultaneously in situ.

Abstract Glioblastoma is a highly aggressive brain tumour that creates an immunosuppressive microenvironment. Microglia, the brain’s resident immune cells, play a crucial role in this environment. Glioblastoma cells can reprogramme microglia to create a supportive niche that promotes tumour growth. However, the mechanisms controlling the acquisition of a transcriptome associated with a tumour-supportive microglial reactive state are not fully understood. In this study, we investigated changes in the transcriptional profile of BV2 microglia exposed to C6 glioma cells. RNA-sequencing analysis revealed a significant upregulation of microglial inhibitor of DNA binding 1 (Id1) and Id2, helix-loop-helix negative transcription regulatory factors. The concomitant regulation of microglial ETS proto-oncogene 2, transcription factor (ETS2)-target genes, i.e., Dusp6, Fli1, Jun, Hmox1, and Stab1, led us to hypothesize that ETS2 could be regulated by ID proteins. In fact, ID2-ETS2 protein interactions increased in microglia exposed to glioma cells. In addition, perturbation of the ID2-ETS2 transcriptional axis influenced the acquisition of a microglial tumour-supportive phenotype. ID2 and ETS2 genes were found to be expressed by the tumour-associated microglia isolated from human glioblastoma tumour biopsies. Furthermore, ID2 and ETS2 gene expressions exhibited inverse prognostic values in patients with glioma in cohorts from The Cancer Genome Atlas. Collectively, our findings indicate that the regulation of ETS2 by ID2 plays a role in the transcriptional regulation of microglia in response to stimuli originating from glioblastoma cells, information that could lead to developing therapeutic strategies to manipulate microglial tumour-trophic functions.

Crab is an exotic marine fishery commodity whose demand is increasing significantly in Indonesia. However, the industry also produces much waste in the form of crab shells, reaching 52.59% of its total weight. This waste (often called by-product) can be processed into several products with economic value such as chitosan, liquid organic fertilizer, and animal feed. This study assesses the environmental impact of crab shells processed into chitosan, liquid organic fertilizer, and animal feed. The study was carried out using the Life Cycle Assessment (LCA) approach with cradle-to-gate scope. The environmental impacts were observed consisting of some aspects such as Global Warming Potentials (GWP), Acidification Potentials (AP), Eutrophication Potentials (EP), and Cumulative Energy Demand (CED). The three-alternative utilization of crab shells produces environmental impacts resulting from fishing, transportation, and processing of the crab shells into these products. Afterward, the results of this study indicate that the crab shells processed into liquid fertilizer have the highest emission according to the GWP, AP, and CED values compared to the other by-product alternatives (i.e., chitosan and fertilizer). Whilst, the highest EP is produced by the processing of CS-based animal feed. These results can potentially become a consideration in making environmental policy by the local government, especially in Karawang Region.

Automated vehicles (AVs) may require the implementation of an external human-machine interface (eHMI) to communicate their intentions to human-driven vehicles. The optimal placement of the eHMI, either on the AV itself or as part of the road infrastructure, remains undetermined. The current driving simulator study investigated the effect of eHMI positioning on human driving behavior, during the approach and execution of right turns at T-intersections. Forty-three participants drove under three conditions: absence of eHMI, eHMI on the AV (eHMIv), and eHMI integrated into the infrastructure (eHMIi). Participants encountered AVs that either yielded or did not yield to their vehicles. The results regarding the placement of the eHMI showed that both concepts are advantageous, but for different reasons. eHMIv was appreciated because implicit and explicit communication are congruent, although the AV must first be visually identified to respond to it. eHMIi was appreciated because a familiar cue is always at a known location in the environment; as a result, participants braked earlier for the intersection and came less close to the AV (which can be interpreted as a safety advantage or efficiency disadvantage). Although there are limitations to a driving simulator study like this, this research provides important insights into the fundamental question of how information placement affects drivers’ visual attention demands and driving behavior, topics that are important in view of the development of future cities.

This research aims to identify the performance and mechanical characteristics of polypropylene-based antistatic bio-nano composites reinforced with 2% mono-diacylglycerols (M-DAG) and 0, 0.5, 2.5% cellulose nanocrystals (CNC) and compared to pure PP. Based on the results of SEM on cross-section, there was an agglomeration of M-DAG and CNC on the PP matrix. XRD diffractogram pattern of antistatic bio-nano composites showed peaks representing the diffraction structure of glycerol monostearate and cellulose I. The FTIR spectrum of each formulation was very similar to the characteristic peaks of PP and showed three distinct peaks compared to pure PP. The melting temperature of antistatic composites without CNC (176.54oC) was higher than pure PP (175.44oC). Thermal stability of antistatic bio-nano composites with 0, 0.5, and 2.5% CNC were 472.07, 470.25, and 475.15 oC, respectively, higher than pure PP (468.27 oC). The best mechanical properties were 2.5% CNC with 11.071 MPa flexural modulus, 30.376 MPa tensile strength, 23.796% tensile elongation, 1.659 J/m2 impact strength, which were higher than pure PP, and it generated antistatic activity of 1010 - 1012 /sq resistivity.

Objective: Neoadjuvant chemotherapy (NAC) in breast cancer (BC) is being considered for a broader range of cases, including locally advanced tumors and situations where downstaging could reduce extensive surgery. Several trials have explored predictive markers of pathological complete response (pCR). The role of Ki-67 as a predictor of pCR has been demonstrated in studies. However, the cut-off remains vague, given the lack of standardization of measurement methods. The aim of our study was to evaluate the predictive value of Ki-67 in response to NAC and to identify the cut-off values that exhibit the strongest correlation with best response. Materials and Methods: This retrospective study included 187 patients who had undergone surgery following NAC for BC at the CHU Souss Massa of Agadir between January 2020 and January 2023. Logistic regression was used to assess the correlation between Ki-67 and patients’ characteristics. Optimal Ki-67 cutoff was identified by receiver operating characteristic curve. Kaplan-Meier curves were used to assess disease-free survival (DFS), and survival comparisons were assessed with the log-rank test. Results: The median age was 51.8±10.7 years and 51.4% of tumors were smaller than 5 cm. Node invasion was found in 55.4%. Luminal B subtype was found in 49.7%, followed by human epidermal growth factor receptor-2 (HER-2)-positive in 27.4%, triple-negative in 14.3% and Luminal A in 8.6%. pCR occurred in 40% of patients overall. Subgroup analysis revealed a significant association between pCR and tumor size (p35% (p35% predicts a better pCR rate in response to NAC. However, this cutoff value remains controversial due to the absence of a standard method of measurement, with inter- and intra-observer variability. It would be necessary to validate this cutoff in other studies.

Abstract Background Redondoviridae is a newly discovered virus family linked to oral and respiratory conditions in people, while there is still debate about whether it is also coinfected with other respiratory viruses. This study aimed to determine the frequency of Redondovirus (ReDoV) in nasopharyngeal samples and to investigate any possible links to SARS-CoV-2 infections. Methods A polymerase chain reaction (PCR) test was conducted on 731 nasopharyngeal samples from individuals referred to medical centers in Tehran, Iran, for SARS-CoV-2 testing to investigate the prevalence of ReDoV. An oral interview was performed to complete information on dental issues and the individuals’ demographics, symptoms, and vaccination history. Results The prevalence of ReDoV was 25.99%, and 15.26% had a coinfection with SARS-CoV-2. No notable correlation was found regarding ReDoVs and SARS-CoV-2 infections (p > 0.05). Women had a higher ReDoV positivity rate of 18.47% compared to men at 7.52% (p = 0.12), and there was no significant correlation between age groups and ReDoV presence. Nonetheless, a significant association was noted between ReDoVs and dental/gum issues (p

Abstract Palatal injections are considered to be one of the most painful dental procedures. As a result, it was important to find alternatives to this painful injection to improve children's cooperation. The dental literature mentioned using EMLA cream as a possible alternative to conventional injections, but its anesthetic effect was debated. Therefore, it was valuable to research the impact of microneedle patches to enhance the effectiveness of this cream. The purpose of this randomized controlled clinical trial was to compare the effectiveness of different methods of anesthesia and pain levels in children aged 7–11 years. The study compared the use of EMLA cream, EMLA with microneedles, and conventional palatal injections. A total of 90 children were randomly assigned to three groups: Group 1 received conventional palatal anesthesia (control), Group 2 received EMLA cream only, and Group 3 received EMLA with microneedles. Pain levels were assessed using the FLACC and Wong-Baker scales at three different time points: T1(during anesthesia), T2(on palatal probing), and T3(during extraction). The FLACC scale revealed a significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 1.00). Similarly, the Wong-Baker scale also demonstrated a statistically significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 0.091). The study concludes that both EMLA cream alone and EMLA with microneedles can be used as an alternative to conventional palatal anesthesia for children.

Abstract Background Period poverty is a significant issue that impacts the physical and psychological well-being of menstruators worldwide which can further contribute to poor mental health outcomes. For menstruators living in refugee camps, access to menstrual hygiene products is often limited or non-existent, leading to increased anxiety, shame, and embarrassment. Therefore, this study aimed to assess the prevalence of the period poverty and to comprehensively analyze the association between period poverty, reusing menstrual products, and depressive symptoms among menstruators living in refugee camps in Jordan. Methods A cross-sectional study surveyed refugee menstruators living in camps in Jordan, aged post-menarche to pre-menopause. Data collection included socio-demographics, menstrual practices, and depressive symptoms using the Patient Health Questionnaire (PHQ-9). Period poverty was assessed through affordability and frequency of struggles with menstrual products. Chi-squared test, independent sample t-test, One Way Analysis of variance (ANOVA) followed by Post hoc, and logistic regression models were used in the analysis. Results The study included a diverse sample of 386 refugee menstruators living in camps in Jordan (mean age 32.43 ± 9.95, age range 13–55). Period poverty was highly prevalent, with 42.0% reporting monthly struggles to afford menstrual products, and 71.5% reusing menstrual products. Univariate analysis revealed that experiencing period poverty was significantly associated with a younger age of marriage, increased number of children, lower education level, lower mother and father education levels, unemployment, decreased monthly income, absence of health insurance, lower reuse need score, and increased PHQ-9 score (p

Abstract Background The rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean can be as high as 27-32.7%. Induction of labor after one previous cesarean (IOLAC) is a high-risk procedure mainly due to the higher risk of uterine rupture. Nevertheless, the American College of Obstetricians and Gynecologists considers IOLAC as an option in motivated and informed women in the appropriate care setting. We sought to identify predictors of a composite of maternal and newborn adverse outcomes following IOLAC. Methods The electronic medical records of women who delivered between January 2018 to September 2022 in a Malaysian university hospital were screened to identify cases of IOLAC. A case is classified as a composite adverse outcome if at least one of these 11 adverse outcomes of delivery blood loss ≥ 1000 ml, uterine scar complications, cord prolapse or presentation, placenta abruption, maternal fever (≥ 38 0C), chorioamnionitis, intensive care unit (ICU) admission, Apgar score

Abstract Background Maternal Group B Streptococcus (GBS) colonization is influenced by many factors but results are inconsistent. Consideration of antenatal risk factors may help inform decision making on GBS microbiological culture screening where universal screening is not standard of care. We sought to identify independent predictors of GBS colonization at 34–37 weeks gestation incorporating vaginal symptoms, perineal hygiene measures, sexual activity, and a potential novel factor, constipation. Methods In this prospective cross-sectional study, 573 women at 34–37 weeks gestation had an ano-vaginal swab taken and sent for selective culture for GBS. Women were asked about vaginal bleeding, discharge, irritation and candidiasis, antibiotic use during pregnancy, ano-vaginal hygiene practices such as douching and perineal cleansing after toileting, sexual intercourse related activities, and a potential novel factor for GBS carriage, constipation. Maternal basic demographics and obstetric-related characteristics were also collected. Bivariate analyses were performed to identify associates of GBS colonization. All variables with p

Background: Following COVID-19 vaccination, some women suffered from menstrual cycle disturbances. This studyaimed to investigate menstrual cycle disturbances after COVID-19 vaccination in women of reproductive age.Materials and Methods: This cross-sectional study was performed on 407 vaccinated women in the vaccinationcenter of Imam Hossein Hospital (Tehran, Iran) between October 2021 and October 2022. They were interviewedbased on a research-made checklist which consisted of two areas of questions about the baseline characteristics of participantsand menstrual cycle characteristics to explore menstrual characteristics following COVID-19 vaccination.Results: The prevalence of menstrual disturbances was higher after the third dose (38.3%) compared with the second(27.9%) and first (17.7%) doses (P