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Abstract Introduction The left atrial appendage (LAA) is a distinct structure with unique developmental and structural characteristics. The LAA is involved in the formation of intra-atrial thrombi, particularly in patients with conditions such as atrial fibrillation and mitral valve disease. Left atrial appendage aneurysms (LAAA) are rare abnormal dilations of the LAA that may cause hazardous complications. However, there are limited data on the demographic features, clinical characteristics, management modalities, and prognosis of LAAA patients. This study aimed to conduct a systematic review of the reported cases of LAAA to explore the baseline characteristics, presentation, preferred diagnostic modalities, and optimal management of LAAA. Methods A systematic review was conducted following the PRISMA guidelines. We performed a literature search using MEDLINE/PubMed and Google Scholar. Eligible articles published between January 1940 and November 2022 were included. The eligibility criteria included case reports and case series of LAAA in English language articles. The data extracted included information on the authors, publication year, patient characteristics, signs/symptoms, diagnostic procedures, treatments, and outcomes. Results We identified 177 patients with LAAA in our study. There was a slight female predominance (50.9%), and the mean age was 29.7 years. Palpitations were the most common symptom reported, followed by shortness of breath and thromboembolic events. Transthoracic and transesophageal echocardiograms were the most common modalities for investigating and diagnosing LAAA, and the mean size of the aneurysm was 7.8 (5.7–9.6) × 5.9 (5.0-6.2) cm. Surgical resection is the treatment of choice for most patients with excellent prognoses. Older age and the presence of arrhythmia were significantly associated with thrombus formation and embolic events. Conclusion Left atrial appendage aneurysm is a rare but potentially life-threatening heart pathology that can lead to arrhythmias and thromboembolic events. Surgical resection appears to be the primary treatment option in the current literature, and most patients show improvement or are asymptomatic after treatment. Additionally, alternative approaches, such as transcatheter closure of LAAA, ablation, and medical treatments, have been reported as viable alternatives to surgical intervention.

Abstract Citrobacter koseri causes infection in people who are immunocompromised. Without effective antibiotics, these infections can become severe and life-threatening, so effective drugs are essential to treat these infections. Utilizing subtractive genomics, 2699 ORFs were predicted and translated into amino acid sequences. Metabolic pathway analysis and subcellular localization helped define the roles of key bacterial proteins. Two druggable proteins, WP_012000829.1 and WP_275157394.1, were discovered as promising targets. Alpha Fold provided 3D structures, and a library of 1600 echinoderm metabolites was docked against these proteins, with Ampicillin, Levofloxacin, and Doxycycline as controls. Notably, CMNPD13085 and CMNPD15632 exhibited the highest binding affinities for WP_012000829.1 and WP_275157394.1, respectively. Molecular dynamics simulations and MM-GBSA binding free energy complemented docking results. However, acknowledging the reliance on computational validations, the study emphasizes the need for essential in-vitro research to transform these potential inhibitors into therapeutic drugs.

Abstract Background Malignant ureteral obstruction (MUO) is a serious health condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention in MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in the Palestinian practice. Methods This study was conducted in retrospective design in one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024. Results In this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions. Conclusion Despite improvements in renal functions, creatinine and BUN levels remained abnormal even after receiving a decompressive intervention. Postoperative complications were frequently reported among patients who received DJS or PCN as decompressive interventions. Larger prospective studies are still needed to determine the optimal interventions to improve outcomes, quality of life, and survival rates of patients with DJS or PCN.

Abstract Purpose Robotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results. Methods The study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes. Results 37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%. Conclusion Robotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits.

Abstract Background Burnout syndrome is marked by three primary domains: emotional exhaustion, depersonalization, and low personal accomplishment. This study assessed the prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit (ICU) nurses in Palestinian hospitals. In addition, this study also sought to assess associations and identify the factors that can predict higher burnout among anesthesiologists, anesthesia technicians, and ICU nurses. Methods This study was conducted in a cross-sectional design using a questionnaire between October 2023 and December 2023. The questionnaire collected the demographic variables of the healthcare providers, their living conditions, lifestyle, working conditions, job satisfaction, and intention to change the profession. The healthcare providers were included from 12 different hospitals. Burnout syndrome was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP). Results A total of 250 healthcare providers were invited to participate in this study, of those, 212 completed the questionnaire, giving a response rate of 84.8%. Of the healthcare providers, 72 (34.0%) were anesthesiologists, 41 (19.3%) were anesthesia technicians, and 99 (46.7%) were ICU nurses. Of all healthcare providers, 151 (71.2%) reported emotional exhaustion, 125 (59%) reported depersonalization and 145 (68.4%) reported a lack of personal achievement based on the MBI-HSS-MP criteria for burnout. Multiple linear regression showed that higher emotional exhaustion scores could be predicted by the number of working hours per day (p-value = 0.039) and higher depersonalization scores could be predicted by having children (p-value = 0.001). On the other hand, lower personal achievement scores could be predicted by having children (p-value = 0.006), not owning a car (p-value = 0.036), and having more night shifts (p-value = 0.049). Conclusions The findings of this study indicated that burnout syndrome was prevalent among anesthesiologists, anesthesia technicians, and ICU nurses in Palestinian hospitals. Healthcare authorities and professional bodies should consider designing interventions to reduce burnout and improve the psychological well-being of anesthesiologists, anesthesia technicians, and ICU nurses. Further studies are required to identify the most effective interventions for reducing burnout among anesthesiologists, anesthesia technicians, and ICU nurses in Palestine.

This paper explores the asymmetric effects of life and non-life insurance on economic growth in Saudi Arabia. Quarterly data on insurance penetration rates and GDP growth from 2009 to 2022, obtained from the Global Economy, Saudi Arabian Monetary Authority, and World Bank databases, are utilized. A nonlinear autoregressive distributed lag (NARDL) model is employed to examine the relationships between insurance and growth. The results reveal a significant and asymmetric relationship between life insurance penetration and GDP growth. Specifically, a 1% increase in life insurance penetration is associated with a 0.3% increase in GDP growth in the long run, while a 1% decrease shows no significant effect. For non-life insurance, both increases and decreases demonstrate significant but asymmetric impacts on growth. A 1% increase in non-life insurance penetration corresponds to a 0.2% increase in GDP growth, whereas a 1% decrease is linked to a 0.15% decrease in GDP growth. These findings support the ‘supply-leading’ hypothesis, suggesting that the insurance sector can play a leading role in promoting economic growth. The results provide new quantitative insights into the relationship between insurance and economic growth in Saudi Arabia, offering valuable implications for policymakers. It is suggested that the insurance industry can be leveraged to foster economic growth by promoting life insurance and managing the asymmetric impacts of non-life insurance.

Abstract Background Worldwide, breast cancer has replaced lung cancer and has become the most commonly diagnosed malignancy. Breast cancer poses a significant burden on the health and quality of life of women and can lead to substantial physical burdens and significant psychological problems, including distress, anxiety, depression, and sexuality-related issues, including negative body image. This study was conducted to assess how women diagnosed with, treated, and/or receiving treatment for breast cancer perceived their body image. Methods A cross-sectional study design was used to assess body image perceptions among Palestinian women diagnosed with breast cancer. The study was conducted in four different hospitals located in the West Bank of Palestine where women with breast cancer received their treatments or visited for follow-up care in the period between November 2023 and March 2024. An interviewer-administered questionnaire was used to collect the data. Body perception was assessed using the body image self-rating questionnaire for breast cancer (BISQ-BC). Results In this study, 376 women with breast cancer completed the interviewer-administered questionnaire (response rate = 75.2%. The mean age of the women was 44.0 ± 5.3 years. Of the women, 74.7% agreed or strongly agreed that they cared about their body image. On the other hand, 43.1% of the women were not satisfied with their body image and 58.8% did not think that their body image was attractive. Multiple linear regression showed that younger age, employment status, living in cities, marital status, educational level, presence of comorbidities, and longer time passes since diagnosis with breast cancer were associated with the different aspects of body image perception and behavior. Conclusion The findings of this study indicated that Palestinian women with breast cancer were concerned about their body image. The findings also indicated that breast cancer and its treatment posed a significant burden on the physical and psychosocial well-being of the affected women and impacted the different dimensions of their lives, including their perceptions of their body image. Patients with significant physical and body image changes might benefit from reconstructive surgeries, psychosocial support, cognitive behavioral therapy, and nutritional, and physical activity interventions.

Drawing on signaling theory, the current experimental study (N = 593) investigated the influence of top employer awards on the connections between the full spectrum of narcissistic personality features (i.e., agentic, antagonistic, neurotic, and communal) and perceived company prestige. The results of our experiment show that employer awards enhance prestige perceptions and that all narcissism facets are positively related to perceptions of prestige. However, the positive associations between narcissistic personality features and company prestige were less pronounced in the award condition than in the no-award condition. Our study contributes to the recruitment and employer branding literature by demonstrating that, while employer awards generally enhance an organization’s prestige, they may not do so for individuals with particular personality features.

Abstract Background Previous research on the risk of dementia associated with education attainment, smoking status, and alcohol use disorder (AUD) has yielded inconsistent results, indicating potential heterogeneous treatment effects (HTEs) of these factors on dementia risk. Thus, this study aimed to identify the important variables that may contribute to HTEs of these factors in older adults. Methods Using 2005–2021 data from the National Alzheimer’s Coordinating Center (NACC), we included older adults (≥ 65 years) with normal cognition at the first visit. The exposure of interest included college education or above, current smoking, and AUD and the outcome was all-cause dementia. We applied doubly robust learning to estimate risk differences (RD) and 95% confidence intervals (CI) between exposed and unexposed groups in the overall cohort and subgroups identified through a decision tree model. Results Of 10,062 participants included, 929 developed all-cause dementia over a median 4.4-year follow-up. College education or above was associated with a lower risk of all-cause dementia in the overall population (RD, -1.5%; 95%CI, -2.8 to -0.3), especially among the subpopulations without hypertension, regardless of the APOE4 status. Current smoking was not related to increased dementia risk overall (2.8%; -1.5 to 7.2) but was significantly associated with increased dementia risk among men with (21.1%, 3.1 to 39.1) and without (8.4%, 0.9 to 15.8) cerebrovascular disease. AUD was not related to increased dementia risk overall (2.0%; -7.7 to 11.7) but was significantly associated with increased dementia risk among men with neuropsychiatric disorders (31.5%; 7.4 to 55.7). Conclusions Our studies identified important factors contributing to HTEs of education, smoking, and AUD on risk of all-cause dementia, suggesting an individualized approach is needed to address dementia disparities.

Abstract Background Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool that is commonly used to visualize soft tissues and anatomical structures. Many patients who undergo MRI scans experience anxiety. This multicenter study was conducted to assess anxiety levels experienced by patients who underwent MRI scans in the Palestinian radiology departments and identify the risk factors associated with higher levels of anxiety experienced by the patients. Methods This multicenter cross-sectional study was conducted in the radiology departments of different hospitals in the West Bank of Palestine using a questionnaire. The questionnaire collected different demographic data of the patients. A 100-mm visual analog scale (VAS) was used to assess the level of anxiety experienced by the patients who received MRI scans. The data were analyzed using SPSS version 28. Results A total of 383 patients participated in this study. Of the patients, 255 (66.6%) reported experiencing low, moderate, or high anxiety levels during the MRI scan. The median anxiety was 20.0 with an interquartile range (IQR) of 0.0–50.0 as measured using the 100-mm VAS. Higher anxiety levels were reported by the patients who were female (p-value

Abstract Background Little studies were conducted to assess the prevalence of stress urinary incontinence among Palestinian women. This study was conducted to determine the prevalence of stress urinary incontinence symptoms, their impact on the quality of life, and the risk factors that were associated with stress incontinence symptoms among Palestinian women. Methods This study was conducted in a cross-sectional design from 2023 to 2024. The data were collected through an interviewer-administered questionnaire. The questionnaire collected the demographic and health characteristics of the women. Additionally, the questionnaire also contained the PRAFAB questionnaire (PRAFAB-Q). Moreover, the questionnaire included the Assessment of Quality of Life (AQoL)-8D scale. Results Data were collected from 386 Palestinian women (response rate = 85.8%). The mean age of women in this study was 37.1 ± 14.7 years. In this study, 104 (26.9%) reported stress urinary incontinence symptoms. Of the women, 102 (26.4%) reported urinary leakage during coughing, 100 (25.9%) reported urinary leakage during sneezing, and 94 (24.4%) reported urinary leakage during laughing. The women who had a family history of stress incontinence were 2.5-fold (95% CI: 1.2–5.2) more likely to have stress incontinence symptoms compared to the women who did not have a family history of stress incontinence. Similarly, the women who were overweight/obese were 2.0-fold (95% CI: 1.1–3.7) more likely to have stress incontinence symptoms compared to the women who were underweight or had a normal weight. PRAFAB-Q scores were predicted by place of residence, family history of stress incontinence, and being recruited from a hospital. Conclusion The study reported a high prevalence of stress urinary incontinence and identified the risk factors that were associated with stress incontinence symptoms among Palestinian women. The findings showed that the intensity of stress urinary incontinence symptoms was associated with deteriorated quality of life of the affected women. These findings could be used by urologists, gynecologists, obstetricians, and other healthcare providers caring for women to design ways to reduce the burden of stress urinary incontinence among Palestinian women and improve their quality of life.

Abstract Background This study was conducted to assess the prevalence of lower urinary tract symptoms (LUTS) among non-obese and obese Palestinians. The study also aimed to assess the effects of LUTS on the quality of life of obese and non-obese Palestinians. Methods This was a cross-sectional study that was conducted among normal-weight, overweight, and obese Palestinians using the King Health Questionnaire. The data collected from participants were entered and analyzed using SPSS (version 22). Results In this study, data were collected from 378 participants. The median age of the participants was 42.0 [30.0, 55.0] years, and the median body mass index was 27.1 [24.0, 30.8] kg/m2. Of the participants, 149 (39.4%) were overweight and 112 (29.6%) were obese. The prevalence of urinary hesitancy, incomplete emptying, urgency, nocturia, urgency, urge incontinence, stress incontinence, nocturnal enuresis, intercourse incontinence, bladder pain, number of urinations/24 h, and number of urinations/night was significantly higher among obese participants. Similarly, role limitations, physical/social limitation, personal relationships, emotions, and sleep/energy were affected significantly higher in obese compared to nonobese participants. Conclusion Higher prevalence of LUTS among obese patients compared to nonobese patients was observed among the Palestinians. Obese patients reported significantly higher deterioration of the quality of life as a result of LUTS compared to nonobese patients. Urologists, nutritionists, public health specialists, and other healthcare providers should consider measures to reduce LUTS among obese patients and improve their quality of life.

Abstract The use of natural fibers has seen a significant rise in the composites sector, resulting in the creation of polymer composites with exceptional strength. These environmentally-friendly alternatives offer a compelling substitute for synthetic composites. This study explores the use of date palm waste as reinforcement for the fabrication of polyvinyl chloride (PVC) composites. A surface modification method was essential for improving the binding interaction between palm fibers and PVC composites. The two-hour benzoyl chloride treatment at 140 °C played a crucial role. The study examined the effects of hydrothermal aging on mechanical properties of composites, using various techniques such as surface morphology analysis, Fourier Transform Infrared spectroscopy, and Thermogravimetric Analysis, on composites made of untreated fibers and those treated with benzoyl chloride. Although the treatment of palm fiber-reinforced composites with benzoyl chloride improved their mechanical properties, it is crucial to note that hydrothermal aging reduced their tensile strength by 10%. Despite this, these composites prove to be well-suited for applications requiring moderate strength and stiffness in mild environmental conditions. These composites, while utilizing benzoyl chloride for surface treatment, still represent a more sustainable alternative to traditional synthetic composites by incorporating renewable date palm waste and enhancing mechanical properties, which potentially reduces overall environmental impact.

Abstract Background S. pneumoniae (SPN) is the most common cause of pneumonia. The disease can be effectively prevented through immunisation. Since December 2020, the Malaysian Government has included the 10-valent pneumococcal conjugate vaccine (PCV10) for all infants born on or after 1 January 2020 as part of the National Immunisation Programme (NIP). However, the epidemiology of pneumonia remains poorly understood. To fill the knowledge gap, we established a multicentre surveillance study to understand the burden of pneumococcal pneumonia among young children in Peninsular Malaysia. Methods MY-Pneumo is a multicentre prospective case–control study conducted in three sentinel sites located in three different states of Peninsular Malaysia – Kuala Lumpur, Pahang, and Kelantan. A cohort of at least 500 incident cases and 500 controls is enrolled beginning in October 2021 and matched for age. Cases are hospitalised children

Sheep milk production is a complex process that is influenced by various factors. This study aims to investigate how the litter size (single vs. twins), birth type (male vs. female), age of the ewes and body weight affect the milk composition and fatty acid profile of milk fat. Milk samples were collected from 119 Najdi ewes that were the subject of this study. Gas chromatography-mass spectrometry (GC-MASS) was used to quantify the fatty acids (FAs). The results showed that the twins birth type (female/female) has a significant influence (P

Abstract Aims Right ventricular failure after left ventricular assist device (LVAD) implantation is a major concern that remains challenging to predict. We sought to investigate the relationship between preoperative pulmonary artery pulsatility index (PAPi) and mortality after LVAD implantation. Methods and results A retrospective analysis of the ASSIST‐ICD multicentre registry allowed the assessment of PAPi before LVAD according to the formula [(systolic pulmonary artery pressure − diastolic pulmonary artery pressure)/central venous pressure]. The primary endpoint was survival at 3 months, according to the threshold value of PAPi determined by the receiver operating characteristic (ROC) curve. A multivariate analysis including demographic, echographic, haemodynamic, and biological variables was performed to identify predictive factors for 2 year mortality. One hundred seventeen patients were included from 2007 to 2021. The mean age was 58.45 years (±13.16), with 15.4% of women (sex ratio 5.5). A total of 53.4% were implanted as bridge to transplant and 43.1% as destination therapy. Post‐operative right ventricular failure was observed in 57 patients (48.7%), with no significant difference between survivors and non‐survivors at 1 month (odds ratio 1.59, P = 0.30). The median PAPi for the whole study population was 2.83 [interquartile range 1.63–4.69]. The threshold value of PAPi determined by the ROC curve was 2.84. Patients with PAPi ≥ 2.84 had a higher survival rate at 3 months [PAPi

Abstract The preclinical study of atherosclerosis has traditionally centred around the use of small animal models, translating to large animal models, prior to first-in-man studies. We propose to disrupt this paradigm by designing an ex vivo pump perfused human limb model. The novel model consists of taking a freshly amputated limb and incorporating it into an ex situ pump-perfused bypass system (akin to extracorporeal membrane oxygenation), circulating warmed, oxygenated blood. The circuit incorporates an introducer sheath and guiding catheter for intravascular imaging and X-ray angiography. Regular monitoring is performed using blood gas analysis, aiming for physiological parameters. The model maintains oxygen saturations > 99% for the length of perfusion (up to 6-h). Clinical grade X-ray angiography, intravascular ultrasound and optical coherence tomography have been successfully performed. Indocyanine green, a near-infrared fluorescent dye that localises to atherosclerotic plaque, has been injected into the system and left to circulate for 90-min. Fluorescence reflectance imaging of the dissected arterial bed confirmed uptake in areas of calcific atherosclerotic plaque on intravascular imaging. This is the first demonstration of an ex vivo pump-perfused “living” limb experimental model of atherosclerosis, which shows promise for future studies in translational interventional imaging and molecular targeting.

This study aimed to create a hoof lamellae model by combining the histomorphometric data of lamellae from animals with odd and even toes. The comparison study showed that odd-toed horses and donkeys have two unique types of epidermal lamellae (EL) in the innermost layer of the capsular wall, known as primary (PEL) and secondary epidermal lamellae (SEL). In contrast, even-toed cows and camels have only PEL. These lamellae form a complex and complicated dermo-epidermal connection by interlocking with the corresponding primary (PDL) and secondary dermal lamellae (SDL). The PEL were all the same shape, and cells made up the intertubular horn of the stratum medium. Animals with odd toes had SEL. A group of non-cornified basal cells and a central area with partially keratinized cells were composed of these Els. A distinct and straightforward connection between SEL and PEL was shown via connective tissue fibers. In both odd-toed and even-toed animals, the PEL originates from basal cells placed at the proximal extremity of the stratum internum. As the cells migrate towards the outermost edge, they undergo keratinization, contributing to the overall count of keratinized cells in the PEL. The results indicated significant differences in lamellae between those animals with odd-toed and even-toed feet. In addition, the current outcomes deliver a new perspective on the relationship between the architecture of hoof lamellae in animals with odd or even toes and their increased ability for keratin formation, which might explain the development of hoof diseases in the future.

Abstract: This study aims to understand the role of algorithms in information misinformation by marginalizing media information, which in turn hinders media literacy. The rapid spread of artificial intelligence and algorithmic systems raises concerns due to their lack of transparency, complicating assessments of compliance with human rights and labor laws. Algorithms can exhibit bias based on the training data and their correlation with processed data features. This issue has spurred discussions within the scientific community about biases and the ethical, computational, and media effects of algorithms. Keywords : Algorithms, Misinformation, Media Literacy, Bias, Transparency

Abstract: The current study examined vowel identification among 72 phonetically trained and untrained Algerian students of English enrolled in Master 2 English Language and Letters and Mathematics courses, respectively, at Mentouri University of Constantine. The study used a multiple alternative forced choice (m-AFC) classification test to assess participants’ identification rates of isolated RP prototypic vowels across varying temporal manipulations. It was hypothesised that phonetically trained and untrained participants would use acoustic features of examined vowels differently to identify vowels, with phonetically trained participants showing higher identification rates compared to untrained ones. Analysis of results demonstrated that the use of temporal and spectral features of vowels varied non-significantly across phonetically trained and untrained participants. The results show that vowel identification may be subject to specific speech mechanisms and non-significantly affected by phonetic training, suggesting the limited role of explicit phonetic instruction in vowel perception among L2 learners and the need for more effective teaching methods. Keywords: vowel identification rate, acoustic, durational manipulations, phonetically trained, untrained

The environmental effects on the response of Date Palm Fiber (DPF) composites are explored through an in-depth analysis of water absorption behavior. This study comprehensively investigates the influence of fiber content, immersion time, and water type on mass gain. Rigorous experimentation and advanced statistical analyses quantify the percent contribution of each factor, emphasizing the dominant role of fiber content at 96.61%. While immersion time and water type contribute relatively smaller percentages (2.11% and 1.28%, respectively), their insights are invaluable for tailored composite design. The study extends to interaction effects, showcasing the combined influence of factors. Regression models, progressing from linear and reciprocal formulations to comprehensive global models, are developed. Meticulous examination of prediction accuracy, using diverse statistical metrics, highlights the superior performance of the global reciprocal model across different water types. This work provides essential insights for optimizing DPF composite design, fabrication, and application, empowering engineers and researchers to make informed decisions in industries demanding tailored water absorption behavior.

Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70–95%]) than MRA (20% [10–30%]), SGLT2i (30% [20–50%]) or (GLP1-RA (10% [5–15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15–40%) vs 18% [10%–25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5–5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers’ dosage reduction was the usual management.

Background Epidural analgesia has emerged as one of the best methods that can be used to reduce labour pain. This study was conducted to assess awareness, attitudes, and practices of pregnant women who visited maternity and antenatal healthcare clinics about epidural analgesia during normal vaginal birth.Methods This multicentre study was conducted in a cross-sectional design among pregnant women using a pre-tested questionnaire. The study population in this study was pregnant women who visited maternity and antenatal healthcare clinics in Palestine.Results In this study, a total of 389 pregnant women completed the questionnaire. Of the pregnant women, 381 (97.9%) were aware of the existence of epidural analgesia, 172 (44.2%) had already used epidural analgesia, and 57 (33.1%) experienced complications as a result of epidural analgesia. Of the pregnant women, 308 (79.2%) stated that epidural analgesia should be available during vaginal birth. Of the pregnant women, 243 (62.5%) stated that they would use epidural analgesia if offered for free or covered by insurance. Multivariate logistic regression showed that women who were younger than 32 years, who have used epidural analgesia, and those who stated that epidural analgesia should be available during vaginal birth were 2.78-fold (95% CI: 1.54–5.04), 4.96-fold (95% CI: 2.71–9.10), and 13.57-fold (95% CI: 6.54–28.16) more likely to express willingness to use epidural analgesia, respectively.Conclusions Pregnant women had high awareness of the existence, moderate knowledge, and positive attitudes towards epidural analgesia for normal vaginal birth. Future studies should focus on educating pregnant women about all approaches that can be used to reduce labour pain including their risks and benefits.

ABSTRACT In this study, the thermal and mechanical characteristics of bamboo fiber-reinforced greenpoxy matrix composites were evaluated by varying the fiber loading from 30wt.% to 60wt.% during the compression molding process. The thermal behavior using dynamic mechanical analysis (DMA) and thermogravimetric analysis (TGA) and their impact and flexural properties of the composites were studied. The results indicate that thermal characterization, the highest peak E’ was observed: B-40 > B-60 > B-30 > B-50, while the peak E’‘ was found to be B-40 > B-30 > B-60 > B-50. The order for tan delta was B-30 > B-40 > B-50 > B-60. The TGA results indicated improved thermal stability with increasing fiber loading, as evidenced by higher residue % and lower weight loss %. Regarding the mechanical properties the impact strength of the composites increased with increasing fiber loading, with the maximum value of 8435.33 J/m2 at 50wt.%. The composite with a 60wt.% fiber loading showed the highest flexural modulus (4.70GPa), while the flexural strength improved at 40wt.%. The SEM analysis of fractured specimens from flexural tests of composite materials with varying fiber volume fractions revealed that an optimal balance between fiber and matrix resin enhanced mechanical properties.

Gel electrophoresis is essential in molecular biology and biochemistry for separating and analyzing DNA, RNA, and proteins. UV sensitivity and compatibility have led to the use of ethidium bromide stains. Mutagenic and toxic, ethidium bromide poses health and environmental risks, requiring strict handling and disposal procedures. This has led to safer, more eco-friendly staining options like SYBR Safe and patented plant-based dyes with reduced toxicity and improved sensitivity. Modern dyes meet rigorous laboratory safety standards and are compatible with safer visualization methods like blue light, improving user safety. We compare the efficacy, cost, and environmental impact of commercial electrophoresis stains in this review. These comparisons suggest using SYBR-safe or plant-based dyes, which stain well in safer lab conditions. These alternatives improve electrophoresis sustainability and safety without compromising analytical quality.

This study aimed to characterize the cervical cancer diagnosis experience of Kenyan women undergoing treatment for cervical cancer. We analyzed qualitative interviews with 29 women living in rural Kenya who were currently undergoing cervical cancer treatment at Machakos Cancer Care and Research Centre at Machakos Level 5 Referral Hospital in eastern Kenya. Semistructured qualitative interviews were conducted in Kiswahili and English and then de-identified and translated to English during transcription. The main themes generated were identified through an inductive approach to determine how women experienced cervical cancer symptoms and their process of navigating healthcare. Three themes emerged from the qualitative interviews: (1) delaying seeking care, (2) misinterpreting or misdiagnoses, and (3) grappling with the costly diagnosis process. Women misattributed early signs of cervical cancer to benign conditions. Women sought care only after experiencing severe symptoms. When they sought care, women reported facing lengthy and costly screening processes before receiving a cervical cancer diagnosis. There is a need to educate women on the early symptoms of cervical cancer and to increase the institutional capacity and availability of cervical cancer screening resources in healthcare facilities.

Congenital hiatal hernia is a rare congenital defect and often occurs at a sporadic basis, but familial cases have also been reported. Here, we report on a 3-year-old male patient of Middle-Eastern descent, diagnosed at 5 months of age patient presenting with a congenital hiatal hernia, vermis hypoplasia manifested by axial hypotonia and horizontal nystagmus, preauricular tag, and dysmorphic features with negative genetic mutations, not fitting any reported association or syndrome, suggesting the potential existence of a novel disease entity and highlighting the necessity for further exploration into rare genetic conditions for comprehensive patient care and syndrome characterization.

IntroductionCarrot (Daucus carota) is a nutrient-dense root vegetable, and carrot pomace is a by-product of the juice extraction procedure, which is recognized a source of phytochemicals and functional components. Almonds (Prunus dulcis) are packed with a decent amount of nutrients and bioactives.MethodsThis study investigates the utilization of carrot pomace powder (CPP) and almond powder (AP) as partial substitutes for straight grade white flour (SGWF) in cakes to enhance their nutritional value and sensory appeal, while reducing waste from carrot processing. The aim is to assess the effects of incorporating CPP (at 5%, 10%, and 15%) and AP (at 5%) on the chemical composition and properties of cakes.Results and discussionComparative analysis reveals that AP is rich in fat (13.8 ± 0.6%) and protein (31 ± 0.6%), while CPP excels in ash (5.0 ± 0.5%) and fiber (43.3 ± 3.3%) content. Furthermore, SGWF exhibits the highest moisture content. Water holding capacities for CPP and AP are 5.2 ± 0.2% and 5.0±0.1%, respectively, and oil holding capacities are 1.3 ± 0.1% and 1.8 ± 0.2%, respectively. Additionally, CPP contains higher levels of sodium, potassium, and calcium, while AP contains higher levels of magnesium, iron, and zinc compared to SGWF. The addition of CPP and AP increases the ash, fat, fiber, and protein contents of the cakes. Notably, cakes containing 80% SGWF, 15% CPP, and 5% AP show significantly higher total phenolic content (TPC) (125.5 ± 3.8 mg GAE/100 g), total flavonoid content (TFC) (58.4 ± 1.4 mg QE/100 g), and DPPH activity (17.6 ± 2.7%) compared to control cakes. Furthermore, a significant increment in mineral content is observed in cakes with high levels of CPP and AP. Sensory evaluations reveal high acceptance of cakes containing 15% CPP and 5% AP. In conclusion, this study suggests that the incorporation of CPP and AP into cakes can improve their nutritional profile, antioxidant activity, and sensory characteristics, offering a sustainable approach to bakery product development.

Background Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality. Methods and Results Mortality from 1999 to 2020, SVI, and demographic data were obtained from CDC databases. County‐specific SVI rankings were linked to PPCM age‐adjusted mortality rates (AAMRs), allowing for a comparative analysis of AAMRs across both cumulative populations and subpopulations to identify disparities. All US counties were then stratified into low‐ and high‐SVI groups, facilitating comparison of SVI rankings by estimation of excess‐deaths per 1 000 000 person‐years attributable to greater social vulnerability and rate ratios (RR) through univariable Poisson regression. We identified a total of 1026 deaths related to PPCM between 1999 and 2020. Overall AAMR increased from 0.180 in 1999 to 0.326 in 2020. Black populations (AAMR: 1.081) and Southern US counties (AAMR: 0.444) had the highest AAMRs compared with other racial and US census groups, respectively. Higher SVI accounted for 0.172 excess deaths per 1 000 000 person‐years (RR=1.800). Among Black and White populations, higher SVI also accounted for 0.248 and 0.071 excess deaths per 1 000 000 person‐years, respectively. Similar impacts of greater social vulnerability were observed when comparing the US census regions (Northeast RR=1.609, Midwest RR=1.819, South RR=1.934, West RR=1.776). Conclusions PPCM mortality disparities exist across racial and geographic populations in the United States. A greater burden of social vulnerability is associated with higher PPCM mortality on a national level.

BackgroundWith the increasing global prevalence of type 2 diabetes (T2D) and obesity, there is a pressing need for novel therapeutic interventions. Lavandula stoechas, a medicinal plant traditionally used for various ailments, holds promise as a potential agent for T2D management, particularly in Morocco, where it is commonly used to treat diabetes. This study aims to evaluate the pharmacological potential of L. stoechas aqueous extract (AqLs) by assessing its lipase inhibition antioxidant and anti-inflammatory activities, identifying phenolic compounds, and examining its efficacy in reducing diabetic complications.MethodsThe pharmacological potential of L. stoechas aqueous extract was investigated using in vitro assays. The inhibitory effect on pancreatic lipase, antioxidant power (FRAP), and anti-inflammatory activity (albumin denaturation method) was assessed. High-performance liquid chromatography (HPLC) analysis identified phenolic compounds. Additionally, albumin glycation was evaluated by estimating fructosamine, carbonyl groups, and amyloid β-structures to assess efficacy in mitigating diabetic complications.ResultsThe extract demonstrated concentration-dependent inhibition of pancreatic lipase (IC50 = 0.132 ± 0.006 mg/mL), potent antioxidant activity (IC50 = 604.99 ± 1.01 μg/mL), and dose-dependent anti-inflammatory effects (IC50 = 207.01 ± 34.94 mg/mL). HPLC analysis revealed phenolic compounds: naringin (38.28%), syringic acid (25.72%), and cinnamic acid (15.88%) were the most abundant, with 4-hydroxybenzoic acid, hydrated catechin, and catechin ranging from 9.60% to 5.24%, and p-coumaric acid (1.73%). Furthermore, the extract inhibited albumin glycation and fructosamine production, suggesting efficacy in mitigating diabetic complications.ConclusionThese findings highlight the multifaceted pharmacological potential of L. stoechas aqueous extract in T2D management, suggesting that this plant can be highly beneficial for diabetic individuals.

Chronic asymptomatic retention of an intragastric foreign body can pose a life-threatening scenario. In the event of migration, it may result in perforation, as shown in our unique case of pericardial perforation through the fundus. Beyond illustrating a rare condition, this case prompts us to engage in a debate about whether to retain or remove asymptomatic foreign bodies in the gastrointestinal tract. It is a 28-year-old male patient, a prisoner, with a history of recurrent foreign body ingestion leading to five previous interventions, presented a year ago to our emergency department after ingesting four metal rods. Despite recommendations, the patient refused the intervention. After 1 year, he presented to our emergency department for respiratory distress. On examination, he had tachycardia, cardiac auscultation revealed a high-pitched sound signing a pericardial knock and abdominal palpation revealed epigastric tenderness. An abdominal X-ray revealed the presence of metallic foreign bodies located in the gastric area. An electrocardiogram showed a low voltage. Given these findings, there was a strong suspicion of rod migration from the stomach to the thoracic cavity with a cardiac tamponade. An emergency CT scan revealed that the rod had pierced through the stomach and pericardium, causing pericardial effusion. The patient was promptly transported to the operating room to discover the tip of the rod out of the stomach and penetrating the left diaphragm and the pericardial layer. The foreign body was removed.

This paper evaluates the policies taken by Jordanian tourism sector before and after COVID-19; it is divided into two parts: the first dealt with the period 2011-2019 which followed the events of Arab Spring, the second focused on the postCOVID-19 period. A mixed methodology was used as for the Arab Spring case a quantitative approach that aimed at measuring the satisfaction of 54 travel agents about policies taken by public tourism sector was used. A Structure Equation Modelling analysis was conducted to test the relationship between specific satisfaction about promotional and economic policies as independent variables, and the general satisfaction as a dependent variable. As for the case of COVID-19, a different approach was used where the Tourism National Strategy 2021-2025 and reports on the influence of COVID-19 on Jordanian Economy were referred to make an evaluation of governmental performance. There was an obvious absence of the concept of “Crisis Management" in tourism national strategies (MOTA, 2003 ; 2010 ; 2015) ; where the focus was on diversifying the tourism product, enhancing the image of the country and increasing competitiveness .

This paper introduces a decoupled unknown input observer (DUIO) for Takagi-Sugeno (T-S) systems, designed specifically for the synchronous reluctance motor (SynRM). The proposed DUIO method demonstrates enhanced robustness and accuracy in state estimation by effectively decoupling the influence of unknown inputs from the estimation error dynamics. Furthermore, the DUIO exhibits superior performance compared to the proportional integral observer (PIO) and the proportional multi-integral observer (PMIO) presented in previous studies, without the need for prior knowledge of the unknown input form or assumptions regarding its boundedness. Stability conditions, achieved using the quadratic Lyapunov function, are expressed as linear matrix inequalities (LMIs), which ensure asymptotic convergence of the estimation error. The effectiveness of the DUIO method is further validated in various scenarios through hardware-in-the-loop (HIL) implementation. This innovative approach significantly enhances the accuracy and reliability of SynRM state estimations and unknown input detections.

In mammals, the pregnant female carries many physiological and anatomical changes. Biochemical profiles are very important tools for monitoring gestation progress. This study was designed to investigate pregnancy-related changes of blood metabolites in Ouled Djellal ewes under semi-arid conditions. Blood samples were collected from ten non pregnant multiparous ewes 4 weeks before conception and 4, 12 and 18 weeks of pregnancy age. The pattern of changes of some biochemical parameters were studied. Cholesterol level showed no significant changes during pregnancy, while triglyceride, AST and Ca decreased up to the 12th week of pregnancy, whereas the total protein, albumin, and creatinine increased toward the 12th week of pregnancy. Urea reached maximum levels at the end of the pregnancy, contrary to ALT that was significantly decreased. Glucose concentration showed a continual decrease varying from 2.08 ± 0.78 g.l−1 at the first month of pregnancy to 0.35 ± 0.36 g.l−1 at the 18th week of pregnancy. On the other hand, pregnancy establishment increased significantly the glucose, triglyceride, albumin, and urea, but it decreased significantly the cholesterol and creatinine levels. No differences were observed between pregnant and non-pregnant ewe for the rest of the parameters. These results demonstrated a clear evidence of pregnancy-related distribution of blood biochemical indices of Ouled Djellal ewe under semi-arid conditions. Some substrates and enzymes were mainly higher during the first half of pregnancy (triglyceride, AST and Ca), and some others increased from the mild pregnancy period (total protein, albumin and creatinine), while urea and ALT changes were observed at late pregnancy. The energetic demand increased with advancing pregnancy.

This article presents an innovative method for efficiently synthesizing radiation patterns by combining the Taguchi method and neural networks, validating the results on a ten-element antenna array. The Taguchi method aims to minimize product and process variability, while neural networks are used to model the relationship between antenna design parameters and radiation pattern characteristics. This approach utilizes Taguchi parameters as inputs for the neural network, which is then trained on a dataset generated by the Taguchi method. After training, the network is validated using a real ten-element antenna array. Analytical results demonstrate that this method enables efficient synthesis of radiation patterns, with a significant reduction in computation time compared to traditional approaches. Furthermore, validation on the antenna array confirms the accuracy and robustness of the approach, showing a high correlation between the performance predicted by the neural network model and actual measurements on the antenna array. In summary, our article highlights that the combined use of the Taguchi method and neural networks, with validation on a real antenna array, offers a promising approach for efficient synthesis of antenna radiation patterns. This approach combines speed, accuracy, and reliability in antenna system design.

Abstract National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.

Objective(s): The current study was conducted to assess the protective mechanisms of n-BuOH fraction from the aerial part of Genista cephontala (BEGC) on APAP-induced liver injury compared to necrostatine-1 (Nec-1).Materials and Methods: A model of APAP-induced hepatotoxicity was created in male rats by injecting a single dose; 1000 mg/kg APAP, the protective effect was performed with (200 mg/kg; 10 days) BEGC compared to Nec-1, (1.8 mg/kg).Results: BEGC or NeC-1 pretreatment significantly abolished impaired effects in APAP-rats, by decreasing the generation of TBARS and ROS in mitochondrial and cytosolic fractions and maintaining liver function activities. A marked response was observed in the levels of both GSH and GSH-system enzymes in liver homogenates and mitochondrial fractions to BEGC. BEGC/ Nec-1 successfully regulated the inflammatory mediators (IL-β, TNF-α, HMGB1, and acHMGB1) and MPO levels. During APAP treatment, no caspase-3 or -8 activity was detected, and the level of fk18; M30 was higher than the levels of cck18; M65. Moreover, RIPK3 and MLKL levels were increased in the APAP group. These results suggested that necroptosis predominates during the APAP liver injury model. Interestingly, these necroptotic factors were significantly down-regulated by BEGC treatment. Both biochemical and histopathological findings were consistent with each other.Conclusion: From all these findings, the hepatoprotective effect of BEGC could be due to the abundance of polyphenols identified by LC-MS/MS analysis, as well as the synergistic interactions of all contents.

Background: Echocardiographic quantification of left ventricular (LV) volume and ejection fraction (EF) is widely used in the pediatric population. However, there is no consensus on the most accurate method of quantifying ventricular volumes and systolic function. Purpose: The purpose of this study is to compare two commonly used echocardiographic methods for the evaluation of LV volume and quantification of EF, the five-sixth area-length (5/6 AL) and the modified biplane Simpson (BS), to cardiac magnetic resonance (CMR) imaging in children. Methods: CMR studies were paired with echocardiograms and retrospectively analyzed in children 18 years of age and younger. Studies performed more than 3 months between modalities, patients with congenital heart disease, and patients who had changes in medication regimen between corresponding CMR and echocardiograms were excluded. LV volumes and EF were calculated using the 5/6 AL and BS methods and compared to volumes and EF measured on corresponding CMR studies. Subgroup analyses were conducted based on LV function, pathology, and weight. Results: We retrospectively analyzed 53 CMR and corresponding echocardiogram studies (23 studies for myocarditis and 30 studies for cardiomyopathy) in 46 patients. LVEF derived by both echocardiographic methods showed a good correlation to CMR (5/6 AL r = 0.85 and BS r = 0.82). However, both echocardiographic methods overestimated LVEF and underestimated LV volumes when compared to CMR. Conclusion: Left ventricular volumes and EF, as measured by echocardiography, correlate well with CMR measurements. Echocardiography underestimates LV systolic and diastolic volumes and overestimates LVEF. While echocardiography is a good surrogate for estimating LVEF, CMR should be considered in patients for whom accurate measurements are needed for critical clinical decision-making.

Abstract This study determined the prevalence and the associated factors with meeting the recommended amount of physical activity among type 2 diabetes mellitus (T2DM) patients receiving care in resource-limited settings of the West Bank of Palestine. Physical activity was assessed using the World Health Organization’s Global Physical Activity Questionnaire. Associations were examined using multivariate logistic regression. Of the 302 patients included, 117 (38.7%) met the recommended amount of physical activity. Being younger than 58 years [aOR = 2.1 (95% CI 1.0–4.3], were employed [aOR = 2.3 (95% CI 1.1–4.9)], had high income [aOR = 3.9 (95% CI 1.3–11.9)], had thought that physical activity was crucial for T2DM patients [aOR = 32.7 (95% CI 3.9–275.5)], did not have comorbidities [aOR = 2.2 (95% CI 1.1–4.4)], had normal weight [aOR = 2.8 (95% CI 1.3–6.0)], and those who were overweight [aOR = 2.6 (95% CI 1.1–6.0)] were more likely to meet the recommended amount of physical activity compared to the patients who were 58 years or older, had low income, did not think that physical activity was crucial for T2DM patients, had comorbidities, and were obese, respectively. There is a need to increase physical activity among T2DM patients in resource limited settings.

Abstract Background The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research. Methods This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared. Discussion/conclusion This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. Systematic review registration PROSPERO CRD42022352333.

The subject of this 6G communication system research is expected to form a hyper-connected network in which various electronic devices can connect continuously without interruption. Several technologies have been built to support 6G communication systems, such as intelligent reflecting surface (IRS). An IRS is a reflector equipped with several two-dimensional passive elements that perform a phase shift by each element, which can reflect electromagnetic (EM) waves coming from the base station (BS) to the user equipment (UE), which is controlled via a controller to increase the signal strength at the UE and overcome poor propagation conditions. IRS can be placed anywhere, such as on a wall or on the roof of a building. The aim of the IRS research is expected to reduce the energy consumption and increase the spectral efficiency of wireless networks using artificial intelligence (AI) with low costs, energy savings, no thermal noise, and fairly small levels of interference. The objective of this research is to evaluate and analyze the energy efficiency (EE), including the achievable rate (AR) and signal-to-noise ratio (SNR), by applying the IRS architecture in a 6G communications system, which uses an operating frequency of 95 GHz and a bandwidth of 800 MHz. Then, the method was based on computer simulation using the Matlab software. In this paper, 6G communication system modeling was proposed. This model uses an urban microcell (Umi) that consists of one base station (BS) with multiple antennas, varying the number of IRS reflecting elements and one user. In this research, AR, SNR, and EE, using the frequency of 95 GHz and simulations with MATLAB@2021a software. The results show that the number of elements as many as 400 is 39% more optimal than the number of elements as many as 40 for the AR results. The SNR results without electromagnetic interference (EMI) are higher than SNR values affected by EMI with SNR results of 100 dBm, and the number of reflecting elements is directly proportional to the SNR results. For 800 elements, the EE value is 26% higher than for 40 elements. Conclusions. The application of IRS in 6G communication systems can increase the AR, SNR, and EE.

Abstract Inertial underdamped collisions preserve the memory of physical parameters that existed before the collision, leading to phenomena usually unseen in overdamped systems. Here we probe the less studied inertial chiral matter with spinners on an air table. We show here the emergence of high levels of spin for a minority of (+) handed spinners in the presence of a majority of (−) handed spinners (vice versa). This deep violation of equipartition occurs due to the inertial (memory preserving) nature of elastic collisions between underdamped translating and rotating objects. Underdamped spinners of the same spin sign annihilate their spins when they elastically collide, transferring their spin angular momentum into orbital angular momentum, while oppositely handed spinners tend to preserve their individual spin levels, leading to the pumping of minority spinners to high spin levels. Entropy production and the flow of entropy in this underdamped system are also counter-intuitive, showing dramatic oscillations in time.

IntroductionMelons are highly sought after worldwide due to their exquisite and delectable taste. However, the peels of these fruits, which are rich in phytochemicals and sustainable components for innovative culinary formulations, are often discarded as waste.MethodsThis study explored the phytochemistry and valorization of three melon fruit, i.e., canary melon (Cucumis melo, var. Fonzy), watermelon (Citrullus lanatus, var. Augusta), and muskmelon (Cucumis melo, var. Cantaloupe), peels in food applications by incorporating into wheat flour biscuits. Peels of fruits were separated, dried and powders were extracted with 70% ethanol.Results and discussionComparing the muskmelon fruit peel to the peels of the other two fruits, the muskmelon fruit peel had the significantly (p

Key Clinical Message The differential diagnoses of popliteal ganglion cysts include Baker's cysts, popliteal artery aneurysms, popliteal tendinitis, popliteal lymphadenopathy, lipomas, and synovial sarcoma.

IntroductionLiver diseases represent a significant global health challenge, with primary causes including excessive alcohol consumption, infections, chemotherapy, and autoimmune disorders. Medicinal plants, due to their natural bioactive compounds, hold promise for developing effective treatments and preventive measures against liver ailments. This study aimed to document the use of herbal remedies in northeastern Morocco for liver diseases and correlate these uses with scientific evidence through a bibliometric analysis.MethodsAn ethnobotanical survey was conducted in remote communities of northeastern Morocco from October 2020 to January 2022. A total of 189 informants were interviewed using semi-structured questionnaires to gather information on local medicinal plants used for liver ailments. The data were analyzed using four ethnobotanical quantitative indices: use value (UV), familial use value (FUV), informant consensus factor (ICF), and fidelity level (FL). Additionally, a bibliometric analysis was performed to evaluate the scientific support for the ethnopharmacological uses documented.ResultsThe survey identified 45 plant species from 26 different families used in the treatment of liver diseases. The most frequently utilized species were Cuminum cyminum L. (UV = 0.1065), Allium sativum L. (UV = 0.1015), Salvia officinalis L. (UV = 0.0761), Asparagus officinalis L. (UV = 0.0558), and Ziziphus lotus (L.) Lam. (UV = 0.0457). The Apiaceae family showed the highest familial use value (FUV = 0.1066), followed by Alliaceae (FUV = 0.1015). Liver congestion had the highest informant consensus factor (ICF = 0.83), followed by hepatic colic (ICF = 0.80). Bibliometric analysis revealed that 61% of the plants identified had documented pharmacological effects related to liver health.DiscussionThe study demonstrates that traditional knowledge in northeastern Morocco encompasses a rich diversity of medicinal plants used to treat liver diseases. The high ICF values indicate a strong consensus among informants on the efficacy of these remedies. The correlation between ethnopharmacological use and scientific validation for a significant portion of these plants suggests their potential as reliable therapeutic agents for liver conditions. However, further scientific investigations are necessary to confirm their efficacy and safety in clinical settings. This research contributes valuable information for future studies on the therapeutic potential of these plants.ConclusionThis ethnobotanical survey provides a comprehensive database of medicinal plants used in northeastern Morocco for liver diseases. The findings highlight the potential of these plants in developing novel treatments for hepatic conditions, although further research is essential to substantiate their therapeutic claims.

In the electronics industry, binary devices have played a critical role since the development of solid-state transistors. While binary technology associates devices' inherent ability to be either ON or OFF with two logic levels, it offers the least amount of information content per interconnect. There's a strong push to switch to a higher radix logic/number system, which can eliminate or reduce many of the limitations of the binary system, due to the exponential growth of data processing and storage needs. The beyond-binary logic systems are strongly motivated by the need to increase processing speed and information density in future micro and nanoelectronic circuits and systems, as well as the expectation that Moore's law will eventually reach saturation. Due to its ability to increase circuit efficiency, multi-valued logic is becoming more and more significant. Novel post-CMOS devices have been designed and made easier to implement ternary logic thanks to technological advances in material science and nanotechnology. When it comes to low power and energy consumption, low complexity, low on-chip and off-chip interconnections, and high speed, the ternary system outperforms the binary system. In order to provide as a starting point for future research and development in the field of ternary logic circuits, this paper provides a brief overview of the implementation of ternary logic systems and their related benefits for the design of digital logic circuit applications using CMOS and various emerging devices as design elements.

ABSTRACT: Aflatoxin B1 (AFB1) is a significant pollutant found in food and feed, posing a threat to public health. The objective of this study was to assess the effect of Lactiplantibacillus plantarum (LACP) against AFB1 in growing rabbits by investigating growth, serum metabolites, immunity, antioxidant capacity, and inflammatory response. A total of 60 growing male rabbits (721.5 ± 2.68g) were allocated to 4 experimental groups. The control group receiving only a basal diet, the AFB1 group (0.3 mg AFB1/kg diet), the LACP group (1 × 109 cfu/g /kg diet), and the combination group (1 × 109 cfu/g + 0.3 mg AFB1/kg diet; AFB1+ LACP) for 8 wk. The administration of AFB1 alone significantly decreased the final body weight, body gain, and feed intake, while significantly increasing the feed conversion ratio (P < 0.05). A significant decline in total proteins and globulins, along with elevated levels of hepatic enzymes (AST, ALP, ALT, and GGT) and renal function markers (creatinine and uric acid), were observed in the AFB1-contaminated group (P < 0.05). Immunoglobulins (IgG and IgM) were significantly decreased, alongside a significant elevation of triglycerides, direct bilirubin, and indirect bilirubin in growing rabbits fed diets with AFB1 (P < 0.05). Supplementing the AFB1 diet with LACP restored the growth reduction, improved liver (AST, ALP, ALT, and GGT) and kidney (creatinine and uric acid) functions, and enhanced immune markers in rabbit serum (P < 0.05). Antioxidant indices (SOD, GSH, and CAT) were significantly decreased in the AFB1 group (P < 0.05). However, the addition of LACP to the AFB1-contaminated diets improved antioxidant capacity and malondialdehyde (MDA) and protein carbonylation (PC) in hepatic tissues of rabbits (P < 0.05). Serum interlukin-4 (IL-4) and interferon gamma (IFN‐γ) levels were significantly increased in the AFB1 group (P < 0.05), but the addition of LACP significantly reversed this elevation. AFB1 downregulated the expression of immune-inflammatory genes such Nrf2, IL-10, and BCL-2 genes, while up-regulating the caspase-3 (CASP3) gene (P < 0.05). Supplementing AFB1 diet with LACP significantly decreased the expression of immune-inflammatory genes (Nrf2, IL-10, and BCL-2) and reduced the expression of the apoptotic-related gene CASP3. This study highlights the potential of L. plantarum (1 × 109 cfu/g /kg diet) as a protective agent against AFB1 in growing rabbits by enhancing antioxidant and immune function and reducing apoptosis and inflammation pathways.