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Objectives: Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile., Methods: This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs., Results: Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining ( N  = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 ( p  < 0.001).  The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min,  p  = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg,  p  = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients., Conclusions: Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O 2  saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.

I-cell disease (Mucolipidosis Type II) is a rare lysosomal storage disorder caused by GNPTAB gene defects, leading to severe morbidity and mortality. The authors present the case of a neonate born at 38 wk gestational age, with suspected skeletal dysplasia during pregnancy and a complex clinical and laboratory presentation after birth. This is a rare case, and its diagnosis was made through placental pathology, which revealed the condition called mucolipidosis Type II. To the best of authors' knowledge, this is one of the few cases diagnosed in the neonatal period with placental pathology globally and the first in Canada, highlighting the significance of placental pathology for the diagnosis of these rare conditions and future counseling of the parents. In conclusion, mucolipidosis Type II is a rare condition in neonates. Early diagnosis in neonates can be made through placental pathology for parental counseling., Competing Interests: Declarations Conflict of Interest None., (© 2024. Crown.)

A gap in the literature exists about the associations between adaptive eating patterns like mindful eating, body appreciation and psychological distress within the Lebanese population. The current culture of acceptance and increased emphasis on wellbeing elicits interest in studying body acceptance and its correlates. The aim of the current study is to assess the mediating effect of psychological distress in the association between body appreciation and mindful eating behaviors among a sample of Lebanese adults. This cross-sectional study enrolled 465 participants. Men and women over the age of 18 were eligible to participate. Then, initial participants were asked to recruit other participants they know. Individuals who consented took an online questionnaire that contained the following scales: a section collecting sociodemographic information, Mindful Eating Behavior Scale, Depression Stress Anxiety Scale (DASS-8) and Body Appreciation (BAS-2). The results of the mediation analysis showed that psychological distress fully mediated the associations between body appreciation and eating with awareness/eating without distraction. Higher body appreciation was significantly associated with less psychological distress, whereas higher psychological distress was significantly associated with less eating with awareness/eating without distraction. However, body appreciation was not associated with eating with awareness/eating without distraction respectively. These findings could guide further research on different categories of adaptive eating patterns and positive body variables within the Lebanese population.

This article presents a Z source (ZS) based switched capacitor multilevel inverter (SC-MLI) with low capacitors charging inrush currents utilizing a modified modulation strategy. The topology generates nine output voltage levels with quadruple voltage gain utilizing eight power switches, five capacitors, two inductors, four discrete diodes, and a single DC source. The voltage gain can be further increased by applying shoot through (ST) states to the frontend ZS-network. Owing to its high voltage gain, the topology is suitable for low voltage renewable energy sources such as photovoltaics (PV), and fuel cells (FC). A modified modulation strategy is presented based on the conventional level shifted sinusoidal pulse width modulation (LS-SPWM). The proposed modulation strategy improves the dc-link utilization at higher modulation index. A detailed mathematical analysis is provided for the gain calculation based on the modified modulation strategy. A comparative study is implemented to verify the merits of the proposed topology. A simulation model is implemented utilizing MATLAB / Simulink to verify the topology characteristics. The power losses and efficiency calculations are presented using Altair PSIM. Furthermore, an experimental prototype is constructed to verify the simulation findings. The topology is tested with different loading conditions at numerous modulation index values and ST duty ratios. Furthermore, step change conditions are implemented to test the topology response. The effect of the ZS network on the switched capacitors charging inrush currents is validated. The proposed topology shows an overall advantage in terms of the output characteristics as well as the hardware requirements., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Previous studies have reported race-based health disparities in North America. It is unknown if emergency medical service (EMS) treatment of out-of-hospital cardiac arrest (OHCA) varies based on race. We sought to compare markers of resuscitation intensity among different racial groups., Methods: Using data of adult EMS-treated OHCAs from the Trial of Continuous or Interrupted Chest Compressions During CPR, we analyzed data from participants for whom on-scene return of spontaneous circulation (ROSC) was not achieved. We fit multivariate regression models using a generalized estimating equation, to estimate the association between patient race (White vs. Black vs. "Other") and the following markers for resuscitation intensity: (1) resuscitation attempt duration; (2) intra-arrest transport; (3) number of epinephrine doses; (4) EMS arrival-to-CPR interval, and (5) 9-1-1 to first shock., Results: From our study cohort of 5370 cases, the median age was 65 years old (IQR: 53-78), 2077 (39 %) were women, 2121 (39 %) were Black, 596 (11 %) were "Other race", 2653 (49 %) were White, and 4715 (88 %) occurred in a private location. With reference to White race, Black race was associated with a longer resuscitation attempt duration and a lower number of epinephrine doses; Black and "Other" race were both associated with a lower odds of intra-arrest transport., Conclusion: We identified race-based differences in EMS resuscitation intensity for OHCA within a North American cohort, although 40% of race data was missing from this dataset. Future research investigating race-based differences in OHCA management may be warranted., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The first aim of the study is to clarify the associations between intuitive eating, self-esteem, physical appearance and psychological distress; and second, to assess the mediating effect of psychological distress on the relationship between self-esteem/physical appearance comparison and intuitive eating. A total of 359 Lebanese participants from several Lebanese governorates were enrolled in this cross-sectional study between September and November 2022. The data was collected through an online questionnaire that included the following scales: Intuitive Eating Scale‑2, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale, and Physical Appearance Comparison Scale. The results of the mediation analysis showed that depression partially mediated the association between self-esteem / physical appearance comparison and intuitive eating. Higher self-esteem was significantly associated with lower depression; higher depression was significantly associated with more intuitive eating. Also, higher self-esteem was directly and significantly associated with more intuitive eating. On another hand, higher physical appearance comparison was significantly associated with higher depression; higher depression was significantly associated with more intuitive eating. Finally, higher physical appearance comparison was directly and significantly associated with less intuitive eating. The current study shows how significantly intuitive eating, an adaptive eating pattern, and psychological variables are interrelated and possibly affect each other. It helps shed light on intuitive eating, a somewhat unfamiliar eating pattern within the Lebanese population. These findings allow practitioners to promote healthy eating behaviors and psychological health by educating and guiding patients and clients about intuitive eating., (© 2024. The Author(s).)

Machines powered by artificial intelligence have the potential to replace or collaborate with human decision-makers in moral settings. In these roles, machines would face moral tradeoffs, such as automated vehicles (AVs) distributing inevitable risks among road users. Do people believe that machines should make moral decisions differently from humans? If so, why? To address these questions, we conducted six studies (N = 6805) to examine how people, as observers, believe human drivers and AVs should act in similar moral dilemmas and how they judge their moral decisions. In pedestrian-only dilemmas where the two agents had to sacrifice one pedestrian to save more pedestrians, participants held them to similar utilitarian norms (Study 1). In occupant dilemmas where the agents needed to weigh the in-vehicle occupant against more pedestrians, participants were less accepting of AVs sacrificing their passenger compared to human drivers sacrificing themselves (Studies 1-3) or another passenger (Studies 5-6). The difference was not driven by reduced occupant agency in AVs (Study 4) or by non-voluntary occupant sacrifice in AVs (Study 5), but rather by the perceived social relationship between AVs and their users (Study 6). Thus, even when people adopt an impartial stance as observers, they are more likely to believe that AVs should prioritize serving their users in moral dilemmas. We discuss the theoretical and practical implications for AV morality., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Duodenal gastrointestinal stromal tumors (D-GISTs) are a rare subtype of GISTs, accounting for only 4% to 5% of all GIST cases. This case report details the presentation, diagnosis, and management of a 48-year-old female who presented with melena and anemia and was eventually diagnosed with a D-GIST. The tumor was identified through imaging studies, and histopathology performed after surgical resection revealed a submucosal neoplasm composed of spindle cells with extensive hemorrhage and necrosis. Given the tumor's rarity and its challenging presentation, which can mimic other conditions such as pancreatic masses, the case underscores the importance of considering D-GIST in differential diagnoses of duodenal or pancreatic lesions. Surgical resection remains the cornerstone of treatment, with adjuvant therapy considered in high-risk cases to prevent recurrence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Amin et al.)

Background: Research on incidence and characteristics of Out-of-Hospital Cardiac Arrest (OHCA) in the Middle East is limited. We assessed the incidence, prehospital characteristics, and outcomes of OHCA in Qatar, a Middle Eastern country. Subsequently, we performed gender-specific analysis., Methods: This was a retrospective examination of data obtained from the OHCA registry at Hamad Medical Corporation (HMC) in Qatar from 2017 to 2022. We included adults, non-traumatic, EMS-treatment OHCA. We calculated the incidence of adult OHCA and conducted descriptive analyses for prehospital characteristics, and prehospital outcomes presented by return of spontaneous circulation (ROSC). We evaluated gender differences in prehospital characteristics and ROSC using Student's t-test and the Chi-Square test as appropriate. Furthermore, we conducted a multivariable logistic regression analysis to investigate the correlation between gender and achieving ROSC., Results: We included 4,306 adult OHCA patients, with 869 (20.2%) being females. The mean annual incidence of adult OHCA was 27.4 per 100,000 population-year. Males had a higher annual incidence of OHCA than females. Among all cases, 36.3% occurred in a public location, 25.8% had an initial shockable rhythm, and 28.8% achieved ROSC. Males had a higher proportion of bystander CPR, arrests in public locations, and initial shockable rhythms. While unadjusted analysis showed no significant gender differences in achieving ROSC, adjusted analysis revealed that male gender was associated with higher odds of achieving ROSC (adjusted OR male vs. female 1.38, 95% CI 1.15-1.66, p < 0.001)., Conclusions: Approximately 720 adults undergo non-traumatic OHCA in Qatar every year, with a higher incidence observed in males. Male gender was associated with higher odds of achieving ROSC. Further gender-specific research in OHCA intervention and outcome in the Middle East is required., (© 2024. The Author(s).)

Objective: Optimal timing for subsequent defibrillation attempts for Out-of-hospital cardiac arrest (OHCA) patients with recurrent VF/pVT is uncertain. We investigated the relationship between VF/pVT duration and return of spontaneous circulation (ROSC) in OHCA patients with recurrent shockable rhythms., Methods: We analyzed data from the Salt Lake City Fire Department (SLCFD) spanning from 2012 to 2023. The implementation of rhythm-filtering technology since 2011 enabled real-time rhythm interpretation during CPR, with local protocols allowing early defibrillation for recurrent/refractory VF/pVT cases. We included patients experiencing four or five episodes of VF and pVT rhythms and employed generalized estimating equation (GEE) regression analysis to examine the association between VF/pVT durations preceding recurrent defibrillation and return of spontaneous circulation (ROSC)., Results: Analysis of 622 appropriate shocks showed that patients achieving ROSC had significantly shorter median VF/pVT duration than those who did not achieve ROSC (0.83 minutes vs. 1.2 minutes, p = 0.004). Adjusted analysis of those with 4 VF/pVT episodes (N = 142) revealed that longer VF/pVT durations were associated with lower odds of achieving ROSC (odds ratio: 0.81, 95% CI: 0.72-0.93, p = 0.005). Every one-minute delay in intra-arrest defibrillation is predicted to decrease the likelihood of achieving ROSC by 19%., Conclusion: Every one-minute increase in intra-arrest VF/pVT duration was associated with a statistically significant 19% decrease in the chance of achieving ROSC. This highlights the importance of reducing time to shock in managing recurrent VF/pVT. The findings suggest reevaluating the current recommendations of two minutes intervals for rhythm check and shock delivery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

In this paper, a single stage buck-boost DC-AC converter based on coupled inductors is presented for renewable energy and electric vehicle applications. The proposed topology works with only three semiconductor switches, two diodes, and three coupled inductors to transfer input DC voltage to a high gain or low gain output AC voltage. A coupled inductor is used instead of normal inductors, which will reduce core and size requirements. The sinusoidal pulse width modulation strategy is used in this paper for controlling the main switch. There are many merits in the presented topology, like high gain up to five times of input voltage, compact size, less number of components, which results in reducing the overall cost, reducing switching loss, and increasing the converter efficiency. The simulation study is carried out using MATLAB/SIMULINK to simulate the operation of the proposed converter. Also, an experimental setup is built up to examine the actual operation of the proposed converter. There is a good agreement between simulation and experimental results which increases the validation and confidence of the model., (© 2024. The Author(s).)

Aims: Previous research has reported racial disparities in out-of-hospital cardiac arrest (OHCA) interventions, including bystander CPR and AED use. However, studies on other prehospital interventions are limited. The primary objective of this study was to investigate race/ethnic disparities in out-of-hospital cardiac arrest (OHCA) interventions: EMS response times, medication administration, and decisions for intra-arrest transport. The secondary objective was to evaluate differences in the provision of Bystander CPR (CPR) and application of AED., Methods: We retrospectively analyzed data from the Salt Lake City Fire Department (2010-2023). We included adults 18 years or older with EMS-treated OHCA. Race/ethnicity was categorized as White people, Asian people, Black people, Hispanic people, and others. We employed multivariable regression analysis to evaluate the association between race/ethnicity and the outcomes of interest., Results: Unadjusted analyses revealed no significant differences across ethnic groups in EMS response, medication administration, bystander CPR, or intra-arrest transport decisions. However, significant ethnic disparities were observed in Automated External Defibrillator (AED) utilization, Black people having the lowest rate (6.5%) and Asian people the highest (21.8%). The adjusted analysis found no significant association between race/ethnicity and all OHCA intervention measures, nor between race/ethnicity and survival outcomes., Conclusions: Our multivariable analysis found no statistically significant association between race/ethnicity and EMS response time, epinephrine administration, antiarrhythmic medication use, bystander CPR, AED intervention, or intra-arrest transport. These results imply regional variations in ethnic disparities in OHCA may not be consistent across all areas, warranting further research into disparities in other regions and additional influential factors like neighborhood conditions and socioeconomic status., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

The current study aims to examine the relationship between Social Media Use Disorder (SMUD) and Orthorexia Nervosa (ON), and evaluate the indirect effect of loneliness in this association. This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. Data about information about the social media applications mostly used (Instagram, Facebook, Twitter, etc.), the number of times of entry to social media applications, the time spent on these applications, ON, loneliness and SMUD, were also collected. The Mplus v.7.2 software was used to estimate categorical confirmatory factor analyses (CFA) of the SMD and loneliness scales. The one-factorial model of the SMD scale fitted well according to χ2/df (69.71/27 = 2.58), TLI (.967), CFI (.956), and RMSEA values (.066; CI [.047-.085]; pclose = .079). The one-factorial model of the loneliness scale fitted well according to χ2/df (10.30/5 = 2.06) TLI (=0.97), CFI (=0.98), and RMSEA values (=0.054; CI [0.000-0.101]; pclose = 0.379). When entering the social media applications and time spent on these applications as independent variables in a first regression model, using Instagram (Beta = 2.73), using Tumblr (Beta = 3.22), spending 30-60 minutes per day on social media apps compared to less than 30 minutes (Beta = 2.33), higher physical activity index (Beta = 0.04) and loneliness (Beta = 0.67) were significantly associated with more ON. When entering the SMUD score as an independent variable in a second regression model, the results showed that higher SMUD (Beta = 0.50) was significantly associated with more ON. Also, loneliness played a partial indirect role in the association between SMUD and ON (by 16%). The current results can help mental health professionals better detect these potential psychological disorders and might help improve future treatment of issues related to ON and SMUD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Prior research indicates sex disparities in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA). This study investigates the presence of such differences in Salt Lake City, Utah., Methods: We analyzed data from the Salt Lake City Fire Department (2008‒2023). We included adults with non-traumatic OHCA. We calculated the annual incidence of OHCA and examined sex-specific survival outcomes using multivariable logistic regression, adjusting for OHCA characteristics known to be associated with survival., Results: The annual incidence of OHCA was 76 per 100,000 person-years. Among the 894 OHCA cases included in the analysis, 67.5% were males, 37.3% achieved return of spontaneous circulation (ROSC), and 13.6% survived hospital discharge. Unadjusted analysis revealed that males had significantly higher OHCA in public locations (43.9% vs. 28.6%), witnessed arrests (54.5% vs. 47.8%), and shockable rhythms (33.3% vs. 22.9%). Males also showed higher rates of ROSC (37.5% vs. 36.9%), hospital discharge survival (14.5% vs. 11.7%), and neurologically intact survival. After adjusting for the OHCA characteristics, there was no significant differences between males and females in ROSC, survival to hospital discharge, and favorable neurological function with adjusted odds ratios (male vs. female) of 0.92 (95% confidence interval [CI] 0.73‒1.16), 0.85 (95% CI 0.59‒1.22), and 0.92 (95% CI 0.62‒1.40), respectively., Conclusion: Approximately, 128 adults suffer OHCA in Salt Lake City annually. Males initially showed higher crude survival rates, but after adjusting for OHCA characteristics, no significant sex differences in survival outcomes were found. Enhancing OHCA characteristics could benefit both sexes. Investigations into the relationship between sex- and region-specific factors influencing OHCA outcomes are needed., Competing Interests: The authors declare they have no conflicts of interest., (© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Objectives: Splenectomy during liver transplant can affect platelet function. In this study, our primary aim was to assess the perioperative platelet function by rotational thromboelastometry and the effects of splenectomy on platelet function., Materials and Methods: We studied 40 consecutive liver transplant recipients with end-stage liver disease (50% as a result of hepatitis C). Patients with splenectomy were compared with patients without splenectomy (n = 20/group). Three platelet function parameters by rotational thromboelastometry were studied: platelet activation with arachidonic acid, platelet activation with adenosine diphosphate, and platelet activation with thrombin receptor-activating peptide 6. Patients were monitored perioperatively and until postoperative day 21. Heparin was infused for 2 days postoperatively (60-180 U/kg/day), followed by administration of subcutaneous low-molecular-weight heparin (40 mg/24 h) on postoperative days 2 and 3 and oral acetylsalicylic acid when platelet count was >50 × 103/μL., Results: Liver disease contributed to low perioperative platelet count and function. Patients showed significant improvement by postoperative day 14 and day 21, particularly after splenectomy. Platelet count was significantly correlated with the 3 platelet function parameters by rotational thromboelastometry (P < .001). Acetyl salicylic acid was required earlier (postoperative day 3) for patients with splenectomy (8/20) but only affected the platelet function represented by platelet activation with arachidonic acid, whereas other platelet activation pathways were less affected. Patients received no transfusions of platelet units., Conclusions: End-stage liver disease significantly contributed to low platelet function and counts before transplant. Two weeks were required for recovery of patients posttransplant, with further enhancement by splenectomy. Some recipients showed recovery that exceeded the normal reference range, which warranted monitoring. Acetyl salicylic acid only affected 1 platelet activation receptor.

Objective: The aim of the current study is to evaluate the moderating effect of psychological distress variables, depression, anxiety and stress on the relationship between affective temperaments and future anxiety, assessed with the Dark Future scale., Methods: Lebanese adults from all districts/governorates of Lebanon participated in this cross-sectional study. The data was collected through a questionnaire including: a section about sociodemographic characteristics, the Dark Future scale (DFS), the Depression Anxiety Stress Scale (DASS-8) and the Affective Temperament Scale (TEMPS-M)., Results: The interaction irritable temperament by psychological distress (p = .007) was significantly associated with dark future; at low levels of psychological distress, more irritable temperament (Beta = 0.16) was significantly associated with more dark future. The interaction anxious temperament by psychological distress (p = .010) was significantly associated with dark future; at low (Beta = 0.34), moderate (Beta = 0.25) and high (Beta = 0.15) levels of psychological distress, more anxious temperament was significantly associated with more dark future., Conclusion: The nature of the associations among depression, anxiety and stress, specific temperaments and anxiety towards the future in a sample of Lebanese individuals was clarified. This is especially significant as Lebanese people live in circumstances that promote psychological distress and future anxiety such as dramatic economic and political crises, instability and lack of security in different aspects of life., (© 2024. The Author(s).)

The electronic structure of ammonia-borane (NH 3 BH 3 ) has been investigated by using valence and core photoelectron spectroscopy and near-edge X-ray absorption fine structure spectroscopy at the nitrogen and boron K edges. The first two valence ionic states display vibronic structure, in agreement with the published results for the first ionic state. Analysis of the vibrational frequency of the second state yields an assignment which is consistent with the calculated molecular orbital character reported in the literature. The energies of the valence ionic states are in good agreement with recent calculations. More accurate experimental core-level binding energies, compared with older values, are provided and are in very good agreement with recent calculations. The near-edge X-ray absorption fine structure spectra display a vibronic structure, and the values of the vibrational energies are analyzed to assign the resonance structure., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Objective: To determine the association of maternal pre-pregnancy body mass index (BMI) and neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA) in infants born < 29 weeks gestation., Study Design: Infants born between 2005 and 2015 at < 29 weeks gestation were included. BMI was categorized into BMI 1 [18.5-24.9 kg/m 2 ], BMI 2 [25-29.9 kg/m 2 ], BMI 3 [ ≥ 30 kg/m 2 ]. Primary outcome was death or NDI (Bayley-III scores < 85, cerebral palsy, hearing or visual impairment). Univariate and multivariate analysis were used., Results: There were 315 infants in BMI 1 , 235 in BMI 2, and 147 in BMI 3 groups. Adjusted odds ratio (aOR) of death or NDI in BMI 2 vs. BMI 1 and BMI 3 vs BMI 1 groups were 1.33 (95% CI 0.86-2.06) and 0.76 (95% CI 0.47-1.22). Adjusted odds ratio of Bayley-III language composite < 85 was 2.06 (95% CI 1.28-3.32)., Conclusion: Pre-pregnancy BMI was not associated with death or NDI in extremely preterm infants. Infants born to overweight mothers had higher odds of low language scores., (© 2023. Crown.)

The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups., (© 2023. Springer Nature Limited.)

Individuals with cancer face daily challenges regarding diet and healthy lifestyle behaviors that may lead them to better health. This quest for improved health can be exaggerated in unhealthy ways if it is not approached with moderation as occurs with a condition called orthorexia nervosa (ON). Our aim in this study was to determine the prevalence of ON tendencies and their behavioral correlates among Lebanese adults with cancer. This was a monocentric cross-sectional study, conducted between December 2021 and February 2022, involving 366 patients. We collected data via telephone and recorded answers online on a Google form. We used the Düsseldorf Orthorexia Scale (DOS) to assess orthorexic behaviors, and we checked for behavioral correlates of orthorexia through a linear regression model using the DOS score as the dependent variable. On the DOS scale, we found that 9% of these participants showed possible ON tendencies, whereas 22.2% had definite ON tendencies. Factors associated with having more ON tendencies were (a) receipt of hormonotherapy, (b) being female and (c) having breast cancer. Having prostate cancer was significantly associated with fewer ON tendencies. Our results should help improve the management of patients with cancer through programs to increase patient awareness and education., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Previous studies conducted in North America, Europe, and East Asia (Liu et al., EClinicalMedicine 44:101293, 2022; Matsui et al., JAMA Netw Open 2:e195111, 2019; Awad et al., J Am Coll Emerg Physicians Open 4:e12957, 2023; Yoon et al., Prehosp Emerg Care :1-7, 2022) reported gender disparities in the provision of bystander CPR for patients with out-of-hospital cardiac arrest (OHCA). However, it remains unknown whether similar disparities exist in the Middle Eastern and Gulf regions. The primary objective of this study is to evaluate gender differences in the provision of bystander CPR for patients with OHCA in Qatar., Methods: Retrospective analysis of data obtained from Hamad Medical Corporation OHCA registry in the State of Qatar (2016-2022). We included adults with non-traumatic and EMS-attended OHCA. We used multilevel logistic regression to examine the association between gender and provision of bystander CPR., Results: In total, 4283 patients were included. Of those, 3414 (79.7%) were males, 1639 (38.3%) arrested in public locations, and 1463 (34.2%) received bystander CPR. Unadjusted comparisons showed that females were significantly older than males (mean age: 62.2 vs. 52.7). Females had a lower proportion of OHCA occurring in public locations (15.1% vs. 44.2%) and a lower proportion of shockable rhythm (11.9 vs. 27.5%). Regarding the outcome variable (provision of bystander CPR), the unadjusted analysis showed that the proportion of females who received bystander CPR was lower than that of males (29.2% vs. 35.4%, p < 0.001). However, after adjustment, we found no significant difference in provision of bystander CPR by gender (adjusted OR female vs. male 0.99, 95% CI 0.84-1.20, p = 0.97). In the subgroup who arrested in public locations, the analysis revealed females had greater odds of receiving bystander CPR (adjusted OR female vs. male 1.47, 95% CI 1.10-1.82, p = 0.04)., Conclusions: Overall, bystander CPR was less common in female gender; after adjustment for other covariates, including arrest location, we found no significant gender differences in provision of bystander CPR. We also observed that females were found to have a lower incidence of cardiac arrest in public locations. Nevertheless, if females were to experience cardiac arrest in a public location, they would be more likely to receive CPR. Further research is required to explain the observed differences in provision of bystander CPR., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To evaluate the effect of depression, anxiety, stress, insomnia, work fatigue, religiosity, and spirituality on quality of life (QOL) among family caregivers of people with mental Illness and those who care for family members without mental illness., Methods: A case-control study was conducted between July and September 2019 that enrolled 600 caregivers using a proportionate sample from all Lebanese governorates. Participants completed a 2-part questionnaire. The first part assessed sociodemographic and other characteristics and the second part comprised various scales including the Quality of Life 12-Item Short Form Health Survey, 9-Item Patient Health Questionnaire, Generalized Anxiety Disorder 7 Item, Perceived Stress Scale, Work Fatigue Inventory, Lebanese Insomnia Scale, Mature Religiosity Scale, and Spirituality Index of Well-Being., Results : Higher stress ( P  < .001), higher depression ( P  < .001), higher emotional work fatigue (P < .001), married parents compared to single ( P  = .026), having a child with an intellectual disability ( P  = .002), and sleep-wake disorders ( P  = .003) were significantly associated with lower physical QOL, whereas higher spirituality ( P  < .001) was associated with higher physical QOL. Higher insomnia ( P  = .01), higher anxiety ( P  = .017), higher mental work fatigue ( P  < .001), living with a patient having a mental psychiatric illness ( P  = .023), caregivers with a chronic disease ( P  = .040), and taking care of a child with depressive disorders ( P  = .027) were significantly associated with lower mental QOL, whereas higher spirituality was significantly associated with higher mental QOL., Conclusions: The care of a person with mental illness involves multiple challenges and problems, leading to negative impacts on the familial caregivers' mental health and magnified by the absence of sufficient support and awareness and training programs in Lebanon., Prim Care Companion CNS Disord 2023;25(4)22m03333 ., Author affiliations are listed at the end of this article., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

In this paper, a single-phase direct pulse width modulation (PWM) buck-boost AC-AC converter is proposed. The proposed converter utilizes a minimum number of semiconductor switches and passive components that decreases the converter power losses and offers high efficiency. It can be operated with simple PWM control and doesn't require soft-commutation strategies. It does not suffer from input source shoot-through and commutation problems. Moreover, it supplies both continuous input and output currents. The common sharing ground of the input and output gives the proposed converter the feature that it can be utilized for voltage sag and swell compensation. A comparison of the proposed converter performance with similar existing converters is presented. Also, detailed circuit analysis, component design guidelines, and simulation results using the MATLAB/Simulink environment are demonstrated. A laboratory prototype has been built and tested to validate the converter performance and confirm the results obtained by computer simulation., (© 2023. The Author(s).)

Objective: We investigated sex differences in 1-year survival in a cohort of patients who survived out-of-hospital cardiac arrest (OHCA) to hospital discharge. We hypothesized that female sex is associated with higher 1-year posthospital discharge survival., Methods: A retrospective analysis of linked data (2011-2017) from clinical databases in British Columbia (BC) was conducted. We used Kaplan-Meier curves, stratified by sex, to display survival up to 1-year, and the log-rank test to test for significant sex differences. This was followed by multivariable Cox proportional hazards analysis to investigate the association between sex and 1-year mortality. The multivariable analysis adjusted for variables known to be associated with survival, including variables related to OHCA characteristics, comorbidities, medical diagnoses, and in-hospital interventions., Results: We included 1278 hospital-discharge survivors; 284 (22.2%) were female. Females had a lower proportion of OHCA occurring in public locations (25.7% vs. 44.0%, P  < 0.001), a lower proportion with a shockable rhythm (57.7% vs. 77.4%, P  < 0.001), and fewer hospital-based acute coronary diagnoses and interventions. One-year survival for females and males was 90.5% and 92.4%, respectively (log-rank P  = 0.31). Unadjusted (hazard ratio [HR] males vs. females 0.80, 95% confidence interval [CI] 0.51-1.24, P  = 0.31) and adjusted (HR males vs. females 1.14, 95% CI 0.72-1.81, P  = 0.57) models did not detect differences in 1-year survival by sex., Conclusion: Females have relatively unfavorable prehospital characteristics in OHCA and fewer hospital-based acute coronary diagnoses and interventions. However, among survivors to hospital discharge, we found no significant difference between males and females in 1-year survival, even after adjustment., (© 2023 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)

Do people hold robots responsible for their actions? While Clark and Fischer present a useful framework for interpreting social robots, we argue that they fail to account for people's willingness to assign responsibility to robots in certain contexts, such as when a robot performs actions not predictable by its user or programmer.

Objective: To investigate the relationship between personality traits and procrastination and the mediating role of emotional intelligence (EI) among a sample of Lebanese medical students., Methods: This cross-sectional study was conducted between June and December 2019. A total of 296 students filled out a questionnaire that consisted of sociodemographic characteristics and the following scales: Procrastination Assessment Scale for Students, Big Five Personality Test, and Quick Emotional Intelligence Self-Assessment Scale., Results: Since no bivariate associations were found between sociodemographic variables, they were not included in the mediation analysis. EI mediated the association between neuroticism and procrastination. Neuroticism was significantly associated with lower EI ( P  < .01) and lower procrastination ( P  < .001), whereas higher EI was significantly associated with lower procrastination ( P  < .001). EI mediated the association between openness to experience and procrastination. Openness to experience was significantly associated with higher EI and higher procrastination ( P  < .001), whereas higher EI was significantly associated with lower procrastination ( P  < .001)., Conclusions: The results emphasize the role of EI in personality and procrastination and highlight its importance in clinical settings. It is important for clinicians, especially school and university counselors, to identify risk factors beyond low levels of adaptive personality traits such as EI within the clinical setting to reduce irrational procrastination and improve academic performance., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

Prenatal stress may evoke considerable physiological consequences on the developing poultry embryos and neonates. The present study aimed to determine prenatal auditory stimulation effects on serum levels of ceruloplasmin (CPN), alpha-1-acid glycoprotein (AGP), corticosterone (CORT), and heat shock protein 70 (Hsp70) regulations in developing chicken embryos and newly hatched chicks. Hatching eggs were subjected to the following auditory treatments; 1) control (no additional sound treatment other than the background sound of the incubator's compressors at 40 dB), 2) noise exposure (eggs were exposed to pre-recorded traffic noise at 90 dB) (NOISE), and 3) music exposure (eggs were exposed to Mozart's Sonata for Two Pianos in D Major, K 488 at 90 dB) (MUSIC). The NOISE and MUSIC treatments were for 20 min/h for 24 h (a total of 8 h/d), starting from embryonic days (ED) 12 to hatching. The MUSIC (1.37 ± 0.1 ng/mL) and NOISE (1.49 ± 0.2 ng/mL) treatments significantly elevated CPN at ED 15 compared to the Control (0.82 ± 0.04 ng/mL) group and post-hatch day 1 (Control, 1.86 ± 0.2 ng/mL; MUSIC, 2.84 ± 0.4 ng/mL; NOISE, 3.04 ± 0.3 ng/mL), AGP at ED 15 (Control, 39.1 ± 7.1 mg/mL; MUSIC, 85.5 ± 12.9 mg/mL; NOISE, 85.4 ± 15.1 mg/mL) and post-hatch day 1 (Control, 20.4 ± 2.2 mg/mL; MUSIC, 30.5 ± 4.7 mg/mL; NOISE, 30.3 ± 1.4 mg/mL). CORT significantly increased at ED 15 in both MUSIC (9.024 ± 1.4 ng/mL) and NOISE (12.15 ± 1.6 ng/mL) compared to the Control (4.39 ± 0.7 ng/mL) group. On the other hand, MUSIC exposed embryos had significantly higher Hsp70 expression than their Control and NOISE counterparts at ED 18 (Control, 12.9 ± 1.2 ng/mL; MUSIC, 129.6 ± 26.4 ng/mL; NOISE, 13.3 ± 2.3 ng/mL) and post-hatch day 1 (Control, 15.2 ± 1.7 ng/mL; MUSIC, 195.5 ± 68.5 ng/mL; NOISE, 13.2 ± 2.7 ng/mL). In conclusion, developing chicken embryos respond to auditory stimulation by altering CPN, AGP, CORT, and Hsp70. The alterations of these analytes could be important in developing embryos and newly hatched chicks to cope with stress attributed to auditory stimulation., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the psychometric properties of the Coping Strategies Inventory-Short Form and investigate the relationship between coping strategies and resilience, taking into consideration the moderating role of emotion regulation., Methods: This cross-sectional study was carried out between May and July 2022. A total of 387 participants was recruited through convenience sampling through several areas in Lebanon governorates. The data was collected through an online questionnaire containing the following sections: sociodemographic information about the participants, Connor-Davidson Resilience Scale (CD-RISC), Emotion Regulation Questionnaire and Coping Strategies Inventory-Short Form., Results: The confirmatory factor analysis results confirmed the four-factor structure of the Coping Strategies Inventory-Short Form, with no measurement invariance across gender. In individuals with high problem-focused engagement and emotion-focused engagement, lower expressive suppression was significantly associated with more resilience. In individuals with high problem-focused disengagement, having high expressive suppression was significantly associated with less resilience., Conclusion: The current study provides novel and distinct findings regarding the relationship between emotion regulation, coping strategies and resilience in all of their dimensions. Furthermore, the present results provide insight on how a population under extreme stress receives and reacts to its reality., (© 2022. The Author(s).)

Background: Desire thinking, impulsivity and suppression are psychological variables that are intricately related to behavioral addictions. Bearing in mind the scarcity of data on desire thinking, impulsivity, thought suppression and pathological social media use in developing countries such as Lebanon, with the existing literature suggesting a heightened mental health burden associated with this problematic social media use, it becomes all the more important to elucidate their relationship. Our study aims at investigating the association between desire thinking and problematic social media use specifically, and to further test the effect of impulsivity and thought suppression in mediating the relation between the two distinct facets of desire thinking and problematic social media use., Methods: A cross-sectional study was carried out between November 2021 and March 2022 using a sample of 414 community-dwelling participants aged above 18 years from all Lebanese districts. The data was collected through an online questionnaire including a section about sociodemographic information, the Desire Thinking Questionnaire (DTQ), Impulsive Behavior Scale (S-UPPS-P), White Bear Suppression Inventory (WBSI) and Social Media Disorder Short Form (SMD). The tests used in the bivariate analysis to assess correlates of SMD were the Student t test to compare two means and the Pearson test to correlate two continuous scores. The PROCESS SPSS Macro version 3.4, model four was used to conduct the mediation analysis., Results: Desire thinking was shown to correlate with increased social media use. Moreover, we found that suppression and lack of premeditation mediated the association between verbal perseveration and social media use disorder whereas suppression and urgency mediated the association between imaginal prefiguration and social media use disorder., Conclusion: This study provides new insight on a topic of increasing public health concern. Although understudied to date, suppression and impulsivity differentially mediate the influence of both facets of desire thinking on problematic social media use disorder. The current findings point to the highly pervasive issue of social media use disorder and the need to investigate underlying psychological factors that aggravate it to better profile and support individuals struggling with it., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Awad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: To evaluate the associations between mindfulness, self-esteem and perfectionism in a Lebanese sample of university students, as well as the indirect effect of self-esteem between mindfulness and perfectionism was investigated., Methods: This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. An online survey that included a part that collected sociodemographic information, the Freiburg Mindfulness Inventory to assess mindfulness, the Rosenberg Self-Esteem Scale to assess self-esteem and the Big Three Perfectionism Scale to assess perfectionism was completed by participants., Results: Higher self-esteem (Beta = 1.30) was significantly associated with more mindfulness, whereas higher self-critical perfectionism (Beta = - 0.61) was significantly associated with less mindfulness. Self-esteem mediated the association between self-critical and narcissistic perfectionism and mindfulness. More perfectionism was significantly and directly associated with less mindfulness and lower self-esteem, whereas higher self-esteem was significantly associated with more mindfulness., Conclusion: This study provides valuable findings that enable practitioners to effectively identify people needing interventions to improve psychological health through mindfulness, self-esteem and perfectionism. The conclusions that can be deduced from this study can help educational psychologists and counselors guide university students towards effective mindfulness practices that can increase self-esteem levels and balance maladaptive perfectionism that can cause distress and impairment in the social and academic settings., (© 2022. The Author(s).)

Purpose: To evaluate the correlation between problematic social media use, alcohol use disorder, and smoking addiction through both cigarettes and waterpipe, among a sample of Lebanese adults., Methods: This cross-sectional study was carried out between January and April 2019. It enrolled 461 residents of the community randomly selected from Lebanon's districts in a proportionate rate., Results: Higher problematic social media use was significantly associated with more waterpipe addiction but not cigarette dependence and alcohol use disorder., (© 2021 Wiley Periodicals LLC.)

Higher or lower incubation temperature may impose some degree of stress on developing poultry embryos. This study was designed to delineate the effects of prenatal thermal stress on serum levels of acute-phase proteins (APPs), namely ceruloplasmin (CPN) and alpha-1-acid glycoprotein (AGP), the regulation of brain mRNA levels of heat shock protein (Hsp) 70, and serum levels of corticosterone (CORT) in embryos and neonatal chicks. Hatching eggs were subjected to three thermal treatments; (i) standard optimum temperature throughout (SS: 37.8 °C and 56 % RH), (ii) heat stress for 12 h daily (HS: 40.0 °C and 56 % RH), and (iii) cold stress for 12 h daily 18 (CS: 30.2 °C and 56 % RH). The heat and cold stress treatments were imposed from the 10th to the 18th day of incubation (ED). Results showed that thermal stress had a negligible effect on hatchability rate and body temperatures of neonatal chicks. The CS treatment was detrimental to embryonic growth. The HS treatment elevated AGP (ED 16, ED 18, and post-hatch day 1), CPN (on post-hatch day 1), and CORT (ED 14). On the contrary, the CS embryos had reduced AGP (ED14, ED16, ED18, and post-hatch day 1), CPN (ED 16), and CORT (ED 14, ED 16, ED 18). The brain mRNA levels of Hsp70 were upregulated throughout the experimental period in both the HS and CS embryos and chicks. Based on these modifications, AGP, together with Hsp70 mRNA expression, could be considered effective biomarkers useful to evaluate the magnitude and the time response of embryos and neonatal chicks to prenatal thermal stress. It is concluded that developing chicken embryos have the ability to evoke APPs, Hsp70 and CORT reactions which are important to cope with thermal stress., Competing Interests: Declaration of competing interest No potential conflict of interest was reported by the authors., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The study objectives were to investigate correlates of healthy orthorexia (HeOr), its relation with impulsivity, and the moderating role of adaptive personality traits among a Lebanese adult sample. The sample was recruited from seven community pharmacies, from the five districts in Lebanon, chosen from a list provided by the Lebanese Order of Pharmacists in a convenient way. The questionnaire included the Teruel Orthorexia Scale (TOS) to measure HeOr, Big Five Inventory (BFI) to assess adaptive personality traits, and the I-8 scale for impulsivity. Higher extraversion (B = -4.31) was significantly associated with lower healthy orthorexia. The interaction perseverance by extraversion was associated with higher healthy orthorexia; in those with higher perseverance, higher extraversion was associated with more healthy orthorexia. Our study presents findings that could be of significant clinical relevance in the future, especially with the interest increase in Orthorexia Nervosa prevalence, which subsequently prompts more research and intrigue about HeOr. Furthermore, it places healthy eating and consistent commitment to a healthy diet within a clearly defined scientific frame, on which further investigation can be based.

How does psychology vary across human societies? The fundamental social motives framework adopts an evolutionary approach to capture the broad range of human social goals within a taxonomy of ancestrally recurring threats and opportunities. These motives-self-protection, disease avoidance, affiliation, status, mate acquisition, mate retention, and kin care-are high in fitness relevance and everyday salience, yet understudied cross-culturally. Here, we gathered data on these motives in 42 countries (N = 15,915) in two cross-sectional waves, including 19 countries (N = 10,907) for which data were gathered in both waves. Wave 1 was collected from mid-2016 through late 2019 (32 countries, N = 8,998; 3,302 male, 5,585 female; M age  = 24.43, SD = 7.91). Wave 2 was collected from April through November 2020, during the COVID-19 pandemic (29 countries, N = 6,917; 2,249 male, 4,218 female; M age  = 28.59, SD = 11.31). These data can be used to assess differences and similarities in people's fundamental social motives both across and within cultures, at different time points, and in relation to other commonly studied cultural indicators and outcomes., (© 2022. The Author(s).)

Objective. When medical resources are scarce, clinicians must make difficult triage decisions. When these decisions affect public trust and morale, as was the case during the COVID-19 pandemic, experts will benefit from knowing which triage metrics have citizen support. Design. We conducted an online survey in 20 countries, comparing support for 5 common metrics (prognosis, age, quality of life, past and future contribution as a health care worker) to a benchmark consisting of support for 2 no-triage mechanisms (first-come-first-served and random allocation). Results. We surveyed nationally representative samples of 1000 citizens in each of Brazil, France, Japan, and the United States and also self-selected samples from 20 countries (total N = 7599) obtained through a citizen science website (the Moral Machine). We computed the support for each metric by comparing its usability to the usability of the 2 no-triage mechanisms. We further analyzed the polarizing nature of each metric by considering its usability among participants who had a preference for no triage. In all countries, preferences were polarized, with the 2 largest groups preferring either no triage or extensive triage using all metrics. Prognosis was the least controversial metric. There was little support for giving priority to healthcare workers. Conclusions. It will be difficult to define triage guidelines that elicit public trust and approval. Given the importance of prognosis in triage protocols, it is reassuring that it is the least controversial metric. Experts will need to prepare strong arguments for other metrics if they wish to preserve public trust and morale during health crises., Highlights: We collected citizen preferences regarding triage decisions about scarce medical resources from 20 countries.We find that citizen preferences are universally polarized.Citizens either prefer no triage (random allocation or first-come-first served) or extensive triage using all common triage metrics, with "prognosis" being the least controversial.Experts will need to prepare strong arguments to preserve or elicit public trust in triage decisions., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Jean-François Bonnefon acknowledges support from the grant ANR-17-EURE-0010 and the research foundation TSE-Partnership. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report., (© The Author(s) 2022.)

Graphene is well-known for its extraordinary physical properties such as broadband optical absorption, high electron mobility, and electrical conductivity. All of these make it an excellent candidate for several infrared applications such as photodetection, optical modulation, and optical sensing. However, a standalone monolayer graphene still suffers from a weak infrared absorption, which is ≅2.3%. In this work, a novel configuration of graphene metamaterial embedded inside Bundt optical-antenna (optenna) is demonstrated. It can leverage the graphene absorption up to 57.7% over an ultra-wide wavelength range from 1.26 to 1.68 µm (i.e., Bandwidth ≅ 420 nm). This range covers the entire optical communication bands of O, E, S, C, L, and U. The configuration mainly consists of a Bundt-shaped plasmonic antenna with a graphene metamaterial stack embedded within its nano-wide waveguide that has a 1.5 µm length. The gold average plasmonic loss is ≅25%. This configuration can enhance graphene ultra-broadband absorption through multiple mechanisms. It can nano-focus the infrared radiation down to a 50 nm spot on the graphene metamaterial, thus yielding an 11.5 gain in optical intensity (i.e., 10.6 dB). The metamaterial itself has seven concentric cylindrical graphene layers separated by silicon dioxide thin films, thus each layer contributes to the overall absorption. The focused infrared propagates tangential to the graphene metamaterial layers (i.e., grazing propagation), and thus maximizes the light-graphene interaction length. In addition, each graphene layer experiences a double-face exposure to the nano-focused propagating spot, which increases each layer's absorption. This configuration is compact and polarization-insensitive. The estimated maximum absorption enhancement compared to the standalone monolayer graphene was 25.1 times (i.e., ≅4 dB). The estimated maximum absorption coefficient of the graphene stack was 5700 cm -1 , which is considered as one of the record-high reported coefficients up to date.

Culture has played a pivotal role in human evolution. Yet, the ability of social scientists to study culture is limited by the currently available measurement instruments. Scholars of culture must regularly choose between scalable but sparse survey-based methods or restricted but rich ethnographic methods. Here, we demonstrate that massive online social networks can advance the study of human culture by providing quantitative, scalable and high-resolution measurement of behaviourally revealed cultural values and preferences. We employ data across nearly 60 000 topic dimensions drawn from two billion Facebook users across 225 countries and territories. We first validate that cultural distances calculated from this measurement instrument correspond to traditional survey-based and objective measures of cross-national cultural differences. We then demonstrate that this expanded measure enables rich insight into the cultural landscape globally at previously impossible resolution. We analyse the importance of national borders in shaping culture and compare subnational divisiveness with gender divisiveness across countries. Our measure enables detailed investigation into the geopolitical stability of countries, social cleavages within small- and large-scale human groups, the integration of migrant populations and the disaffection of certain population groups from the political process, among myriad other potential future applications.

Technological advances are enabling roles for machines that present novel ethical challenges. The study of 'AI ethics' has emerged to confront these challenges, and connects perspectives from philosophy, computer science, law, and economics. Less represented in these interdisciplinary efforts is the perspective of cognitive science. We propose a framework - computational ethics - that specifies how the ethical challenges of AI can be partially addressed by incorporating the study of human moral decision-making. The driver of this framework is a computational version of reflective equilibrium (RE), an approach that seeks coherence between considered judgments and governing principles. The framework has two goals: (i) to inform the engineering of ethical AI systems, and (ii) to characterize human moral judgment and decision-making in computational terms. Working jointly towards these two goals will create the opportunity to integrate diverse research questions, bring together multiple academic communities, uncover new interdisciplinary research topics, and shed light on centuries-old philosophical questions., Competing Interests: Declaration of interests The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To explore the possible moderating relation between impulsive behavior and maladaptive personality traits in regards to orthorexia nervosa (ON)., Methods: This cross-sectional study was conducted between July and December 2019 and recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. The Teruel Orthorexia Scale (TOS) was employed to assess orthorexic eating tendencies, the I-8 measured impulsivity and the Personality Inventory for DSM-5 (PID) evaluated maladaptive personality traits., Results: Our results showed that, for I-8 subscales, only higher perseverance (B = 0.31) was significantly associated with higher ON. In regard to PID-5 subscales, only higher negative affect (B = - 0.34) was significantly associated with lower ON. Furthermore, significant interactions were found between personality traits and impulsivity to predict TOS-ON., Conclusion: The current results show that female gender, maladaptive personality traits and impulsivity present contributing factors regarding orthorexic eating. Certain impulsivity dimensions were confirmed to interact with personality traits in the prediction of orthorexic eating thereby highlighting possible risk factors and psychopathological mechanisms., Level of Evidence: Level V, cross-sectional descriptive study., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Type 1 diabetes mellitus (T1DM) is characterized by autoimmune destruction of insulin-producing pancreatic beta (β-) cells. Previous studies suggested an imbalance between and pro- and anti-inflammatory cytokines exacerbates T1DM development., Objectives: We aimed to test the hypothesis that patients with T1DM carry a higher frequency of regulatory genes associated with low levels of the anti-inflammatory cytokines interleukin-4 (IL-4), its receptor (IL-4R), and interleukin-10 (IL-10)., Methods: Accordingly, we compared frequencies of five different single nucleotide polymorphisms (SNPs) in T1DM patients and healthy controls who had been typed for HLA-DRB1, HLA-DQA1, and HLA-DQB1 genes., Results: The frequencies of rs2070874 (IL-4) alleles C and T differed between T1DM patients and controls ( c p = 0.0065), as did their codominant ( c p = 0.026) and recessive ( c p = 0.015) models. Increased frequencies were observed in T1DM patients for HLA alleles: DRB1*03 (pc < 0.0013), DRB1*04 ( c p = 0.0169), DQA1*03 ( c p = 0.0222), DQA1*05 ( c p < 0.0006), DQB1*02 ( c p = 0.0005), and DQB1*06 ( c p < 0.0005). And lower frequencies were observed for: DRB1*07 ( c p = 0.0078), DRB1*11 ( c p = 0.0013), DRB1*13 ( c p < 0.0364), DRB1*15 ( c p < 0.0013), DQA1*01 ( c p < 0.0006), and DQA1*02 ( c p = 0.0348). Certain DRB1: DQA1: DQB1 haplotypes showed greater frequencies, including, 03:05:02 (p < 0.0001) and 04:03:03 (p = 0.0017), whereas others showed lower frequencies, including, 07:02:02 (p = 0.0032), 11:05:03 (p = 0.0007), and 15:01:06 (p = 0.0002). Stratification for the above HLA haplotypes with rs2070874 C/C exhibited no significant differences between T1DM patients overall and controls. However, when stratified for the vulnerable HLA haplotype (03:05:02/04:03:03), young patients in whom T1DM began at ≤13 years had a higher frequency of the SNP (rs2070874 C/C); a gene associated with low IL-4 production (p < 0.024)., Conclusion: This study suggests that possession of the rs2070874 C/C genotype, which is associated with low production of IL-4, increases the risk of T1DM in young individuals carrying vulnerable HLA alleles/haplotypes.

Classic metaphyseal lesions (CML) or bucket handle fractures are usually associated with child abuse or non-accidental injury. The most common sites affected are the distal femur, proximal and distal tibia, and proximal humerus. Few case reports documented its association with difficult extraction at delivery in term large for gestational age (LGA) neonates. We present a case of CML in an extremely preterm neonate following abnormal presentation and difficult cesarean delivery. Management of CML is usually conservative, and fractures heal without any deformities. Thorough history taking is essential in the diagnosis of CML.

When compared to the general population, socioeconomically disadvantaged communities frequently experience compromised health. Monitoring the divide is challenging since standardized biomedical tests are linguistically and culturally inappropriate. The aim of this study was to develop and test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explore the relationships between the objective health measures and subjective health outcomes, as evaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in a socioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelve most vulnerable districts in Sweden. The study revealed that compared to conventional protocols the less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, the collected biomedical data illustrated that the apparent health of the participants from the ethnically diverse low-income neighborhood was comparable to the general Swedish population. Statistically significant correlations between perceived health and biomedical data were disclosed, even though the dependences found were complex, and recognition of the manifest complexity needs to be included in further research. Our results validate the potential of non-invasive technologies in combination with advanced statistical analysis, especially when combined with linguistically and culturally appropriate healthcare methodologies, allowing participants to appreciate the significance of the different parameters to evaluate and monitor aspects of health., (© 2021. The Author(s).)

Background: There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia., Methods: This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists., Results: Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia., Conclusion: Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations., (© 2021. The Author(s).)

Trust in leaders is central to citizen compliance with public policies. One potential determinant of trust is how leaders resolve conflicts between utilitarian and non-utilitarian ethical principles in moral dilemmas. Past research suggests that utilitarian responses to dilemmas can both erode and enhance trust in leaders: sacrificing some people to save many others ('instrumental harm') reduces trust, while maximizing the welfare of everyone equally ('impartial beneficence') may increase trust. In a multi-site experiment spanning 22 countries on six continents, participants (N = 23,929) completed self-report (N = 17,591) and behavioural (N = 12,638) measures of trust in leaders who endorsed utilitarian or non-utilitarian principles in dilemmas concerning the COVID-19 pandemic. Across both the self-report and behavioural measures, endorsement of instrumental harm decreased trust, while endorsement of impartial beneficence increased trust. These results show how support for different ethical principles can impact trust in leaders, and inform effective public communication during times of global crisis. PROTOCOL REGISTRATION STATEMENT: The Stage 1 protocol for this Registered Report was accepted in principle on 13 November 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.13247315.v1 ., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Presently, 1 in 4 Lebanese adolescents is involved in bullying, with 12% being perpetrators. In Lebanon, around 90% of bullying incidents occur in schools. Given the lack of studies tackling bullying perpetration in Lebanon, this study aims to identify and target risk factors of bullying perpetration among Lebanese adolescents, which would serve future prevention and intervention programs., Methods: This cross-sectional study took place between January and May 2019 in a proportionate random sample of schools from all Lebanese districts. A total of 1810 (90.5%) out of 2000 students accepted to participate., Results: Results showed that 831 (49.1%, CI: 0.46-0.51) participants had bullied other people. A stepwise linear regression, using as the dependent variable the bullying perpetration score, showed that higher psychological (β = 0.12; 95% CI 0.083-0.176), sexual (β = 0.26; 95% CI 0.128-0.411), neglect (β = 0.08; 95% CI 0.051-0.120), physical abuse (β = 0.13; 95% CI 0.036-0.235), higher internet addiction (β = 0.07; 95% CI 0.057-0.097), higher social fear (β = 0.10; 95% CI 0.075-0.140), and having separated parents (β = 1.60; 95% CI 0.561-2.650) were significantly associated with more bullying perpetration. Higher social avoidance (β = - 0.03; 95% CI -0.062- -0.003) was significantly associated with less bullying perpetration., Conclusion: The results revealed that bullying perpetration is significantly associated with parental status, child abuse, internet addiction, and social fear. Educational and relevant governmental institutions could use our findings to develop and implement efficient bullying prevention and intervention programs for all involved parties.