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Aftab Ahmed Khan,1 Abdulaziz Abdullah AlKhureif,1 Manal Almutairi,2 Abrar Nasser bin Nooh,3 Saeed Awod bin Hassan,4 Yasser M Alqahtani5 1Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Pediatric Dentistry and Orthodontics Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; 3Restorative Dentistry Department, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 4Restorative Dental Sciences Department, College of Dentistry, King Khalid University, Abha, Saudi Arabia; 5Restorative and Esthetic Dentistry Department, Ministry of Health, Abha, Saudi ArabiaCorrespondence: Aftab Ahmed Khan, Dental Biomaterials Research Chair, College of Applied Medical Sciences, King Saud University, Room &num; 2307, Building &num; 24, Riyadh, 11451, Saudi Arabia, Email aftkhan@ksu.edu.saIntroduction: There is a critical need to address concerns surrounding the potential impact of bleaching gels specifically on the tooth substrate. Therefore, this laboratory investigation aimed to assess the impact of a hydrogen peroxide (HP)-free bleaching (HiSmileTM) in comparison to an HP-based bleaching (Opalescence RegularTM) on the surface and mechanical characteristics of tooth substrate.Methods: Sixty sound human premolar teeth were sectioned to produce dentin fragments and divided into two primary groups based on the bleaching agent used. Each group was subdivided into three subgroups (n = 10) per distinct bleaching regimens: (T1) fragments underwent a 7-day immersion in distilled water at 37°C without any bleaching treatment, (T2) fragments underwent a 7-day immersion in distilled water at 37°C, with the application of bleaching gel occurring on the seventh day for 10 minutes, and (T3) fragments underwent a bleaching regimen for seven consecutive days, each session lasting for 10 minutes. The initial and final evaluations of surface roughness, nano-hardness, and elastic modulus were performed. Following the bleaching regimens of T3, a composite stub was fabricated on the dentin fragments for the shear bond strength (SBS) test. Statistical testing was accomplished using the analysis of variance (P < 0.05).Results: HP-based bleaching gel showed significant differences between measurement intervals in surface roughness, elastic modulus, and SBS parameters (P < 0.05). In contrast, HP-free bleaching gel showed insignificant differences within the group (P > 0.05). The SBS between dentin-composite was significantly affected with the use of HP-based bleaching gel, while HP-free bleaching gel showed insignificant difference between measurement intervals. The qualitative validation of the treatment’s impact was further demonstrated using the scanning electron microscopy.Conclusion: The findings suggest that the bonding stability of composite restorations to dentin may be compromised after bleaching with an HP-based gel, whereas immediate bonding procedures can be safely conducted following the application of an HP-free bleaching gel.Keywords: dental bleaching gel, dentin, hydrogen peroxide, mechanical properties, phthalimidoperoxycaproic acid, nanohydroxyapatite

Digital transformation and the digitalization of economic activity are ongoing trends profoundly shaping the global economy. Digitalization reflects digital inputs in the production process and new household and government consumption modes, investment possibilities, and financial instruments, increasingly envisaged by digital technologies and tools. This is also impacting the labour markets, on the one hand substituting machines to labour for routinized tasks and thus decreasing the demand for soft skills labour, but on the other hand, increasing the need for new professions revolving around new production and consumption modalities and digital skills. Considering these contrasting effects, it is essential to estimate the overall impact of digitalization on employment. Therefore, this study captures the impact of economic growth and digitalization on unemployment change, evaluating a modified version of Okun’s Law on a balanced panel data set for 58 countries between 2013 and 2019. The results from the estimation of a fixed-effect model show the empirical validity of Okun’s law for the sampled countries and a significant contribution of digitalization on unemployment reduction.

Background: Ethylmalonic encephalopathy (EE) is a devastating early-onset inborn error of metabolism, and heterogenous disorders manifest as chronic diarrhea, petechial rash, and neurological manifestations. The mutation in the ETHE1 gene leads to hydrogen sulfide accumulation and eventually results in mucosal cell damage in the large intestines and vascular endothelial cells system. Case presentation: Here, we describe four patients from three different tribes in Oman, and the clinical data revealed that the four patients shared an early-onset phenotype and the neurological manifestations were variable. The biochemical markers, specifically the urine organic acid and hyperlactimic acidosis, supported and tailored the diagnosis. Molecular diagnosis was confirmed by full gene sequencing of the ETHE1 gene in the index case and followed by target variant testing for others. Interestingly, all four patients identified to harbor the same homozygous missense pathogenic variant (c.487c > t) in the ETHE1 gene, and their parents were all heterozygous. These findings indicate that we probably have a founder variant associated with EE in our area. Conclusion: These findings are of great importance for diagnosis and surveillance for Omani families with EE. Given the relatively high number and frequency of genetic diseases in the region and the limited resources, screening for these founder mutations should provide a rapid and cost-effective tool for molecular diagnosis. Additionally, these findings should help in designing appropriate measures for carrier screening measures at the regional level. [JBCGenetics 2021; 4(1.000): 51-55]

Abstract Background Antimicrobial resistance (AMR) is an emerging threat to public health worldwide. A significant evidence has suggested that the knowledge and attitude trends among the community, pharmacists and physicians can play a critical role in managing the ever increasing threat of AMR. Methods A cross-sectional survey was performed using three specific self-administered questionnaires for community members, pharmacists/pharmacy owners and physicians on a randomly selected sample population of 473, 424 and 308 respectively. Bivariate and multivariate logistic regression and Pearson chi-square tests were performed during data analysis. Result A response rate of 81.2% (n = 385), 37.7% (n = 160) and 53.9% (n = 166) was achieved for general community, pharmacists/pharmacy owners and physicians respectively. More than half of the community participants (55.6%; n = 214) possess poor knowledge of AMR. Furthermore, knowledge and attitude of the community participants were also found to be significantly correlated (r2 = 0.02) with each other. In 90.6% (n = 145) of the pharmacies included in the survey, a qualified pharmacist was not present at the time of the operations. Only 36.9% physicians (n = 60) knew about the environmental route of dissemination of AMR. Majority of the physicians agreed that AMR is a global problem and also recognize the need for initiating AMR stewardship programs. Conclusion Our study will provide effective assessment and potential insights in designing tri-faceted interventions for rationalizing antibiotics consumption thus controlling the development and dissemination of AMR.

The purpose of this article is to assess the relationship between employment intensity and sectoral output growth, to examine whether economic growth was jobless or has created more jobs. Using panel data for 10 sectors over the period 1983-2010 for two Middle Eastern countries; Egypt and Jordan, we estimate employment-value added elasticities at the sectoral level using a random coefficient estimation technique. Our main findings show that while manufacturing is the most important sector that creates jobs in Egypt, services are more important in Jordan. For both countries, the mining sector is insignificant. Indeed, this shows to what extent this sector is capital intensive, does not have a significant value-added and thus does not create jobs. A more detailed look at the decomposition analysis shows that the contribution of employment growth to value-added was higher than that of labor productivity. For Jordan, its growth was mainly attributed to employment growth while its productivity growth was negative.

A Shipyard is trying to change, but facing employee Resistance to Change (RTC). Resistance is attributed to the dysfunctional organisational context in the form of technical and political/structural issues giving rise to non-conformance behaviour. An action research was conducted with the author as a participant researcher to understand and identify the underlying behaviour of the employees. Lean production was used as an intervention to re-couple tasks to behavioural elements. Resistance is due to incoherency of a person’s belief in established standards, giving rise to cognitive dissonance. Lean principles reduces dissonance, creating psychological flow in the workforce and the momentum for change. As a result, the shipyard managed to recovered the delay of a ship and delivered it on-time, with cost avoidance of RM63 million in liquidated damage. The Shipyard also managed to reduce the average delay for ships undergoing repair to 6 months, compared to previous average delay of 17 months. This research was a collaboration between the employees and the researcher to identify the source of RTC. The outcome is both, insightful in creating change and contribution to knowledge. The significance of this study is the realisation of how individuals and groups’ past behaviour can subconsciously challenge the existence of the organisation and better methods. The study provides an exploratory model on the workings of human behavioural elements in Lean production. The knowledge of how the researcher gained utility from resistance and mediate through the application of these techniques would be of considerable benefit to leaders of change management.

The local automotive suppliers are facing a number of important challenges such asglobalisation, new requirement in market specifications and the competition brought about by theAsean Free Trade Area (AFTA) agreements. In an effort to enhance the competitiveness of themanufacturing sector, the government has implemented the Second Industrial Master Plan, IMP2(1996-2005). The focus of the IMP2 is more on innovation and applications of new technologies, sothat industries can move up the value chain of their activities. Innovative capabilities achieved fromcompanies’ new product development activities have been recognized to be crucial for companies tosustain their competitiveness and organisational success. The importance of product development ismost obvious in the context of the discussion on the competitiveness of the Malaysian automotivesuppliers. The study will focus on the small medium enterprises (SMEs) that make up more than 60 %of these automotive suppliers. The study is to determine the extensiveness of the suppliers’ productdevelopment activities by examining the involvement of the suppliers in customer’s productdevelopment activities. Consequently, the impact of this involvement to the competitiveness of thesuppliers is examined. The results were established based from a survey to parts and componentssuppliers of Proton, the Malaysian car national assembler. The study has shown that the SMEs wereinvolved from the early stages of the product development process that is during the design stage. Theproduct development efforts have shown to contribute towards increasing firms’ market share andfirms were also able to gain a better understanding of future product demand. A significant number ofthe suppliers have managed to penetrate the export market. Unfortunately, among the respondents,there is only one system supplier. This indicates that, either the technological capabilities of theSMEs still needed upgrading for the requirement as a system suppliers or it may not be the onlydeciding factor for suppliers to be chosen as system suppliers. It is intended that this paper shouldserve to inform management in particular the suppliers on the present status of the SMEs in seekingto improve their competitiveness from product development effort.Keywords: Product development, SMEs, automotive suppliers, competitiveness

Ulnar variance is a relative length difference in the wrist between the ulna and radius bones. It is a critical factor in helping to diagnose wrist disorders. The typical standard classification of length difference (ulnar variance) is divided into three major types: positive ulnar variance, negative ulnar variance, and neutral ulnar variance. Conventional or manual methods of measuring ulnar variance are long and time-consuming. With the urgent need for high efficiency and high speed, achieving more accurate diagnoses has become essential. In this paper, a deep learning-based methodology is used to automatically detect ulnar variance from radiographic images. Advanced Convolutional Neural Networks are exploited instead of traditional manual methods. Specifically, U-Net is used in the segmentation of ulna and radius bones, while DenseNets are applied to classify the type of ulnar variance. The essential contribution of this work is collecting a dataset of fully annotated wrist radiographs that are specific to this topic, which can be used as a resource to train and validate our models. Another contribution of this paper is optimizing the DenseNets model's hyperparameters to enhance its performance. Our model achieved a segmentation accuracy of 97.7% and an ulna variance classification accuracy of 92.1%. It outperformed previous deep learning-based methods in automatically segmenting the ulna and radius. This advancement not only reduces diagnosis time but also improves result reliability. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization reports that 600 million cases of food-borne illnesses occur every year. Additionally, it is estimated that upto 30% of people in developed countries experience food-borne illnesses annually, while developing countries suffer around 2 million deaths from these diseases each year. Inadequate sanitation and challenges in maintaining proper food handling practices are the major contributing factors of food-borne illnesses in developing countries including Somaliland. Aims: The aim of the study was to assess food safety practices and its associated factors among food handlers working in food and drinking establishments in Hargeisa, Somaliland. Methods: A community-based cross-sectional study was conducted from September 20 to October 20, 2024, involving 306 randomly selected food handlers in Hargeisa, Somaliland. Data was collected using a structured questionnaire and analyzed with SPSS version 22. Descriptive analysis summarized respondents' socio-demographic characteristics, while bivariate and multivariable analyses examined relationships in the data. Independent variables with a p-value below 0.25 were included in multivariable logistic regression to identify significant factors, using adjusted odds ratios (AORs) and a 95% confidence interval (CI), with a significance threshold of p < 0.05. Results: In this study, a total of 306 food handlers participated. The majority (85.3%) of food handlers was males and 84% had non-formal education. The prevalence of poor food safety practices among food handlers was at 52.3%. Lack of food safety training (AOR = 0.172; 95% CI: 0.070, 0.420), less working experience (AOR = 1.757; 95% CI: 1.026, 3.009), lack of appropriate water storage equipment (AOR = 0.602; 95% CI: 0.364, 0.996), lack of regular sanitary inspection (AOR = 1.691; 95% CI: 1.028, 2.783), and poor knowledge (AOR = 0.589; 95% CI: 0.353, 0.983) were statistically associated with poor food safety practices. Conclusion: The study found low level of poor food safety practices; attributed to factors like food handler training, work experience, water storage equipment, sanitation inspections, and knowledge. However, enhancing food handling practices, particularly training is crucial to minimize food-borne diseases and promote optimal food safety practices. [ABSTRACT FROM AUTHOR]

Cryptography serves as the cornerstone for safe communication and data security in today's digital environment. Because they feature substitution boxes, substitution-permutation networks (SPNs) are crucial for cryptographic algorithms such as the popular Advanced Encryption Standard (AES). The structure and properties of S-boxes have a significant impact on the overall security of cryptographic systems. This article aims to improve cryptographic security through unique S-box construction methodologies. The proposed S-boxes improve the security features by employing chaotic maps and Galois fields, which go beyond traditional design approaches. The S-boxes were analyzed and the weaknesses were removed to design strong candidate S-boxes. The efficiency of the proposed S-boxes in increasing cryptographic resilience is thoroughly explored thereby taking nonlinearity, strict avalanche requirements, bit independence constraints, linear approximation, and differential approximation into account. The dynamic S-boxes have average scores of nonlinearity, strict avalanche criteria(SAC), nonlinearity of Bit Independence Criteria (BIC Nonlinearity), SAC of Bit Independence Criteria (BIC SAC), Linear Approximation Probability (LAP) and Differential Approximation Probability (DAP) is 111.1025, 111.1022, 0.5014, 0.5024, 111.1082, 111.0964, 0.5024, 0.5022, 0.0726, 0.0729 and 0.0214, 0.0219, respectively. Furthermore, given the prevalence of images in modern communication and data storage, this work studies the seamless incorporation of advanced S-boxes into image encryption systems. With its thorough research, the paper contributes to the current discussion on cryptographic security by providing theoretical understandings and practical solutions to improve digital communication and data security in an era of rising cyber dangers and ubiquitous connectivity. [ABSTRACT FROM AUTHOR]

The importance of writing skills in enhancing student performance in language exams and even other subject areas is widely acknowledged. At Jaffery secondary, the approach to the teaching of writing has generally been to use three approaches: product-based approach with focus on what the students composed; process-based approach that is focused on the step-by-step process of writing; and a genre-based approach that addressed the requirements of the "O" level IGCSE Curriculum. With the unveiling of the School Development Plan in late 2012, which gave attention to among other things improvements to the learning framework, the department of languages made it a priority to improve the quality of students' writing (and by extension performance). In a bid to enhance writing skills, we have embarked on a quest that has raised certain questions: (1) How could methods of teaching writing be made more effective?; (2) Could learners' awareness of assessment descriptors improve the quality of their writing?; and (3) Would a combination of genre and product-based teaching i.e., combining instructions on how to produce ideal writing (descriptors) with the examples of ideal writing (exemplars), help improve the quality of student writing? These questions formed a basis for the search of an improved method of teaching writing. This paper explores the use of exemplars alongside descriptors as part of a mixed approach to teaching and learning writing, and provides evaluation of narrative essays and feedback of questionnaires administrated to year 10 students who constitute the study sample. The questionnaires required the students to comment on their preference of the different learning approaches. Specifically, the study focused on the teaching of narrative writing in French, Arabic, and English. This approach reinforces the findings of Sadler R. D. (1989) who wrote on the value of using exemplars as a means of showing what quality is. The study suggests that a mixed approach that combines descriptors with exemplars could provide an effective way forward for the teaching and learning of written compositions.

The COVID-19 pandemic has raised concerns over secondary infections because it has limited treatment options and empiric antimicrobial treatment poses serious risks of aggravating antimicrobial resistance. Many studies have shown that COVID-19 patients are predisposed to developing secondary infections. The prevalence of urinary tract infections (UTI) was evaluated in 248 patients admitted to different hospitals in Erbil city, Iraq. Results showed 138 (55.65%) patients were positive for bacterial growth, of which 72 isolates of Gram-negative and 66 isolates of Gram-positive bacteria were isolated and identified from the urine of COVID-19 patients depending on the 16S rRNA gene using PCR. The predominant obtained bacteria were Staphylococci species, of which isolates belong to 6 species, and the predominant Gramnegative species was Pseudomonas spp. which belongs to 4 species. Also, their susceptibility to 15 antibiotics was tested and it was found that most of the Gram-negative isolates were highly resistant to ampicillin 66(91.66%), amoxicillin 60(83.33%), cephalexin 52(72.22%) and cefixime 50(69.44%). While the most effective antibiotic was imipenem, and with percentage of 26(36.11%), it also showed variable sensitivity to other antibiotics. For Grampositive bacteria, the highest resistance was against cefixime 40(60.60%), ampicillin 28(42.42%), and 18(27.27%) for both amoxicillin and ciprofloxacin, while the most effective antibiotic was gentamicin, which showed effectiveness against all the Gram-positive isolates. Another part of the study concerned with detection of the existence of ESBLs genes responsible for antibiotic resistance. The results revealed that all the isolates possessed the 16S rRNA gene, whereas blaTEM and blaCTX-M were found to be the most possessed genes in all the isolates, with a percentage of (88.33%). [ABSTRACT FROM AUTHOR]

Background: Cancer is a leading cause of morbidity and mortality in the Gulf Cooperation Council (GCC) countries. This study aims to provide cancer incidence and mortality estimates in 2020 in the GCC countries alongside future projections for 2040 to shape cancer control policy in the region. Methods: The estimated numbers of new cancer cases and deaths were extracted from the GLOBOCAN database developed by the International Agency for Research on Cancer; new cancer cases, cancer deaths, and corresponding age‐standardized incidence and mortality rates for the year 2020 are presented. Results: An estimated 42,475 new cancer cases and 19,895 deaths occurred in the GCC countries in 2020, with corresponding age‐standardized incidence and mortality rates of 96.5 and 52.3 per 100,000, respectively. Female breast (16%), colorectal (13%), and thyroid (9%) were the most common types of cancer in the GCC countries, accounting for almost 40% of all cancer incidence. Colorectal (14%) followed by breast cancer (9%) were the leading causes of cancer death, though the magnitude of rates of the major cancer types varied substantially across the GCC countries. Even if we assume rates in the region will remain unchanged over the next two decades, the cancer burden in the GCC will increase by 116% (Saudi Arabia) to 270% (Qatar), reaching nearly 104,000 cancer cases by the year 2040. Conclusion: The sharp increase in the estimated cancer incidence and mortality predicted over the next decades in the region requires workforce and financial planning for the healthcare systems in the constituent countries, alongside broader strengthening of national cancer prevention and control efforts. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Metformin‐associated lactic acidosis is a rare but serious complication in patients with type 2 diabetes, especially those with multiple health conditions. Prompt recognition and treatment, including potential renal replacement therapy, are crucial for managing severe acidosis and improving patient outcomes. Metformin (MTF) is commonly prescribed as a first‐line treatment for diabetes, effectively preventing microvascular and macrovascular complications. However, metformin‐associated lactic acidosis is a rare yet severe complication, associated with a mortality rate of up to 50%. We encountered a case involving a 73‐year‐old woman with type 2 diabetes, mental illness, and hypothyroidism, who developed life‐threatening lactic acidosis while on metformin therapy. Upon presenting to the emergency department with complaints of weakness, nausea, and decreased urination for 5 days, she also reported abdominal pain and shortness of breath. Hypotension was noted with a blood pressure of 80/50 mmHg. Initial laboratory results revealed severe acidosis, prompting discontinuation of MTF. Despite resuscitation efforts and vasopressor therapy, severe acidemia persisted, leading to the initiation of renal replacement therapy. Following treatment with continuous renal replacement therapy, her acidemia resolved, and she was discharged from the hospital on the sixth day without complications, with normal kidney function. [ABSTRACT FROM AUTHOR]

Covert hepatic encephalopathy (CHE) is a form of cerebral dysfunction that affects 30–40% of patients with liver cirrhosis as a grave sequel of disease progression. Although being a silent condition, yet; CHE has been reported as seriously predictive for the development of overt hepatic encephalopathy. Covert hepatic encephalopathy is said to conclude grades (0 and 1) hepatic encephalopathy in West Heaven grading of hepatic encephalopathy, hence; inferring to discrete deficits in attention, cognition, and motor control, strongly associated with poorer quality of private and social aspects of the patients' life. Clinical recognition of cases of CHE is such a tedious task that unluckily devoid of discernment. Worthwhile; the battery of neuropsychometric tests widely known as the only tool to identify CHE can give abnormal results without specifying the cause of brain dysfunction Therefore, dedicated history-taking and clinical evaluation of liver cirrhosis patients are still the cornerstones that should unify other diagnostic tools to identify those patients at risk of developing overt hepatic encephalopathy. Diagnosis of CHE is challenging and often neglected in clinical practice, so the aim of this review is to improve our approach to CHE and begin a unified effort for the advancement of CHE through studying easy, fast, and reliable psychometric diagnostic tests to meet our clinical needs. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hyponatraemia increases the morbidity and mortality risks of orthopaedic patients. When undergoing spine surgery, hyponatraemic patients have high risks of pneumonia and of staying in hospital for up to 1 day longer compared with non-hyponatraemic patients. This study aims to assess the occurrence of adverse events among patients with pre-operative hyponatraemia after undergoing lumbar surgery. Materials and Methods: A retrospective cohort study was conducted. Patients who underwent spinal surgery in 2011 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between hyponatraemic patients and normonatraemic patients. Post-operative adverse events, need for blood transfusion and length of stay were considered as clinical outcome data. Results: A total of 58,049 patients were included; pre-operatively, 55,012 (94.8%) were normonatraemic and 3037 (5.2%) were hyponatraemic. Multivariate analysis showed that hyponatraemic patients had higher rates of adverse events, blood transfusions and urinary tract infections. Specifically, 632 (20.8%) hyponatraemic patients developed adverse events, compared with 6821 (12.4%) normonatraemic patients; the hyponatraemic patients received transfusions, compared with 6821 (7.4%) normonatraemic patients; and 97 (3.2%) hyponatraemic patients developed urinary tract infections, compared with 715 (1.3%) normonatraemic patients. Finally, an extended length of stay beyond 6 days occurred in 604 (19.9%) hyponatraemic patients, compared with 4676 (8.5%) normonatraemic patients. Conclusions: Our study identified an association between pre-operative hyponatraemia and post-operative adverse events in spinal surgery patients. However, it is unclear whether hyponatraemia caused the higher adverse event rate. [ABSTRACT FROM AUTHOR]

Previous studies have determined that the type-1 PDZ sequence at the extreme carboxy-terminus of the ß1-adrenergic receptor (ß1-AR) binds SAP97 and AKAP79 to organize a scaffold involved in trafficking of the ß1-AR. In this study we focused on characterizing the domains in SAP97 that were involved in recycling and resensitization of the ß1-AR in HEK-293 cells. Using a SAP97 knockdown and rescue strategy, we determined that PDZ-deletion mutants of SAP97 containing PDZ2 rescued the recycling and resensitization of the ß1-AR. Among the three PDZs of SAP97, PDZ2 displayed the highest affinity in binding to the ß1-AR. Expression of isolated PDZ2, but not the other PDZs, inhibited the recycling of the ß1-AR by destabilizing the macromolecular complex involved in trafficking and functional resensitization of the ß1-AR. In addition to its PDZs, SAP97 contains other protein interacting domains, such as the I3 sequence in the SRC homology-3 (SH3) domain, which binds to AKAP79. Deletion of I3 from SAP97 (ΔI3-SAP97) did not affect the binding of SAP97 to the ß1-AR. However, ΔI3-SAP97 could not rescue the recycling of the ß1-AR because it failed to incorporate AKAP79/PKA into the SAP97-ß1-AR complex. Therefore, bipartite binding of SAP97 to the ß1-AR and to AKAP79 is necessary for SAP97-mediated effects on recycling, externalization and functional resensitization of the ß1-AR. These data establish a prominent role for PDZ2 and I3 domains of SAP97 in organizing the ß1-adrenergic receptosome involved in connecting the ß1-AR to trafficking and signaling networks.

Carpal boss is a bony protrusion on the dorsal aspect of wrist quadrangular joint. The exact cause and prevalence are not well understood. Most of the patients are asymptomatic, although some experience pain, bony prominence, restricted mobility, and joint instability in sever neglected cases. We are presenting a case of a 24-year-old male had chronic dorsal wrist pain with bony prominence appearance underwent surgical excision of a carpal boss lesion in concomitant with soft tissue ganglion cyst over the carpal boss after failed conservative management, resulting in significant symptom improvement and restored range of motion. Carpal boss lesion is a common condition that can be undiagnosed due to asymptomatic presentation or the presence of overlying soft tissue pathology as ganglion cyst. Although conservative treatment is helpful in some patients, most symptomatic carpal boss lesion patients eventually need surgical excision. [ABSTRACT FROM AUTHOR]

Maintaining pressure within the wellbore to avoid the uncontrolled flow of formation fluids is essential, and this process is known as well control. When there is an influx during drilling, different techniques are employed to maintain well control. The Driller's Method and Wait and Weight Method are common conventional methods used in the drilling industry due to their effectiveness and adaptability. One of the limitations of these two methods is when having a kick size exceeding the kick tolerance. In order to ensure the safety and integrity of a well in such conditions, it is imperative to explore alternative methods for managing large influxes of formation fluids that may occur during drilling operations. One promising approach involves implementing a reverse well control operation, which would enable the circulation of such influxes from the wellbore without compromising the integrity of the well. By reversing the flow of fluids from the wellbore and diverting them inside the strongest pipe from the beginning, the annulus pressures will be lower. This method can effectively manage and control huge influx sizes without exposing the annulus to high pressures. This paper does a detailed comparison between the Driller's Method and Reverse Driller's Method. [ABSTRACT FROM AUTHOR]

Background & objectives mHealth technologies, with their potential in improving public health, have recently gained considerable interest in India, offering an opportunity to deliver tailored and low cost interventions to the selected populations, especially in resource-poor settings. Project Vayoraksha aimed at developing and pilot testing mHealth technology-assisted strategies (Vayoraksha mobile application and field Vayoraksha network) to improve healthcare delivery and reverse quarantine at the field level among the geriatric population. Methods This field operational research study was implemented in Pathanamthitta, Kerala, from October 2020 to July 2021. The Vayoraksha mobile phone application for the geriatric users and a web interface used by healthcare workers involved in the field Vayoraksha network was developed with multisectoral expertise. Vayoraksha had facilities for symptom surveillance, teleconsultation and assessment of needs and included a community-based system to monitor and meet their needs that can help in reverse quarantine of the geriatric population. Results The project was implemented using the field Vayoraksha campaign involving frontline health workers and community volunteers. A baseline survey of 4782 geriatric population in the study area was conducted in Phase I, and 2383 (49.8%) had access to a smartphone facility to use Vayoraksha. Of these, 1257 (52.7%) were covered under the 'field Vayoraksha campaign' using intersectoral coordination and community participation. A total of 750 (59.6%) geriatric individuals downloaded the application of whom, 452 (60.3%) used the services of Vayoraksha. Needs were registered by 56 (12.3%) individuals of which 46 (82.1%) were medical needs related to the management of chronic diseases. More than 70 per cent of the needs were met through the Vayoraksha field network under the local primary health centre. More than 80 per cent of the geriatric individuals reported symptoms related to COVID-19 during the intervention period. Compliance with quarantine was observed in 77.7 per cent of the geriatric populations. Among those who used Vayoraksha , 26 (5.7%) availed tele-counselling services, and 3 (0.6%) used teleconsultation facilities. It was observed that Vayoraksha users had a higher proportion of the geriatric population who were young, educated, having chronic morbidity and living with family. Regular symptom surveillance was done within this group; only 12 (2.6%) of them tested positive for COVID-19 during this study. Interpretation & conclusions Results of this pilot study are promising, with 60 per cent of the geriatric population downloading and using Vayoraksha within a short time. Technology-assisted interventions can supplement the existing system for improved healthcare delivery among the vulnerable groups and have good potential for scale-up in the near future in developing countries. [ABSTRACT FROM AUTHOR]