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Successful construction projects are those to be completed within the planned time, cost and quality, in addition to minimizing waste, pollution and energy consumption. It is believed that adopting lean principles in the construction industry can help a lot in achieving these goals. This research aims at studying the benefits, obstacles and readiness to adopt lean construction in Iraq and the actions needed. A questionnaire was designed based on extensive review of relevant literature and then directed to (123) professionals involved in the Iraqi construction industry. The results were statistically analyzed and tested and found to be valid and reliable. Contradictions of very few aspects were then discussed and clarified through direct interviews with (10%) of the questionnaire respondents . The research revealed that the Iraqi construction industry is in need of all potential benefits that lean construction can provide through value maximization and using modern construction techniques. The research also revealed that the main obstacles are lack of expertise, skills, awareness and knowledge in lean principles and poor culture related to waste identification and control. Concerning the readiness success factors, more emphasis was made to the integration of design, manufacture and construction and life-cycle engineering. Finally, proactive actions were suggested on national and institutional scales taking into account that the major role to shift to lean construction rests with the government and the construction sector leaders. Keywords: Lean Thinking, Lean Production, Lean Construction, Construction Industry, Construction Projects

Velopharyngeal valve closure is essential for adequate speech intelligibility as well as for other activities. The variations in the contribution of different components of the velopharyngeal port walls produce different closure patterns. The aim of this cross-sectional study is to identify the prevalence of the different velopharyngeal closure patterns in Arabic-speaking individuals with no perceived hypernasality or velopharyngeal dysfunction.After verification of selection criteria, 100 subjects with age range between 15 and 60 years underwent nasoendoscopic examination and both the extent of movement of the different velopharyngeal walls as well as closure pattern were observed.Almost all participants had grade 4 (full range) velar mobility, most participants had grade 3 lateral pharyngeal wall movement, and none showed any observable posterior pharyngeal wall movement. Coronal closure pattern was the most frequent (75%) among participants followed by circular pattern (25%). There was no statistically significant difference between both genders in the extent of velar and lateral pharyngeal wall movements, yet the frequency of closure patterns differed statistically significantly between males and females.Coronal pattern was the most prevalent type of velopharyngeal closure in subjects with normal habitual resonance, of both sexes, yet it occurred more frequently in males.

The presented work shows the design and evaluation of the NIS 1 kN·m primary torque standard machine. The machine covers the range up to 1000 N·m with a very wide range of torque steps thanking different 4 mass stacks. The machine has a double-side lever arm with half-moon ends to provide calibration in the clockwise and anticlockwise directions. An air bearing was used as a fulcrum to provide a low friction coefficient. FEA was used in the design and optimization process of the lever arm. The relative expanded uncertainty of the machine is 0.03% which is proved by recalibration of two reference torque transducers of 200 N·m and 1000 N·m capacity. All En values are less than unity, which reveals the competence of the developed machine.

Background: Vinflunine is the only cytotoxic agent that had been tested as a second line therapy in platinum refractory urothelial carcinoma patients in a phase III clinical trial. The aim of our study was to evaluate the efficacy and safety of vinflunine as a second line after failure of platinum containing regimen. Patients and methods: We prospectively included 27 patients of locally advanced or metastatic urothelial cancer who presented to the National Cancer Institute (NCI) of Egypt. The primary objective was to assess the disease control rate. However, the secondary objectives were to assess the progression free survival (PFS) and overall survival (OS). Results: A total of 27 patients were treated at the NCI of Egypt. Median age was 64.1 years (42.3-76.8). Male to female ratio was 26:1. Eastern Cooperative Oncology Group performance status was zero in 2 patients, one in 23 patients while the ECOG PS 2 was in only 2 patients. The vast majority of the patients received 2 cycles (12 patients), one patient received 3 cycles, 5 patients received 4 cycles, and 8 patients received 6 cycles while one patient received 8 cycles. A complete response was observed in one patient, partial response in 9 patients and stable disease in 12 patients and progressive disease in 5 patients with a disease control rate of 81.4%. Median progression free survival (PFS) and overall survival for the entire population were 3.45 months and 3.22 months respectively. Median OS for the responders was 7.24 months. Toxicity was mild, and grade 3-4 adverse events were anemia (11.1%), neutropenic fever (4%), fatigue (14.8%) and constipation (7.4%). Conclusion: Vinflunine is an efficient and tolerable second line treatment in advanced urothelial carcinoma.

Objective To obtain the major benefits of having a long open hole completion with maximum multiple reservoirs contact, full control and optimization over the flow without coil tubing intervention have become a challenge for the operators. This paper presents a step change in the engineering for optimizing oil production across multiple reservoirs by deploying the first mono-bore smart completion technology with four inflow control valves, swell packers and permanent downhole gauges across an open hole horizontal reservoir drain of 4,600 feet in ADNOC Group Fields.

Background: Antinuclear antibodies (ANA) detection is a crucial laboratory test for diagnosing systemic autoimmune disorders and is commonly the initial step in autoantibodies screening. ANA are immunoglobulins that differentiate a wide range of nuclear and cytoplasmic components. ANAs are consistently present in the sera of patients with a variety of rheumatic disorders. The purpose of the study was to investigate the kinds and the expansion of disease-specific antinuclear antibodies (ANAs) and their link to rheumatic disorders in the general Syrian people. Method: Immunofluorescence (IIF) was used for testing ANA in serum samples gained from 529 patients. Individualities positive for IF­ ANA were further tested for disease­ specific ANAs using line Immunoblot assay. Results: Based on the result of the IF­ ANA assay, the rates of positive samples were 7.9%. Anti-SSA/Ro and anti-dsDNA antibodies were detected in 7and 6 individuals, respectively, anti Scl70, anti-Nucleosome, anti-U1-RNP, anti-CENP B were detected in 4 different individuals, but anti-Sm, anti-PCNA, and anti-Jo-1 antibodies were undetectable. Among 42 IF­ ANA­ positive individualities, 24 were found to have disease ­specific ANAs: nine SLE, three Sclerosis, and two rheumatoid arthritis. Conclusions ANA should generally not be examined without a clinical indication. Positive ANA finding in the absence of clinical symptoms and signs has limited diagnostic usefulness and should be interpreted by a rheumatologist constantly, in the context of clinical symptoms and the results of laboratory tests for specific autoantibodies.

The purpose of this paper is to prove the following assertion. Let S be a ring having a nontrivial idempotent element e which satisfies some conditions. We prove that any multiplicative centrally-extended derivation of S is a centrally-extended derivation.

The shear strength of soil is one of the most important soil properties that should be identified before any foundation design. The presence of gypseous soil exacerbates foundation problems. In this research, an approach to forecasting shear strength parameters of gypseous soils based on basic soil properties was created using Artificial Neural Networks. Two models were built to forecast the cohesion and the angle of internal friction. Nine basic soil properties were used as inputs to both models for they were considered to have the most significant impact on soil shear strength, namely: depth, gypsum content, passing sieve no.200, liquid limit, plastic limit, plasticity index, water content, dry unit weight, and initial voids ratio. Multi-layer perceptron training by the backpropagation algorithm was used in creating the network. It was found that both models can predict shear strength parameters for gypseous soils with good reliability. Sensitivity analysis of the first model indicated that dry unit weight and plasticity index have the most significant effect on the predicted cohesion. While in the second model, the results indicated that the gypsum content and plasticity index have the most significant effect on the predicted angle of internal friction.

In this paper, the effect of footing shape resting on dry sand when subjected to machine dynamic loading is experimentally investigated. A laboratory set-up was prepared to simulate the case at different operating frequencies. Nine models were tested to examine the effects of the combinations of two parameters, including different frequencies of (0.5, 1, and 2 Hz) and different footing shapes (circular, square and rectangular). The tests were conducted under a load amplitude of (0.25 ton) using sand with medium and dense relative densities corresponding to (R.D. = 50% and 80%) having unit weights of (17.04 and 17.96 kN/m3) respectively. A shaft encoder and a vibration meter were used to measure the strain and amplitude displacement, while the stress in the soil at different depths was measured using flexible pressure sensors. It was found that the shape of footing has a considerable influence on the bearing capacity of the supporting soil under dynamic loading. For instance, the strain of dry sand under a circular footing was nearly (41%) higher, the amplitude displacement was nearly (17%) higher, and stress was nearly (12%) higher than square and rectangular footings, under the same conditions.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of oral hypoglycemic agents commonly prescribed in type 2 diabetes (T2D). They have been shown to slow the progression of diabetic nephropathy and improve cardiovascular outcomes in high-risk individuals, although major cardiovascular and renal outcome clinical trials have excluded renal transplant patients. The aim of this review was to determine the outcomes and safety with use of SGLT2 inhibitors in renal transplant patients with diabetes. We conducted a review of randomized controlled trials, cohort studies, case series and case reports that assessed use of SGLT2 inhibitors in patients post-renal transplant with either pre-existing T2D or new-onset diabetes after transplant. The outcomes assessed included blood pressure, renal allograft function (estimated glomerular filtration rate), proteinuria (urinary albumin-to-creatinine ratio), glycemic control, body weight and adverse effects. A total of 9 studies, which included 144 patients, were reviewed. SGLT2 inhibitor use in renal transplant patients demonstrates either a small or nonsignificant reduction in blood pressure and results in overall stable renal allograft function. It also results in modest improvement in glycemic control as well as weight reduction. The incidence of adverse effects is low and reversible, as reported in previous nontransplant clinical trials. Overall, our findings suggest beneficial outcomes with no significant adverse effects or complications with the use of SGLT2 inhibitors in renal transplant patients with diabetes; however, these findings are based on small trials, and thus well-designed trials in this population are warranted.

Red Sea represents one of the most remarkable marine ecosystems. However, it is also one of the world's least explored areas of marine biodiversity. The aims of this investigation were therefore, to isolate marine microorganisms from the seashore sediments and water in shallow region from west Yemen coast, to assess their antimicrobial potential, to identify the highly active isolate, and to purify and identify the bioactive compounds from it. In this regard, twenty-five bacterial strains have been isolated from twenty samples and tested for their antimicrobial ability against some pathogenic bacteria and yeast by using the agar disk diffusion and agar well diffusion assay. Out of the total 25 marine actinomycetes isolates only 13 exhibited interesting antimicrobial activity. The morphological, biochemical, and phylogenetic characteristics of the potential isolate 1S1 were compatible with their classification in the genus Streptomyces. The 16S rRNA gene sequences have shown that the isolate 1S1 clustered with Streptomyces longisporoflavus. The strain Streptomyces sp. 1S1 was cultivated and extracted with ethyl acetate. The GC–MS study of the extract indicated the presence of certain fatty acyl compounds e.g., tetradecanoic acid, 9-octadecenoic acid, hexadecanoic acid, and 9,12,15-octadecatrienoic acid. Using chromatographic techniques, three compounds were isolated and by spectroscopic methods e.g., IR, MS and NMR structurally elucidated. The three compounds were identified as a triacylglyceride, 9-octadecenoic acid, and hexadecanoic acid. The study reinforces the evidence of the potential of Streptomyces sp and the ability to produce several antimicrobial compounds.

The COVID-19 issue forced necessary changes in medical education that have been demanding and adjusting for different medical colleges, but they also provide a great opportunity for the betterment and possible challenging and useful transformation of medical education. This chapter examined the responses of medical organizations to this pandemic, its merits, and its challenges. It analyzed the potential effects of new strategies’ recognition and application on medical education in the post-COVID-19 period. The status of medical education before COVID-19 and the challenges of adopting competencies have been reviewed. The teaching and assessment strategies innovated in the COVID-19 era and reflections from faculty and students were discussed. Over the previous years, the pandemic has questioned concepts about how medical education should be delivered. The COVID-19 pandemic offers the medical education community a unique chance to reorient itself away from outdated standards and practices and toward more societally responsible and accountable standards and practices. All involved in medical education should all work together to prevent situations from “snapping back” to how they have always been because they were accepted practices and would be lost if the pandemic had the potential to disrupt growth and reform.

Rare earth metal cerium-doped titania nanoparticles (titanium dioxide [TiO2]) were produced utilizing a low-cost and straightforward sol–gel technique, and its enhanced photodynamic anticancer activity was tested on Y79 retinoblastoma cancer cells. The structural, optical, morphological, anticancer activity, and cytotoxicity of pure and cerium-doped TiO2 (Ce-doped TiO2) were investigated. In X-ray diffraction (XRD) measurements, apparent doping of cerium in TiO2 was detected, with reported anatase patterns shifting toward a lower angle in the anatase structure. Raman spectra verify the presence of cerium doping in TiO2 by revealing greater wave number shifting. The scanning electron microscope (SEM) and transmission electron microscope (TEM) analysis showed that the synthesized TiO2 and Ce-doped TiO2 nearly spherical. TiO2 and Ce-doped TiO2 were studied for their photodynamic anticancer activities, and the results suggest that cerium doping in TiO2 improves anticancer activity.

In this article we use one-dimensional, monoenergetic diffusion kinetic equation with one delayed neutron precursor concentration in Cartesian geometry to reconstruct the neutron flux of a reactor from the nuclear parameters, boundary, and initial conditions. The mathematical model is governed by a system of linear partial differential equations with prescribed boundary and initial conditions. As a matter of fact, the exact solution for any physical problem, if available, is of great importance which inevitably leads to a better understanding of the behavior of the involved physical phenomena. The present work represents an attempt for doing so, where the flux and precursor equations are solved by the help of Laplace transform in both spatial and time variables and consequently the exact expressions for the flux and concentration in space and time are established. We report numerical simulations as well study of numerical convergence of the obtained results.

Before and after illumination, as well as when it was coupled with the medicine Paclitaxel, the visible-light induced fac-Mn(CO)3 molecule of 8-amino showed interesting cytotoxicity against triple-negative breast cancer.

Individual survival would be impossible without anxiety, which is a natural and important emotion. Anxiety is considered a disease that requires treatment when it occurs in the absence of a threat, or in a disproportionate proportion to a threat, as well as when it prevents the affected individual from leading a normal life. Generalized Anxiety Disorder (GAD) is a widespread mental disorder characterized by excessive and difficult-to-control anxiety and concerns. as well as a variety of psychological and physical symptoms. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. There are several proposed etiological explanations for GAD, including Freud's psychoanalytic theory, Stack's interpersonal theory, and the Stress Diathesis Model. The exact pathophysiological process of the disease is not fully understood. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. In this article, we’ll be discussing GAD epidemiology, etiology, evaluation, and treatment.

Experimental model was done for pile model of L / D = 25 installed into a laminar shear box contains different saturation soil densities (loose and dense sand) to evaluate the variation of pore water pressure before and after apply seismic loading. Two pore water pressure transducers placed at position near the middle and bottom of pile model to evaluate the pore water pressure during pullout tests. Seismic loading applied by uniaxial shaking table device, while the pullout tests were conducted through pullout device. The results of changing pore water pressure showed that the variation of pore water pressure near the bottom of pile is more than variation near the middle of pile in all tests. The variation of pore water pressure after apply seismic loading is more than the variation before apply seismic loading near the middle of pile and near the bottom of pile and in loose and dense sand. Variation of pore water pressure after apply seismic loading and uplift force is less than the variation after apply seismic loading in loose sand at middle and bottom of pile.

Background: The upgrowth and rapid prevalence of pandrug-resistant Acinetobacter baumannii strains that have a pathogenic activity to cause several infections are of considerable influence on the health of communities worldwide. No infections by these bacterial strains were recorded before 1998, and currently, the numbers are on the rise. Methods: The A. baumannii strains were isolated from male and female patients in Medical Microbiology Department, King Fahd Medical City (KFMC) in Riyadh, Saudi Arabia between 1/1/2020 to 29/12/2020. The statistical analysis was performed base on sex, age, source of samples, and response to commercially available antibiotics. The A. baumannii strains that resisted all the antibiotics including colistin and imipenem were selected for the synergic test. Results: The data showed that 62.28%, 77.07% of 342 A. baumannii strains were isolated from males and patients over 35 years of age. A. baumannii strains (pandrug-A. baumannii) that can resist all tested antibiotics were 8.19%. The major source of the A. baumannii isolates was the respiratory system (>50%). Among all isolates (N = 342), azidothymidine-resistant A. baumannii strains were more than 85%. There is a statistically significant difference (P < 0.05) in the number of colistin-resistant A. baumannii strains isolated from males comparing with the female. The combinations of colistin and silver nanoparticles or imipenem and silver nanoparticles resulted in synergistic action led to reduction of MICs of colistin, imipenem, and silver nanoparticles (more than four-fold reduction). Also, the combinations of colistin and imipenem had high synergistic action. Conclusion: The pandrug-resistant A. baumannii strains may represent a current and future threat that must be fought, and the synergy action of antibiotics and nanoparticles may be one of the available, rapid, and easy strategies to confront this global problem.

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

Aim: To assess the level of knowledge and awareness of undergraduate medical students in order to determine whether the undergraduate virology course is up to standard for preparation of the COVID-19 pandemic. Methodology: A cross-sectional study was conducted online by random-sampling method with a multi-central approach. Data was collected from 311 respondents for a time period of one month during May 2020. IRB approval was granted. Descriptive analysis was done on student demographics, their knowledge and opinions, using the research tool SPSS 24. Results: Majority of students had factually correct knowledge about Covid-19, according to the WHO guidelines. However, there was poor knowledge regarding animal reservoirs and other diseases caused by Coronaviruses. Most students had learned about Coronaviruses from sources apart from the syllabi or course material and 93% were in agreement for wanting an improved Coronavirus module in their undergraduate virology courses. Conclusion: Medical students have good knowledge about Coronavirus, but are lacking in some crucial topics such as sources of animal reservoir and types of diseases etc. More studies need to be conducted in order to assess whether undergraduate syllabi are sufficient for educating and training students about future possible pandemics. An efficient prospective course of action should be determined accordingly. Keywords: Medical students, Coronaviruses, Covid-19, Pandemic, Knowledge, Awareness.

A 53-year-old man with a subcutaneous implantable cardioverter-defibrillator (S-ICD) presented with inappropriate shocks. He underwent device extraction, and the lead was freed using a rotating mechanical dilator sheath. As patients with S-ICDs get older, extractions will become more complicated and more common. We have described a novel method of S-ICD lead extraction. (Level of Difficulty: Advanced.), Central Illustration

Carcinoma of the breast is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases. Median age at diagnosis is one decade younger than in countries of Europe and North America and most patients are premenopausal. Tumours are relatively advanced at presentation. The majority of tumours are invasive duct subtype and the profile of hormone receptors is positive for estrogen receptors and /or progesterone receptors in less than half of cases. This overview examines genetic changes, potential and established predictive and prognostic markers and end results of surgery, radiotherapy and systemic therapy for early, locally advanced and metastatic disease stages. Disease presentations common to the region and early detection strategies are presented