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In recent years, regional cohesion policies have received increasing attention worldwide. Therefore, international organizations, governments, and researchers have sought to assess the vulnerability in lagging regions. However, most studies have focused on exposure to a particular risk, with little work to examine overall interactions or adaptability from a multidimensional perspective. This study aims to fill the current research gap by developing a multidimensional composite index using the IPCC approach and a Delphi survey to define the criteria and specify the weights of the variables by the AHP method. The results showed that the municipality, which has an adaptive capacity through physical and economic capabilities, has overcome environmental, social, and demographic risks. On the other hand, some municipalities have been affected by their isolation, resulting in a high sensitivity to economic, social, and demographic challenges. A quantitative assessment of the various aspects of vulnerability and adaptability assists experts in mitigating the effects of vulnerability through management, planning, and decision-making; developing appropriate strategies; and serving as a manual for governments in managing vulnerability decrease to achieve sustainable development.

Applied element method (AEM) is a recently displacement-based structural analysis method. It provides the benefits of both the finite element method (FEM) and the discrete element method (DEM). This method relies on those structures are segmented into rigid elements linked by normal and shear springs. In this paper a brief note of the AEM is given. Then, using the AEM, a 2D MATLAB open source program was created to analyze different structures with varied boundary conditions and to permit researchers for enhancing the method. The proposed program was verified using linear elastic analysis and large deformation static analysis. The influence of element size and the number of connecting springs between elements was studied. Finally, the proposed program was capable of tracking failed elements and their spread. In addition, the program could predict deflection values and structure deformed shape.

Several infections can predispose to certain malignancies in different body parts. These infections include viral, bacterial, and fungal pathogens. Imaging plays a vital role in the diagnosis, staging, and management of these neoplastic conditions. Furthermore, it can help in differentiating infection-related non-neoplastic processes that can mimic malignancies. Both radiologists and clinicians should be familiar with these conditions. This review discusses the epidemiology, pathogenesis, and imaging features of infection-related tumors.

Elder abuse may result in serious physical injuries and long-term psychological consequences and can be life threatening. Over the past decade, attention to elder abuse has increased owing to its high prevalence, with one in six people aged 60 years and older experiencing some form of abuse worldwide. Despite this, the detection and reporting rates remain relatively low. While diagnostic imaging is considered critical in detection of child abuse, it is relatively underused in elder abuse. The authors discuss barriers to use of imaging for investigation and diagnosis of elder abuse, including lack of training, comorbidities present in this vulnerable population, and lack of communication among the intra- and interdisciplinary care providers. Moreover, imaging features that should raise clinical concern for elder abuse are reviewed, including certain types of fractures (eg, posterior rib), characteristic soft-tissue and organ injuries (eg, shoulder dislocation), and cases in which the reported mechanism of injury is inconsistent with the imaging findings. As most findings suggesting elder abuse are initially discovered at radiography and CT, the authors focus mainly on use of those modalities. This review also compares and contrasts elder abuse with child abuse. Empowered with knowledge of elderly victims' risk factors, classic perpetrator characteristics, and correlative imaging findings, radiologists should be able to identify potential abuse in elderly patients presenting for medical attention. Future recommendations for research studies and clinical workflow to increase radiologists' awareness of and participation in elder abuse detection are also presented.

Sickle cell disorder (SCD) refers to a spectrum of hematologic disorders that cause a characteristic clinical syndrome affecting the entire body. It is the most prevalent monogenetic hemoglobinopathy worldwide, with a wide range of focal and systemic expressions. Hemoglobin gene mutation leads to the formation of abnormal sickle-shaped red blood cells, which cause vascular occlusion and result in tissue and organ ischemia and infarction. Recurrent episodes of acute illness lead to progressive multisystem organ damage and dysfunction. Vaso-occlusion, hemolysis, and infection as a result of functional asplenia are at the core of the disease manifestations. Imaging plays an essential role in the diagnosis and management of SCD-related complications in the abdomen and pelvis. A thorough understanding of the key imaging findings of SCD complications involving hepatobiliary, gastrointestinal, genitourinary, and musculoskeletal systems is crucial to timely recognition and accurate diagnosis. The authors aim to familiarize the radiologist with the SCD spectrum, focusing on the detection and evaluation of manifestations that may appear at imaging of the abdomen and pelvis. The topics the authors address include

Background: Biomedical photoacoustic imaging (PAI) is a hybrid imaging modality based on the laser-generated ultrasound waves due to the photoacoustic (PA) effect physical phenomenon that has been reported firstly by A. G. Bell in 1880. Numerical modeling-based simulation for the PA signal generation process in biological tissues helps researchers for decreasing error trials in-vitro and hence decreasing error rates for in-vivo experiments. Numerical modeling methods help in obtaining a rapid modeling procedure comparable to pure mathematics. However, if a proper simplified mathematical model can be founded before applying numerical modeling techniques, it will be a great advantage for the overall numerical model. Most scientific theories, equations, and assumptions, been proposed to mathematically model the complete PA signal generation and propagation process in biological tissues, are so complicated. Hence, the researchers, especially the beginners, will find a hard difficulty to explore and obtain a proper simplified mathematical model describing the process. That’s why this paper is introduced. Methods: In this paper we have tried to simplify understanding for the biomedical PA wave’s generation and propagation process, deducing a simplified mathematical model for the whole process. The proposed deduced model is based on three steps: a- pulsed laser irradiance, b- diffusion of light through biological tissue, and c- acoustic pressure wave generation and propagation from the target tissue to the ultrasound transducer surface. COMSOL Multiphysics, which is founded due to the finite element method (FEM) numerical modeling principle, has been utilized to validate the proposed deduced mathematical model on a simulated biological tissue including a tumor inside. Results and Conclusion: The time-dependent study been applied by COMSOL has assured that the proposed deduced mathematical model may be considered as a simplified, easy, and fast startup base for scientific researchers to numerically model and simulate biomedical PA signals’ generation and propagation process utilizing any proper software like COMSOL.

Rationale: Predicting recovery of consciousness in unresponsive, brain-injured individuals has crucial implications for clinical decision-making. Propofol induces distinctive brain network reconfig...

Background Stroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version). Results Rural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS? Conclusion Urban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

https://hunandaxuexuebao.com/details.php?id=DOI:10.17605/OSF.IO/VWBUQ

Purposes. This study was conducted to compare between cervical proprioception and hand dexterity in physiotherapists with and without mechanical neck pain, and to determine the relationship between cervical proprioception and hand dexterity in physiotherapists. Materials and methods. Sixty physiotherapists (30 with chronic mechanical neck pain (G1), mild to moderate neck pain lasted more than 6 months and 30 healthy control (GII)). Both sexes were enrolled with; age ranged from 25 to 35 years, normal body mass index (BMI) and at least one year of practice of manual work. All participants undergone evaluation of cervical joint position error (JPE) using cervical range of motion device (CROM) through head-to-neutral repositioning (NHR) and head-to-target repositioning (THR) tests in flexion direction in addition to evaluation of hand dexterity using Purdue pegboard test. Results. There was statistically significant difference in median values of JPE and hand dexterity between both groups. There was statistically significant indirect medium to strong correlation between JPE in flexion (NHR and THR) and hand dexterity (in dominant and assembly tests). Conclusions. Physiotherapists with neck pain have impairment in cervical proprioception which in turn negatively affects hand dexterity. Hand dexterity is important functional property for physiotherapist to apply different manual techniques. So, impairment of hand dexterity may interfere with the efficiency of manual application.

purpose: Epilepsy is a major public health problem worldwide. The aim of this study was to explore the level of awareness, knowledge regarding epilepsy and attitudes prevalent toward epilepsy among king Khalid university students. Methods: The descriptive and cross-sectional study was conducted with the voluntary participation of 227 participants from students at King Khalid University. The mean age of participating was (20.10 ± 1.3). Theoretical and practical colleges used questionnaires to assess students' knowledge about epilepsy and their attitudes towards it. Results: A total of 227 respondents completed the survey; the results showed almost all had heard about epilepsy. Only 83.7% have never had any information on how to treat a patient with epilepsy. 80.6% think non-medical treatment is beneficial for epilepsy %13.2% do not know how to do first aid to deal with epileptic seizures. Almost 32.6% did not know the cause of epilepsy, 59% believed that it was a hereditary disorder 44.1% believed epilepsy is a form of mental illness, 57.3% believed that epilepsy patients die because of epileptic seizures. 59% believed that it was a hereditary disorder 44.1% believed epilepsy is a form of mental illness, 11% of participants thought that epilepsy is caused by evil spirits, 57.3% believed that epilepsy patients die because of epileptic seizures. There were also many students who held negative attitudes towards patients with epilepsy in regard to major life milestones such as marriage and having children. 16.7% indicated that it presents an impediment in participation in sports, approximately 6.2% objected to marrying someone with epilepsy, Moreover 11.5% thought they should not have children and, the study showed 46,3% would not allow their child to play with a child with epilepsy. Moreover 14.5 afraid to live with someone with epilepsy. the study showed 6,6 % objected accept working with a patient with epilepsy. Conclusions: The level of awareness, knowledge, and attitudes of students at King Khalid toward epilepsy were acceptable regarding this study. However, the negative attitudes and misconceptions still exist. Further studies are needed to determine methods of overcoming these negative attitudes and misconceptions toward epilepsy.

Introduction: The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). Methods: We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm3 were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. Results: Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm3 and lower PLR ≤18.4 increased the risk of drainage failure (p = 0.009 and 0.001, respectively). Conclusion: Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Background: Endoscopic vein harvesting (EVH) became a standard technique with several advantages over open vein harvesting (OVH). Thrombus formation inside the vein lumen is one of the main concerns after EVH. It is not known whether heparin use before EVH could prevent this complication. The study aimed to assess the safety of not giving intravenous heparin before starting the open system EVH procedure using the PeriVu™ Disposable Angioscopy (LeMaitre® VASCULAR- France) as a modality to assess the intraluminal vein clots. Methods: This research is a randomized study that compared two groups of patients undergoing CABG. One group had 2500 IU heparin before EVH using (Virtusaph plus, Terumo) (n=50) and the other group had EVH without giving heparin (n=50). Intraluminal clots in the vein segments were evaluated using PeriVu Disposable Angioscopy ( LeMaitre-VASCULAR). Results: Preoperative data were comparable between groups with no statistically significant difference. The mean duration of the procedure in the heparin group versus the non-heparin group was 30.6±5.8 and 28.7±5.9, respectively (P= 0.11). Intraluminal clots were detected in two segments out of 103 segments (1.94%) in the No heparin group, while none was detected in the heparin group (P= 0.24). Conclusion: There was no difference between heparin versus no heparin during endoscopic vein harvest regarding intraluminal thrombus formation. Further studies are recommended to confirm our findings.

Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.

Background: Hepatocellular carcinoma is a highly prevalent tumor globally and the world's second leading cause of cancerrelated deaths. Glypican-3, a heparan sulfate proteoglycan expressed on the surface of HCC cells, has emerged as a new molecule with a strong link to occurrence and progression of HCC. Objective: This study was done to determine the role of Glypican-3 in diagnosis of HCC and its prognostic value following different treatment modalities. Patients and methods: The study included thirty patients with liver cirrhosis and HCC on top, and thirty patients with liver cirrhosis without HCC. Standard laboratory investigations, abdominal ultrasound and triphasic computed tomography were done for all patients. Serum alpha fetoprotein and Glypican-3 were measured in all patients before and one month after different treatment modalities. Results: Glypican-3 was significantly higher in HCC group (2.28 ± 0.97) in comparison to cirrhosis group (0.56 ± 0.31) with P-value 1.1 ng/ml Glypican-3 has 93.3% sensitivity, 96.67% specificity, 96.6% PPV and 93.5% NPV for detection of HCC. Conclusion: Glypican-3 can be a valuable diagnostic marker for HCC diagnosis and prognosis after various treatment modalities and may be complementary to alpha fetoprotein increasing overall sensitivity of HCC detection.

Methotrexate (MTX) is a potent anti-cancer drug, commonly associated with nephrotoxicity via the induction of oxidative stress and apoptosis with alteration of renal water channel proteins, namely aquaporins (AQPs). Omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) have shown cytoprotective effects through their anti-oxidant and antiapoptotic activities. The present study aims for the first time to explore the role of LC-PUFA against MTX-induced nephrotoxicity. Rats were divided into the following groups: saline control, LC-PUFA control, MTX, MTX + LC-PUFA (150 mg/kg), or MTX + LC-PUFA (300 mg/kg). Then, H&E staining and immunohistochemical staining for the anti-apoptosis marker B-cell lymphoma 2 (BCL-2), the apoptosis marker BCL2-Associated X Protein (BAX), the proinflammatory marker Nuclear factor kappa B (NF-kB), AQPs 1 and 2 were performed in kidney sections with an assessment of renal oxidative stress. The MTX caused a renal histopathological alteration, upregulated renal BAX and NF-kB, downregulated Bcl-2 and AQP1, altered the distribution of AQP2, and caused oxidative stress. The LC-PUFA attenuated the pathological changes and decreased renal BAX and NF-kB, increased BCL-2 and AQP1, restored the normal distribution of AQP2, and decreased the oxidative stress. Therefore, LC-PUFA is a good adjuvant to MTX to prevent its adverse effects on kidneys through its antiapoptotic, antioxidant, and anti-inflammatory effect and its role in the restoration of the expression of AQPs 1 and 2.

Purpose This paper aims to enlighten the importance of the risk management process which is considered as a major procedure to effectively handle the potential inherent risks in the construction industry. However, most traditional risk analysis techniques are based on theories that deal with each risk factor as an independent, which does not take into consideration the causal relationships between risk factors. Design/methodology/approach This study aspires to identify the overall risk of the administrative construction projects in Egypt and to recognize the most influencing risk factors through the project life cycle by using Bayesian belief networks (BBN). Through a review of the literature, 27 risk factors were identified and categorized as the most common risk factors in the construction industry. A structured questionnaire was performed to estimate the probability and severity of these risks. Through site visits and interviews with experts in the construction field, 200 valid questionnaires were collected. A risk analysis model was developed using BBNs, then the applicability of this model was verified using a case study in Egypt. Findings However, the outcome showed that critical risks that manipulate administrative construction projects in Egypt were corruption and bribery, contractor financial difficulties, force majeure, damage to the structure and defective material installation. Practical implications The proposed study presents the possibilities available to the project parties to obtain a better forecast of the project objectives, including the project duration, total project cost and the target quality by examining the causal relationships between project risks and project objectives. Originality/value This study aspires to identify the overall risk of the administrative construction projects in Egypt and to recognize the most influencing risk factors through the project life cycle by using BBNs.

Due to the data paucity about the functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with a preoperative age above the age of 45 years and according to the elderly definition (age ≥ 65 years), we conducted this study to clarify the different outcomes in adults presented with late hydronephrosis. We included patients who were managed by pyeloplasty with a preoperative age ≥ 45 years. We further subdivided those patients into; group (A) patient’s age ≥ 65 years and group (B) patient’s age ≥ 45 and

Radium-223 (Ra-223) has been recommended for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). Second-generation hormone therapy in combination with Ra-223 in mCRPC has been utilized, yet its benefit has not been well elucidated. We investigated the potential survival benefit of concomitant enzalutamide with Ra-223 in the third-line setting and predictors of improved overall survival (OS).We retrospectively identified 51 patients with bone-dominant mCRPC that were treated with Ra-223 in the postchemotherapy and post-hormone therapy setting, either alone (group A; n = 32) or with concomitant enzalutamide (group B; n = 19). The primary endpoint was to study the OS difference between groups A and B. The secondary endpoint was to identify predictors of improved OS with Ra-223 in the third-line setting.Mean age was 70.9 years, median baseline prostatic-specific antigen (PSA) was 23.1 ng/mL, alkaline phosphatase was 91 IU/L, and hemoglobin was 12.5 g/dL. There was no difference in median OS between groups A and B, at 20.4 versus 17.5 months, respectively (P = .5186). In univariate and multivariate analyses, only pre-Ra-223 PSA 30 ng/mL and Eastern Cooperative Oncology Group performance status 2 were associated with improved OS.In our study cohort, concomitant use of enzalutamide with Ra-223 in the mCRPC setting was not associated with improved OS. Only pretreatment PSA 30 ng/mL and pretreatment Eastern Cooperative Oncology Group performance status 2 were associated with improved OS. Further prospective studies are warranted.

It is unclear if attention-deficit hyperactivity disorder (ADHD) increases the risk of head trauma in children.We conducted a multicenter prospective observational study of children with minor blunt head trauma. Guardians were queried, and medical records were reviewed as to whether the patient had previously been diagnosed with ADHD. Enrolled patients were categorized based on their mechanism of injury, with a comparison of those with motor vehicle collision (MVC) versus non-MVC mechanisms.A total of 3410 (84%) enrolled children had ADHD status available, and 274 (8.0%; 95% confidence interval, CI: 7.1, 9.0%) had been diagnosed with ADHD. The mean age was 9.2 ± 3.5 years and 64% were males. Rates of ADHD for specific mechanisms of injury were: assaults: 23/131 (17.6%; 95% CI 11.5, 25.2%), automobile versus pedestrian 23/173 (13.3%; 95% CI: 8.6, 19.3%), bicycle crashes 26/148 (17.6%; 95% CI: 11.8, 24.7%), falls 107/1651 (6.5%; 95% 5.3, 7.8%), object struck head 31/421 (7.4%; 5.1, 10.3%), motorized vehicle crashes (e.g., motorcycle, motor scooter) 11/148 (7.4%; 3.8, 12.9%), and MVCs 46/704 (6.5%; 95% CI: 4.8, 8.6%).Children with ADHD appear to be at increased risk of head trauma from certain mechanisms of injury including assaults, auto versus pedestrian, and bicycle crashes but are not at an increased risk for falls.

This article proposes a differential power processing (DPP) configuration applied to a series photovoltaic (PV) string. The proposed configuration operates each PV element at its local maximum power point (MPP) while processing only a small portion of its total generated power through the modular-integrated converters. The current processed through each converter is the difference between the local PV element MPP current and the local PV string current. This leads to higher energy capture at an increased conversion efficiency while overcoming the difficulties associated with unmatched MPPs that result from partial shading, temperature gradients, manufacturing defects, and nonuniform cells aging. A state-space model of the proposed system is driven, and a comparative analysis is carried out with respect to the conventional DPP architectures. Additionally, modular and compact design is proposed for a large number of PV panels in a series PV string. The authors designed and built a hardware prototype for three PV panels connected in series to validate the proposed configuration effectiveness and experimentally demonstrate its robustness.

Extraskeletal Ewing sarcoma (EES) is a rare subtype in the Ewing sarcoma family of tumors (ESFT), which also includes Ewing sarcoma of bone (ESB) and, more recently, primitive neuroectodermal tumors. Although these tumors often have different manifestations, they are grouped on the basis of common genetic translocation and diagnosis from specific molecular and immunohistochemical features. While the large majority of ESFT cases occur in children and in bones, approximately 25% originate outside the skeleton as EES. Importantly, in the adult population these extraskeletal tumors are more common than ESB. Imaging findings of EES tumors are generally nonspecific, with some variation based on location and the tissues involved. A large tumor with central necrosis that does not cross the midline is typical. Despite often nonspecific findings, imaging plays an important role in the evaluation and management of ESFT, with MRI frequently the preferred imaging modality for primary tumor assessment and local staging. Chest CT and fluorine 18 fluorodeoxyglucose PET/CT are most sensitive for detecting lung and other distant or nodal metastases. Management often involves chemotherapy with local surgical excision, when possible. A multidisciplinary treatment approach should be used given the propensity for large tumor size and local invasion, which can make resection difficult. Despite limited data, outcomes are similar to those of other ESFT cases, with 5-year survival exceeding 80%. However, with metastatic disease, the long-term prognosis is poor.