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During the October 30, 2020 Mw7.0 Samos Earthquake, the Turkiye-Izmir-Bayrakli district was affected the most due to the geometry and the deep-soft alluvial nature of the basin, although the district is approximately 70 km away from the epicenter. In this study, the seismic response of the Bayrakli basin, and the role of the soil stratigraphy and basin geometry on the recorded amplifications and prolonging of seismic shakings are investigated by using 1-, 2- and 3-D non-linear finite element-based dynamic response analyses. The assessment results are presented in the form of spectral amplification ratios, A T . The highest A (T) values were estimated at spectral periods T = 0.85 and 1 s. They exceed five in both the east–west and the north–south directions, more pronounced in the latter one. A T was decomposed into the product of two independent amplification factors, namely rock to soil amplifications, A Soil (T) , and 1-D soil column to 3-D soil basin amplifications, A Basin (T) . A Basin (T) values for T = 0.85 and 1 s are estimated as high as 1.4 and 1.6, in the east–west and the north–south directions, respectively. These values suggest that the 3-D geometry of the Bayrakli basin amplifies the spectral accelerations by 40–60% at T = 0.85 and 1 s. The unique combination of a deep-soft alluvial site with 3-D basin geometry, and overlying 7–9 story residential buildings, consistently favors and amplifies the seismic energy in the spectral period range of 0.7–1.0 s. This multi-fold increased seismic demand, combined with poor structural design and construction details, lead to localized structural damage and over 117 life losses. [ABSTRACT FROM AUTHOR]

The prediction of the behavior of vibration isolators is essential for effective and efficient design of these devices, as well as for accurately characterizing the isolator behavior. In this work, an experimental study was performed to characterize the behavior of metal-mesh isolators. Although these elements' performance is of great interest because of their usage in several applications, their characterization is complex due to their nonlinear nature, among other factors. This study's aim was to obtain the quasi-static behavior of these isolators, although dynamic tests are required for their complete characterization. These quasi-static tests allowed for the highlighting of some characteristics in a simpler and faster manner and also provided a starting point for designing future dynamic tests. The quasi-static tests performed resulted in the calculation of the hysteresis cycle under different operating conditions and manufacturing parameters. The study of different insulator characteristics, such as the energy dissipation coefficient and stiffness, led to interesting conclusions about the isolator performance. From the results, it was observed that the relative density affected most the nonlinear behavior of the insulator. Moreover, to correctly characterize their behavior, not only the Coulomb's damping but also the viscous damping had to be considered. [ABSTRACT FROM AUTHOR]

Objective: Asthma is one of the most prevalent chronic diseases with a substantial impact on the health status of affected patients. Further research is necessary to identify factors contributing to poor asthma control. The current study aimed to investigate the factors associated with poor asthma control among adult asthmatic patients. Methods: In this case-control study, the Asthma Control Test (ACT) was translated into Arabic and distributed to adults with asthma attending two hospitals in Jordan to evaluate the degree of asthma control. The following variables were collected for each patient: sociodemographic information, comorbidities, appropriate use of inhaler technique, spirometric measurements, and medications use. Binary regression was used to evaluate factors associated with asthma control. Results: A total of 314 participants with a mean age of 51.47 years (±16.37) completed the study. ACT score had a mean of 16.68 (±4.86). The majority of asthmatic patients had insufficiently controlled asthma (64.6%). Binary regression results showed that previous respiratory infection history (p = 0.014, OR = 0.473 (95%CI 0.261–0.857)), higher exposure to irritants (p = 0.010, OR = 0.747 (95%CI 0.598–0.933)) decreased the odds of being in the controlled asthma group. Patients receiving inhaled corticosteroids (ICS) had higher odds of being in the controlled asthma group (p = 0.039, OR = 2.372 (95%CI 1.043–5.392)). Conclusions: The majority of asthma patients had insufficiently managed disease. The main factors that contributed to poor asthma control were respiratory infection history, increased exposure to asthma symptoms triggers, and ICS nonuse. [ABSTRACT FROM AUTHOR]

Background: Incorrect use of inhalers is a problem associated with poor patient outcomes. Despite improvement in the technique after verbal educations, this deteriorates over-time requiring re-enforcement through different educative strategies. This study aimed to assess the impact of a novel video-based teach-to-goal (TTG) educational intervention on: mastery of inhaler technique, disease control, medication adherence and disease-related quality of life (QoL) over-time among asthma and COPD patients. Methods: This prospective, open-label, randomized controlled trial was registered in ClinicalTrials.gov: Identifier NCT05664347. After baseline assessment participants received either a verbal (control group) or a video-based (intervention group) TTG strategy. After 3-month the intervention was assessed for impact on the intended outcomes. Inhaler technique was assessed using standardized checklists, disease control using the Asthma control test and COPD assessment test respectively for asthma and COPD patients while adherence using the Morisky Green Levine scale. For QoL, the mini asthma quality of life questionnaire and the St. George respiratory questionnaire were used for asthmatic and COPD patients, respectively. Differences in outcomes between intervention-control groups were analyzed using either Chi-Square (X2)/Fisher Exact or Mann Whitney test. The impact of intervention on outcomes over-time was examined using either McNemar or Wilcoxon test. Results: At baseline, intervention (n = 51) and control (n = 52) groups had comparable demographic/clinical characteristics. At follow-up, inhaler technique improved among intervention group compared to control group (93.4% vs 67%) and to baseline (93.4% to 49.5%), (P<0.05). Similarly, medication adherence ameliorated among the intervention group in comparison to control group (88.2% to 61.5%) and to baseline (88.2% to 66.7%), (P<0.05). In regards to disease control, results showed an amelioration among the intervention group compared to baseline (35.3% to 54.9%) (P<0.05). QoL scores improved significantly among asthma patients (intervention group) at follow-up vs baseline. Better scores were also observed for COPD patients compared to controls, (P<0.05). Conclusion: Video-based (TTG) was effective in enhancing inhaler technique over time as well as improving disease control, medication adherence, and QoL. Trial registration: ClinicalTrials.gov: NCT05664347. https://clinicaltrials.gov/ct2/show/NCT05664347. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic disease in childhood. Exacerbation is a significant problem for asthmatic patients, and viral infections remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of parents of asthmatic children towards providing influenza vaccine to their children. This cross-sectional study enrolled parents of asthmatic children who visited the outpatient respiratory clinics of two Jordanian hospitals. The present study enrolled 667 parents of asthmatic children (62.8% female). The median age of the participants' children was 7 years. The results showed that 60.4% of the children with asthma never received a flu vaccine. Most of those who had received the flu vaccine reported that the side effects were mild (62.7%). Asthma duration was positively and significantly associated with increased vaccine hesitancy/rejection (OR = 1.093, 95% CI = (1.004–1.190), p = 0.04; and OR = 1.092, 95% CI = (1.002–1.189), p = 0.044, respectively). As the attitude towards flu vaccine score increases, odds of vaccination hesitancy/rejection decreased (OR = 0.735, 95% CI = (0.676–0.800), p < 0.001; and OR = 0.571, 95% CI = (0.514–0.634), p < 0.001, respectively). The main reasons for vaccination hesitancy/refusal included "I don't think my child needs it" (22.3%) followed by "I forget it" (19.5%). The rate of vaccination among children was low and emphasized the necessity of encouraging parents with asthmatic children to vaccinate their children by conducting health awareness campaigns and also emphasized the role of doctors and other healthcare professionals. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication. Objectives: This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients. Design: A cross-sectional study was performed over a period of 4 months (July–October 2021) targeting 128 patients using psychotropic drugs. Results: The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend's advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist's recommendation were the main reported reasons for using generic drugs. Conclusion: During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies. [ABSTRACT FROM AUTHOR]

The cylindrical shell made of metal rubber has a strong ability to reduce and absorb vibration, which widens its application in the industrial field. Therefore, it is of great significance to study the vibration characteristics of metal-rubber cylindrical shells (MRCSs). However, there is relatively little research on this aspect. Based on this, the dynamic properties of MRCS are investigated in this paper based on viscoelastic theory, the Rayleigh–Ritz method, and the Gram–Schmidt orthogonal polynomials. The correctness of the proposed model was verified by comparison with the literature and experimental verification. The results show that the preloading state and boundary conditions have significant effects on the natural frequency and modal loss factor of MRCS. The effect of the Pasternak elastic foundation on the natural frequency and modal loss factor of MRCS varies with the change of the axial half wave number m. The effect of the Pasternak elastic foundation on higher-order vibrations is similar to that of the artificial spring technique. [ABSTRACT FROM AUTHOR]

Spindle cell lipoma (SCL) is a benign adipocytic tumor that primarily occurs in the subcutis of the posterior neck, upper back, and shoulder, particularly of middle-aged males. SCL and pleomorphic lipoma (PL) represent a morphological spectrum of one disease process. The lesion typically presents as a relatively small (<5 cm), mobile, slow-growing, painless mass. Magnetic resonance imaging reveals the lesion to be a welldefined subcutaneous mass with a mixture of adipose and nonadipose components. Intense enhancement of the non-adipose component is seen after contrast administration. Histologically, SCL is composed of variable distributions of mature adipocytes, bland spindle cells and ropey collagen bundles and PL also contains pleomorphic and multinucleated floret-like giant cells. By immunohistochemistry, the spindle and pleomorphic/floretlike giant cells of SCL/PL are diffusely positive for CD34 and show loss of nuclear RB transcriptional corepressor 1 (RB1) expression. Recent cytogenetic and molecular genetic studies have shown heterozygous deletions of 13q14, including the RB1 gene. SCL/PL can be successfully treated with simple excision, with a very low recurrence rate. Knowledge of these peculiar tumors is important because it can mimic a variety of benign and malignant soft-tissue tumors. This review provides an updated overview of the clinical, radiological, histopathological, cytogenetic, and molecular genetic features of SCL/PL. [ABSTRACT FROM AUTHOR]

Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA. This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for ∼35 min, thrice/week over 12 weeks. The maximal inspiratory (IPmax) and expiratory (EPmax) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index], and asthma control test (ACT) were assessed before and after the intervention. The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (P=.031 and P=.009 respectively) or the In-MT (P=.029 and P=.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (P=.001, P=.004, and P=.0005 respectively) or In-MT (P=.038, P=.037, and P=.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (P<.001) or In-MT (P=.002) training. This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to assess inhaler technique skills, asthma control level, adherence, and quality of life scores amongst asthmatic patients living in Amman, Jordan, investigating the role of pharmacist's educational intervention. Patients and Methods: This single-blinded randomized parallel-group active-controlled study was conducted at the Jordan University Hospital (JUH) clinic in 2019. Patients were assessed at baseline and follow-up (after three months) on their inhaler technique (based on validated published checklists), asthma control based on the asthma control test (ACT) questionnaire, adherence to treatment, and quality of life (QoL). Patients in the active group were counseled on correct inhaler technique and administration skills, orally and using inhaler adhesive labels delivered by the clinical pharmacist. Results: Asthma patients (n = 157; active, n = 79, and control, n = 78) were recruited into the study and grouped based on the controller inhaler they were using (Turbohaler (TH) and Accuhaler (ACC). There was no statistically significant difference between both groups at baseline for inhaler technique, adherence, ACT, and QoL. At follow-up, 93.7% of the active group patients used their inhalers correctly, while only 16.7% of the control group used them correctly (P-value < 0.001). Also, the ACT mean score was significantly higher for the active group (21.21± 5.27) versus the control group (15.92± 7.31; P-value < 0.001). The QoL mean score was significantly improved for the active group compared with the control group (active = 63.85± 24.78, Control = 38.746± 3.23, P-value < 0.001). Improvement in adherence for the active group was noticed compared with the control group but did not reach a significant level (P-value=0.691). Conclusion: Through a practical educational intervention, pharmacists were found to significantly improve patients' asthma inhaler technique, ACT scores, and QoL scores for patients with asthma. [ABSTRACT FROM AUTHOR]

Background: Bulimia nervosa (BN) is a disorder that is characterized by binge eating and inappropriate compensatory behavior to control weight. The aim of this study was to evaluate the mediating role of anxiety and depression between problematic social media use (PSMU) and BN among a sample of Lebanese university students. Methods: This cross-sectional study was carried out between July and September 2021; a total of 363 university students was recruited through convenience sampling. The PROCESS SPSS Macro version 3.4, model four was used to test the indirect effect and calculate three pathways. Pathway A determined the regression coefficient for the effect of PSMU on mental health issues (depression/anxiety); Pathway B examined the association between mental health issues on BN, and Pathway C' estimated the direct effect of PSMU on BN. Pathway AB was used to calculate the indirect effect of PSMU on BN via depression/anxiety. Results: Results showed that depression and anxiety partially mediated the association between PSMU and BN. Higher levels of PSMU were associated with more depression and anxiety; higher depression and anxiety were associated with more BN. PSMU was directly and significantly associated with more BN. When entering anxiety (M1) then depression (M2) as consecutive mediators in a first model, the results showed that only depression mediated the association between PSMU and bulimia. When taking depression (M1) then anxiety (M2) as consecutive mediators in a second model, the results showed that the mediation PSMU → Depression → Anxiety → Bulimia was significant. Higher PSMU was significantly associated with more depression, which was significantly associated with more anxiety, which was significantly associated with more bulimia. Finally, higher PSMU was directly and significantly associated with more bulimia Conclusion: The current paper highlights the relationship that social media use has on BN and other aspects of mental health such as anxiety and depression in Lebanon. Future studies should replicate the mediation analysis conducted in the current study while taking into account other eating disorders. Additional investigations of BN and its correlates must strive to improve the comprehension of these associations' pathways through designs that allow to draw temporal frameworks, in order to efficiently treat this eating disorder and prevent its negative outcomes. Plain English summary: Bulimia nervosa, an eating disorder, is characterized by an impulsive consumption of food in a short period of time, followed by behaviors that compensate the eating such as vomiting or excessive exercise in order to avoid weight gain. Individuals with problematic social media use were found to have higher levels of bulimia symptoms. Symptoms of bulimia can also be associated with both depression and anxiety. The aim of the current study was to examine the mediating role of anxiety and depression between problematic social media use and bulimia nervosa. The results of our study found that problematic social media use was directly associated with more bulimia nervosa and also associated with higher depression and anxiety, both of which were associated with bulimia nervosa. Tackling associated disorders may help reduce symptoms of bulimia nervosa. Clinicians should carefully examine these associations while assessing and implementing treatment plans. [ABSTRACT FROM AUTHOR]

Asthma education has been shown to improve asthma control. Our goal was to evaluate the efficacy of asthma education on the frequency of utilization of health-care services, lung function results, degree of asthma severity, and quality of life (QOL) level in children with asthma. A single-arm prospective interventional trial was conducted in a tertiary facility. Thirty children with asthma and their parents were recruited for the research. Following an assessment of the participants' and caregivers' knowledge about asthma using an asthma knowledge questionnaire, degree of asthma control using asthma control test, inhaler technique using standardized inhaler technique checklists, and QOL using pediatric asthma QOL questionnaires, they participated in a three-month education program in the form of monthly live interactive sessions followed by weekly phone interviews. Measures taken before and after the intervention were compared. The educational intervention improved asthma control dramatically including daytime asthma symptoms, night awakenings, and frequency of use of short-acting beta2- adrenergic receptor agonists. Furthermore, the number of emergency department visits and hospitalizations fell considerably after the intervention (p < 0.001 for all). Asthma education was also linked to better inhalation technique and lung function (p < 0.001). Furthermore, all quality-of-life measures increased (p < 0.001 for all). Implementing an asthma education program that included both children with asthma and their parents improved asthma control levels, lung function measures, and overall quality of life. Furthermore, it increased asthma awareness, decreased the use of health-care resources, and reduced asthma severity, resulting in better asthma management. [ABSTRACT FROM AUTHOR]

Simple Summary: Malignant phyllodes tumor of the breast (MPTB) is a rare fibroepithelial tumor. Because of its rarity, research based on large clinical datasets is currently lacking. Moreover, the prognostic factors of MPTB have yet to be determined. Prognostic models and staging systems for MPTB patients are needed, but are also lacking. Here, we conducted a comparison between MPTB cases and invasive ductal carcinoma cases. Our findings reveal substantial differences in the clinical features of invasive ductal carcinoma and MPTB. We applied the KAPS algorithm to explore and establish a new stage- and age-stratification system. The system exhibited a good prognostic stratification ability for both the internal cohort and the external cohort. Furthermore, we developed independent prognostic models for MPTB using Cox proportional hazards regression and random survival forests (RSF). Finally, we built a user-friendly web app to allow researchers and doctors to access our model. Purpose: To build a new staging system and new prognostic models for MPTB. Methods: We performed a comprehensive analysis of the data from the SEER database. Results: We discussed the characteristics of MPTB by comparing 1085 MPTB cases with 382,718 invasive ductal carcinoma cases. We established a new stage- and age-stratification system for MPTB patients. Furthermore, we built two prognostic models for MPTB patients. The validity of these models was confirmed through multifaceted and multidata verification. Conclusions: Our study provided a staging system and prognostic models for MPTB patients, which can not only help to predict patient outcomes, but also enhance the understanding of the prognostic factors associated with MPTB. [ABSTRACT FROM AUTHOR]

Efficient desalination through a reverse osmosis (RO) membrane requires the prior removal of blockade-causing substances from raw seawater. To achieve ultrahigh-speed processing of a pretreatment process for seawater RO desalination, we combine traditional softening with ballasted flocculation (SBF) for Ca2+ and Mg2+ removal. An alkaline mixture of Ca(OH)2 and Na2CO3 was the most suitable softening agent for Ca2+ and Mg2+ removal with a reduced amount of generated sludge. This softening treatment simultaneously removed the suspended solids and bacteria from actual seawater. The settling velocity of the suspended solids generated via seawater softening was extremely low. Under the optimum conditions for desalinating actual seawater using an anionic polymer flocculant and microsand, the settling velocity exceeded 3.5 cm/s, 833 times higher than that of softening without ballasted flocculation. The amount of sludge after standing for 3 min was 76.5% lower in SBF than in conventional softening. The silt density index of the treated seawater met the water-supply standard of RO membranes (i.e., <3.0). Furthermore, the SBF-generated sludge exhibited considerably improved dewatering property than the sludge obtained via conventional softening. SBF can efficiently and quickly remove the causative substances of RO membrane fouling from seawater, thereby improving the treatability of generated sludge. SBF provides a new pretreatment process for seawater desalination using RO membranes. [ABSTRACT FROM AUTHOR]

Turkey is in an active earthquake zone. Recently, Izmir city was shaken by a major earthquake in October 2020. The earthquake caused extensive structural damage and more than 100 casualties. Therefore, the analysis of the dynamic response of local soils in this region is of great importance. In this study, the shear modulus and damping ratio of natural silts obtained from Izmir province are determined. A total of 29 cyclic triaxial tests and 12 tests with pre-loading were performed to establish a general framework for understanding the behavior of local silt soils before and after an earthquake. Besides the effect of an earthquake, the characteristic behavior of Izmir silts of different levels of plasticity was also investigated and significant changes were observed. In addition, the effect of void ratio, effective confining pressure, plasticity, and shear stress amplitude of the pre-loading stage on the dynamic characteristics of the low plasticity silts were investigated. It is understood that after seismic action, changes in the small strain behavior of silts are remarkable. [ABSTRACT FROM AUTHOR]

To evaluate the drug persistence in patients with rheumatic and musculoskeletal diseases (RMDs) during the current economic crisis in Lebanon and to estimate predictors of persistence. A nationwide multicentric cross-sectional study using an online questionnaire was conducted in Lebanon with patients with chronic inflammatory rheumatic diseases (CIRDs) and non-inflammatory RMDs controls between July and October 2022. Disease-modifying antirheumatic drugs (DMARDs) were categorized as conventional synthetic (cs), biological (b), subcutaneous (SC) or intravenous (IV), and targeted synthetic (ts). Persistence was defined as "number of tablets or injections taken during the past month versus prescribed". The percentage of patients who discontinued or changed treatment due to cost or non-availability was reported. Factors associated with persistence were identified using multivariable linear regression. The study included 317 patients with RMDs (286 CIRDs); mean age 49.5 years, 68% females, 58% reporting currently low economic level. Persistence at one month was low for tsDMARDs (36%) and bDMARDs (SC55%, IV63%), and acceptable for csDMARDs (88%). A persistence ≥80% was found in 23.3% of patients on tsDMARDs, 42.9% on SC bDMARDs, 45.0% on IV bDMARDs, and 74.7% on csDMARDs. During the past 6 months, 55.8% of CIRD patients discontinued or changed treatment due to non-availability (45.3%) or cost (21.2%). Persistence was positively associated with finding alternative sources such as buying abroad (36%), depending on friends or families abroad (20%), charities (10%), and negatively associated with unemployment and low financial status. Persistence was significantly compromised for essential antirheumatic drugs and was mostly driven by treatment unavailability and cost., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In recent years, we have witnessed numerous indoor fires caused by the flammable properties of cotton. Flame-retardant cotton deserves our attention. A novel boric acid and diethylenetriaminepenta (methylene-phosphonic acid) (DTPMPA) ammonium salt-based chelating coordination flame retardant (BDA) was successfully prepared for cotton fabrics, and a related retardant mechanism with ion transfer was investigated. BDA can form a stable chemical and coordination bond on the surface of cotton fibers by a simple three-curing finishing process. The limiting oxygen index (LOI) value of BDA-90 increased to 36.1%, and the LOI value of cotton fabric became 30.3% after 50 laundering cycles (LCs) and exhibited excellent durable flame retardancy. Fourier-transform infrared (FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM) methods were used to observe the bonding mode and morphology of BDA on cotton fibers. A synergistic flame-retardant mechanism of condensed and gas phases was concluded from thermogravimetry (TG), cone calorimeter tests, and TG-FTIR. The test results of whiteness and tensile strength showed that the physical properties of BDA-treated cotton fabric were well maintained. [ABSTRACT FROM AUTHOR]

On October 30, 2020 14:51 (UTC), a moment magnitude (Mw) of 7.0 (USGS, EMSC) earthquake occurred in the Aegean Sea north of the island of Samos, Greece. Turkish and Hellenic geotechnical reconnaissance teams were deployed immediately after the event and their findings are documented herein. The predominantly observed failure mechanism was that of earthquake-induced liquefaction and its associated impacts. Such failures are presented and discussed together with a preliminary assessment of the performance of building foundations, slopes and deep excavations, retaining structures and quay walls. On the Anatolian side (Turkey), and with the exception of the Izmir-Bayrakli region where significant site effects were observed, no major geotechnical effects were observed in the form of foundation failures, surface manifestation of liquefaction and lateral soil spreading, rock falls/landslides, failures of deep excavations, retaining structures, quay walls, and subway tunnels. In Samos (Greece), evidence of liquefaction, lateral spreading and damage to quay walls in ports were observed on the northern side of the island. Despite the proximity to the fault (about 10 km), the amplitude and the duration of shaking, the associated liquefaction phenomena were not pervasive. It is further unclear whether the damage to quay walls was due to liquefaction of the underlying soil, or merely due to the inertia of those structures, in conjunction with the presence of soft (yet not necessarily liquefied) foundation soil. A number of rockfalls/landslides were observed but the relevant phenomena were not particularly severe. Similar to the Anatolian side, no failures of engineered retaining structures and major infrastructure such as dams, bridges, viaducts, tunnels were observed in the island of Samos which can be mostly attributed to the lack of such infrastructure. [ABSTRACT FROM AUTHOR]

On October 30, 2020 14:51 (UTC), a moment magnitude (M) 7.0 (USGS, EMSC) earthquake occurred in the Aegean Sea. This paper presents the reconnaissance findings regarding the site effects on recorded strong ground motion intensities and duration, along with the resulting induced-structural damage in Izmir Bay and Samos Island, respectively. In all rock records, relatively high intensity long period rock spectral accelerations were observed in the mid to long period range of 0.5–1.5 s, which are attributed to the source, more specifically, to the slower rupture-mechanism of the event. These rich spectral intensities were further amplified by soil site effects and soil-superstructure resonance, leading to two to six times amplified overall responses and prolonged seismic shaking durations, more pronounced in Bayrakli and other Izmir Bay sites in Turkey. However, these amplified and prolonged excitations are still below design basis earthquake levels, which addresses the lack of proper structural design and construction deficiencies, as the underlying causes for the collapse to heavy damage performance of 795 buildings. On the other hand, although located only about 10 km from the rupture (22 km from the epicenter) and within the near fault zone, the town of Vathy on Samos Island (Greece) was rather lightly affected by the earthquake, with relatively few collapsed or heavily damaged buildings, partially attributed to the low height/low weight of structures in the area. However, a concentration of damage in low-rise buildings in Ano Vathy hill is considered indicative of a combination of coupled valley and topography effects on the strong motion. This event once again addressed the need to develop region-specific zonation and provisions, when more general code practices are proven to be inadequate to assess these extreme site effects. [ABSTRACT FROM AUTHOR]

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID‐19 pandemic. However, those in conflict‐based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict‐based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health. [ABSTRACT FROM AUTHOR]

Background: Persistent Müllerian duct syndrome (PMDS) is an autosomal recessive congenital abnormality in which Müllerian derivatives, uterus, cervix, upper two‐thirds of the vagina, and fallopian tubes persist in otherwise normally virilized males. Mutations in anti‐Müllerian hormone (AMH) and AMH receptor type II (AMHR2) genes have been identified as causative. However, functional experimental analysis of AMHR2 or AMH variants that cause PMDS is still lacking. Materials and Methods: A Chinese Han family affected by PMDS was identified. To assess the history and clinical manifestations of PMDS, physical, operational, ultrasonographical, pathological, and other examinations were performed on family members. The variant screening was conducted using trio whole‐exome sequencing (trio WES) and Sanger sequencing. Complementation‐based NanoLuciferase Binary Technology (NanoBiT) was used to examine the interaction between AMH and AMHR2 variants in vivo. The effect of the two variants on the transcriptional activity of the TGFβ/BMP pathway was evaluated using a luciferase assay. Results: Classic phenotypic manifestations of PMDS in a pair of identical twins were described and confirmed by genetic sequence analysis. Molecular studies revealed two novel variants c.118G > C [p.(Gly40Arg)], c.1222G > C [p.(Ala408Pro)] in the AMHR2 gene. The AMHR2 p.Gly40Arg variant reduces its ability to bind to AMH, while the p.Ala408Pro variant alters the kinase domain structure. Both variants significantly reduce TGFβ/BMP signaling. Conclusion: Two missense AMHR2 variants associated with PMDS were identified. These findings provide novel insights toward better clinical evaluation and further understanding of the molecular basis of PMDS. [ABSTRACT FROM AUTHOR]

We consider the use of AI techniques to expand the coverage, access, and equity of urban data. We aim to enable holistic research on city dynamics, steering AI research attention away from profit-oriented, societally harmful applications (e.g., facial recognition) and toward foundational questions in mobility, participatory governance, and justice. By making available high-quality, multi-variate, cross-scale data for research, we aim to link the macrostudy of cities as complex systems with the reductionist view of cities as an assembly of independent prediction tasks. We identify four research areas in AI for cities as key enablers: interpolation and extrapolation of spatiotemporal data, using NLP techniques to model speech- and text-intensive governance activities, exploiting ontology modeling in learning tasks, and understanding the interaction of fairness and interpretability in sensitive contexts. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are a significant factor associated with physician burnout and poor patient care, reported to have a significant frequency among the youth in the Middle East. However, to date, no study has explored the prevalence of anxiety among resident physicians in the Arabian Gulf country of Oman. This cross-sectional study, conducted among a random sample of residents affiliated with the Oman Medical Specialty Board, aimed to examine the frequency and factors associated with anxiety symptoms among them. Participants were asked to complete the General Anxiety Disorder Assessment (GAD-7) to assess anxiety, as well as a socio-demographic questionnaire. Results: In a total of 251 residents, the prevalence of anxiety was 14.7% (GAD-7 cut-off score ≥ 10). More than 60% of the respondents were female (68.9%). The age breakdown ranged from 25 to 30 years old (66.5%) and the majority were married (64.9%). More than 70% of respondents attended at least 5 shifts in their weekly schedule and received at least 5 on-call shifts from the hospital per week. Logistic regression showed that residents with chronic disease were 2.5 times (95% CI 1.36–4.72, p = 0.003) more likely to have anxiety than those without them. Those residents who did not exercise were 2.1 times (95% CI 1.04–4.46, p = 0.038) more likely to have anxiety than those who exercise often or regularly. Residents who received 6 or more on-calls from the hospital were 2.6 times (95% CI 1.35–5.25, p = 0.005) more likely to have anxiety than those who received 5 or fewer on-calls in a month. Conclusions: The factors seemingly responsible for anxiety symptoms in this sample of resident physicians are those that are typically associated with poor work-life balance and unhealthy lifestyles. Pending further scrutiny, these results could be used to lay the groundwork for the identification of those who will require more protracted help during their training in Oman and in other culturally similar Middle Eastern countries. [ABSTRACT FROM AUTHOR]

Background: Traumatic experiences can lead to a range of mental health problems such as depression, anxiety and post-traumatic stress disorder. The prevalence of post-traumatic stress disorder depends on the cumulative exposure to traumatic stress. The Yazidis (Êzidî) are a Kurdish religious minority living in the north of Iraq, western Iran, eastern Turkey, and northern Syria. Islamic State of Iraq and Syria (ISIS) had sought to destroy the Yazidis population through killings; sexual slavery, enslavement, torture, degrading treatment, and forcible migration causing serious physical and mental disorders. The objectives of the study were to estimate the prevalence of traumatic events and post-traumatic stress disorder among Yazidi population in Yazidi community and to assess the association between post-traumatic stress disorder and gender. Methods: A cross-sectional study was conducted during period from June to August 2019. The participants were chosen by a random sampling method from Chammshko camp in Zakho district that it's a city in Kurdistan region – Iraq. The questionnaire consisted of questions for demographical characteristics (e.g., gender, age, marital status, education, and job), and PTSD symptoms was assessed by using Harvard Trauma Questionnaire. Results: The females consisted 54.7% of the subjects. The majority of the participants were married (54.1%) and 98 (54.1%) of them were uneducated. About 79% of the subjects had PTSD symptoms. There was a statistically significant association between gender and PTSD, the female subjects had higher mean of trauma and PTSD symptoms scores (17.84 ± 3.5), (117.34 ± 13.8) respectively compare to that of male subjects (15.95 ± 3.1), (104.61 ± 18.8) respectively (p <.001) Conclusion: High rate of PTSD among Yazidi population, Female subjects highly suffered from trauma and PTSD. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Asthma and obstructive sleep apnea (OSA) are common respiratory disorders that can coexist and cause sleep disturbances. The strength of this association and the impact of OSA on asthma severity and control remain unclear. The study aims to estimate the prevalence of OSA in patients with severe asthma in Oman and to examine whether the severity of OSA contributed to the level of asthma control. METHODS: Adult patients with confirmed diagnosis of severe asthma who attended the respiratory clinic in a tertiary hospital in Oman over a period of 19 months were enrolled in the study. Eligible participants were screened by asthma control test (ACT) and Berlin questionnaire (BQ). Patients with high risk for OSA were subjected further to level 3 sleep study. The prevalence of OSA in patients with severe asthma and the associations between the severity of OSA and asthma control were calculated. RESULTS: We identified 312 adult asthma patients on Global Initiative for Asthma step 4 or 5 management out of 550 who were screened. The mean age of the study population was 56.59 ± 12.40 years and the mean body mass index (BMI) 40.30 ± 12.24 kg/m2. The prevalence of OSA in asthma patients with severe asthma was found to be 32.4%. Out of the 138 well-controlled asthma patients (ACT ≥20), 35 had high risk of OSA based on BQ, and 32 were confirmed to have OSA (23%). Of the 174 uncontrolled patients, 80 patients had high risk of OSA and 69 patients were confirmed to have OSA (39.65%). Severe OSA was seen in 63.8% and 9.4% in uncontrolled and controlled asthma patients, respectively (P = 0.002). The median respiratory event index in the uncontrolled group was 43, and it was significantly higher than 12.5 in the controlled group (P < 0.001). CONCLUSIONS: The prevalence of OSA was high (32.37%) in patients with severe asthma. Uncontrolled severe asthma was significantly associated with severe OSA. [ABSTRACT FROM AUTHOR]

Persistent Müllerian duct syndrome (PMDS) is a rare autosomal recessive condition defined by the presence of Müllerian duct-derived structures in an otherwise normally masculinized phenotypical and genotypical (46,XY) male. We describe the case of an infant diagnosed with PMDS, managed and followed up for 7 years. The diagnosis of PMDS was made at laparoscopy at 6 months of age for investigation and management of bilateral impalpable testes. A Müllerian structure resembling a uterus with bilateral fallopian tube-like structures was seen in the pelvis, along with bilateral intra-abdominal testes. Gonadal biopsy confirmed normal testicular tissue. The child underwent successful bilateral two-stage Fowler-Stephens orchidopexies. The Müllerian remnant was preserved to maintain testicular vascularity. At the most recent follow-up, the testes are intrascrotal and normal on palpation. There have been no clinical symptoms or concerns with the Müllerian remnant during surveillance with ultrasound and MRI. To date, there are less than 300 cases described in the medical literature, with limited consensus on management. We reflect on challenges the condition poses, including fertility preservation in PMDS, testicular and Müllerian malignancy risk in PMDS, and optimal management and surveillance of PMDS. [ABSTRACT FROM AUTHOR]

Background: Insomnia is commonly reported in patients with asthma. However, the prevalence of insomnia and its relationship to asthma control have not been established. Objective: To determine the prevalence of insomnia in adults with asthma and to evaluate the association between insomnia and level of asthma control. Methods: This is a cross-sectional study of 200 patients recruited from pulmonary clinics at a tertiary care center. Adults (age ≥ 16 years) diagnosed with asthma by the primary treating physician were recruited over a 6-month period from December 2018 to May 2019. Asthma and insomnia severity were assessed using the Asthma Control Test and Insomnia Severity Index (ISI). Results: The mean age of participants was 51± 17 years, and 67% were female. Insomnia (ISI score ≥ 10) was present in 46.5% of the participants. The severity of insomnia was inversely related to the level of asthma control: moderate-to-severe insomnia was more frequent in patients with uncontrolled asthma (43%) than in those with partially controlled asthma (25%) or well-controlled asthma (12%) (P < 0.05 for all comparisons). Conclusion: Insomnia is common among patients with asthma, especially those with suboptimal asthma control. Further investigations are required to more fully understand the complex relationship between asthma and insomnia. [ABSTRACT FROM AUTHOR]

It is reported that residual aluminum from coagulation pretreatment can increase membrane fouling in nanofiltration (NF) or reverse osmosis (RO) desalination systems. However, the membrane fouling mechanism of residual aluminum and the effective control measures are not very clear. In this study, the nanofiltration membrane fouling caused by poly-aluminum chloride (PACl), the inhibitory effect of amino trimethylene phosphonic acid (ATMP) on aluminum foulants, and calcium carbonate scale in the presence of residual aluminum were investigated by permeate experiments and scanning electron microscopy (SEM) observation of the fouled membranes. Besides, the effect of adding ultrafiltration before nanofiltration on reducing membrane fouling caused by residual aluminum was also investigated. The results showed that most of the residual aluminum in feed eventually formed insoluble particles and fine flocs, and accumulated gradually on the membrane surface, which was a typical colloid particle fouling. ATMP can reduce the membrane fouling caused by residual aluminum to some extent, and the permeate flux ratio (J/Jc) increased from 0.83 to 0.89 when ATMP increased to the optimal dose of 6 mg⋅L−1. However, this means can still effectively eliminate carbonate scale, even in the presence of residual aluminum. Moreover, ultrafiltration pretreatment prior to nanofiltration was very effective to control membrane fouling, and the comprehensive cost was calculated to be only 0.006 $⋅m−3. Therefore, the combined process of coagulation-ultrafiltration as a pretreatment of nanofiltration or reverse osmosis should be an ideal way to prevent membrane fouling caused by residual aluminum. [ABSTRACT FROM AUTHOR]

Background: A persistent Müllerian duct syndrome is a rare disorder of sexual differentiation characterized by the presence of the female reproductive system in a normal male. Case presentation: Herein, we report a case of a 35-year-old father with persistent Müllerian duct syndrome and seminoma in the right undescended testis. The exploratory laparotomy was performed and revealed a mass in the right undescended testis and Müllerian duct structures. Conclusions: For patients with cryptorchidism and inguinal hernia, the persistent Müllerian duct syndrome should be considered, and radiological evaluation of the genitourinary system is recommended for early diagnosis of persistent Müllerian duct syndrome. The persistent Müllerian duct syndrome is usually detected during a surgical operation, and it is considered a risk factor for developing testicular malignancies. [ABSTRACT FROM AUTHOR]

Persistent Mullerian duct syndrome is a rare form disorder of sexual differentiation characterised by the persistence of Mullerian derivatives (fallopian tubes, uterus and the proximal vagina) in males with an XY karyotype and normal virilisation. We report a case of a 29‐year‐old man with right transverse testicular ectopia, mix germ cell cancer at ectopic right testis and left‐sided obstructed inguinal hernia containing a uterus and fallopian tube. We performed orchiectomy and hysterectomy on the patient. [ABSTRACT FROM AUTHOR]

This study proposed victimisation-by-ingroup consciousness as a novel concept, which denotes that intragroup violence or wrongdoings by some group members victimise other members of the same group and may elicit sense of physical, material, cultural and psychological sufferings among the victim members. Applying this concept to the context of religious radicalism, this study revealed that among a sample of Indonesian Muslims (N = 810), the perceptions of physical, material and cultural sufferings positively predicted psychological suffering. This sense of psychological suffering turned out to motivate participants to perceive intragroup violence as illegitimate. This perceived illegitimacy of intragroup violence ultimately facilitated participants to report less emotional, attitudinal and intentional radical tendencies to support terrorists. Finally, we found as expected that Islamic blind patriotism negatively predicted, but constructive Islamic patriotism positively predicted participants' victimisation-by-ingroup consciousness. These empirical findings broadly suggest that accepting the deficiency of the ingroup may be beneficial for tackling Muslims' radical tendencies, but this prospect depends on modes of Muslims' emotional attachment to their own group. We close by discussing the theoretical and practical implications of those empirical findings, as well as limitations and practical implications of this study. [ABSTRACT FROM AUTHOR]

In this article, we propose an expert recommendation tool that relies on the skills of experts and their interventions in collaboration. This tool provides us with a list of the most appropriate (effective) experts to solve business problems in the field of industrial maintenance. The proposed system recommends experts using an unsupervised classification algorithm that takes into account the competences of the experts, their preferences and the stored information in previous collaborative sessions. We have tested the performance of the system with K-means and C-means algorithms. To fix the inconsistencies detected in business rules, the PROMETHEE II multi-criteria decision support method is integrated into the extended CNP negotiation protocol in order to classify the experts from best to worst. The study is supported by the well known petroleum company in Algeria namely SONATRACH where the experimentations are operated on maintenance domain. Experiments results show the effectiveness of our approach, obtaining a recall of 86%, precision of 92% and F-measure of 89%. Also, the proposed approach offers very high results and improvement, in terms of response time (154.28 ms), space memory (9843912 bytes) and negotiation rounds. [ABSTRACT FROM AUTHOR]

There are complex potential inter-relationships between the chronic inflammation of asthma and poor control, vitamin D deficiency, musculoskeletal pain and anxiety and depression. The aim was to investigate associations between vitamin D and these possible co-morbidities. This case-controlled study involved 75 adults with asthma and 75 controls. Serum 25-hydroxyvitamin D (25(OH)D) was measured, levels of anxiety, depression, musculoskeletal pain, and asthma control were assessed. Participants with asthma had lower 25(OH)D and higher anxiety scores and higher measures of musculoskeletal pain compared to controls. Binary logistic regression showed that asthma was associated with decreased 25(OH)D (Odds ratio (OR) = 0.86), general weakness (OR = 13.29), complaint of musculoskeletal pain (OR = 13.73), and increased intensity of musculoskeletal pain (OR = 0.61) and number of painful sites (OR = 2.58). Asthma was not associated with anxiety or depression. Further studies are required to investigate if vitamin D supplementation can improve asthma symptoms and musculoskeletal pain. [ABSTRACT FROM AUTHOR]

The Saudi Initiative for Asthma 2021 (SINA-2021) is the fifth version of asthma guidelines for the diagnosis and management of asthma for adults and children, which is developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5–12 years, and children aged less than 5 years. SINA guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. Medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. [ABSTRACT FROM AUTHOR]

Background: For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process. Aims: The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences. Method: An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication. Results: Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of "depressive episode" mostly came from the concept itself, that of "schizophrenia" was largely based on its social impact and stigmatization associated with "mental illness". When rephrasing "depressive episode", a majority kept the root "depress*", and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on "schizophrenia". Finally, when communicating, no one used the phrase "depressive episode". Some participants used words based on "depress", but no one mentioned "episode". Very few used "schizophrenia". Conclusion: Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account. [ABSTRACT FROM AUTHOR]

Malignant gastrointestinal neuroectodermal tumor (GNET) is a rare disease with a handful of cases described in literature. GNET has only become a well-known/widely accepted entity in the recent years, but it is still not listed in the database of rare diseases. Due to the rarity of disease, there are no guidelines on standard therapeutic approaches in the adjuvant or metastatic setting. Here, we describe a unique case of GNET with a 7-year disease-free survival following adjuvant cisplatin and etoposide chemotherapy. This is the longest disease-free survival that has ever been described in literature and may support using this combination in a larger cohort of patients in the context of a global clinical trial. We will also review the histopathologic features of GNET and potential therapeutic options in the metastatic setting. [ABSTRACT FROM AUTHOR]

Asthma is a clinical problem with social, psychological and economic burdens. To improve patient disease management, different education programmes have been developed. Challenges in asthma management may be partially attributed to non‐adherence or improper use of inhalers. This study aimed to implement and assess hospital‐based pharmaceutical care services for asthmatic patients. A 12‐month, single‐centre, randomized, controlled study was initiated in asthmatic adult patients who had been divided into either a control or intervention group. Patients in the control group received the usual care, and patients in the intervention group received patient counselling per study protocol that covered asthma knowledge, control, adherence to treatment and inhalation techniques. The main variables compared measurements at baseline with those at 6 and 12 months. A total of 192 patients completed the study protocol: 90 in the control group and 102 in the intervention group. The control group included 90 patients, and the intervention group included 102 patients. Over the course of the 12‐month follow‐up period, a significant difference was observed between intervention and control groups with respect to asthma control (38.2% vs 10.0%; P <.001), mean correct inhalation technique (confidence interval [CI]: 8.1, 7.8‐8.5 vs CI: 6.1; 5.6‐6.6; P =.01) and good medication adherence (60.7% vs 50.0%, P =.02). There were 34% and 25% decreases in emergency room visits and hospital admissions, respectively, in the intervention group compared to the control group. This study emphasizes the importance of patient counselling in asthma management and the significant contribution that the pharmacist's intervention can have on asthma control. [ABSTRACT FROM AUTHOR]

In the article, the authors present their study to determine whether Syrian refugee children experience more peer bullying than their Turkish classmates in a school district in Istanbul, Turkey and the possible effects of bullying on their mental well-being. Methods used in the study include the War Trauma Questionnaire and the Children's Revised Impact of Event Scale (CRIES-8). Also mentioned are the Syrian children's experiences of war and friendship.

Extraosseous Ewing's sarcoma is a rare and aggressive malignant tumor with a poor prognosis. The pancreas is an extremely uncommon primary site, with only 27 cases that have been published worldwide. We report a 26-year-old female who presented with 5 days of left upper quadrant pain, nausea, and vomiting. On examination, she was anicteric and had epigastric and left upper quadrant tenderness without guarding, rebound tenderness, or a palpable mass. She had slightly elevated serum aminotransferase and lipase levels. Abdominal computerized tomography revealed a multilobulated tumor arising from the body and tail of the pancreas. A biopsy confirmed a small round cell tumor, and immunohistochemistry was positive for CD99 in approximately 70% of the tumor cells. A fluorescence in situ hybridization (FISH) assay showed a 22q12 rearrangement. She was diagnosed with extraosseous Ewing sarcoma of the pancreas and underwent multiagent neoadjuvant chemotherapy followed by surgical resection, but subsequent imaging revealed evidence of systemic disease progression. She chose to go on hospice care and died a few weeks later. [ABSTRACT FROM AUTHOR]

Background: Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach.Methods: A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques.Results: A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05-0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31-0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41-0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22-0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min-163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min-164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min-151.58 min, p = 0.003).Conclusions: Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacists can have a valuable role in educating patients on correct inhaler technique leading to improved asthma management. Rural areas can benefit from the role of the pharmacist considering the barriers found in attending primary health-care facilities. Objectives: This study aimed to assess the impact of inhaler technique education delivered by pharmacists on patients' inhaler technique, Asthma Control Test (ACT) score, forced expiratory volume in the first 1 second (FEV1%), and reliever use (puffs/day). Methods: A pre–post interventional study was conducted over 6 months from February 2017 to July 2017 in rural areas in Jordan. Asthma patients visiting respiratory clinics and using metered dose inhaler (MDI) or turbuhaler (TH) controlled medication were randomly recruited. Inhaler technique was assessed via published checklists. The ACT, FEV1%, and reliever use (puffs/day) were assessed. Patients were educated on inhaler technique via demonstration with return demonstration education. All assessments were repeated 3 months post education. Results: A total of 103 (TH, n=44; MDI, n=59) patients were recruited (mean age=46.5±13.5), 74% females. Patients reported an overuse of their reliever (5.1±4.2 puffs/day). Only 2 patients (1.9%) had well-controlled asthma, while the rest had either moderately (19.4%) or poorly (78.6%) controlled asthma. Patients using the MDI achieved 3.03±4.30 ACT score improvement (p<0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 (p=0.031). FEV1% improved significantly for MDI users (p=0.005) but not for TH users (p=0.097). Reliever use decreased significantly for MDI and TH users. Conclusion: Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV1% scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV1% scores and lowered reliever use over time. [ABSTRACT FROM AUTHOR]

We present a case of a Chinese child with X‐linked Simpson–Golabi–Behmel syndrome (SGBS). To the best of our knowledge, this is the first report of 46,XY disorders of sex development (ambiguous genitalia, cryptorchidism, and uterus in the pelvis) in surviving SGBS patients. Other external anomalies included characteristic facial anomalies, overgrowth, macrocephaly, organomegaly, pectus excavatum, and cryptorchidism. It could be that the GPC3 gene mutation caused Leydig cell dysfunction in our patient. Disorders of sex development can be included as part of the clinical spectrum of SGBS. [ABSTRACT FROM AUTHOR]