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This study investigates the effect of energy consumption on greenhouse gas (GHG) emissions in 33 African countries from 1995–2017. It contributes to the literature by investigating the effect of disaggregated measures of energy consumption (coal, oil and other liquids, renewable energy, and electricity) on GHG emissions (CO2, N2O, CH4, and total GHG emissions) in Africa and identifies the transmission channels through which energy consumption affects GHG emissions. The system GMM is used in the study as it accounts for possible endogeneity and the potential correlation between the error term and the country fixed effects. The results show that coal consumption significantly increases CO2, CH4, and total GHG emissions and reduces N2O emissions. Oil consumption increases CO2 and total GHG emissions but reduces N2O and CH4 emissions. Renewable energy consumption reduces CO2 and CH4 emissions but increases N2O emissions. Finally, electricity consumption promotes CO2, N2O, CH4 and total GHG emissions in Africa. Further analyses show that foreign trade and economic growth are the channels through which oil consumption increases GHG emissions. The adverse effect of electricity is through urbanization. Renewable consumption could decrease GHG emissions through sustainable urbanization and trade policies. The findings suggest that countries should gradually reduce coal consumption and encourage renewable energy consumption, which has the lowest impact on the environment.

Necrotizing soft tissue infections (NSTIs) are surgical emergencies associated with high morbidity and mortality. Identifying risk factors for poor outcome is a critical part of preoperative decision-making and counseling. Sarcopenia, the loss of lean muscle mass, has been associated with an increased risk of mortality and can be measured using cross-sectional imaging. Our aim was to determine the impact of sarcopenia on mortality in patients with NSTI. We hypothesized that sarcopenia would be associated with an increased risk of mortality in patients with NSTI.This is a retrospective cohort study of NSTI patients admitted from 1995 to 2015 to two academic institutions. Operative and pathology reports were reviewed to confirm the diagnosis in all cases. Average bilateral psoas muscle cross-sectional area at L4, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography (CT). Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was in-hospital mortality. Multivariate logistic regression was performed to assess the association between sarcopenia and in-hospital mortality.There were 115 patients with preoperative imaging, 61% male and a median age of 57 y interquartile range (IQR 46.6-67.0). Overall in-hospital mortality was 12.1%. There was no significant difference in sex, body mass index (BMI), comorbidities and American Society of Anesthesiologists classification (Table 1). After multivariate analysis, sarcopenia was independently associated with increased in-hospital mortality (Odds ratio, 3.5; 95% Confidence Interval [CI], 1.05-11.8).Sarcopenia is associated with increased risk of in-hospital mortality in patients with NSTIs. Sarcopenia identifies patients with higher likelihood of poor outcomes, which can possibly help surgeons in counseling their patients and families.

BACKGROUND: Geographic variation is an inherent feature of the United States health-system. Despite efforts to account for geographic variation in trauma-system strengthening, it remains unclear how trauma “regions” should be defined. The objective of this study was to evaluate the utility of a novel definition of Trauma Referral Regions (TRR) for assessing geographic variation in inpatient trauma across the age-span of hospitalized trauma patients. MATERIALS AND METHODS: Using 2016–2017 State Inpatient Databases, we assessed the extent of geographic variability in three common metrics of hospital use (localization index, market share index, net patient flow) among TRR and, as a comparison, trauma regions alternatively defined based on Hospital Referral Regions (HRR), Hospital Service Areas (HSA), and counties. RESULTS: A total of 860,593 admissions from 102 TRR, 127 HRR, 884 HSA, and 583 counties were included. Consistent with expectations for distinct trauma regions, TRR presented with high average localization indices (mean [SD]: 83.4 [11.7%]), low market share indices (mean [SD]: 11.9 [7.0%]), and net patient flows close to 1.00. Similar results were found among stratified pediatric, adult, and older adult patients. Associations between TRR and variations in important demographic features (e.g. travel time by road to the nearest Level 1/2 Trauma Center) suggest that while indicative of standalone trauma regions, TRR are also able to simultaneously capture critical variations in regional trauma care. CONCLUSIONS: TRR offer a standalone set of geographic regions with minimal variation in common metrics of hospitals use, minimal geographic clustering, and preserved associations with important demographic factors. They provide a needed, valid means of assessing geographic variation amongst trauma-systems.

Physical education, health and sports is a very complete subject because it is able to develop all aspects that exist in students. Elementary school students are students who must be well shaped by all aspects that exist in themselves, namely aspects of skills, social, emotional and personality. However, at SD Negeri Siem, in class V, there is a problem, namely the back roll material. The problem that arises is in the aspect of student skills, students have not been able to do a back roll well. Based on the existing problems, an idea was born as a solution to the problem, namely Improving the Back Rolling Basic Motion Using the TPACK-based PBL model for Class V students of SD Negeri Siem, Aceh Besar District. The formulation of the problem is as follows; Can the TPACK-based PBL model improve the basic back bladder movement for Class V students at SD Negeri Siem, Aceh Besar District? The purpose of this study was to find out that the TPACK-based PBL model could improve the basic movements of the back bladder for fifth graders at SD Negeri Siem, Aceh Besar District. This research uses classroom action research method. The results of this study, namely in Cycle I, it was known that the number of students was 26 people with a total score of 1775, the average value of students was 68.27 with the highest score of 80 and the lowest score of 50. 50%) and 13 people (50%) who did not complete it. And the second cycle is known that the number of students as many as 26 people with a total score of 1985, the average value of students is 76.35 with the highest score of 90 and the lowest score of 50. So it can be seen also that the students who completed are 24 people (92.31% ) and 2 people who did not complete it (7.69%). The conclusion is that the TPACK-Based PBL Model can improve the basic movements of the back bladder for Class V students of SD Negeri Siem, Aceh Besar District.

This study investigates the effect of imaginative instruction strategy on developing speaking skills among female tenth-grade students. The study sample consisted of (53) female tenth-grade students selected by the convenience sampling method from a public school in Jarash directorate of education. The study sample is assigned randomly into two groups: an experimental group of (27) female students, studied through innovative instruction strategy, and the control group of (26) female students, which studied through a traditional approach to achieve the objectives of the study, speaking test is applied; who verified the validity and reliability of the instruments. The study's findings showed statistically significant differences in each of the speaking skills and the skills attributed to the experimental group—so statistically significant differences in each of the speaking skills whole attributed to the experimental group. In light of the findings, the researchers recommend using the imaginative instruction strategy in teaching Arabic language courses because of the positive impact on developing speaking skills.

The aim of this study was to evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury.The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors.Moderate-severely injured adult patients treated at 1 of 3 level-1 trauma centers were prospectively followed 6 to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle 2 quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury.A total of 3153 patients were included [54% male, mean age 61.6 (SD = 21.6)]. The median overall SVI percentile rank was 35th (IQR: 16th-65th). compared to low SVI patients, high SVI patients were more likely to have new functional limitations [odds ratio (OR), 1.51; 95% confidence interval (CI), 1.19-1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40-2.89), and to screen positive for post-traumatic stress disorder (OR, 1.56; 95% CI, 1.12-2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes.The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.

This research paper aims to shed light on one of the Arabic-speaking EFL learners' lexical problems, concerning translating words used in context from English into Arabic. It focused on translating polysemous words when they are used both in their direct core and indirect secondary meanings. In order to investigate this problem, a translation test was administered to a sample comprised 28 male and female students studying English at the Faculty of Education- Yafea, University of Aden, Yemen. The test consisted of 10 English sentences used to collect quantitative data from the participants. Each five sentences tested one polysemous word (break and sound,). The meanings of the polysemous words in the first sentence in each five sentences is direct, core meaning; whereas their meanings in the other 4 sentences are indirect secondary meanings. Based on the results of the study, it was found that Arabic-speaking EFL learners were unable to a great extent to translate the words well, especially when those words were used in their indirect secondary meanings. Based on the results, this research suggested that polysemous words should be given much attention in ELT B.educational courses at all stages of English language learning and teaching because of students' drastic incompetence in understanding the different meanings of polysemous words.

Management of patients on the kidney transplant waitlist lacks oversight, and transplant centers can delist candidates without consequence. To better understand between-center differences in waitlist management, we examined delisting rates and mortality after delisting within 3 years of removal from the kidney transplant waitlist.This is a retrospective cohort study using data from the Scientific Registry of Transplant Recipients of adults listed for deceased donor kidney transplant in 2015 and followed until the end of 2018. Patients of interest were those delisted for reasons other than transplant, death, or transfer. Centers were excluded if they had fewer than 20 waitlisted patients per year. We calculated probability of delisting and death after delisting using multivariable competing risk models.During follow-up, 14.2% of patients were delisted. The median probability of delisting within 3 years, adjusted for center-level variability, was 7.0% (interquartile range [IQR]: 3.9% to 10.6%). Median probability of death was 58.2% (IQR: 40% to 73.4%). There was no meaningful correlation between probability of delisting and death (τ = -0.05, p = 0.34).There is significant variability in the rate of death after delisting across kidney transplant centers. Likelihood of transplant is extremely important to candidates, and improved data collection efforts are needed to inform whether current delisting practices are successfully removing patients who could not meaningfully benefit from transplant, or whether certain populations may benefit from remaining on the list and maintaining eligibility.

Humans now spend the bulk of their time on the Internet, thanks to the huge rise of social media and other applications. Organizations and individuals have a shared platform to express their thoughts and ideas on any entity in the globe. Every website has a massive amount of information about products and services. Through social media tools, we, as humans, may remark on any subject or incident. Most of the time, these public opinions are considered by organizations and individuals to better corporate operations and strategies, or in the decision-making process. Although these user opinions are practical in decision-making processes, manually analyzing and summarizing them is a difficult effort. It is a lengthy process. As a result, having automated opinion mining techniques to analyze user sentiments is critical. Since the beginning of social media, sentiment analysis has been a hot research area. Many studies have been conducted in various fields. The tourism sector is highlighted as one of the important topics for diversification in Oman Vision 2040. This study suggests an analysis of user reviews of Omani restaurants, categorizing them as positive or bad, and ranking the restaurants according to the reviews. The reviews are analyzed using opinion mining methods

In 2016, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan. The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions.We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as 60% or greater of panelists agreeing on the priority category. We then coded research questions using an National Trauma Research Action Plan taxonomy of 118 research concepts, which were consistent across all 11 panels.Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups-severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury. The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%).This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mTBI, and spinal cord injury that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research.Diagnostic Test or Criteria, Level IV.

Management of orthopaedic injury is an essential component of comprehensive trauma care, and availability of orthopaedic surgeons impacts trauma system capacity and accessibility of care. We sought to estimate the geographic distribution of orthopaedic injury in the United States and identify regions needing additional orthopaedic trauma resources.In this retrospective cross-sectional study using 2014 Agency for Healthcare Research and Quality State Inpatient Datasets from 26 states and the District of Columbia, administrative data were used to determine hospital referral region (HRR)-level incidence of orthopaedic trauma and surgical care. Factors associated with HRR-level orthopaedic trauma volume were identified using negative binomial regression, and model parameters were used to estimate injury incidence and operative volume in unobserved HRRs. The primary outcomes of interest were HRR-level incidence of orthopaedic injury, polytrauma, and emergency orthopaedic surgery, as well and the number of emergency orthopaedic surgery patients per orthopaedic surgeon.Orthopaedic injury incidence and operative patients per orthopaedic surgeon were associated with HRR-level volume of medical service use, population characteristics, geographic characteristics, and existing trauma care resources. Orthopaedic injury incidence ranged from 20 patients/HRR to 33,260 patients/HRR. Polytrauma incidence ranged from10 patients/HRR to 12,140 patients/HRR. Emergency orthopaedic surgery incidence ranged from10 patients/HRR to 18,759 patients/HRR. The volume of operative orthopaedic trauma patients per orthopaedic surgeon ranged from10 patients/surgeon to 224 patients and/or surgeon.The incidence of orthopaedic injury and volume of injury patients per orthopaedic surgeon varies substantially across HRRs in the United States. Regions with high patient volume and moderate patient-to-provider ratios may be ideal settings for orthopaedic trauma training programs or post-fellowship professional opportunities. Future research should examine the impact of high volume orthopaedic trauma volume and high patient-to-provider ratios on health outcomes.

The research aims to develop an instructional tool based on Discovery Learning (DL) combined with a Metacognitive Knowledge Strategy (MKS) to enhance students’ Critical Thinking Skills (CTSs). In doing so, the study employed a Research and Development (R&D) method to develop such a tool. The developed instructional tool was tested for its validity by experts and practitioners’ evaluation. Further, the empirical data were collected from the results of implementation in learning and the student's responses, while the data of tools effectiveness were acquired from the critical thinking tests given to students (analyzed by related t-test). The developed instructional tools were implemented in a limited-scale trial of 32 students and a large-scale trial of 59 students. The results show that: firstly, the DL and MKS-integrated instructional tools are stated as valid in terms of the lesson plan, student worksheet, and critical thinking test. Secondly, the practicality criteria have been successfully met; the learning implementation, students’ activity, and students' responses were regarded as in accordance with the feasibility standard. Thirdly, the instructional tool was deemed effective in enhancing students’ CTSs (p = 0.05).

Donald Hebb who is the founder of theory of learning behavior from the perspective of cognitive neuroscience based on the cell assembly. Where he explained the occurrence of learning through the Hebb's synapse, which explained the mechanism of interaction and connection between synaptic cells, and the activity that occurs between them to produce learning and related thinking and memory. Also, how the induce that occurs between the cell assembly in the Hebb's synapse has a significant role to understand learning and associated skills, abilities and behavior. Therefore, this theory in the field of education and psychology was employed in the mechanism of long-term Potentiation (LTP) to interpret the occurrence of learning in terms of cognitive neuroscience. Keywords: Cognitive Neuroscience, Theory, Hebb, Learning, Teaching, Brain, Neuron

Majority of the Island inhabitants depends on groundwaters for drinking therefore the hydrogeochemistry and health risks assessment with respect to WHO standards is absolutely essential for protection policy formulation. The groundwater samples for analyses were collected from selected four wells within each (Chukwani-Mbweni, DarajaMbovu - Amani and Mwanakwerekwe) suburb during the moderate rainy season of January2020.The selection was based on their strategic positions taking into consideration relevant geographical and environmental factors commensurable with this study. Various contaminants and physiochemical parameters were determined using Atomic Absorption spectroscopy, GC/MS, Temp/pH/TDS/EC meter and DR/3900 spectrophotometer. Chemical Oxygen Demand values were also determined. Microbial contamination was determined using the MPN technique. The results shows that these groundwaters are slightly alkaline, microbially contaminated, have high C.O.D. values ranging from 188.5 to 305.7 mg/L indicating the existence of some organic based endocrine disruptive elements, and disparities in water quality parameters with respect to the recommended WHO standards thus ascertaining possible public health risks. The research recommends the need for continuous monitoring, assessment and treatment of these raw groundwaters for drinking at the point of collection rather relying on the old conventional boiling method or drinkingas it is.

The aim of this paper is to explain the advantages of using sulfuric acid in Qarmat Ali water treatment plant belong to Basrah Oil Company, which produces water for injection into the Rumaila reservoirs. Sulfuric acid is a strong acid providing rapid and effective pH reduction. Maintaining the coagulation pH within the optimum value (6.4) by inject specific value of sulfuric acid to RAW water enhances the clarification performances by reducing the clarified water turbidity to minimum value (5.1). It was preferable for operating at a pH below the saturation pH to prevent the precipitation of minerals such as calcium carbonate which are contributing to blocking the surface filters installed downstream (auto back wash filters) and The clarifiers that cause increased the feed from 500 MBD to 1000 MBD. With a fast and rapid dissociation in Water, Sulfuric acid is an effective and practical way to lower the pH on Qarmat Ali plant which producing in excess of 1,000MBD of export water.

BACKGROUND Timely recognition of sepsis and identification of pathogens can improve outcomes in critical care patients but microbial cultures have low accuracy and long turnaround times. In this proof-of-principle study, we describe metagenomic sequencing and analysis of nonhuman DNA in plasma. We hypothesized that quantitative analysis of bacterial DNA (bDNA) levels in plasma can enable detection and monitoring of pathogens. METHODS We enrolled 30 patients suspected of sepsis in the surgical trauma intensive care unit and collected plasma samples at the time of diagnostic workup for sepsis (baseline), and 7 days and 14 days later. We performed metagenomic sequencing of plasma DNA and used computational classification of sequencing reads to detect and quantify total and pathogen-specific bDNA fraction. To improve assay sensitivity, we developed an enrichment method for bDNA based on size selection for shorter fragment lengths. Differences in bDNA fractions between samples were evaluated using t test and linear mixed-effects model, following log transformation. RESULTS We analyzed 72 plasma samples from 30 patients. Twenty-seven samples (37.5%) were collected at the time of infection. Median total bDNA fraction was 1.6 times higher in these samples compared with samples with no infection (0.011% and 0.0068%, respectively, p < 0.001). In 17 patients who had active infection at enrollment and at least one follow-up sample collected, total bDNA fractions were higher at baseline compared with the next sample (p < 0.001). Following enrichment, bDNA fractions increased in paired samples by a mean of 16.9-fold. Of 17 samples collected at the time when bacterial pathogens were identified, we detected pathogen-specific DNA in 13 plasma samples (76.5%). CONCLUSION Bacterial DNA levels in plasma are elevated in critically ill patients with active infection. Pathogen-specific DNA is detectable in plasma, particularly after enrichment using selection for shorter fragments. Serial changes in bDNA levels may be informative of treatment response. LEVEL OF EVIDENCE Epidemiologic/Prognostic, Level V.

Trauma care for injured older adults is complicated by pre-existing chronic illness. We examined the association between chronic illness and post-injury function, healthcare utilization and quality of life.Trauma patients ≥65 years with an Injury Severity Score (ISS) ≥9 discharged from one of three level-1 trauma centers were interviewed 6-12 months post-discharge. Patients were asked about new functional limitations, injury-related emergency department (ED) visits or readmission, and health-related quality of life (HRQoL). Trauma registry data was used to determine presence of seven chronic illnesses. Adjusted regression models examined associations between increasing number of chronic illness (0, 1, ≥2) and outcomes.Of 1,379 patients, 46.5% had at least one chronic illness. In adjusted analysis, any chronic illness was associated with higher odds of new functional limitation (1 chronic illness, OR1.54, CI: 1.20-1.97; ≥2, OR1.69, CI: 1.16-2.48) and worse physical health-related QoL (1 chronic illness adj. mean diff= -4.0, CI: -5.6 to -2.5; ≥2 adj. mean diff.= -4.4, CI: -7.3 to -1.4, p0.01). Mental health post-injury was consistent with population norms across all groups.Presence of any chronic illness in older adults is associated with new functional limitations and worse physical HRQoL post-injury, but unchanged mental health. Focused interventions are needed to support long-term recovery.