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In this paper, a new class of bidimensional fractional linear systems is considered. The stability radius of the disturbed system is described according to the H ∞ norm. Sufficient conditions to ensure the stability margins of the closed-loop system are offered in terms of linear matrix inequalities. The concept of D stability region for these systems is also considered. Examples are provided to verify the applicability of our main result.

Abstract Ramadan fasting (RF) involves abstaining from food and drink during daylight hours; it is obligatory for all healthy Muslims from the age of puberty. Although sick individuals are exempt from fasting, many will fast anyway. This article explores the impact of RF on individuals with kidney diseases through a comprehensive review of existing literature and consensus recommendations. This study was conducted by a multidisciplinary panel of experts. The recommendations aim to provide a structured approach to assess and manage fasting during Ramadan for patients with kidney diseases, empowering both healthcare providers and patients to make informed decisions while considering their unique circumstances.

PTPRF interacting protein alpha 1 (PPFIA1) encodes for liprin‐α1, a member of the leukocyte common antigen–related protein tyrosine phosphatase (LAR‐RPTPs)‐interacting protein family. Liprin‐α1 localizes to adhesive and invasive structures in the periphery of cancer cells, where it modulates migration and invasion in head and neck squamous cell carcinoma (HNSCC) and breast cancer. To study the possible role of liprin‐α1 in anticancer drug responses, we screened a library of oncology compounds in cell lines with high endogenous PPFIA1 expression. The compounds with the highest differential responses between high PPFIA1‐expressing and silenced cells across cell lines were inhibitors targeting mitogen‐activated protein kinase kinase (MEK)/extracellular signal‐regulated kinases (ERK) signaling. KRAS proto‐oncogene, GTPase (KRAS)‐mutated MDA‐MB‐231 cells were more resistant to trametinib upon PPFIA1 knockdown compared with control cells. In contrast, liprin‐α1‐depleted HNSCC cells with low RAS activity showed a context‐dependent response to MEK/ERK inhibitors. Importantly, we showed that liprin‐α1 depletion leads to increased p‐ERK1/2 levels in all our studied cell lines independent of KRAS mutational status, suggesting a role of liprin‐α1 in the regulation of MAPK oncogenic signaling. Furthermore, liprin‐α1 depletion led to more pronounced redistribution of RAS proteins to the cell membrane. Our data suggest that liprin‐α1 is an important contributor to oncogenic RAS/MAPK signaling, and the status of liprin‐α1 may assist in predicting drug responses in cancer cells in a context‐dependent manner.

ABSTRACTBackground The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD).Methods A total of 1247 subjects with adult-onset asthma (age range: 31–91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020.Results The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02–1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29–2.48], p = 0.001 and 1.69 [1.15–2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34–4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets.Conclusions Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.

AbstractThis study aimed to examine the acquisition of Roman alphabetic script among young children within a bilingual (Arabic and English) educational environment employing a language separation pedagogical approach in Muscat, Oman. Data were collected utilizing participant observations, video recordings to capture the interactions of three children and the instructive practices of the teacher, and teacher interviews, in order to explore the efficacy of this model. The findings of the study indicate that children demonstrate proficiency in script composition in their second language (Roman-English) through engagement in diverse classroom activities, including mathematical and artistic pursuits. Despite prevalent negative perceptions associated with language separation methodologies, our findings suggest its potential effectiveness in facilitating second language acquisition and literacy development. Implications of the study’s outcomes are discussed, along with avenues for future research inquiry.

ABSTRACTThe objective of this study is to develop and evaluate self-sensing capabilities in additively manufactured parts by embedding conductive elements that are copper and continuous carbon fiber. Two sets of test specimen were manufactured using a custom g-code on material extrusion-based Anisoprint A4 machine. Each set contained copper and continuous carbon fiber in an amorphous thermoplastic matrix. A tailor-made test setup was developed by improvising the American Society for Testing and Materials (ASTM D790) three-point loading system. Electrical resistance measurements were conducted under flexural loads to evaluate the self-sensing capability of each test specimen. The results confirmed that material extrusion technology can allow production of self-sensing parts. The electrical resistance increases linearly (Sensing tolerance 93.8% p-value

PurposeZanubrutinib is a potent, irreversible next-generation Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target kinase inhibition. We hypothesized that complete/sustained BTK occupancy may improve efficacy outcomes and increased BTK specificity may minimize off-target inhibition-related toxicities.Patients and methodsALPINE (ClinicalTrials.gov identifier: NCT03734016) is a global, randomized, open-label phase III study of zanubrutinib versus ibrutinib in patients with relapsed/refractory chronic lymphocytic leukemia. The primary end point was investigator-assessed overall response rate (ORR). The preplanned interim analysis was scheduled approximately 12 months after the first 415 patients were enrolled.ResultsBetween November 1, 2018, and December 14, 2020, 652 patients were enrolled. We present the interim analysis of the first 415 enrolled patients randomly assigned to receive zanubrutinib (n = 207) or ibrutinib (n = 208). At 15 months of median follow-up, ORR (partial or complete response) was significantly higher with zanubrutinib (78.3%; 95% CI, 72.0 to 83.7) versus ibrutinib (62.5%; 95% CI, 55.5 to 69.1; two-sided P < .001). ORR was higher with zanubrutinib versus ibrutinib in subgroups with del(17p)/TP53 mutations (80.5% v 50.0%) and del(11q) (83.6% v 69.1%); 12-month progression-free survival in all patients was higher with zanubrutinib (94.9%) versus ibrutinib (84.0%; hazard ratio, 0.40; 95% CI, 0.23 to 0.69). Atrial fibrillation rate was significantly lower with zanubrutinib versus ibrutinib (2.5% v 10.1%; two-sided P = .001). Rates of cardiac events, major hemorrhages, and adverse events leading to treatment discontinuation/death were lower with zanubrutinib.ConclusionZanubrutinib had a significantly higher ORR, lower atrial fibrillation rate, and improved progression-free survival and overall cardiac safety profile versus ibrutinib. These data support improved efficacy/safety outcomes with selective BTK inhibition.

The advancement of research and development of effective intervention programs for workplace bullying require high-quality assessment tools. One serious limitation that research on workplace bullying in Arab countries suffers from is the absence of good measures. In this study, we examined the psychometric characteristics of the nine-item Short Negative Acts Questionnaire (S-NAQ) and proposed two cutoff scores using a sample of Omani healthcare workers (N = 256). Exploratory factor analysis identified a one-factor solution that explained 51.77% of the variance in the data (Cronbach's alpha = 0.90). Confirmatory factor analysis supported a one-factor solution, with a Cronbach's alpha of 0.92. A receiver operator characteristic curve analysis identified two cutoff scores of > 14 and > 21. Based on these two cutoff points, the participants were divided into three groups: no exposure to bullying at work, occasional exposure, and frequent exposure. Overall, the findings of this study suggest that the Arabic S-NAQ is suitable for use in many Arabic-speaking countries. However, because each of these countries has its own dialect, future research is needed to replicate our findings in other Arab countries, as well as in different work settings.

Este artigo tem a originalidade de apresentar o conceito de tecnoextrativismo ontológico a partir de um estudo de caso: Amazônia NFT (Non-Fungible Territory). Em termos metodológicos, três campos são aproximados (Estudos Sociais das Ciências e das Tecnologias, Sociologias da Utopia Crítica e das Mudanças Climáticas) e no nível interpretativo-crítico é mobilizada a análise crítica de narrativa. Como resultado são identificados sete grupos de agentes humanos e não humanos compostos por algumasfiguras ideológico-utópicas centrais (e. g., ancestralidade, agentes artificiais, filantropo climático) e uma configuração entendida como Leviatã Ciberclimático.

Objectives This scoping review aims to survey healthcare providers (HCPs) in the Middle East and North Africa (MENA) about their knowledge, attitudes and barriers to working with women who have experienced intimate partner violence (IPV). This review aims to map the breadth of available peer-reviewed literature that may inform future educational training programmes.Design Scoping review.Data sources The scoping review included studies up to December 2023 from PUBMED, Medline, COCHRANE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO and Arabic medical journals.Eligibility criteria Selected articles were restricted to those carried out in the MENA region, available in full text and with no date restrictions.Data extraction and synthesis Data were extracted from all studies to include research location, year of publication, type of journal, methodology, design, participants, knowledge, attitudes and barriers. By charting the information into a table, the data were analysed using frequency, counts and descriptive content analysis.Results Of the 1060 articles reviewed, 29 eligible studies were included in this scoping review. 27% of the articles reported HCPs’ lack of knowledge about IPV protocols. The dominant attitude reported was a preference to treat the presenting health complaint and avoid discussing IPV. Finally, 30% of articles reported HCPs’ lack of training as the main barrier.Conclusion Our paper concluded that there is a lack of research in understanding the knowledge, attitudes and barriers surrounding HCPs in the MENA region and IPV. This scoping review highlights the need for further research, informed interventions and training for HCPs in the region.

Introduction Throughout their academic pursuits, students may encounter various sleep-related issues, including insomnia, sleep apnea, hypersomnia, or sleep terror disorder. These disorders can profoundly impact their well-being, emotional state, and academic achievements. Objective This study, of significant relevance to the field of nursing and sleep disorders, aimed to investigate the prevalence of sleep disorders and their impact on academic performance among undergraduate nursing students in the United Arab Emirates. Methods A cross-sectional research method was implemented among 177 undergraduate nursing students. Two tools were used: Too I consisted of two parts: sociodemographic and academic performance classifications, whereas Tool II comprised the SLEEP-50 questionnaire. Results Our findings revealed that 30.6% of nursing students had one or more sleep disorders. Insomnia was the most prevalent among the nursing students (37.5%), followed by circadian rhythm (33.3%), narcolepsy (26.6%), sleep apnea and restless leg syndrome (25%), nightmares (22.2%), and sleepwalking (11.11%). There was a significant relation between restless leg syndrome and academic performance, while in linear regression analysis, it was found that the variable that most affects sleep is gender. Conclusion The implications of this study's findings are clear-nursing schools must intensify their efforts to raise awareness about the detrimental effects of sleep problems on academic performance. Furthermore, subsequent research is crucial to evaluate the execution of interventions aimed at preventing such disorders.

BackgroundWith the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. ObjectiveThis study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. MethodsWe used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. ResultsThe deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model’s interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. ConclusionsThe results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.

Abstract Background Our population‐based study has previously shown that being born in winter or spring was associated with adult‐onset asthma. The aim was to study if season of birth (SOB) is associated with airway allergy and related diseases: NSAID exacerbated respiratory disease (N‐ERD), asthma, allergic rhinitis (AR), nonallergic rhinitis (NAR), chronic rhinosinusitis with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) in Finland. Methods A randomly sampled retrospective registry‐based follow‐up data (n = 74,868) of patients visiting Hospital District of Helsinki and Uusimaa (HUS) in Finland was used. The birth date, sex, visit date and comorbidities were collected from electronic health record data during visits from 2005 to 2019. Results The mean (SD, range) age of the sample was 34.53 (25.47, 0–102) years, with 48.7 % being men. We divided the whole population in four groups based on the season they were born (SOB‐groups). When observing these four SOB‐groups, the proportion of those having asthma was 43.1%, 42.1%, 41.1%, 42.7%, in winter, spring, summer, and autumn SOB‐groups, respectively. The proportion of those having AR was 12.6%, 12.0%, 10.7%, 12.1%, respectively. When having summer as a reference, being born in any other time of year was significantly associated with AR and, being born in autumn or winter was associated with asthma. No significant association was observed in CRS or N‐ERD or NAR groups in adjusted models. Conclusions The study suggests that early life immunological events may have a role a role in pathogenesis of asthma and AR. As no association was observed between SOB and CRSsNP, CRSwNP, N‐ERD or NAR, further studies on this are warranted.

The increasing interest in cultivating groundcover plants in warm and semiarid areas requires a better understanding of the salinity effects on landscape plants. This work aimed to study the response of three groundcovers (Alternanthera dentate, Sphagneticola trilobata, and Alternanthera amoena) to high sodium chloride concentrations. The trial was conducted in the natural greenhouse environment. Plants were raised in pots filling clay-loamy soil. Hewitt’s nutrient solution containing 0, 25, 50, 75, and 100 mM NaCl irrigated the plants. Plant growth, antioxidative enzyme activity, and the relative water content (RWC), proline, sodium, potassium, and chloride were determined. The study indicated that increasing NaCl concentration in the nutrient solution led to: a) significant differences in the fresh weight of shoots among salinity treatments and among species; b) increased root growth with increasing salinity stress up to the mild stress level of 25 mM NaCl, however at different rates with three species; c) reduced RWC of the leaves of three species grown under salinity-induced stress; d) the increased proline content of the leaves, and more pronounced increases with A. dentate and A. amoena from 0 to 50 mM NaCl, and with S. trilobata from 0 to 100 mM NaCl; e) significant changes in the activities of antioxidative enzymes including superoxide dismutase, peroxidase, and catalase; f) significant decrease of the K+/Na+ ratio along with increase of salinity stress; g) increased ratio of leaf/ root content of Cl– in A. dentate and in particular, A. amoena; h) a significant reduction in visual qualities of all examined plants. Therefore, because of its ability to maintain leaf characteristics, visual quality, and salt-tolerance mechanisms even under high salinity, S. trilobata can be considered for urban landscaping projects in semiarid and saline areas where low-quality water is used for irrigation.

The US health care delivery system does not systematically engage or support family or friend care partners. Meanwhile, the uptake and familiarity of portals to personal health information are increasing among patients. Technology innovations, such as shared access to the portal, use separate identity credentials to differentiate between patients and care partners. Although not well-known, or commonly used, shared access allows patients to identify who they do and do not want to be involved in their care. However, the processes for patients to grant shared access to portals are often limited or so onerous that interested patients and care partners often circumvent the process entirely. As a result, the vast majority of care partners resort to accessing portals using a patient’s identity credentials—a “do-it-yourself” solution in conflict with a health systems’ legal responsibility to protect patient privacy and autonomy. The personal narratives in this viewpoint (shared by permission) elaborate on quantitative studies and provide first-person snapshots of challenges faced by patients and families as they attempt to gain or grant shared access during crucial moments in their lives. As digital modalities increase patient roles in health care interactions, so does the importance of making shared access work for all stakeholders involved—patients, clinicians, and care partners. Electronic health record vendors must recognize that both patients and care partners are important users of their products, and health care organizations must acknowledge and support the critical contributions of care partners as distinct from patients.

This study examines the triggering mechanism of hotel guests’ engagement in word-of-mouth (WOM) by integrating guest experience, well-being perception, one-to-one WOM intention, one-to-many WOM intention and many-to-many WOM intention. A survey was conducted with 306 experienced guests of the resort hotel sector in China. Partial least squares structural equation modeling (PLS-SEM) was employed to estimate relationships between guest experience, well-being perception and WOM intentions. The findings of this study indicated a significantly direct effect of esthetic experience on well-being perception, followed by escapism experience, education experience and entertainment experience. The findings also revealed well-being perception was a salient predictor of WOM intentions (i.e., one-to-one, one-to-many and many-to-many), aided to tourism and hospitality literature by providing empirical evidences to demonstrate how different WOM intentions were triggered by various experiences via psychological reaction of well-being perception. The theoretical and managerial implications for the tourism marketers were discussed.

Multidisciplinarity and the enrichment of science and mathematics education toward the so-called STEAM-approach where the A stands for art, has raised a lot of academic interest in the past decade. In this study, 5th and 6th graders from the greater Helsinki area (N = 390) participated in a several months long, Mars-colonization themed STEAM-learning intervention. Testing the students' science knowledge using pre- and post-tests, their learning outcomes were compared to those of 5th and 6th graders from a control school (N = 119), who during the same period studied STEM-subjects in a more traditional manner. The main factors that were taken into account during the comparisons were gender and academic achievement level. Based on only whether there was any improvement between the pre- and post-test scores, girls were found to have benefitted from the Mars-module more than boys did. While also considering the magnitude of the said improvement, no significant difference in the effectiveness of the learning module was found between genders. The group of academically highest-achieving students improved their test scores the most after participating in the STEAM-learning module. This is an important, somewhat surprising finding, as often informal, outside of school learning has been found to benefit especially students with lower grade point averages.

Abstract Mnemonic strategies can facilitate working memory performance, but our knowledge on strategy use as a function of task characteristics remains limited. We examined self-reported strategy use in several working memory tasks with pretest data from two large-scale online training experiments. A three-level measure of strategy sophistication (no strategy, maintenance, manipulation) was coded based on participants’ open-ended strategy reports. A considerable portion of participants reported some memory strategy, and strategy sophistication was associated with objective task performance. We found a consistent effect of stimulus type: verbal stimuli (letters or digits) elicited higher strategy sophistication than nonverbal ones (colours or spatial positions). In contrast, the association between task paradigm and strategy sophistication was less consistent in the two experiments. The present results highlight the importance of self-generated strategies in understanding individual differences in working memory performance and the role of stimulus characteristics as one of the task-related determinants of strategy use.

The lung nodule detection technology plays a vital role in the diagnosis and treatment of early lung cancer. Deep learning is currently one of the main technologies applied in computer vision related fields. Therefore, this topic is to combine deep learning and lung nodule detection technology. Different from some research methods, we improved from two-dimensional space to three- dimensional space and applied it to lung nodule detection. After statistically analyzing the lung CT data, we find that the lung CT data has inconsistent scales on the vertical axis. Aiming at the problem of lung CT data, this article is based on the deep learning method. First, the lung interpolation network based on voxel flow is used to achieve the same scale, and then the lung nodule detection network based on three-dimensional convolution is used to complete the detection of lung nodules. The entire network combines U- Net-like and RPN-like network structures. Through data slice input, it avoids the limitation of the display memory of the computing platform. The network structure also introduces prior knowledge of the coordinate information of the input slices to improve the classification accuracy of lung nodules. The experimental results show that the lung slice data of consistent scale is achieved through interpolation, and then through the three-dimensional convolution of the lung nodule detection network, the state- of-the-art detection effect is achieved. Because of the introduction of the interpolation network, the time- consuming has increased. Of course, the overall speed stillmeets the actual use value.

In the rapidly evolving landscape of digital technology, the security of web and mobile applications stands paramount. As these platforms become increasingly integrated into our daily lives, the need for robust safety measures becomes imperative. This research paper delves into the intricate realm of web and mobile request safety, unraveling a multi-faceted exploration that combines traditional feature engineering with state-of-the-art machine learning models. Beginning with foundational models like TextCNN and TextRNN, we scrutinize their effectiveness in discerning the safety of requests. Advancing our investigation, we delve into the capabilities of sophisticated architectures, including Bidirectional LSTMs, DistilBERT, and RoBERTa. Beyond individual assessments, we introduce hybrid models that synergize the strengths of various approaches, establishing a comprehensive defense against emerging security threats. Throughout this research, we navigate the intricacies of model training, evaluation, and performance metrics. From accuracy and precision to recall and confusion matrices, each metric paints a nuanced picture of the efficacy of these models in ensuring the safety of web and mobile interactions. In a world where cyber threats loom large, the significance of this research lies not only in its technical contributions but also in its practical implications. By providing insights into innovative strategies for enhancing the security and resilience of digital applications, this paper contributes to the ongoing discourse on fortifying the digital infrastructure.

This paper introduces a method for computing reactive terminations for scatterer elements in antenna arrays. With the fixed scatterer elements, we shape embedded element patterns of sparse arrays to focus the radiation into a grating-lobe-free limited field of view. The reactive terminations of the scatterer elements are determined by optimizing reflection coefficients on a Riemannian manifold. In addition, we show that widening the grating-lobe-free field of view is possible by tilting the field of view. We design both 5-element linear and 4-by-4-element planar reactively loaded antenna arrays with 1.4-wavelength inter-element distances. The terminations of the scatterer elements are optimized so that the arrays cover either the broadside-located or the tilted grating-lobe-free field of view. The results obtained from the linear array are validated through measurements of manufactured prototypes.

The security landscape of Internet of Things (IoT) networks continues to draw significant attention from recent networks; the Version Number Attack (VNA) stands out as a prominent threat to IoT network resources. Routing Protocol for Low-Power and Lossy Network structures low-power and lossy networks through one or more Destination Oriented Directed Acyclic Graphs (DODAGs). Each DODAG is assigned a version number, serving the purpose of ensuring the existence of loop-free paths to the root node. In the event of any inconsistency detected by the root node, the version number is incremented, triggering a global repair process and the reconstruction of the Directed Acyclic Graph. A potential security concern arises when a malicious node advertises a false version number in its control message, compelling the initiation of a global repair process. This study conducts a comprehensive analysis of the VNA’s impact, considering various parameters that have not been explored in previous research articles. These parameters include an examination of the additional forwarding tasks introduced by the attack and an exploration of factors contributing to node hyperactivity (such as loops, local and global repairs, etc.). The article delves into the specific control messages that result in the detrimental effects of the attack, offering a detailed analysis of control overhead, energy consumption, Packet Delivery Ratio, and latency. The obtained results show that the DAO (Destination Advertisement Object) messages dominate the total control overhead and are the main contributor to the total consumer energy, where the closest the malicious node to the sink the more damaging is the attack.

Abstract Background The Driver Behavior Questionnaire (DBQ) is one of the most used tools for measuring self-reported aberrant driving behavior. Several versions of the DBQ exist varying in terms of the item number and factor structure. Objectives This study aimed to investigate the psychometric properties and the factorial structure of the DBQ for assessing aberrant behavior among Lebanese drivers and to examine the relationship between DBQ subscales and socio-demographic characteristics and traffic-related variables. Methods A cross-sectional study was conducted among Lebanese drivers aged over 18 years from all Lebanese governorates. Data were collected using a convenient sampling technique and an anonymous Arabic self-administered questionnaire that included socio-demographic characteristics and the Arabic Lebanese version of the DBQ (DBQ-L). Statistical analyses were performed using SPSS version 24 and Amos software. Exploratory factor analysis (N = 568) and confirmatory factor analysis (N = 534) were used to test the factorial structure of the DBQ-L. Linear regression analyses were performed to examine the association between DBQ-L, sociodemographic, and relevant traffic variables. Results A total of 1102 drivers aged between 18 and 82 years participated in the study with an average age of 34.64 (SD = 12.33). Of the total, 68.4% of participants were male with an average driving experience of 13.46 years (SD = 10.76). The DBQ-L total scale revealed high internal consistency (Cronbach’s α = 0.892). Exploratory and confirmatory factor analysis supported the original four-factor structure reflecting aggressive violations, ordinary violations, errors, and lapses dimensions. Aggressive violations had the highest mean among all the DBQ subscales. Men were found to have a higher tendency to commit aggressive and ordinary violations than females. Furthermore, the ordinary violation score was positively associated with younger age and increased mileage. All DBQ subscales decreased with the highest educational level. Being a professional driver increased the likelihood of drivers reporting violations, errors, and lapses, and increased mileage amplified the tendency of displaying aggressive violations and lapses when driving. However, errors decreased for young drivers and increased with age and larger driver experience. Conclusion The cross-cultural adapted version of the DBQ was found to be a reliable and valid tool for assessing aberrant behaviors among Lebanese drivers. This study revealed distinct behavior patterns, with men frequently displaying aggressive violations, and younger, high-mileage drivers more prone to ordinary violations and lapses. Higher education correlated with safer driving, while professional drivers reported more violations, errors, and lapses. These findings highlight the importance of tailored road safety interventions based on driver demographics. Further studies are needed to examine the ability of DBQ to predict road accidents.

Abstract Background Emergency medical services (EMS) were the first point of contact for many COVID-19 patients during the pandemic. The aim of this study was to investigate whether the non-conveyance decision of a COVID-19 patient was more frequently associated with a new EMS call than direct ambulance transport to the hospital. Methods All confirmed COVID-19 patients with an EMS call within 14 days of symptom onset were included in the study. Patients were compared based on their prehospital transport decision (transport vs. non-conveyance). The primary endpoint was a new EMS call within 10 days leading to ambulance transport. Results A total of 1 286 patients met the study criteria; of these, 605 (47.0%) were male with a mean (standard deviation [SD]) age of 50.5 (SD 19.3) years. The most common dispatch codes were dyspnea in 656 (51.0%) and malaise in 364 (28.3%) calls. High-priority dispatch was used in 220 (17.1%) cases. After prehospital evaluation, 586 (45.6%) patients were discharged at the scene. Oxygen was given to 159 (12.4%) patients, of whom all but one were transported. A new EMS call leading to ambulance transport was observed in 133 (10.3%) cases; of these, 40 (30.1%) were in the group primarily transported and 93 (69.9%) were among the patients who were primarily discharged at the scene (p

PurposeThe focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability.MethodsOn September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments.ResultsIn total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes.ConclusionsSPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Learning intervention based on a "Mars and Space" exhibition was designed according to STEAM-education (Science, Technology, Engineering, Art and Mathematics) principles and practices in order to bridge the gap between formal and informal learning. The cognitive learning of 12-year-old students in Finland ("N" = 306) showed a sustained level for a six months period. The results of this study provided evidence that situational motivation was enhanced by interest in school science in the STEAM science exhibition context. This led to better cognitive learning results in the post-knowledge test. Thus, interest and situational motivation were the first steps, and the superficial situational motivation seemed to successfully change into content-based intrinsic motivation with longer-lasting, deep learning outcomes. STEAM intervention apparently produced long-term learning, and this exhibition learning setting is shown to provide an appropriate platform to reach the deeper layers to successfully retain knowledge. Boys' scores rose even in the delayed test. Using structural equation modelling (SEM) to assess the effects on individual, motivational and situational interest in learning, situation motivation is shown to work as a catalyst and acting as a catalyst and also acted as a stepping stone for intrinsic motivation as part of relative autonomy (RAI) and a deep learning strategy.

The purpose of this article is to present a design for additive manufacturing assignment focused on creativity rather than functionality and to analyze its results (N = 70) acquired during five years. The assignment teaches the unique advantages of additive manufacturing to engineering students and encourages learning from failure to achieve designs that are possible to manufacture. The students of the course assignment were in their fourth year of studies and pursued master's degrees in mechanical engineering. The article presents the design for additive manufacturing course assignment in enough detail for it to be applied by educators in the sphere of additive manufacturing. The result assessment is performed with a numerical method and a jury method. The statistical significance of the correlation of the numerical approach with the jury approach is evaluated. The study conducts a multi-point creativity assessment on a large sample of parts created by students acquired over five years with the support of 10 jury members. This assessment process gives insight on how creativity in design for additive manufacturing can be quantified and can be readily applied by educators. The data of the jury evaluation are verified with an interrater reliability evaluation. Our results indicate that conducting the course assignment for multiple years increases the quality of the student work. The improvement of the results is theorized to be partly due to students gaining inspiration from an increasing number of high-quality parts from previous years of the assignment. The numerical method of result assessment can be used for evaluation when resources are scarce; however, the jury method should be used if possible.

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited condition characterized by the growth of multiple bilateral cysts in the kidneys. We describe the case of a 35-year-old male with combined ADPKD and type 1 diabetes mellitus with a strong family history of both. At the age of 32, he developed end-stage kidney disease for which he underwent preemptive simultaneous pancreatic and kidney transplant, which in turn led to multiple perioperative complications. Evaluation of familial clustering of genetic disease is critical in genetic epidemiology and precision medicine as it enables estimation of lifetime disease risk and early assessment as well as detection of the disease among one’s siblings.

Introduction: Increased Actin-like 6A (ACTL6A) expression is associated with various cancers, but its comprehensive investigation across different malignancies is lacking. We aimed to analyze ACTL6A as a potential oncogene and therapeutic target using bioinformatics tools.Methods: We comprehensively analyzed ACTL6A expression profiles across human malignancies, focusing on correlations with tumor grade, stage, metastasis, and patient survival. Genetic alterations were examined, and the epigenetic landscape of ACTL6A was assessed using rigorous methods. The impact of ACTL6A on immune cell infiltration in the tumor microenvironment was evaluated, along with molecular docking studies and machine learning models.Results: Our analysis revealed elevated ACTL6A expression in various tumors, correlating with poor prognostic indicators such as tumor grade, stage, metastasis, and patient survival. Genetic mutations and epigenetic modifications were identified, along with associations with immune cell infiltration and key cellular pathways. Machine learning models demonstrated ACTL6A's potential for cancer detection.Discussion: ACTL6A emerges as a promising diagnostic and therapeutic target in cancer, with implications for prognosis and therapy. Our study provides comprehensive insights into its carcinogenic actions, highlighting its potential as both a prognostic indicator and a target for anti-cancer therapy. This integrative approach enhances our understanding of ACTL6A's role in cancer pathogenesis and treatment.

Registers recording only 1 tumour per patient do not enable assessment of the real burden of cutaneous squamous cell carcinoma. To investigate recent changes in the incidence and characteristics of tumours, a retrospective 15-year patient cohort study was performed in Finland. Histopathological diagnoses of cutaneous squamous cell carcinomas diagnosed between 2016 and 2020 were obtained from the pathology database and clinical data from patient medical records and combined with previously collected data for the years 2006–2015. Altogether 1,472 patients with 2,056 tumours were identified. The crude incidence increased from 19/100,000 persons in 2006 to 42 in 2020 (p

The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.

Abstract Background Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12 weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. Methods This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0–89 years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n = 1461). The covariates of interest were collected from electronic health records based on ICD‐10 codes and keyword searches. Results Among pediatric patients (n = 104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n = 1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p