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Abstract Background Development of multidrug resistance in Uropathogenic Escherichia coli (UPEC) makes treatment of Urinary Tract Infections (UTIs) a major challenge. This study was conducted to investigate the effect of trans-resveratrol (t-RSV) at a subinhibitory concentration (sub-MIC-t-RSV) on phenotypic and genotypic expression of virulence factors of clinical isolates of UPEC and develop a nanoformulation of t-RSV. Fifty-five clinical UPEC strains were investigated for the presence of virulence factors by phenotypic methods and PCR detection of virulence genes. The effect of sub-MIC-t-RSV was studied on the phenotypic and genotypic expression of virulence factors. t-RSV-loaded nanoemulgel formulation was prepared and characterized. Results Out of the 55 tested isolates, 50.9% were biofilm producers, 23.6% showed both mannose-sensitive and mannose-resistant hemagglutination, 21.8% were serum-resistant, 18.2% were hemolysin producers, while 36.4% showed cytotoxic effect on HEp-2 cells. A total of 25.5% of the isolates harbor one or more of hly-A, cnf-1 and papC genes, while 54.5% were positive for one or more of fimH, iss and BssS genes. A concentration of 100 µg/mL of t-RSV effectively downregulates the phenotypic and genotypic expression of the virulence factors in positive isolates. A stable t-RSV-nanaoemulgel with droplet size of 180.3 nm and Zetapotential of -46.9 mV was obtained. Conclusion The study proves the effective role of t-RSV as an antivirulence agent against clinical UPEC isolates in vitro and develops a stable t-RSV-nanoemulgel formulation to be assessed in vivo. The promising antibacterial and antivirulence properties of t-RSV place this natural compound to be a better alternative in the treatment of persistent UTIs.

Abstract Deep neural networks (DNNs) are fundamental to modern applications like face recognition and autonomous driving. However, their security is a significant concern due to various integrity risks, such as backdoor attacks. In these attacks, compromised training data introduce malicious behaviors into the DNN, which can be exploited during inference or deployment. This paper presents a novel game-theoretic approach to model the interactions between an attacker and a defender in the context of a DNN backdoor attack. The contribution of this approach is multifaceted. First, it models the interaction between the attacker and the defender using a game-theoretic framework. Second, it designs a utility function that captures the objectives of both parties, integrating clean data accuracy and attack success rate. Third, it reduces the game model to a two-player zero-sum game, allowing for the identification of Nash equilibrium points through linear programming and a thorough analysis of equilibrium strategies. Additionally, the framework provides varying levels of flexibility regarding the control afforded to each player, thereby representing a range of real-world scenarios. Through extensive numerical simulations, the paper demonstrates the validity of the proposed framework and identifies insightful equilibrium points that guide both players in following their optimal strategies under different assumptions. The results indicate that fully using attack or defense capabilities is not always the optimal strategy for either party. Instead, attackers must balance inducing errors and minimizing the information conveyed to the defender, while defenders should focus on minimizing attack risks while preserving benign sample performance. These findings underscore the effectiveness and versatility of the proposed approach, showcasing optimal strategies across different game scenarios and highlighting its potential to enhance DNN security against backdoor attacks.

Abstract This study proposes a new deep-learning approach incorporating a superfluity mechanism to categorize knee X-ray images into osteoporosis, osteopenia, and normal classes. The superfluity mechanism suggests the use of two distinct types of blocks. The rationale is that, unlike a conventional serially stacked layer, the superfluity concept involves concatenating multiple layers, enabling features to flow into two branches rather than a single branch. Two knee datasets have been utilized for training, validating, and testing the proposed model. We use transfer learning with two pre-trained models, AlexNet and ResNet50, comparing the results with those of the proposed model. The results indicate that the performance of the pre-trained models, namely AlexNet and ResNet50, was inferior to that of the proposed Superfluity DL architecture. The Superfluity DL model demonstrated the highest accuracy (85.42% for dataset1 and 79.39% for dataset2) among all the pre-trained models.

Abstract Few empirical research has attempted to determine the impact of Intelligent Computer-Assisted Language Assessment (ICALA) in philosophy-based language instruction (PBLI) on critical thinking, self-evaluation, and academic resilience, despite the significant role that higher-order thinking skills play in influencing English as a Foreign Language (EFL) learners’ cognition, including their learning processes. This research addresses this knowledge vacuum by examining how ICALA in PBLI influences the development of the four primary abilities associated with critical thinking, self-evaluation, and academic resilience. A quasi-experimental strategy was used in this study among 81 EFL learners. The participants were split into two groups: one to participate in the experiment and another to serve as a control. The books for both groups were revised or supplemented according to the underlying PBLI principles. The control group (CG) students were exposed to paper format assessment. In comparison, the experimental group (EG) attended ICALA. The statistical significance of the differences between the two groups was determined using multivariate analysis of variance (MANOVA). The results demonstrated that the learners in EG outperformed their peers in CG foreign language-speaking development. Moreover, they received better critical thinking, self-evaluation, and academic resilience results.

Abstract Background C3H10T1/2 is a mesenchymal cell line capable of differentiating into osteoblasts, adipocytes and chondrocytes. The differentiation of these cells into osteoblasts is modulated by various transcription factors, such as RUNX2. Additionally, several interconnected signaling pathways, including the NOTCH pathway, play a crucial role in modulating their differentiation into mature bone cells. We have investigated the roles of DLK1 and DLK2, two non-canonical inhibitory ligands of NOTCH receptors, in the osteogenic differentiation of C3H10T1/2 cells. Results Our results corroborate existing evidence that DLK1 acts as an inhibitor of osteogenesis. In contrast, we demonstrate for the first time that DLK2 enhances this differentiation process. Additionally, our data suggest that NOTCH2, 3 and 4 receptors may promote osteogenesis, as indicated by their increased expression during this process, whereas NOTCH1 expression, which decreases during cell differentiation, might inhibit osteogenesis. Moreover, treatment with DAPT, a NOTCH signaling inhibitor, impeded osteogenic differentiation. We have confirmed the increase in ERK1/2 MAPK and p38 MAPK phosphorylation in C3H10T1/2 cells induced to differentiate to osteoblasts. Our new findings reveal increased ERK1/2 MAPK phosphorylation in differentiated C3H10T1/2 cells with a decrease in DLK1 expression or an overexpression of DLK2, which is coincident with the behavior of those transfectants where we have detected an increase in osteogenic differentiation. Additionally, p38 MAPK phosphorylation increases in differentiated C3H10T1/2 cells with reduced DLK1 levels. Conclusions Our results suggest that DLK1 may inhibit osteogenesis, while DLK2 may promote it, by modulating NOTCH signaling and the phosphorylation of ERK1/2 and p38 MAPK pathways. Given the established inhibitory effect of DLK proteins on NOTCH signaling, these new insights could pave the way for developing future therapeutic strategies aimed at treating bone diseases.

Abstract Moyamoya disease (MMD) is a chronic, rare cerebrovascular disorder of unknown cause featured by extensive narrowing of the terminal internal carotid artery (ICA) and its main branches. As a compensatory mechanism, perforators dilate forming fragile collateral vessels that appear as an abnormal vascular network resembling ‘puff of smoke drifting in the air’ observed via angiography around stenotic area in the brain. Patients and methods The database of the current hospital was retrospectively studied. All patients with ischemic strokes owing to MMD treated with surgical revascularization between January 2015 and December 2022 were included. MMD was identified on catheter-based digital subtraction angiography (DSA) by the presence of stenosis at the terminal portions of both internal carotid arteries and the development of abnormal collateral “moyamoya vessels” around the base of the brain. Clinical, radiological and follow-up data were retrospectively analyzed. Results During the mentioned time window, nine patients were diagnosed with moyamoya disease among all pediatric patients with established diagnosis of ischemic stroke in our institute; six of them underwent surgery. Unilateral EDMS was performed in 5 cases (83.3%), while one patient (16.67%) underwent staged bilateral surgeries with no added neurological deficit. Conclusion Indirect revascularization surgery for pediatric moyamoya-related stroke patients has high rates of reperfusion and promising outcomes.

Abstract Background Exercise is associated with improved survival, physical functioning, treatment tolerability, and quality of life in early-stage breast cancer. These same endpoints matter in metastatic breast cancer (MBC). Prior trials in MBC have found exercise to be not feasible or of limited benefit, possibly due to inclusion of patients with heterogeneous disease trajectories. Patients with MBC have variable disease trajectories and supportive care needs; those with indolent MBC have longer life expectancy, lower symptom burden and distinct priorities, and are well-positioned to participate in and benefit from an exercise program. The EMBody trial aims to determine the impact of a multimodal exercise intervention on cardiorespiratory fitness, physical function, body composition, and patient-reported outcomes, specifically in patients with stable, indolent MBC. Methods Eligible patients have MBC with no evidence of disease progression on current therapy in the prior 12 months and cannot be receiving cytotoxic chemotherapy. The trial aims to enroll 100 patients, randomized 1:1 to the exercise intervention versus usual care, stratified by baseline function. The virtually-delivered exercise intervention arm achieves moderate intensity exercise with exercise physiologists 3 days/week for 16 weeks. The 60-minute sessions include aerobic, resistance, balance and stretching exercises. The exercise arm receives informational sessions on the role of exercise in cancer and principles of habit and self-efficacy. The primary endpoint is 16 week change in fitness on a ramp treadmill test between the exercise and control arms. Secondary endpoints include change in a physical function, muscle mass assessed by CT scans, and PROs of fatigue and quality of life. Exploratory analysis includes behavioral modifiers of exercise adherence and effectiveness and serologic measures of inflammatory, metabolic, and immune pathway biomarkers. Discussion The EMBody trial evaluates exercise in a unique patient population with indolent, non-progressive MBC. Patients living with MBC experience similar symptom burden to those undergoing therapy for early-stage disease and the benefits achieved with exercise could be similarly impactful. This trial will contribute evidence to support expansion of exercise recommendations, among other survivorship care efforts, to those living with metastatic disease. Clinical trial information: NCT05468034. Trial registration NCT05468034. Date of registration: 7/12/2022.

Abstract Selenium nanoparticles (SeNPs) and SeNPs conjugated with lysozyme (SeNPs-lysozyme) were synthesized via sodium selenite reduction with ascorbic acid and polysorbate-80 stabilization. These were physiochemically characterized to impart antibacterial properties. X-ray diffraction analysis (XRD) revealed that both formulations had hexagonal crystalline structures. Fourier transform infrared (FT-IR) confirmed the successful conjugation of lysozyme to SeNPs through the emergence of amine peaks at 1542 cm−1. Dynamic light scattering (DLS) showed lysozyme conjugation increased nanoparticle size from 76.6 to 92.4 nm and charge from − 12.6 to + 17.6 mV. Transmission electron microscopy (TEM) images confirmed that spherical morphologies and size increased from 73–79 nm for SeNPs to 84–98 nm for SeNPs-lysozyme after lysozyme capping. Both formulations exhibited identical minimum inhibitory concentrations (MIC) of 125 μg/mL. However, lysozyme conjugation reduced SeNPs cytotoxicity by 2.4-fold based on IC50 values from an MTT (Thiazolyl Blue Tetrazolium Bromide) assay. When tested in phosphate-buffered saline (PBS), SeNPs and SeNPs-lysozyme fully inhibited Bacillus cereus (B. cereus) proliferation up to 6 log10 CFU/mL inoculums over 24 h of incubation. However, at (7 log10 CFU/mL) inoculum, only partial inhibition occurred, with (2.5 ± 0.3 log10 CFU/mL) growth still detected for SeNPs and (2.2 ± 0.2 log10 CFU/mL) for SeNPs-lysozyme. At all inoculum levels (5, 6, and 7) log10 CFU/mL, B. cereus grew a lot in milk (more than 8 log10 CFU/mL). This was probably because SeNPs or SeNPs-lysozyme tend to aggregate around milk components, making them less effective.

Abstract Background Chromosome 16p11.2 deletions and duplications were found to be the second most common copy number variation (CNV) reported in cases with clinical presentation suggestive of chromosomal syndromes. Chromosome 16p11.2 deletion syndrome shows remarkable phenotypic heterogeneity with a wide variability of presentation extending from normal development and cognition to severe phenotypes. The clinical spectrum ranges from neurocognitive and global developmental delay (GDD), intellectual disability, and language defects (dysarthria /apraxia) to neuropsychiatric and autism spectrum disorders. Other presentations include dysmorphic features, congenital malformations, insulin resistance, and a tendency for obesity. Our study aims to narrow the gap of knowledge in Saudi Arabia and the Middle Eastern and Northern African (MENA) region about genetic disorders, particularly CNV-associated disorders. Despite their rarity, genetic studies in the MENA region revealed high potential with remarkable genetic and phenotypic novelty. Results We identified a heterozygous de novo recurrent proximal chromosome 16p11.2 microdeletion by microarray (arr[GRCh38]16p11.2(29555974_30166595)x1) [(arr[GRCh37]16p11.2(29567295_30177916)x1)] and confirmed by whole exome sequencing (arr[GRCh37]16p11.2(29635211_30199850)x1). We report a Saudi girl with severe motor and cognitive disability, myoclonic epilepsy, deafness, and visual impairment carrying the above-described deletion. Our study broadens the known phenotypic spectrum associated with recurrent proximal 16p11.2 microdeletion syndrome to include developmental dysplasia of the hip, optic atrophy, and a flat retina. Notably, the patient exhibited a rare combination of microcephaly, features consistent with the Dandy-Walker spectrum, and a thin corpus callosum (TCC), which are extremely infrequent presentations in patients with the 16p11.2 microdeletion. Additionally, the patient displayed areas of skin and hair hypopigmentation, attributed to a homozygous hypomorphic allele in the TYR gene. Conclusion This report expands on the clinical phenotype associated with proximal 16p11.2 microdeletion syndrome, highlighting the potential of genetic research in Saudi Arabia and the MENA region. It underscores the importance of similar future studies.

Abstract In order to enhance the tribological and corrosion properties of AISI 316 substrate, rf plasma carbonitriding was involved to form a carbonitrided layer on AISI 316 base substrate. The deposition of TiN top layer was executed engaging titanium nitride target in argon plasma atmosphere. All the deposition working parameters were reserved to be constant excepting the deposition period that was altered from 4 to 20 min. The effect of TiN top layer thickness on the structure, tribological and electrochemical characteristics of TiN@AISI 316 CN duplex treatment was explored. It was demonstrated, that the duplex coating enhanced the hardness (max: 1740 HV0.025 for TiN (1325nm)@AISI 316 CN sample) and improved the wear and corrosion resistance. Besides, the coefficient of friction is reduced to 0.12–0.2 for TiN@AISI 316 CN duplex treated samples compared with untreated AISI 316 which recorded a value of 0.47.

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Chronic hepatitis and liver cirrhosis lead to accumulation of genetic alterations driving HCC pathogenesis. This study is designed to explore genomic landscape of HCC in Egyptian patients by whole exome sequencing. Methods Whole exome sequencing using Ion Torrent was done on 13 HCC patients, who underwent surgical intervention (7 patients underwent living donor liver transplantation (LDLT) and 6 patients had surgical resection}. Results Mutational signature was mostly S1, S5, S6, and S12 in HCC. Analysis of highly mutated genes in both HCC and Non-HCC revealed the presence of highly mutated genes in HCC (AHNAK2, MUC6, MUC16, TTN, ZNF17, FLG, MUC12, OBSCN, PDE4DIP, MUC5b, and HYDIN). Among the 26 significantly mutated HCC genes—identified across 10 genome sequencing studies—in addition to TCGA, APOB and RP1L1 showed the highest number of mutations in both HCC and Non-HCC tissues. Tier 1, Tier 2 variants in TCGA SMGs in HCC and Non-HCC (TP53, PIK3CA, CDKN2A, and BAP1). Cancer Genome Landscape analysis revealed Tier 1 and Tier 2 variants in HCC (MSH2) and in Non-HCC (KMT2D and ATM). For KEGG analysis, the significantly annotated clusters in HCC were Notch signaling, Wnt signaling, PI3K-AKT pathway, Hippo signaling, Apelin signaling, Hedgehog (Hh) signaling, and MAPK signaling, in addition to ECM-receptor interaction, focal adhesion, and calcium signaling. Tier 1 and Tier 2 variants KIT, KMT2D, NOTCH1, KMT2C, PIK3CA, KIT, SMARCA4, ATM, PTEN, MSH2, and PTCH1 were low frequency variants in both HCC and Non-HCC. Conclusion Our results are in accordance with previous studies in HCC regarding highly mutated genes, TCGA and specifically enriched pathways in HCC. Analysis for clinical interpretation of variants revealed the presence of Tier 1 and Tier 2 variants that represent potential clinically actionable targets. The use of sequencing techniques to detect structural variants and novel techniques as single cell sequencing together with multiomics transcriptomics, metagenomics will integrate the molecular pathogenesis of HCC in Egyptian patients.

Abstract Background The global probiotics dietary supplements market size is continuously growing. To overcome probiotics’ health concerns, metabiotics are recognized as a safer alternative. Aiming to deal with the escalating antimicrobial resistance, the current work demonstrates synergistic metabiotic-antibiotic combinations against antibiotic-resistant pathogens. Methods The probiotic properties of lactic acid bacteria (LAB) strains isolated from 3 commercial dietary supplements were characterized in vitro. The combinations of the cell-free supernatants (CFS) of selected probiotic strains and conventional antibiotics against Staphylococcus aureus and Escherichia coli clinical isolates were evaluated using the time-kill assay. To our knowledge, the current literature lacks sufficient time-kill assay studies revealing the kinetics of such metabiotic-antibiotic combinations against S. aureus and E. coli. Results Four LAB strains isolated from dietary supplements as well as two reference strains were included in this study. The isolated LAB strains were identified by MALDI-TOF mass spectrometry as follows: P2: Lactobacillus acidophilus, P3: Lactiplantibacillus plantarum, P4: Lacticaseibacillus rhamnosus, and P5: Pediococcus acidilactici. The identification matched with that annotated by the manufacturers, except for P3. The tested strains could resist the acidic environment at pH 3. Excluding P2, the examined strains showed less than 1 log reduction in survivors upon the addition of reconstituted skimmed milk to pepsin at pH 2 and displayed an acceptable tolerance to 0.3% ox-bile. All the strains tolerated pancreatin. The hydrophobicity and autoaggregation capacities ranged between 7–92% and 36–66%, respectively. P2 was excluded owing to its inferior probiotic potential. Although the remaining strains showed excellent growth at 0.2% phenol, their growth was reduced at higher concentrations. L. plantarum and P. acidilactici strains possessed bile salt hydrolysis activity. The time-kill assay revealed promising synergistic activities of the combinations of CFS of L. rhamnosus P4 with either ceftazidime or gentamicin against E. coli and with only ceftazidime against S. aureus, as well as CFS of P. acidilactici P5 and ceftazidime against S. aureus. Conclusions Strict identification and evaluation of the probiotic strains incorporated in dietary supplements is crucial to ensure their safety and efficacy. The CFS of probiotics could be utilized to formulate novel biotherapeutics targeting problematic pathogens. However, future in vivo studies are required to evaluate the appropriate treatment regimen.

Based on the importance of achieving a safe environment at home from the dangers of earthquakes, which in turn occur suddenly, so, the house had to be equipped with an interior design system and furniture equipped for this purpose in terms of securing the human within that system. By fulfilling the requirements of security and safety from earthquakes which were divided into: requirements for human behavior during an earthquake, and direction to the safest places, such as entrances, load-bearing supports, solid furniture, in addition to referring to the survival triangle. As for the most dangerous places in the house: like standing in the middle of the room, or standing next to a heavy piece of furniture and stand by windows and electrical appliances. Requirements for interior design elements such as increasing the empty spaces in the corridors for ease of escape, removing the bed from the bottom of the window to avoid falling glass, and not hanging anything heavy that might cause harm by falling over. Relying on sliding doors and windows, and special requirements for furniture design, the method and place of its placement, as well as the methods and means of fixation and the materials made from it, and using locks for all kind of cabinets, and relying on built-in cabinets is the best option to avoid the dangerous of their fall.

The smart technologies of the digital revolution have penetrated all different fields of life. As a reflection of that, "smart architecture" appeared on the horizon, and it serves as a linking element between the field of architecture and interior design, passing through furniture, especially the kitchen, which was and still is one of the most important areas of work and movement inside the house, which must be carefully studied. Just as the use of traditional methods in planning and equipping kitchens wastes a lot of time and effort, especially wasting a lot of spaces that can be exploited. The use of these technologies has affected not only saving time and effort and providing better information, but also providing large spaces to serve other activities inside the house. The research dealt with the kitchen space of the dwelling, and the smart kitchen system that saves space, time, and effort within the residential unit, such as the smart sink, smart faucet, smart handles, smart dish maker, and other ideas. In an attempt to shed light on modern technological methods to complete the performance tasks in the most efficient manner and quickly, which works to save time, effort and spaces for that purpose.

Research conducted on emotionality in bilinguals suggests that language use modulates emotional expression. The current study examines bilingual disadvantaged minority members' emotional experience and expression as shaped by the group relations in a conflict area. We hypothesised that, in general, greater emotionality will be found in one's native language. Moreover, since the second language is imposed and acquired in a negative context, there may be differential effects on negative and positive language. A novel ecological paradigm was used: Twenty-eight Palestinian citizens of Israel were videotaped while recounting emotional stories in both Arabic (L1) and Hebrew (L2), resulting in 212 videos. Two studies followed: In Study 1 we compared participants' emotional ratings (1a) and analyzed the content of emotional expression (1b). In Study 2, American participants rated emotional expressiveness. In Study 1, an interaction effect was found between language and valence, with less positive emotions and expressions in L2. In Study 2, a general difference in expressiveness was found in favour of L1. These studies show an effect of power disparities on the emotional load of the second language, thus highlighting the emotional costs of using a second language acquired in a conflict area.

External and internal architecture is distinguished from all arts in that it deals with the basic three dimensions "length, width, and height" as well as the fourth dimension, which is time. In the art of photography, for example, man deals with two dimensions in addition to the dimension of time, but the person remains outside all these works, looking at and watching them. As for architecture, it represents a huge structural sculptural piece that a person approaches, enters, and walks in enjoying, examining it at all levels in a chronological sequence and within a certain schematic scale. The design thought shows the possibility of implementing paper folding designs with alternative industrial materials, such as: paper, cardboard, rubber, polyvinyl chloride, polypropylene, polyethylene, fabrics, and natural materials, such as: leather, copper, aluminum, plywood, which led to an expansion Scope of using paper folding technology to form larger, thicker and more intense models. The design process relied on this approach, which was represented in achieving the values of the creative thought of interior design derived from the folding technique, and how to deal with interior design vocabulary dynamically so that it was possible to solve interior design problems inspired by the art of folding through a global perspective consistent with the principles of contemporary thought. Spectral process means the physics of adaptation in the theory of chaos or disasters, while in architecture, the concept of folding expresses a technique of origami art, which is the process of bending one layer upon another layer, and while the folding process appears as if in its content a process of repetition of the form, it is theoretically considered a subjective process As it does not delete or add any elements that make up the shape, and it is considered a precise process that addresses one of the most quality characteristics of the shape, which is the transition from one dimension to another (the second dimension to the third dimension), and it is also a process that involves changes that expand the geometric qualities of the element while maintaining with its topology.

The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic/likely pathogenic (P/LP) variants associated with increased risk of breast, ovarian, pancreatic, and prostate cancer, including BRCA1, BRCA2, CDH1, PALB2, PTEN, and TP53, and recommended approaches to genetic counseling/testing and care strategies in individuals with these P/LP variants. These NCCN Guidelines Insights summarize important updates regarding: (1) a new section for transgender, nonbinary and gender diverse people who have a hereditary predisposition to cancer focused on risk reduction strategies for ovarian cancer, uterine cancer, prostate cancer, and breast cancer; and (2) testing criteria and management associated with TP53 P/LP variants and Li-Fraumeni syndrome.

AbstractThe main objective of this study is to examine the moderating effect of employees’ national identity on organizational trust and organizational commitment among employees in hotel establishments in the Hail region, of Saudi Arabia. A conceptual model was developed to find a mechanism through which organizational trust impacts organizational commitment dimensions through the factor of national identity. Multiple statistical analyses were applied to test the hypotheses developed in this study using structured equation modelling. These hypotheses were tested through a survey questionnaire. Measurements of organizational trust and organizational commitment were developed. 212 employees from 20 hotels in Hail, Saudi Arabia, voluntarily participated in the current study. Their responses were examined using linear regression, confirmatory factor analysis and structural equation modelling. The findings reveal that organizational trust is a positive predictor of all types of organizational commitment (affective, continuance, and normative). The results also indicate that nationality does not significantly moderate the impact of organizational trust on either affective commitment or normative commitment. However, it significantly moderates the relationship between organizational trust and continuance commitment. This study may assist managers in better understanding the importance of organizational trust and organizational commitment. Cultivating a trusting environment can help increase employees’ trust in their establishments, which can lead to better levels of organizational commitment and improved job performance, which can be reflected positively in their profitability. The study highlights that hotel establishments should emphasize organizational-trust-related dimensions, including competence, dependability, integrity, and transparency, as they can lead to the organizational commitment of employees and their intention to continue with their establishments.

ABSTRACTObjective: Preterm babies are prone to experiencing apnea of prematurity (AOP), mostly characterised by a pause in breathing lasting a minimum of 20 seconds. Recent literature supported higher maintenance doses of caffeine, indicating benefits. This study evaluated the cost-effectiveness of high maintenance dose (HD) versus low maintenance dose (LD) caffeine for AOP in neonates.Methods: From the hospital perspective of Hamad Medical Corporation (HMC), Qatar, a cost-effectiveness decision-analytic model was constructed to follow the use of a HD maintenance caffeine of 20 mg/kg/dose versus a LD maintenance caffeine of 10 mg/kg/dose, in a simulated cohort of AOP neonates, over a therapy follow-up duration of six weeks, until neonatal intensive care (NICU) discharge. The clinical inputs were primarily literature-based, while the resource cost and utilisation were locally extracted in HMC. The cost-effectiveness outcome measure was calculated per therapy success, defined as survival with no apnea and successful extubation removal within 72 hours, with or without adverse events. One-way and multivariate sensitivity analyses were performed to confirm the robustness of the results.Results: With 0.23 (95% CI, 0.23–0.23) enhancement in success rate, at United States dollar (US$) 3869 (95% CI, US$ 3823–3915) added infant cost, the HD caffeine was between dominant (34.8%) and cost-effective (63.7%), with an average incremental cost-effectiveness ratio of US $16,895 (95% CI, US$ 15,242–18,549) relative to LD caffeine per additional case of success. The hospitalisation contributed the most to the total infant cost, and the probability of patent ductus arteriosus was the model input that influenced the results most.Conclusion: This is the first literature economic evaluation of caffeine for AOP. Despite increasing the cost of therapy, HD maintenance caffeine seems to be a cost-effective alternative to LD caffeine in Qatar. Our results support the recent global trends of increased use of HD caffeine for AOP in NICU.

The Public Private Partnerships (PPP) and the Private Finance Initiative (PFI) have been significantly adopted over the last three decades as a mechanism for the delivery and financing of projects. Various infrastructure project types in the energy and the transport sectors have adopted this procurement system for their ‘anticipated’ effectiveness in risk distribution and value for money. Yet, their acclaimed benefits, particularly in ensuring value for money in the waste to energy – or energy-from-wastes (EfW) – sector are under significant scrutiny. Governments and investors are increasingly questioning their fiscal efficiency and overall benefit to taxpayers. Despite these concerns, studies investigating whether PFI provides value of money of PFI in EfW are lacking. This study addresses this gap by comparing the PFI models used in the UK and Canada in currently operative EfW projects using mixed risk epistemology approach combining methods that provide both a real and objective evaluation of issues and risks and a subjective (or opinion-based) evaluation. The former is achieved through a quantitative probabilistic model for simulating EfW feasibility at the operation phase. The quantitative probabilistic model is capable to model and capture how operational phase costs and profitability are affected by lifecycle risks (such as quality of service driven by contractual requirements that are usually passed on to the Operation and Maintenance (O&M) contractor) and a range of technical, payment and incentive dynamic variables and their fluctuations. If the impact of these variables is not considered and modelled accurately, the O&M contractor could incur significant losses undermining the viability of the EfW project. The latter employs a psychometric methodology to delve into the primary concerns of professionals involved in EfW projects regarding associated risks. The results show that common O&M risks identified in EfW PPP projects in UK and Canada prevail around unplanned maintenance, infeed waste reduction, market price, unsustainable debts, and policy changes.

Introduction Healthcare systems in developing countries faced significant challenges during COVID-19, grappling with limited resources and staffing shortages. Assessment of the impact of pharmaceutical care expertise, particularly in critical care units during the pandemics, in developing countries remains poorly explored. The principal aim of our study was to assess the impact of the Drug and Therapeutics Committee (DTC), comprising clinical pharmacists, on the incidence, types, and severity of medication errors and associated costs in using COVID-19 medications, especially antibiotics.Methods An interventional pre–post study was carried out at a public isolation hospital in Egypt over 6 months.Results Out of 499 medication orders, 238 (47.7%) had medication errors, averaging 2.38 errors per patient. The most frequent were prescribing errors (44.9%), specifically incorrect drug choice (57.9%), excessive dosage (29.9%), treatment duplication (4.5%), inadequate dosage (4.5%), and overlooked indications (3.6%). Linezolid and Remdesivir were the most common medications associated with prescribing errors. Pharmacists intervened 315 times, primarily discontinuing medications, reducing doses, introducing new medications, and increasing doses. These actions led to statistically significant cost reductions (p

Purpose This paper aims to identify key factors influencing the lack of formal volunteering among married Qatari youth.Methodology Utilizing data from the Qatar Youth Survey with a sample of 598 married individuals, factor analysis and multiple regression were employed for analysis.Findings The principal findings highlight significant associations with non-volunteerism, including a negative work environment, preference for a male boss, parents’ engagement with food and play, home-based parental involvement, and spousal caregiving responsibilities.Practical Implications The proposed study is expected to assist policymakers and decision-makers in Qatar draw strategies based on volunteers’ rebuttals when calling for community service and unpaid helpers from local youth.Originality This research contributes to existing knowledge as the first study in Qatar exploring the causes of non-volunteerism using multiple observed statements derived from previous research.

Cardiovascular diseases (CD), or heart diseases (HD), lead to approximately 17.9 million deaths each year, constituting 32% of global fatalities. Early detection and appropriate treatment of HDs can significantly reduce mortality rates, with timely intervention before disease progression enhancing treatment efficacy. Early detection is achievable through routine medical examinations and monitoring key symptoms, such as cholesterol levels, blood pressure variations, diabetes and obesity. This manuscript introduces a heart disease prediction (HDP) model designed to identify the presence of HDs at an initial stage. The study explores three methodologies: (a) traditional convolutional neural network (CNN), (b) CNN augmented with flower pollination optimization (FPO) algorithm and (c) CNN combining Teaching Learning-Based Optimization (TLBO) coupled with genetic algorithm (GA) for refined HDP. The model progresses through stages of data preparation, model construction, training and evaluation. The traditional CNN model resulted an accuracy of 81.97%, precision of 84%, recall of 81% and F1-score of 83%. Incorporating the FPO algorithm, model’s performance is enhanced with accuracy, precision, recall, F1-score of 85.25%, 90%, 81% and 85%, respectively. Further, optimized with TLBO and GA hybrid approach lead to superior performance with an accuracy, precision, recall, F1-score of 86.9%, 87.5%, 87.5% and 87.5%, respectively. The area under curve (AUC) for the receiver operating characteristics (ROC) and precision–recall curve (PRC) highlights the performance of the proposed hybrid methodology. These outcomes underscore the effectiveness of merging bio-inspired algorithms with CNN for early stage HD prediction (HDP), offering significant advancements in healthcare diagnostics.

Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0–59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008–2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011–2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1–20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31–0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73–5.23]), blood (3.29 [95% CI 1.85–5.86]) and urine cultures (7.12 [3.77–13.43]), levels of C-reactive protein (1.02 [1.01–1.02]) and leukocytes (1.05 [1.01–1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.

Background: The COVID-19 outbreak had significant global healthcare implications, including the use of medications. This is specifically evident in the surge in use of some medication and a decline in the use of others. As a result, some medications end up unused, which may have subsequent health, economic, and environmental impacts. Aim: To explore patients' insights into unused medications during the COVID-19 outbreak. Materials and methods: Semi-structured interviews were conducted with 30 patients attending various public and private healthcare facilities in Qatar between January and July 2021. A thematic analysis approach was utilized, with 2 researchers independently analyzing, comparing, and discussing the coding. The resulting themes were further discussed in research group meetings until a consensus was reached. Results: Seven themes emerged: awareness of unused medications and their impacts on health, economy, and the environment; barriers contributing to nonadherence/unused medications; sources of medications; factors facilitating medication use; patients' behaviors toward donated medications/reuse; patients' awareness of medication storage requirements; and patients' desire to appropriately dispose of unused medications. Conclusion: The COVID-19 outbreak disrupted medication supply and adherence, resulting in an increase in unused medications and inappropriate disposal. Adherence is crucial for improving patients' health and preserving medications. Implementing mail-return systems for unused medications could be a viable solution during disease outbreaks.

Summary: Background: In industrialized countries, the incidence of inflammatory bowel disease (IBD) appears stabilized. This study examined the incidence and phenotype of IBD in Northern France over a 30-year period. Methods: Including all IBD patients recorded in the EPIMAD population-based registry from 1988 to 2017 in Northern France, we described the incidence and clinical presentation of IBD according to age, sex and time. Findings: A total of 22,879 incident IBD cases were documented (59% (n = 13,445) of Crohn’s disease (CD), 38% (n = 8803) of ulcerative colitis (UC), 3% (n = 631) of IBD unclassified (IBDU)). Over the study period, incidence of IBD, CD and UC was 12.7, 7.2 and 5.1 per 105 person-years, respectively. The incidence of CD increased from 5.1/105 in 1988–1990 to 7.9/105 in 2015–2017 (annual percent change (APC): +1.9%, p

District heating and cooling networks distribute centrally generated heat through insulated pipes to multiple buildings, offering efficiency and reduced emissions, especially when using renewable heat sources. However, these systems face high upfront costs, heat loss during transport, and are most effective in densely populated areas. Despite interest in geothermal energy for district heating, empirical research on adoption factors is lacking. This review systematically examines literature to identify factors, opportunities, and challenges influencing geothermal energy adoption in district heating networks. Using the Web of Science database, 220 academic documents were analysed, highlighting common technical, economic, regulatory, and social challenges. The study also explores innovative technologies and methodologies for optimising geothermal district heating systems. It assesses the environmental, economic, and social benefits of geothermal systems over conventional heating and other renewable energy sources. Recommendations are made for policymakers, practitioners, and researchers to overcome barriers, address knowledge gaps, and foster collaboration for sustainable heating solutions.

Solid waste quantification and characterization are essential for waste management, environmental protection, and resource preservation. This study investigates the quantity and composition of waste at Qassim University (QU), in the Kingdom of Saudi Arabia (KSA). The potential for waste recycling and energy production was assessed in this audit based on the waste ingredients. Furthermore, the waste composition was compared between waste generated from both male and female colleges. The total quantity of the generated waste was estimated at 11.6 tons per day during regular study days. The results indicated that waste is generated at a rate of 29 g/day/capita in female colleges and 72 g/day/capita in male colleges. Meanwhile, the generation rate on the main campus was estimated at 278 g/day per capita due to the presence of student and faculty hostels. Waste characterization at QU revealed that plastic and paper are the primary components of the generated waste. Recyclable materials accounted for 87% of the generated waste, while combustible materials for energy production comprised 76%. A pilot study on waste segregation at its source was conducted at the College of Engineering, demonstrating the impact of environmental education on sustainability. The results of this study aid decision-makers in implementing sustainable development programs and resource conservation, aligning with KSA Vision 2030.

هدف البحث إلى دراسة الدور الذي تلعبه الأنشطة الداعمة لسلسلة القيمة في تحقيق الميزة التنافسية وذك في المصرف التجاري في محافظة اللاذقية، حيث اعتمدت الباحثة على أربعة أبعاد للميزة التنافسية(التكلفة المتميزة-الجودة المتميزة-المرونة المتميزة-الكفاءة المتميزة). اعتمدت الباحثة على المنهج الوصفي التحليلي، حيث تم استخدام عينة ميسّرة بلغ حجمها 97، كما تم استخدام الاستبانة كأداة لجمع البيانات الأولية وتحليلها من خلال البرنامج الإحصائي(SPSS-26)، ولاختبار فرضيات الدراسة قامت الباحثة باستخدام اختبار T ستيودنت لعينة واحدة، وكذلك تحليل الانحدار الخطي البسيط. توصل البحث إلى مجموعة من النتائج أهمها: ارتفاع مستوى استخدام الأنشطة الداعمة لسلسلة القيمة في المصرف التجاري وفروعه في محافظة اللاذقية، وارتفاع مستوى تحقق كل من التكلفة المتميزة والجودة المتميزة كأبعاد للميزة التنافسية، في حين تبين انخفاض مستوى تحقق كل من المرونة المتميزة والكفاءة المتميزة كأبعاد للميزة التنافسية في المصرف المدروس. وقدمت الباحثة مجموعة من التوصيات المتعلّقة بضرورة اتخاذ القرارات الفعّالة بناءً على تحليل شامل للأنشطة الأساسية والداعمة ضمن سلسلة القيمة، وتطبيق استراتيجية قيادة التكلفة، وتحقيق التميز في عنصر المرونة للعمليات المصرفية.

As the world increasingly focuses on renewable energy sources, grid-connected PV systems will continue to play a critical role in meeting our energy needs. This integration has brought many benefits, but has also created various problems related to power quality and stability at the connection points. Various techniques are used to improve the power quality, such as passive filters, tuned passive harmonic filters, and active filters. This paper presents the use of a series active filter on the DC side of grid-connected PV systems to improve their power quality, stability, and dynamic performance. The proposed filter consists of an inductor, two capacitors, and four transistor-diode pairs, the operation of which is controlled by a sinusoidal pulse width modulation (SPWM) scheme. The MATLAB/Simulink is used to build and validate a comprehensive mathematical model of the studied system. The transfer function of the system is identified and its transient response is studied under various test input signals. A Bode plot is also generated to assess the impact of the integration of this component on the stability of the system. The results showed that incorporating the filter resulted in a significant reduction in the total harmonic distortion factor (Thd%) for both the voltage and current waves at the inverter output. Moreover, it improved the transient response characteristics of the system by significantly reducing the maximum overshoot value of the system response with respect to the test input signals. The results indicate that the stability of the system is improved after the filter addition, as evidenced by the increased gain margin and phase margin in the system Bode plot.

BackgroundHealth system reform initiatives have increasingly embraced decentralization as a key trend. The implementation process and its outcomes are influenced by a myriad of factors, including economic forces, political dynamics, and ideological factors. Comprehending and carefully examining the implementation phase of decentralization and its consequences to achieve desired outcomes is crucial. Notably, this phase is often considered the weakest aspect of policy reforms, especially in developing countries. Therefore, this study aimed to explore and analyze the implementation phase of decentralization and its implications as essentials for achieving intended goals. The study objectives evolved around examining the entire decentralization as a multifaceted social and political process in Khartoum State, Sudan, from its early stages of decision-making, policy formulation, and implementation process and the influencing contextual factors.MethodsThis study was an exploratory qualitative study that employed in-depth interviews to gather perspectives of healthcare providers and policymakers, semi-structured observations, and thematic analysis. The study utilized Grindle’s framework for analysis.FindingsThis study revealed a political nature of decision-making, with a top–down approach to the implementation, which also lacked stakeholder involvement. It showed a lack of transparency, official documentation, and proper handover procedures from the Ministry of Health to the devolved hospitals during the implementation process. A conflict of interest between the federal and the state level was also reported. It is important to note that this process occurred within the context of structural adjustment program (SAP) schemes, which had already empowered the private sector in Sudan.ConclusionThis study documented the implementation process of decentralization of health services and its influencing factors. The study recommended reforming the decentralization policy through consultative stakeholder involvement and by implementing a concurrent responsibility paradigm that divides authority between the federal and state levels.

Background and aimsColchicine is an anti-inflammatory drug that may prevent post-operative atrial fibrillation (POAF). The effect of this drug has been inconsistently shown in previous clinical trials. We aimed to compare the efficacy and safety of colchicine vs. placebo to prevent POAF in patients undergoing cardiac surgery.Methods and resultsA systematic search of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) was conducted from inception till April 2023. The primary outcome was the incidence of POAF after any cardiac surgery. The secondary outcome was the rate of drug discontinuation due to adverse events and adverse gastrointestinal events. Risk ratios (RR) were reported using the Mantel Haenszel method. A total of eight RCTs comprising 1885 patients were included. There was a statistically significant lower risk of developing POAF with colchicine vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; P < 0.01, I2 = 0%), and this effect persisted across different subgroups. There was a significantly higher risk of adverse gastrointestinal events (RR: 2.20; 95% CI: 1.38-3.51; P < 0.01, I2 = 55%) with no difference in the risk of drug discontinuation in patients receiving colchicine vs. placebo (RR: 1.33; 95% CI: 0.93-1.89; P = 0.11, I2 = 0%).ConclusionThis meta-analysis of eight RCTs shows that colchicine is effective at preventing POAF, with a significantly higher risk of adverse gastrointestinal events but no difference in the rate of drug discontinuation. Future studies are required to define the optimal duration and dose of colchicine for the prevention of POAF.