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Abstract Background The private healthcare sector has become an essential component of healthcare systems globally. This interest has increased with the universal health coverage agenda. However, in most low- and middle-income countries, few classificatory studies of the private hospital sector were carried out. Methods This study describes the private hospital sector in a developing country setup and propose a typology that could facilitate the identification of its categories and the understanding of its organizational and strategic characteristics. Results All private hospitals in Morocco as of December 31, 2021 including 397 facilities are included. Most hospitals are for-profit, poly-disciplinary, independent, commercial societies, have fewer than 30 beds or between 30 and 99 beds and are located in urban areas. Private hospitals have a median turnover of 9.8 million MAD and a median capital value of 2 million MAD. The clustering method identifies three main categories of private hospitals: for-profit hospitals with medium size and turnover, spread across the country but with a high concentration in large regions; not-for-profit hospitals, with medium to large size, high turnover, located in large regions and including university hospitals; and small for-profit hospitals with low turnover, independent ownership and wide distribution over the country. Three criteria have the most significant discriminatory power: ownership, size (beds, turnover) and mode of governance. Conclusions Private hospitals in Morocco are organized into three types according to three similarity criteria including ownership, size and governance. These criteria might be used as the basis for a common typology of private hospitals in Morocco and possibly in other low- and middle-income countries with similar contexts.

Hereditary spastic paraplegias represent a rare set of monogenic disorders encompassing 79 distinct genetic variations. The principal culprit behind recessive hereditary spastic paraplegia is frequently attributed to mutations in the spastic paraplegia gene, particularly type 11, closely followed by type 15. This category is typically characterized by nonspecific clinical features, including cognitive decline, which may precede the development of progressive lower limb weakness and spasticity. While the thinning of the spinal cord is recognized as the magnetic resonance imaging hallmark of hereditary spastic paraplegia, insights into specific subtypes can be gleaned from brain magnetic resonance imaging findings.Notably, thinning of the corpus callosum emerges as a prominent abnormality in almost one-third of recessive hereditary spastic paraplegias, providing pertinent diagnostic clues. Additionally, recent observations introduce a distinctive anomaly termed the “ears of the lynx” sign, primarily affecting the forceps minor of the corpus callosum. This sign is highly indicative of type 11 and 15 hereditary spastic paraplegias. We present the case of a patient diagnosed with hereditary spastic paraplegia type 15 through exome genetic testing, with the initial magnetic resonance imaging revealing the characteristic “ears of the lynx” sign.

Sudan has been racked by complex and volatile conflicts for decades, with a new round of civil conflict erupting in April 2023, leading to significant loss of life and property. Despite the ongoing violence, the associations between conflicts and local contextual factors remain ambiguous. In this study, we developed an event-grid dataset, consisting of 50,033 observations with 20 variables derived from nighttime light (NTL) data, OpenStreetMap data, and other geographic data. Machine learning algorithms were employed to model the outbreak of conflict in 2023. Furthermore, the SHapley Additive exPlanations method was utilized to explain the relationships between diverse explanatory variables and conflicts. The results indicate that eXtreme Gradient Boosting model outperforms other models, such as Categorical Boosting and Light Gradient Boosting Machine. Multiple factors jointly contribute to conflicts. NTL-derived variables and transportation-related variables emerge as the most influential factors, followed by climate and agricultural factors. Regions characterized by economic inequality and proximity to transportation hubs are found to be more prone to conflicts. Additionally, variables impact the outbreak of conflict not only individually but also through mutual interactions. Notably, this study enhances a comprehensive and quantitative understanding of conflicts in Sudan, providing valuable insights to support humanitarian aid efforts.

Wind energy conversion systems (WECS) are emerging as among the most reliable alternative energy sources, requiring innovative control strategies to improve performance and reduce operating costs. The objective of this paper is the implementation of sliding mode control (SMC) for a permanent magnet synchronous generator (PMSG) to optimize the dynamical response and wind turbine system (WTS) stability. The control architecture comprises the PMSG, an AC-DC power converter, and a DC bus link, with a particular focus on extracting the optimum wind turbine power during variable wind speeds. A complete system model was developed and tested in MATLAB for a PMSG of 2 MW subjected to uncertain fluctuations in wind speed. The simulation results confirm that the SMC technique significantly improves speed-tracking accuracy, minimizes current ripple, and improves overall system stability. In addition, the proposed method ensures robust performance under non-linear and uncertain conditions, making it a viable solution for large-scale wind applications. These results highlight the potential of SMC to enhance the accuracy and efficiency of the WECS.

In this paper, a Modified Genetic Algorithm (MGA) combined with ETAP (Electrical Transient Analyzer Program), is proposed to optimize the placement and sizing of Distributed Generation (DG) units while considering multiple objectives, such as improving voltage profiles, reducing line losses, and managing short-circuit levels. These factors are critical for maintaining power quality, system reliability, and overall stability. The MGA approach is validated through simulations using the IEEE 33-bus distribution system, modeled in both MATLAB and ETAP. The results show significant improvements in voltage stability, loss reduction, and short-circuit level management, enhancing energy management and operational efficiency. A comparative analysis with alternative algorithms, including the Bat Algorithm (BA), Bacterial Foraging Optimization Algorithm (BFOA), and Artificial Immune System (AIS), demonstrates that MGA achieves superior convergence speed and accuracy, making it highly effective for DG placement and power system performance optimization.

Abstract Silicon is indisputably the most advanced material for scalable electronics, but it is a poor choice as a light source for photonic applications, due to its indirect band gap. The recently developed hexagonal Si1−x Ge x semiconductor features a direct bandgap at least for x > 0.65, and the realization of quantum heterostructures would unlock new opportunities for advanced optoelectronic devices based on the SiGe system. Here, we demonstrate the synthesis and characterization of direct bandgap quantum wells realized in the hexagonal Si1−x Ge x system. Photoluminescence experiments on hex-Ge/Si0.2Ge0.8 quantum wells demonstrate quantum confinement in the hex-Ge segment with type-I band alignment, showing light emission up to room temperature. Moreover, the tuning range of the quantum well emission energy can be extended using hexagonal Si1−x Ge x /Si1−y Ge y quantum wells with additional Si in the well. These experimental findings are supported with ab initio bandstructure calculations. A direct bandgap with type-I band alignment is pivotal for the development of novel low-dimensional light emitting devices based on hexagonal Si1−x Ge x alloys, which have been out of reach for this material system until now.

This study introduces a novel adjustment to the firefly algorithm (FA) through the integration of rare instances of cannibalism among fireflies, culminating in the development of the honeybee mating-based firefly algorithm (HBMFA). The IEEE Congress on Evolutionary Computation (CEC) 2005 benchmark functions served as a rigorous testing ground to evaluate the efficacy of the new algorithm in diverse optimization scenarios. Moreover, thorough statistical analyses, including two-sample t-tests and fitness function evaluation analysis, the algorithm’s optimization capabilities were robustly validated. Additionally, the coefficient of determination, used as an objective function, was utilized with real-world wind speed data from the SR-25 station in Brazil to assess the algorithm’s applicability in modeling wind speed parameters. Notably, HBMFA achieved superior solution accuracy, with enhancements averaging 0.025% compared to conventional FA, despite a moderate increase in execution time of approximately 18.74%. Furthermore, this dominance persisted when the algorithm’s performance was compared with other common optimization algorithms. However, some limitations exist, including the longer execution time of HBMFA, raising concerns about its practical applicability in scenarios where computational efficiency is critical. Additionally, while the new algorithm demonstrates improvements in fitness values, establishing the statistical significance of these differences compared to FA is not consistently achieved, which warrants further investigation. Nevertheless, the added value of this work lies in advancing the state-of-the-art in optimization algorithms, particularly in enhancing solution accuracy for critical engineering applications.

This study focuses on examining the failure behavior of interfacial cracks in bimaterial structures. Bimaterials present a unique challenge due to their composition, consisting of two materials that can be homogeneous and isotropic, with a specific emphasis on the ceramics/metal combination. The disparity in elastic and physical properties between these materials leads to stress singularities and embrittlement of the interface. In order to investigate the behavior of an interfacial crack without propagating into the individual materials, numerical simulations of a 4-point bending model were conducted. The stress intensity factors were computed at the crack tip to determine the energy release rate, which is a crucial parameter in evaluating interfacial crack behavior. The energy release rate, along with the mixed mode angle (G, ψ), provides insights into the crack’s response. The findings demonstrate that an increase in the thickness ratio (H1/H2) of the assembled materials, as well as a reduction in the Young’s modulus ratio (E1/E2), result in higher energy release rates for interfacial cracks in bimaterials. This indicates that the properties of the assembled materials play a significant role in determining the dominant mode of crack propagation tendency.

Introduction Eating disorders affect almost one million people in France. More than half of them have not been screened for the disorder, and are still unable to access treatment! Objectives To shed light on the clinical characteristics and management of patients with eating disorders Methods We report on a series of clinical situations involving patients presenting with binge eating disorder at the adolescent unit of the Gonesse hospital. Results Our sample included 5 patients, all female, aged between 13 and 16 years. They presented with anorexia nervosa with or without hyperphagia. Comorbidities included depression, anxiety disorders, chronic illness and suicidality. In some cases, treatment is based on re-feeding via a nasogastric tube. In others, behavioral treatment was sufficient. Pharmacological treatment for comorbidities was prescribed. Conclusions Untreated eating disorders can be a source of deterioration in patients’ quality of life and high mortality. Early detection and diagnosis is essential for better patient management. Disclosure of Interest None Declared

Introduction Buddha Blue, or PTC for “Pète Ton Crâne”, is a synthetic drug particularly popular with young people. It is sold as a liquid to be inhaled in electronic cigarettes. Objectives To discuss the clinical manifestations and psychopathology associated with PTC. Methods We shed light on PTC addiction through clinical vignettes of patients who were hospitalized in pediatrics at the Gonesse hospital. Results We received two male patients with manifestations of PTC intoxication or withdrawal. One of the patients presented with an acute delirious flush requiring long-term treatment, while the second presented with somatic manifestations of pain and vomiting, as well as psychiatric manifestations such as hallucinations, without meeting the criteria for a psychiatric disorder. Both cases required addictological follow-up and child psychiatric therapy. Conclusions PTC addiction can lead to life-threatening complications, hence the importance of prevention and screening in order to institute early and effective treatment. Disclosure of Interest None Declared

Introduction Anxiety and mood disorders are frequent causes of consultation in child psychiatry. In pediatrics, they can be the cause of life-threatening or psychological complications, such as suicidal ideation, anxiety attacks, scarification or suicide attempts. Objectives Discuss the clinical and therapeutic features of anxiety-depressive syndromes. Methods We shed light on anxiety-depressive syndromes through the study of complex clinical cases encountered in child psychiatric hospitalization. Results We report a case series of 10 patients, the majority of whom were female. The age range was 12 to 17 years. Clinical features included emotional manifestations such as sadness, tantrums and anxiety, as well as cognitive symptoms such as memory and concentration problems, with dark or suicidal ideation, and occasional endangerment behaviors such as scarification or suicide attempts. Treatments range from psychosocial interventions, including therapeutic mediation, psychotherapy and social support, to pharmacological treatment with antidepressants, hypnotics, neuroleptics and, rarely, mood regulators. Conclusions The frequency and severity of anxiety-depressive syndromes in the absence of adequate care underlines the importance of screening, early diagnosis and treatment of children with these disorders. Disclosure of Interest None Declared

Introduction ADHD is a very frequent reason for consultation in child psychiatry. It affects 2.5% of children and 5% of adults. Diagnosis is clinical. Treatment is based on medication combined with psychosocial interventions. Objectives Develop an ADHD guide for caregivers. Methods We carried out a literature review covering the last 5 years using the google scholar and pubmed search engines, including the key words ADHD, in order to produce a printable guide for caregivers working with children, in particular school teachers and healthcare personnel. Results Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 5% of school-age children. It is characterized by abnormally high levels of developmental inattention, hyperactivity and impulsivity, leading to impaired personal, social, academic or occupational functioning. Because of its pervasiveness, ADHD can interfere negatively with general well-being, as well as with social life, academic performance and the development of social skills, which can lead to low self-esteem. ADHD has multiple etiologies. It is thought to be due to a complex interaction between genes and environment. In fact, genetic vulnerability predisposes to the disorder which, under the influence of an unfavorable environment, expresses itself in clinical symptoms represented by 2 dimensions: inattention, hyperactivity and impulsivity. Diagnosis is essentially clinical, and treatment is based on medication combined with psychosocial interventions. Conclusions ADHD is one of the most frequently encountered disorders in general practice, pediatrics and child psychiatry. Early recognition of the disorder enables appropriate management, while limiting the impact of the disease on the functioning of the young person and his or her family. Disclosure of Interest None Declared

Introduction Schizophrenia is a severe mental disorder marked by abnormal interpretations of reality, often resulting in hallucinations, delusions, and disordered thinking that significantly impairs daily functioning and can be disabling. Lifelong treatment is necessary, and early intervention can help manage symptoms and improve long-term outcomes. Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm causing an excess of red blood cells in the peripheral blood (polyglobulia). While the disease typically presents with symptoms, it can also be asymptomatic and discovered incidentally during routine laboratory tests, leading to a diagnosis of polycythemia when no secondary cause is apparent. While early 20th-century literature linked PV to intense neurological and psychiatric symptoms, contemporary studies rarely make such references. Objectives The aim of this study is to explore, through a clinical case of a patient undergoing treatment for treatment-resistant schizophrenia with clozapine, and concurrently diagnosed with Polycythemia Vera, the potential causes of this condition. We seek to discern whether it represents mere comorbidities or if Polycythemia Vera is an adverse effect of antipsychotic treatment, particularly with clozapine. Methods A 41-year-old patient, with a history of cranial trauma at the age of 5 and 19 years of treatment for schizophrenia, also has a tobacco use disorder. While hospitalized for the management of symptomatic reactivation of schizophrenia, despite being on clozapine, the patient underwent various therapeutic combinations with no observed clinical improvement. A few months later, follow-up blood tests indicated an elevation in all blood cell lines. An internal medicine consultation was sought, resulting in the diagnosis of Polycythemia Vera. Results The evaluations conducted led us to the conclusion that there are two distinct nosological entities, with the treatment of the psychiatric condition revealing true polycythemia. Even after reducing the doses of clozapine and changing the atypical antipsychotic, all subsequent evaluations showed no effectiveness in managing the psychiatric disorder or improvement in the hematological condition. Conclusions In summary, schizophrenia is a severe and lifelong mental disorder requiring early intervention for symptom management. Polycythemia Vera (PV), a myeloproliferative disorder, typically presents with symptoms but can also be asymptomatic. While early literature linked PV to intense neurological and psychiatric symptoms, contemporary studies seldom reference such associations. The coexistence of schizophrenia and PV in a patient underscores the need for comprehensive and interdisciplinary care to address the complex interplay between mental and physical health. Further research is needed to deepen our understanding of concurrent psychiatric and hematological conditions. Disclosure of Interest None Declared

Pancreas divisum (PD) is the most common congenital variant of the pancreatic ductal system, in which only a few patients develop symptomatic disease. Overall, PD is an underrecognized cause of many cases of recurrent acute pancreatitis. The PD must be systematically suspected in case of multiple episodes of acute idiopathic pancreatitis when exhaustive etiological investigations are negative. We present a 37-year-old woman whom presented several previous pancreatic pains. She came to the emergency department for epigastric pain, accompanied by post-prandial dietary vomiting after a copious meal. Lipasemia was greater than 3 times normal (498 UI/L). An abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a PD. The patient improved after the initial management measures. An endoscopic cholangiopancreatography was planned after the resolution of the acute episode. Recurrent pancreatitis is defined as 2 or more episodes of distinct acute pancreatitis with more than 3 months between episodes. Patients with this condition are usually asymptomatic while 5% of patients develop acute pancreatitis or chronic pancreatitis. We can underline the interest of deepening the radiological and endoscopic investigations to make the diagnosis of PD and to propose an endoscopic or surgical treatment, in order to avoid recurrences.

Dropped gallstones are a common complication during a laparoscopic cholecystectomy. The formation of an abdominal abscess related to the dropped gallstones is rare because the majority of these calculi do not cause complications. Ultrasound is a usually used first-line imaging modality to detect gallstones in the abscess. CT scan may be used to confirm the diagnosis of abscess and for topographic analysis. We report the case of a lady presented to the emergency department 2 months after laparoscopic cholecystectomy; for acute cholecystitis; with acute abdomen and fever. Laboratory values revealed an elevated white blood cell count (WBC) and C-reactive protein concentration (CRP). The diagnosis of intra-abdominal abscess was evoked by ultrasound and contrast-enhanced CT, and confirmed by laparoscopy. The purpose of this paper is to illustrate the importance of searching and recognizing dropped gallstone within collection, particularly in the context of previous laparoscopic cholecystectomy.

Conclusion: Cell-free fetal DNA is a reliable screening tool for autosomal trisomies. It is also useful for sex chromosome aneuploidies, although the positive predictive values are lower. A positive screening result should be followed with a confirmatory test.

Abstract Background Streptococcus pneumoniae (S. pneumoniae), remains a major cause of mortality and morbidity worldwide. The objective of this study was to determine the trends of invasive pneumococcal diseases (IPD) in adult and elderly population in Casablanca (Morocco) before and after introduction of pneumococcal conjugate vaccine (PCV) by determining the distribution of pneumococcal serotypes and antibiotic resistance profile of isolated strains. Method The proposed study is a retrospective laboratory-based surveillance of IPD in hospitalized adult (15–59 years old) and elderly (≥ 60 years old) patients in Ibn Rochd University Hospital Centre from 2007 to 2019 (13 years). All the 250 non-duplicate clinical invasive isolates from adult and elderly patients, confirmed as S. pneumoniae according to the laboratory standard identification procedures, are included in this study. Results A significant decrease of the overall incidence in IPD was observed only in adults from 0.71 to 0.54/100000 populations (P = 0.02) and to 0.47/100000 populations (P = 0.0137) in the early and mature post-vaccine period respectively compared to the pre-vaccine period. Our results also showed a significant reduction in the overall prevalence of vaccine serotypes from 28.17 to 6.90% (P = 0.0021) for the PCV-10 serotypes, and from 46.48 to 25.86% (P = 0.0164) for the PCV-13 serotypes only in the mature post-vaccine period (2015–2019). In parallel, the rate of non-vaccine serotypes did not significantly change in the early post-vaccine period (2011–2014) while it increased considerably from 54 to 74.14% (P = 0.0189) during the mature post-vaccine period. The rate of penicillin non-susceptible pneumococcal isolates decreased significantly from 23.94 to 8.77% (P = 0.02) in adult patients, and the rate of cotrimoxazole non-susceptible pneumococcal isolates significantly decreased from 29.58 to 8.77% in the early post-vaccine period (P = 0.003) and to 7.24% in the mature post-vaccine period (P = 0.0007). Conclusion Although childhood vaccination has considerably reduced the incidence of IPD in adult population through the herd effect, IPD remain a real public health problem due to the alarming increase in non-vaccine serotypes (NVS) and the lack of herd effect among elderly population. The rate of antibiotic resistance was relatively low. Nevertheless, resistance constitutes a serious problem to the therapeutic arsenal due to the known capacity for genetic dissemination in the pneumococcus.

IntroductionGlobal HIV infections due to HIV-1 recombinants are increasing and impede prevention and treatment efforts. Key populations suffer most new HIV infections, but their role in the spread of HIV-1 recombinants is unknown. We conducted a global analysis of the associations between key populations and HIV-1 recombinants.MethodsWe searched PubMed, EMBASE, CINAHL, and Global Health for HIV-1 subtyping studies published from 1/1/1990 to 31/12/2015. Unpublished data was collected through a global survey. We included studies with HIV-1 subtyping data of key populations collected during 1990-2015. Key populations assessed were heterosexual people (HET), men who have sex with men (MSM), people who inject drugs (PWID), vertical transmissions (VERT), commercial sex workers (CSW), and transfusion-associated infections (BLOOD). Logistic regression was used to determine associations of key populations with HIV-1 recombinants. Subgroup analyses were performed for circulating recombinant forms (CRFs), unique recombinant forms (URFs), regions, and time periods.ResultsEight hundred and eighty five datasets including 77,284 participants from 83 countries were included. Globally, PWID were associated with the greatest odds of recombinants and CRFs (OR 2.6 [95% CI 2.46–2.74] and 2.99 [2.83–3.16]), compared to HET. CSW were associated with increased odds of recombinants and URFs (1.59 [1.44–1.75] and 3.61 [3.15–4.13]). VERT and BLOOD were associated with decreased odds of recombinants (0.58 [0.54–0.63] and 0.43 [0.33–0.56]). MSM were associated with increased odds of recombinants in 2010–2015 (1.43 [1.35–1.51]). Subgroup analyses supported our main findings.DiscussionAs PWID, CSW, and MSM are associated with HIV-1 recombinants, increased preventative measures and HIV-1 molecular surveillance are crucial within these key populations.Systematic review registrationPROSPERO [CRD42017067164].

Satellite-observed night-time light data has been widely applied to estimate natural disaster loss, which is important for evaluating progress of SDG 11 and 13, but large uncertainty of the time series data hindered the evaluation in high accuracy. This study aims to estimate power outage, a proxy of economic loss, after natural disasters using VIIRS daily night-time light data with improved quality, which is able to capture abrupt change of the light. Firstly, an angular normalization algorithm was developed to generate a stable time series of night-time light data with less fluctuation, and it was validated with different metrics. The algorithm was then applied to analyze power outage after 2017 Maria Hurricane in Puerto Rico, and it was found that the Pearson correlation coefficient between the improved night-time light data and power supply is 0.929 in Puerto Rico, suggesting that the data is accurate to reflect the power supply. For the eight regions in Puerto Rico, they totally lost 78.01% of the power supply after the hurricane, while Caguas, Guayama and Humacao are the regions suffering from the hurricane most severely, losing 94.29%, 92.85% and 88.38% of power supply, respectively, and their recovery speeds are also relatively slow compared to other regions. In addition, we discuss the possibility of using the night-time light indicator for estimating GDP loss of service and industry due to disaster-derived power outage.