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Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.

Respiratory syncytial virus (RSV) is an important cause of severe respiratory disease in older adults. Understanding the disease burden is crucial for guiding vaccination policy and raising disease awareness. We estimated the burden of RSV hospitalizations and deaths in adults in five middle-income countries: Argentina, Brazil, Chile, Mexico, and Malaysia. Hospital discharge and death statistics due to any respiratory disease (ICD-10 codes: J00–99) from 2010 to 2022 were obtained. The RSV attributable burden on hospitalizations and deaths by age group was determined for 2019 using previously published estimates. Latin American countries showed distinct annual peaks in respiratory-related hospitalizations and deaths during winter months that were absent in Malaysia. Among ≥20-year-olds in 2019, there were 14,604 RSV-attributable hospitalizations nationally in Argentina, 44,323 in Brazil, 4529 in Chile, 7416 in Malaysia, and 8651 in Mexico, and 60–74% in ≥65-year-olds. There were also 3518 RSV-attributable deaths in Argentina, 9115 in Brazil, 801 in Chile, 704 in Malaysia, and 3806 in Mexico 79–88% in ≥65-year-olds. Incidences of RSV-attributable hospitalizations in ≥75-year-olds ranged between 256.3 and 294.3 per 100,000 population, and deaths between 33.6 and 112.9 per 100,000 population. RSV is associated with a substantial disease burden beyond pediatric age groups, and preventive vaccines could have a major impact on this burden, especially in older adults.

Abstract Background The acceptance of online courses by medical and dental students, especially during the coronavirus disease 2019 crisis, is substantial, as reported in various studies. However, the unfavourable online learning experiences of the students during the pandemic were also highlighted. As the teaching-learning process is returning to the “new normal,“ it is necessary to identify online learning domains implemented during the pandemic crisis that may be applied in pre-clinical courses in the future. Methods A validated Student Online Learning Readiness questionnaire assessed pre-clinical students’ online learning competence. Students’ academic performance in face-to-face post-pandemic was compared with their performance in online settings during the pandemic crisis. Students’ satisfaction with online learning was evaluated using a self-made survey questionnaire. Descriptive statistics, the t-test, and multiple regression analysis were used to analyze the data gathered with a p-value ≤ 0.05 considered statistically significant. Results Except for social skills with classmates and groupmates, in which 47.5% of respondents indicated unreadiness, most students were prepared for online learning. Theory-wise, online learners outperformed traditional learners, but the difference was insignificant. In contrast, students’ practical skills in face-to-face modality are significantly higher (p = 0.029). Students rated their satisfaction with online learning higher for interactions with instructors and staff and lower for interactions with classmates and group mates and skill acquisition. Conclusion Providing high-quality pre-clinical online teaching was achieved for theoretical components but not practical skills acquisition. Students’ social engagement with peers is one of the key elements crucial to online learning success. Academic leaders and curriculum developers must recognize potential gaps as they transition to online learning.

This study aims to assess the level of metal contamination and the ecological risk index at the abandoned Zaida Pb/Zn mining site in eastern Morocco and identify native plant species found on the site that can be used in site rehabilitation through phytoremediation strategies. Samples from seven native and abundant plant species at the site, along with their rhizospheric soils, were collected and analyzed using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to determine the concentrations of various metal(loid)s, including As, Cu, Ni, Cd, Sb, Zn, and Pb. Indicators of soil pollution and ecological risks were also assessed, including the enrichment factor (EF), pollution index (PI), and ecological risk index (ERI). The Biological Accumulation Coefficient (BAC), Translocation Factor (TF), and Biological Concentration Factor (BCF) of plant samples were calculated. The results reveal polymetallic soil contamination, with notably higher concentrations of Pb, Cu and Zn, reaching respectively 5568 mg kg-1 DW, 152 mg kg-1 DW, and 148 mg kg-1 DW, indicating a significant potential ecological risk. The enrichment factor (EF) was also assessed for each metal(loid)s, and the results indicated that the metal contamination was of anthropogenic origin and linked to intensive mining activities in Zaida. These findings are supported by the pollution index (PI) ranging from 1.6 to 10.01, which reveals an extremely high metal(loid)s pollution level. None of the plant species exhibited a hyperaccumulation of metal(loid)s. However, Artemisia herba alba demonstrated a strong capacity to accumulate Pb in its aboveground parts, with a concentration of 468 mg kg-1 DW. Stipa tenacissima, Retama spherocarpa, and Astragalus armatus, showed a significant Pb accumulation in their roots reaching 280, 260, and 256 mg kg-1 DW.respectively. Based on BAC, TF, and BCF, Stipa tenacissima exhibited potential for Ni and Cd phytostabilization, as well as the ability for Zn phytoextraction. Additionally, Artemisia herba alba displayed the capability to phytoextract Cd and had a high propensity to translocate all the studied metal(loid)s. Astragalus armatus has the potential to be used in the phytostabilization of Zn and Ni, as well as for the phytoextraction of As and Sb. These native species from the Zaida site, although not hyperaccumulators, have the potential to contribute significantly to the phytoextraction or phytostabilization of potentially toxic elements (PTEs). Moreover, they can serve as vegetative cover to mitigate the erosion and dispersion of metal(loid)s.

Lead (Pb) contamination is a widespread environmental problem due to its toxicity to living organisms. Hirschfeldia incana L., a member of the Brassicaceae family, commonly found in the Mediterranean regions, is characterized by its ability to tolerate and accumulate Pb in soils and hydroponic cultures. This plant has been reported as an excellent model to assess the response of plants to Pb. However, the lack of genomic data for H. incana hinders research at the molecular level. In the present study, we carried out RNA deep transcriptome sequencing (RNA-seq) of H. incana under two conditions, control without Pb(NO3)2 and treatment with 100 µM of Pb(NO3)2 for 15 days. A total of 797.83 million reads were generated using Illumina sequencing technology. We assembled 77,491 transcript sequences with an average length of 959 bp and N50 of 1330 bp. Sequence similarity analyses and annotation of these transcripts were performed against the Arabidopsis thaliana nr protein database, Gene Ontology (GO), and KEGG databases. As a result, 13,046 GO terms and 138 KEGG maps were created. Under Pb stress, 577 and 270 genes were differentially expressed in roots and aboveground parts, respectively. Detailed elucidation of regulation of metal transporters, transcription factors (TFs), and plant hormone genes described the role of actors that allow the plant to fine-tune Pb stress responses. Our study revealed that several genes related to jasmonic acid biosynthesis and alpha-linoleic acid were upregulated, suggesting these components’ implication in Hirschfeldia incana L responses to Pb stress. This study provides data for further genomic analyses of the biological and molecular mechanisms leading to Pb tolerance and accumulation in Hirschfeldia incana L.

Recently, the electronic and structural properties of large self-assembled domains of [7]thiaheterohelicene-2,13-carboxaldehyde helicene ([7]TH-dial) molecules on Au(111), Cu(001), and NiAl(110) metal surfaces have been characterized by scanning tunneling microscopy (STM). Several distinct areas of the self-assembled structures can be observed. To describe and explore the morphology of and the interactions in these distinct self-assembled nanostructures, we combine the results obtained through calculations in a semi-empirical framework and calculated STM images. It is revealed that these supramolecular nanostructures, on metallic substrates, originate from the two orientations P and M of the [7]TH-dial molecules linked in different orientations (head-to-tail, sideways, head-on, and tail-on) through van der Waals interactions. The results presented here provide valuable insights for understanding the intermolecular and substrate–molecule interactions within the self-assembled nanostructures of [7]TH-dial molecules on metallic surfaces. [ABSTRACT FROM AUTHOR]

The integration of renewable sources and energy storage in residential microgrids offers energy efficiency and emission reduction potential. Effective energy management is vital for optimizing resources and lowering costs. In this paper, we propose a novel approach, combining the imperialist competitive algorithm (ICA) with particle swarm optimization (PSO) as ICA-PSO to enhance energy management. The proposed energy management system operates in an offline mode, anticipating data for the upcoming 24 h, including consumption predictions, tariff rates, and meteorological data. This anticipatory approach facilitates optimal power distribution among the various connected sources within the microgrid. The performance of the proposed hybrid ICA-PSO algorithm is evaluated by comparing it with three selected benchmark algorithms, namely the genetic algorithm (GA), ICA, and PSO. This comparison aims to assess the effectiveness of the ICA-PSO algorithm in optimizing energy management in multi-source residential microgrids. The simulation results, obtained using Matlab 2023a, provide clear evidence of the effectiveness of the hybrid ICA-PSO algorithm in achieving optimal power flows and delivering substantial cost savings. The hybrid algorithm outperforms the benchmark algorithms with cost reductions of 4.47%, 14.93%, and 26% compared to ICA, PSO, and GA, respectively. Furthermore, it achieves a remarkable participation rate of 50.6% for renewable resources in the energy mix, surpassing the participation levels of the ICA (42.88%), PSO (40.51%), and GA (38.95%). This research contributes to the advancement of power flow management techniques in the context of multi-source residential microgrids, paving the way for further research and development in this field.

In this work, a cylindrical-shaped dielectric resonator antenna (DRA) with four elements is designed and presented at 28 GHz for millimeter-wave applications. The microstrip line is designed to excite the dielectric resonator (DR) with a relative permittivity of 8.3, and then the proposed single cylindrical DR antenna has been mounted on a FR4-Epoxy substrate with a relative permittivity of 4.4 and a thickness of 1.8 mm. However, the optimized single element was used to create a particular array for improving the gain and achieving the required antenna performance. The resulting antenna enabled a response range for the reflection coefficient from 26.8 GHz to 30.6 GHz, which covers the operational frequency. This allows for a maximum gain of 19.07 dB, an impedance bandwidth of 3.8 GHz, and a total efficiency of 80.62%, meeting the requirements for millimeter-wave and fifth-generation applications. [ABSTRACT FROM AUTHOR]

Peganum harmala L., commonly known as Harmal, is an aromatic and medicinal plant that grows in North Africa. P harmala is a pseudometallophyte that occur both in heavy metals contaminated and non contaminated soils. In order to identify the best adapted and suitable populations within P. harmala species, a comprehensive analysis and evaluation of the morphological, physiological, and biochemical responses to lead (Pb) and zinc (Zn) were performed in three metallicolous populations (MP) and a non-metallicolous one (NMP). In Zaida, Mibladen, and Aouli Morrocan sites, P. harmala growing soils show a low organic matter content, high Pb and Zn concentrations, and a pollution index higher than 1, indicating a significant contamination level. The effects of Pb and Zn on growth, physiological, antioxidant enzyme activities, and Pb/Zn accumulation capacity were compared between a NMP and three MP of P. harmala. Plants were grown in hydroponic culture with 100 µM of ZnSO4 or 100 µM of Pb(NO3)2 for 15 days. Our results show that Pb and Zn significantly decreased the aboveground biomass in the NMP, MP-Mibladen, and MP-Aouli compared to MP-Zaida. Pb and Zn decreased significantly the root biomass in the NMP compared to the MP. There is no significant difference in chlorophyll a and b contents between NMP and MP. Under Pb exposure, anthocyanin content is shown to be significantly higher in MP-Zaida than in other populations. In contrast, there is no difference between NMP and MP under Zn stress. Proline content as well as the catalase, peroxidase, and ascorbate peroxidase activities was significantly higher in NMP than in MP under Pb and Zn exposure. In particular, lower proline content, and antioxidant activities were observed in MP-Zaida under the Pb and Zn exposure. Pb and Zn accumulations were significantly higher in the NMP than in the MP, both in roots and aboveground parts, showing that the NMP plants accumulated highly but tolerated less compared to the MP. In the present study, the MP-Zaida accumulated less Pb and Zn in their tissues and tolerated more than the other populations, suggesting this population as a good candidate for a phytostabilization strategy. [ABSTRACT FROM AUTHOR]

Abstract Background The SNAPSHOT program provides current data on the allergic rhinitis burden in the adult general population of five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia and the United Arab Emirates, the latter three grouped into a Gulf cluster). Methods A multi-country, cross-sectional, epidemiological program conducted by telephone in a random sample of the adult general population; quotas were defined per country demographics. Subjects were screened for allergic rhinitis using the Score For Allergic Rhinitis questionnaire. Current prevalence (last 12 months) was estimated. Disease severity and control were assessed using the Allergic Rhinitis and its Impact on Asthma classification and Rhinitis Control Assessment Test respectively. Quality of sleep, impact on daily activities and quality of life were measured using the Epworth Sleepiness Scale, Sheehan Disability Scale and EuroQol Five-Dimension questionnaire respectively. Multivariate logistic regression analyses were used to investigate risk factors and co-morbidities. Results 1808 of 33,486 subjects enrolled in the SNAPSHOT program fulfilled the case definition for allergic rhinitis. Prevalence was 3.6% [95% CI 3.2–4.0%] in Egypt, 6.4% [95% CI 5.9–6.9%] in Turkey and 6.4% [95% CI 6.0–6.9%] in the Gulf cluster. Risk factors identified were country, co-morbid asthma and income. Subjects with allergic rhinitis reported a significantly lower quality of life compared to the general population (p

Abstract Background Asthma is a common chronic respiratory disease leading to morbidity, mortality and impaired quality of life worldwide. Information on asthma prevalence in the Middle East is fragmented and relatively out-dated. The SNAPSHOT program was conducted to obtain updated information. Methods SNAPSHOT is a cross-sectional epidemiological program carried out in five Middle Eastern countries (Egypt, Turkey, Kuwait, Saudi Arabia, and the United Arab Emirates, the latter three grouped into a Gulf cluster) to collect data on asthma, allergic rhinitis, benign prostatic hyperplasia and bipolar disorder. The survey was carried out by telephone in a random sample of the adult general population with quotas defined according to country demographics. The analysis presented in this paper focuses on asthma. Subjects were screened for asthma based on criteria from the global Asthma Insights and Reality studies. Current prevalence (last 12 months) was estimated. Multivariate logistic regression analyses were used to investigate risk factors related to asthma and the association with allergic rhinitis and other co-morbidities. Quality of life was assessed using the three-level EQ-5D questionnaire. Results 2124 out of the 33,486 subjects enrolled in the SNAPSHOT program fulfilled the criteria for asthma. The adjusted prevalence of asthma ranged from 4.4% [95% CI: 4.0–4.8%] in Turkey, to 6.7% [95% CI: 6.2–7.2%] in Egypt and 7.6% [95% CI: 7.1–8.0%] in the Gulf cluster. Prevalence was higher (p

Nurdan Kokturk,1 Mehmet Polatli,2 I Kivilcim Oguzulgen,1 Sarfraz Saleemi,3 Mohammed Al Ghobain,4 Javed Khan,5 Adam Doble,6 Luqman Tariq,7 Fayaz Aziz,7 Abdelkader El Hasnaoui7 1Department of Pulmonary Medicine, School of Medicine, Gazi University, Besevler, Turkey; 2Department of Pulmonary Medicine, School of Medicine, Adnan Menderes University, Aydin, Turkey; 3Section of Pulmonary Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 4Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 6Foxymed, Paris, France; 7GlaxoSmithKline, Dubai, UAE Background: COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia. Methods: An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity. Results: Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314). Conclusion: Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence. Keywords: COPD, non-adherence, 8-item Morisky Medication Adherence Scale, MMAS-8, EuroQol Five-Dimension questionnaire, EQ-5D, COPD Assessment Test, CAT, Turkey, Saudi Arabia