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Purpose – The purpose of this paper is to explore factors and their impacts influencing online grocery shopping intentions among customers in the post COVID-19 situation. Moreover, the study aims at evaluating the mediating roles of shopping habits during COVID-19 between perceived usefulness, perceived ease of use and post COVID-19 online grocery shopping intentions. Design/methodology/approach – Based on a review of the literature and collection of 401 useable valid responses, the study was conducted through structured questionnaires applying personal interview technique. The subsequent analysis was conducted through partial least squares structural equation modeling (PLS-SEM) using Smart PLS 3.3.3. Findings – The study findings revealed that perceived usefulness, perceived ease of use and shopping habits during COVID-19 have a significant influence on post COVID-19 online grocery shopping intentions. Also, the study has uncovered that perceived usefulness and perceived ease of use significantly influence shopping habits during COVID-19 among customers. Furthermore, the current study has revealed that hopping habit during COVID-19 significantly mediates the relationship between perceived usefulness, perceived ease of use and post COVID-19 online grocery shopping intentions. Practical implications – The study findings have provided practical suggestions of developing and improving technological platforms to attract new customers for online grocery shopping. Further, the study suggests that online grocery retailers should apply adjusted pricing strategies using coupons and discount offers. Originality/value – This paper investigates factors and its impacts on online grocery shopping intentions in post COVID-19 context. Therefore, the study uncovers the factors that add value to understanding customers' post COVID-19 online grocery shopping intentions by integrating perceived usefulness, perceived ease of use and shopping habits during COVID-19.

Trigeminal neuralgia (TN) associated with brainstem lesions as revealed by Magnetic resonance imaging (MRI), is a rare condition. The MRI often shows a distinctive single pontine in cases of TN (SPL-TN). While the significance of this MRI finding remains unclear, various case reports suggest a potential link to chronic injury in the pontine pathways of the trigeminal nerve. In this report, we present the case of a 42-year-old female who was referred for TN that is refractory to medical treatment with an ipsilateral MRI lesion over the pons who had an excellent response to a trigeminal nerve bock, shedding light on the intriguing interplay between TN and pontine lesions.

The Spatiotemporal variability of air quality is influenced by various factors over time. The objectives of this research are to create prediction models for Carbon monoxide (CO) and Nitrogen dioxide (NO2) and determine the factors which that most impact CO and NO2 monthly using Random Forest Prediction. The methodology relies on Random Forest Prediction to predict air quality monthly in 2021, incorporating eight variables land surface temperature (LST), normalized difference built-up index (NDBI), built-up index (BU index), normalized difference vegetation index (NDVI), digital elevation model (DEM), relative humidity (RH), wind speed (WS), and wind direction (WD). The results indicate that RH, elevation, WD, and LST are the most significant factors influencing CO concentrations, representing 33%, 24%, 12%, and 10% respectively at annual level in 2021. Similarly, WD, WS, RH, elevation and LST are the most importance factors impacting NO2 concentrations, representing 24%, 21%, 18%, 12%, and 10% respectively at an annual level in 2021. Furthermore, NDBI and BU index had the lowest impact in on both CO and NO2, with BU index showing a slightly higher percentage in NO2 models compared to CO models. Regarding cross-validation, the MAE values in CO models range from 0.11 to 0.18, and the RMSE values range from 0.14 to 0.23. Additionally, the MAE values in NO2 models ranges from 3.78 to 7.30, and RMSE values range from 4.93 to 9.23.

Robotic assisted partial nephrectomy is the gold standard treatment for small renal masses. Ureteric stricture is a rare but serious complication that significantly increase the morbidity and worsens the quality of life for cancer patients. Definitive treatment such as surgical reconstruction or ureteroureterostomy is not always feasible as in patients with significant morbidity or high-risk patients. Other options include ureteric double J stent or nephrostomy tube placement with regular exchange. We present a case of iatrogenic upper ureteric stricture post robotic assisted partial nephrectomy for right renal mass that was discovered on postoperative follow up imaging treated with metallic ureteral stent (Memokath) as reconstructive surgery was difficult due to proximity to the tumor bed. We found that if reconstructive surgery is not feasible, metallic ureteral stents has good durability, better quality of life than ureteric double stents for the management of ureteric stricture.

Abstract Cladribine tablets (CladT), like alemtuzumab, acts as an immune reconstitution therapy. However, CladT is administered orally (alemtuzumab is given by infusion) and without the potential for serious side effects that limit the therapeutic use of alemtuzumab in multiple sclerosis (MS). Treatment with CladT, given initially as short courses of treatment 1 year apart, provides years of freedom from MS disease activity in responders to treatment. The appearance of mild or moderate MS disease activity after the initial 2 years of treatment may prompt careful follow-up or a further course of CladT, depending on the nature of the activity and individual circumstances. The appearance of severe MS disease activity requires a switch to an alternative high-efficacy disease-modifying treatment (DMT). The accumulating data from CladT-treated people with MS in real-world studies, including those with follow-up durations extending for years beyond the initial treatment, have demonstrated long-term freedom from MS disease activity in a good proportion of patients. This clinical experience has also confirmed that treatment with CladT is generally safe and well tolerated. The best time to prescribe a high-efficacy DMT is the subject of debate, with evidence that earlier versus later use of such agents may provide more effective long-term protection from disability progression. High-efficacy DMTs have traditionally been reserved for use in people with MS and high disease activity on presentation or breakthrough disease on one or more DMTs, as per the current product labels. The latest evidence from real-world studies suggests that CladT is effective and safe in DMT-naïve patients, including those with shorter disease duration.

Abstract Purpose Hepatocellular carcinoma (HCC) is one of the most common types of liver cancer that could potentially be surrounded by healthy arteries or veins that a surgeon would have to avoid during treatment. A realistic 3D liver model is an unmet need for HCC preoperative planning. Methods This paper presents a method to create a soft phantom model of the human liver with the help of a 3D-printed mold, silicone, ballistic gel, and a blender. Results For silicone, the elastic modulus of seven different ratios of base silicone and silicone hardener are tested; while for ballistic gel, a model using 20% gelatin and 10% gelatin is created for the tumor and the rest of the liver, respectively. It is found that the silicone modulus of elasticity matches with the real liver modulus of elasticity. It is also found that the 10% gelatin part of the ballistic gel model is an excellent emulation of a healthy human liver. Conclusion The 3D flexible liver phantom made from a 10% gelatin-to-water mixture demonstrates decent fidelity to real liver tissue in terms of texture and elasticity. It holds significant potential for improving medical training, preoperative planning, and surgical research. We believe that continued development and validation of such models could further enhance their utility and impact in the field of hepatobiliary treatment planning and education.

Urban noise pollution poses significant challenges to public health and environmental sustainability, particularly in rapidly developing tourist destinations. Noise pollution and associated annoyance level in five major intersections of Cox's Bazar City, Bangladesh, was assessed in this study during the peak tourist season. Noise measurements were conducted using various indices (L10, Leq, and TNI) across morning, midday, and afternoon time slots. TNI scores were compared with Mean Dissatisfaction Score (MDS) standards to assess traffic-induced noise annoyance levels. Additionally, a survey of 675 respondents was conducted to assess their perceptions of noise pollution. Statistical analyses included linear regression for noise indices, multinomial logistic regression for TNI-related dissatisfaction, and ordinal logistic regression for respondents' perceived annoyances. Results revealed significant noise pollution issues, with Leq scores consistently exceeding national guidelines across all intersections and time periods, particularly on weekends during afternoon timeslots. TNI values frequently surpassed standard dissatisfaction regulations, with 19 out of 105 time slots exhibiting extreme dissatisfaction levels. Link Road and Kolatoli Circle intersections consistently showed higher noise levels and dissatisfaction. Over 95% of survey respondents perceived increased noise pollution during peak tourist seasons, with 87.11% describing it as ''extremely'' or ''very'' noisy. Longer exposure duration and awareness of health risks were significantly associated with reported perceived annoyance levels. Respondents reported various health impacts, including annoyance (84.44%), headaches (62.37%), and cognitive impairment (44.44%). This comprehensive study provides valuable insights for policymakers, city planners, and environmentalists to develop sustainable urban strategies that balance the acoustic environment with the well-being of residents and tourists alike.

As blockchain technology increasingly underpins digital transactions, smart contracts have emerged as a pivotal tool for automating these transactions. While smart contracts offer efficiency and security, their automation introduces significant legal challenges. Detecting and preventing fraud is a primary concern. This paper proposes a novel application of artificial intelligence (AI) to address these challenges. We will develop a machine learning model, specifically a Convolutional Neural Network (CNN), to effectively detect and mitigate fraudulent activities within smart contracts. The AI model will analyze both textual and transactional data from smart contracts to identify patterns indicative of fraud. This approach not only enhances the security of digital transactions on blockchain platforms but also informs the development of legal standards and regulatory frameworks necessary for governing these technologies. By training on a dataset of authentic and fraudulent contract examples, the proposed AI model is expected to offer high predictive accuracy, thereby supporting legal practitioners and regulators in real-time monitoring and enforcement. The ultimate goal of this project is to contribute to legal scholarship by providing a robust technological tool that aids in preventing cybercrimes associated with smart contracts, thereby laying a foundation for future legal research and development at the intersection of law, technology, and security.

Due to their high price, RFID tags are not yet widely used in applications for monitoring, tracing, and information inscribing, such as manufacturing lines, supply chains, and inventory management. The currently utilized barcode-like tracing techniques lack security, experience data limitation, are semi-automated, and are prone to external damage. Chipless RFID technology is a potential replacement, able to overcome shortcomings. However, due to the uncertainty created by the absence of a communication antenna and microchip, the detection of chipless RFID tags has a 2–5% detection error rate. The recent advancement in spatial chipless RFID technology has opened up a plethora of opportunities to use deep learning, which is becoming increasingly popular, to detect chipless RFID tags from a 2D virtual image created from the backscattered signal. In this study, we presented a comprehensive and exhaustive investigation of several deep learning techniques to improve the detection capability of deep learning-based chipless RFID tag detection. Our proposed fine-tuning methods yielded better mathematical metrics on the state-of-the-art on its original setup. A confusion matrix used to measure error rates on unseen data shows that the improved deep learning architecture we introduced works at roughly 99.99% accuracy.

Abstract Background Spinal muscular atrophy (SMA) is a fatal autosomal recessive disorder for which several treatment options, including a gene therapy, have become available. SMA incidence has not been well-characterized in most Arab countries where rates of consanguinity are high. Understanding SMA disease epidemiology has important implications for screening, prevention, and treatment in those populations. Methods We perform SMA diagnostic testing in a clinical multi-national patient cohort (N = 171) referred for hypotonia and/or muscle weakness. In addition, we carry out genetic newborn screening for SMA on 1502 healthy Emirati newborns to estimate the carrier frequency and incidence of the disease in the United Arab Emirates. Results Patients referred for SMA genetic testing are mostly Arabs (82%) representing 18 countries. The overall diagnostic yield is 33.9%, which is higher (>50%) for certain nationalities. Most patients (71%) has two SMN2 copies and earlier disease onset. For the first time, we estimate SMA carrier frequency (1.3%) and incidence of the disease (1 in 7122 live births) in the United Arab Emirates. Using birth and marriage rates in two Arab populations (United Arab Emirates and Saudi Arabia), as well as disease incidence in both countries, we show that, besides preventing new cases, premarital genetic screening could potentially result in around $8 to $324 million annual cost savings, respectively, relative to postnatal treatment. Conclusions The SMA carrier frequency and incidence we document suggests high potential benefit for universal implementation of premarital genomic screening for a wide range of recessive disorders in Arab populations.

Pulmonary arterial hypertension is a complex and heterogeneous condition, associated with a considerable diagnostic delay, diminished exercise capacity, and poor outcomes. In pulmonary arterial hypertension, biomarker research has become a subject of intense inquiry, and novel circulating biomarkers acknowledged in a multitude of mechanistic pathways are emerging. Beyond the widely used natriuretic peptides, novel biomarkers may provide deeper pathophysiological understanding, support clinical decision-making, and prompt the incorporation of precision medicine by enabling a more precise individual phenotyping. In this state-of-the-art review, the recent advances in circulating biomarkers in pulmonary arterial hypertension from a clinical perspective are discussed, with particular emphasis on the current state of knowledge, gaps in evidence, and future perspectives.

Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P

PurposeTo evaluate clinical outcomes and prognostic factors in non-metastatic oral cavity squamous cell carcinoma (OCSCC) patients who underwent surgery with or without adjuvant therapy.MethodsFrom 2007 and 2018, 116 patients were analyzed. The primary endpoint was overall survival (OS), and secondary endpoints were disease-free survival (DFS), local failure (LF), regional failure (RF), and distant metastases (DM). Kaplan-Meier method and log-rank test assessed survival outcomes, while Cox proportional hazard tests analyzed prognostic factors.ResultsMedian patient age was 53 years, most were smokers (93.5%) and males (62.9%). Predominant subsite was the oral tongue (58.6%). Treatment included surgery alone (16.4%), adjuvant radiotherapy (46.6%), or adjuvant concurrent chemoradiotherapy (CCRT) (37%). The median follow-up time was 45.9 months. There were significant differences between groups in terms of gender (P=0.028) and RT dose (P=0.01). The 3-year OS, DFS, LF, RF and DM for the entire cohort were 60.9%, 55.1%, 20.11%, 8.43%, and 17.13%, respectively. Surgery alone yielded higher 3-year OS (81.4%) than adjuvant RT (70%) or adjuvant CCRT (41.4%), (p=0.012). Adjuvant CCRT correlated with higher LF compared to adjuvant RT and surgery alone groups (p=0.029). Lymphovascular invasion (LVI) impacted OS (HR=2.034, p=0.0498) and DM (HR=3.380, p=0.0132), while higher tumor grade increased DM likelihood (HR=8.477, p=0.0379).ConclusionsThis study reports OCSCC patient outcomes in Jordan across different treatment modalities. Adjuvant CCRT correlated with higher LF rates, and LVI impacted OS and DM, aligning with existing OCSCC treatment literature.

Background: The presence of frailty or delirium among patients hospitalized for acute decompensated heart failure (ADHF) is associated with increased mortality and prolonged hospital stay. Objectives: The purpose of this study was to assess the combined effect of frailty and delirium on in-hospital mortality and disposition at discharge among older adults hospitalized with ADHF. Methods: We conducted a retrospective observational study using Nationwide Inpatient Sample data from the Agency for Healthcare Research and Quality from 2016 to 2018. Patients aged 65 years or older with a diagnosis of ADHF (both with preserved and reduced left ventricular ejection fraction) were included. For analysis, we conducted a multivariable logistic regression analysis to determine OR for in-hospital mortality or nonhome discharge from delirium and frailty. Results: A total of 3,577,433 weighted number of hospitalizations with ADHF were included. Delirium, moderate frailty risk, and high frailty risk increased the OR for in-hospital mortality (3.74; 95% CI: 3.70-3.78, 4.02; 95% CI: 3.96-4.09, and 8.63; 95% CI: 8.47-8.78, respectively) and nonhome discharge (4.21; 95% CI: 4.18-4.25, 2.95; 95% CI: 2.94-2.97, and 8.86; 95% CI: 8.78-8.94, respectively). When the combination of delirium and frailty was assessed, compared to those without delirium and with low frailty risk, the OR of mortality among those with delirium and high frailty risk was the highest at 12.18 (95% CI: 11.89-12.48). For nonhome discharge, the OR was the highest among those with delirium and high frailty risk at 14.01 (95% CI: 13.77-14.26). Conclusions: Frailty and delirium, independently and in combination, led to higher odds of in-hospital mortality and nonhome disposition at discharge among patients hospitalized with ADHF.

Topical corticosteroids (TCS) are the most widely prescribed and abused topical medications worldwide. TCs have melanogenic, anti-pruritic, atrophogenic, immunosuppressive effects on the epidermis and sex-hormone-like, in addition to anti-inflammatory activity. Several of these, if used without judgment, may have serious local and systemic negative repercussions. The current study was designed to evaluate the possible local and systemic effects of topical corticosteroid misuse among women in Basrah City and Amara city, Iraq. Totally 125 participants were categorized into three major groups: control individuals, patients who utilize TCs for 1–3 months, and patients with long-term TC use for more than 3 months. A questionnaire was filled out, and a full skin examination was performed by a special dermatologist. Blood was drawn for hematological, hormonal, and biochemical analysis. TCS abuse was linked to the development of skin conditions with various percentages and frequencies, such as erythema, photosensitivity, dryness, acne, atrophy, infections, pigmentation, hirsutism, and rosacea. TCs also have systemic adverse effects in addition to their cutaneous ones, especially with prolonged use. TCS prolongs bleeding time compared to control group. Long-term TCS suppresses ACTH and decreases cortisol concentrations significantly while having no effect on insulin or testosterone levels. Interestingly, TCS significantly reduced serum vitamin D and serum interleukin 6 compared to the normal control group. TCS misuse is a big disaster in Iraq, associated with huge skin impacts and systemic deterioration, including hormonal and hematological consequences that require medical intervention and educational and legal approaches for successful treatment.

IntroductionBreaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization’s (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals’ experiences in delivering bad news within the WHO’s Eastern Mediterranean Region.MethodsThis scoping review was conducted according to the Joanna Brigg Institute’s scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to “breaking bad news” and “health professionals” was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO’s Eastern Mediterranean Region.ResultsOut of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants.ConclusionThe scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO’s Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.

An attempt is made to use biochar (BC), a carbon rich low-cost green material, as a platform to house conducting polymer for fabricating stable graphite electrodes for application in next generation supercapacitor devices. Here, BC is first prepared from sucrose solution using a simple hydrothermal method. The seeded chemical oxidative copolymerization of aniline and pyrrole is then carried out at identical comonomer weight ratio using BC as seed particles. Two different BC to mixed monomer (w/w) ratios (1:0.7 and 1:1) have been used and the prepared composites are named as BC/P(Ani-Py)1:0.7 and BC/P(Ani-Py)1:1 respectively. Independent of composition, both BC seed and composite particles are spherical. The smooth homogeneous surface of BC turned heterogeneous after composite formation. The average size of BC seed particles is 2.56 µm and those of composites prepared at weight ratios of 1:0.7 and 1:1.0 are 2.72 and 2.90 µm respectively. Cyclic voltammetry (CV), galvanostatic charging discharging (GCD), and electrochemical impedance spectroscopy (EIS) are used to evaluate the electrochemical properties. Comparatively, the BC/P(Ani-Py)1:1 composite modified graphite electrode exhibited the highest capacitance value (274.27 F g−1 at a current density of 1.0 A/g) and is capable of acting as a supercapacitor electrode. A long-term cycling test of the BC/P(Ani-Py)1:1 modified electrode at a current density of 5.0 A/g displayed a capacitance retention of 96.6 % after 1000 cycles of charge and discharge, indicating a very good cycle stability.

Summary: This case report describes reversible hyperglycaemia in a severely ill six-month old Saudi boy treated with nifedipine for hypertension. Hyperglycaemia became manifest on the second day of treatment with nifedipine and was not dose-related. Following discontinuation of the drug, the patient rapidly became euglycaemic. It is concluded that the hyperglycaemia was induced by nifedipine. This side effect of nifedipine has been reported in adults but the present case would appear to be the first of a similar report in a child. We suggest that dehydration due to hyperglycaemia-induced osmotic diuresis can constitute a risk to small infants on nifedipine, hence it should be used with caution on outpatient basis.

Background: Appropriate initial education for type 1 diabetes mellitus (T1DM) is important to prevent late complications. However, type 1 children with diabetes do not appreciate traditional learning methods since they rarely contain the elements of fun and interactivity. In this study, we developed, implemented, and evaluated an edutainment tool for the initial education of type 1 children with diabetes. Materials and Methods: The Health Park pack is an edutainment tool that contains three games, two board games “The Health Park, Slides & Ladders” and one card game “Match-Up.” The games were designed to provide essential information about food, exercise, and insulin. A total of 46 children with T1DM evaluated the degree of entertainment, usability, and clinical usefulness of the games with the structured questionnaire. Results: More than 95% of T1DM children showed interest in the edutainment approach as the game was useful for initial education for T1DM. More than 90% agreed that they had fun playing the game, and 68% agreed to play the game again. The majority of them recommended the game to friends with diabetes and friends without diabetes. Conclusion: Using games could be an interesting edutainment tool for children with T1DM to motivate and educate them.

BACKGROUND: Literature on the frequency, response to treatment, and outcomes of acute ischemic stroke (AIS) due to intracranial atherostenosis (ICAS)-related intracranial large artery occlusion (ILAO) from Saudi Arabia is scarce. The aim of this study was to identify the percentage, describe the characteristics, and observe the treatment response in patients with AIS attributed to ICAS-related ILAO. MATERIALS AND METHODS: This cross-sectional study included all adult patients from 2017-2021 who fulfilled the inclusion criteria for the diagnosis of ICAS-related AIS. Patients were dichotomized based on ILAO. Mortality and functional outcomes (FOCs) based on 90 days’ dependence level were compared between the two groups. The association between ILAO and other variables was assessed using the Chi-squared test, odds ratios (OR), and 95% confidence interval (CI). RESULTS: ILAO was found in 38.7% of patients with ICAS-related AIS. Men comprised three-fourths of the cohort and were more frequent in the ILAO group. Smoking was associated with increased (P = 0.04) likelihood of ILAO. Patients with ILAO had more severe strokes (P ≤ 0.001) than patients without. Middle cerebral artery was the most common occluded vessel (52%). Functional dependence (P = 0.003, OR = 2.87, CI = 1.42–5.77), malignant transformation (P = 0.001, OR = 8.0, CI = 1.82–35.9), and mortality (P ≤ 0.001, OR = 7.67, CI = 2.40–24.5) were significantly higher among ILAO group. Patients with ILAO with unfavorable FOC were older than those who achieved better FOC (P ≤ 0.001). Thrombolysis (P = 0.02, OR = 2.50, CI = 1.15–5.41) and mechanical thrombectomy (MT) improved FOC in patients with ILAO (P = 0.04, OR = 2.33, CI = 1.10–4.92). CONCLUSION: ILAO is common in patients with ICAS-related AIS. Timely hyperacute stroke treatment can help improve the FOC of otherwise disabling stroke due to ILAO. Raising awareness of the community about stroke is needed, so that a higher number of patients can arrive at hospital within the golden hours. Further data from the region are required to recognize the efficacy of MT in ICAS-related ILAO.

Dermal cosmetic fillers are commonly used in camels in the last few years in Gulf countries. Therefore, this study aimed to describe the radiographic as well as sonographic findings of injected cosmetic fillers in Arabian camel perinasal region in beauty shows. Total number of (n = 11,626) Arabian camels (Camelus dromedarius) were thoroughly investigated for injection of cosmetic fillers in the perinasal area. The age of the camels was 6 months to 10 years, and their weights were 400 to 650 kg. In parallel, control group consists of 30 age/weight–matched non-injected camels were used. Of the 11,626 examined camels, 25 animals (0.0.002%) were injected with cosmetic fillers in the perinasal region. Of the 25 camels, 19 (76%) were females and 6 (24%) were males. Radiographic examinations were carried out for the 25 injected camel perinasal regions. Parallel, ultrasonographic examination of the injected perinasal regions revealed precise discrimination of the filler material, which was appeared hypo-echogenic in 17 camels (68%) and with anechoic spots in the remaining 8 camels (32%). Variable degrees of swelling caused by injection of moderate and large quantities of fillers were noted by radiographic assessment, the injected cosmetic filler was precisely diagnosed in perinasal region grey in color having soft tissue density in obtained radiographs. In conclusion, radiographic and ultrasonographic examinations are reliable, accurate, and non-invasive diagnostic imaging techniques can precisely discriminate a filler agent in the soft tissues and determine the situ and size of cutaneous deposits in dromedary camels (Camelus dromedarius). [Open Vet J 2024; 14(3.000): 840-845]

Background: The prevention of drug-induced cardiotoxicity is a complicated challenge facing healthcare providers during the last few decades. This challenge is raised from the unclear definition of the term “cardiotoxicity”, the overlapping of the symptoms of heart dysfunction due to the underlying diseases and the used drugs or using a combination of drugs which makes it difficult to distinguish between the side effects of each drug. Objective: This review discusses the most causative agents of cardiotoxicity, and their mechanisms to induce cardiac muscle damage, and finally focuses on the most applicable methods to deal with these dangerous heart problems. Methods: The search method involved electronic databases, including PubMed, Web of Science, Springer, Google Scholar, and others to resume relevant trials of heart disease published in the period between 2010-2023. Conclusion: Cardiotoxicity is a common substantial adverse effect of many drugs including anticancer drugs and others. The prevention methods may include medications, such as (Enalapril or carvedilol), supplementation with antioxidants, or cardioprotective natural products.

The study was carried out in Matiranga Upazila, Bandarban district, which is considered one of Bangladesh's major hill tract regions. The study aimed to identify present farming conditions, prospects, and problems and suitable solutions to the problems of fish farming. Different participatory rapid appraisal tools such as focus group discussion, field visits, and farmers' interviews were used to collect relevant fish farming information in the study area. The polyculture method was the most practised aquaculture method. Among the selected farms, eleven fish species were identified as culture species. The transportation cost for seeds purchased from remote areas was high (11% of total seed cost). The average transportation-related mortality of fish fry and fingerlings was 7.2% and 2.8%. Feed cost was found as the major cost (58.4%) in aquaculture. Costs and revenue for fish production per decimal varied from BDT 311 to 3528 and BDT 23 to 1268. Utilization of vacant lake, youth and women engagement, integrated aquaculture, the desire of people to engage in aquaculture, and available human resources were found as significant prospects. The major problems identified were lack of hatchery, high feed cost, lack of stakeholder linkage, lack of capital for fish farming, and lack of proper knowledge, guidelines, and consultancy for fish culture. A community-based aquaculture model was proposed to overcome the present challenges and problems in the study area. The model may help to expand aquaculture and thus improve the livelihood and socio-economic status of the people of the hilly areas of Bangladesh.

In this paper, we consider a third-order explicit scheme based on Taylor's formula to obtain an approximate solution for the Cauchy problem of systems of ODEs. We prove an estimate for the accuracy of the approximate solution with an explicit constant that depends only on the right-hand side of the equation and the domain of the solution.

Climate change hazards continue to pose detrimental impacts on coastal cities in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, UAE, Qatar, Bahrain, Kuwait, and Oman) of the Middle East, which undermines their climate resilience. The situation is exacerbated by the rapid urban development in coastal cities in the GCC countries over the past 20 years. This review study examined the climate change hazards that are having negative impacts on the resilience of coastal cities in the GCC countries using a systematic literature review approach. It also explores the urban resilience strategies implemented towards climate change hazards mitigation and adaptation in order to build climate-resilient coastal cities in the GCC countries. A total of 48 peer-reviewed articles were included in the systematic review derived from Scopus, WoS, and Google Scholar, covering the nine coastal cities in the six GCC countries. Most of the studies were focused on the coastal cities of Jeddah (30 %) in Saudi Arabia and Doha (24 %) in Qatar, compared to the other seven coastal cities in the GCC countries. Flooding, rising temperature, sea level rise, dust storms, cyclones, and migration of sand dunes were the six most reported climate change hazards, respectively, posing significant negative impacts on coastal cities and undermining their resilience to current and future climate change impacts. The various urban resilience strategies implemented against climate change hazards were categorised under five resilience dimensions: infrastructure resilience, social resilience, environmental resilience, economic resilience, and governance and policy resilience dimensions. The infrastructure resilience dimension was reported in 50.7 % of the studies, since it is the most implemented, while far less research attention was given to the environmental (14.5 %), government and policy (8.7 %), and economic (2.9 %) resilience dimensions of coastal cities in the GCC countries. The urban resilience strategies for climate mitigation and adaptation were reported to have successfully reduced the vulnerability of coastal cities to climate change hazards over the past decade, by improving their climate resilience. The findings contribute to informing urban planning policy-making focused on coastal environmental management in the coastal cities of the GCC countries that should further enhance the climate resilience of these coastal cities.

This study evaluates topologically optimized lattice structures for high strain rate loading, crucial for impact resistance. Using the BESO (Bidirectional Evolution Structural Optimisation) topology optimisation algorithm, CompIED and ShRIED topologies are developed for enhanced energy absorption and impact resistance. Micromechanical simulations reveal CompIED surpasses theoretical elasticity limits for isotropic cellular materials, while the hybrid design ShRComp achieves theoretical maximum across all relative densities. Compared to TPMS, truss, and plate lattices, the proposed structures exhibit higher uniaxial modulus. Manufactured via fused deposition modeling with ABS thermoplastic, their energy absorption capabilities are assessed through compression tests and impact simulations. The ShRComp lattice demonstrates superior energy absorption under compression compared to CompIED. Impact analyses of CompIED and ShRComp sandwich structures at varying velocities show exceptional resistance to perforation and higher impact absorption efficiency, outperforming other classes of sandwich structures at similar densities. These findings position these new and novel topologies as promising candidates for impact absorption applications.

ABSTRACTThis study investigates the mechanical behavior of a novel set of Cuboidal Spherical Plate Lattice (CSPL) materials. The procedure of constrained-domain topology optimization is implemented with the aim of enhancing stiffness. The micromechanical finite element homogenization approach is used to evaluate the effective elastic-plastic properties of the CSPLs and their topologically optimized counterparts, TOCSPLs (Topologically Optimized Cuboidal Spherical Plate Lattices). The TOCSPLs demonstrate higher uniaxial, shear, and bulk moduli compared to the CSPLs, with an increase of 31%, 14%, and 36% respectively. Moreover, there is an increase in the yield strengths under uniaxial, shear, and hydrostatic loading conditions, with enhancements of 103%, 55%, and 62%, respectively. The topologies are additively manufactured through Fused Deposition Modeling (FDM) out of ABS thermoplastic material. The quasi-static compression experiments demonstrate the superiority of TOCSPL 111+100 over the other topologies in terms of uniaxial modulus. The suffix 111+100 denotes the crystallographic planar orientations in which the solid plate-like disks were formed within a cubic system. The topologies proposed herein outperform certain types of Triply Periodic Minimal Surface, honeycomb, truss-, and plate-based lattice materials. The proposed topologies offer a compelling justification for their utilization in applications that require load-bearing and impact absorption capabilities.

Abstract There are already a number of autonomous robots that play a significant role in improving the quality of healthcare in different areas ranging from basic health diagnosis to complex surgeries. However, using robots and machine learning applications in the healthcare context poses concerns over liability for patient injury. This paper will thus attempt to investigate the potential legal problems that might arise if AI technology evolves or is commonly used in clinical practice. It also examines whether the traditional doctrines of liability can adequately address the liability for the injuries stemming from acts of autonomous robots. As such, this paper adopted both descriptive and analytical methodologies to explore the main focus of the study. while the descriptive methodology was used to spot light on various theories of liability, the analytical methodology was used to critically examine the main theories that have been advanced to deal with autonomous robots and predict the necessity of legal reform. Throughout this paper, the authors insist on the importance of distinguishing between robots in light of their degree of autonomy and then drafting liability rules depending on whether the action was done autonomously by an unattended robot or whether it was done automatically by an attended robot. Finally, the paper concludes with the proposal of a series of factors to be considered for the future regulation of AI Robots in the healthcare context.

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.

IntroductionObstructive sleep apnea (OSA) can have negative impacts on the health outcomes of individuals with type 2 diabetes. However, in the United Arab Emirates (UAE), there is a lack of understanding regarding the relationship between OSA and type 2 diabetes despite the significant implications it has on health. The primary objective of this study is to investigate the association between OSA risk and type 2 diabetes, associated risk factors, and gender differences in OSA symptoms among Emirati adults.MethodsWe conducted a cross-sectional analysis of the baseline data from the UAE Healthy Future Study (UAEHFS) collected between February 2016 and March 2023. Our sample consisted of 4578 participants aged 18-71 who completed the STOP-BANG survey, provided body measurements and blood samples. We stratified the patients according to their OSA risk and diabetes. We used univariate and multivariate logistic regression models to analyze the relationship between OSA risk and type 2 diabetes and to identify factors associated with risk for OSA and type 2 diabetes. We estimated odds ratios (ORs) with corresponding 95% confidence intervals (95% CI).ResultsThe mean age was 27.5 years (± 8.35), and 55.81% (n=2555) were men. The overall prevalence of high risk for OSA was 16.58% and was higher in men compared to women (26.46% vs 4.10%). Women reported feeling tired more often than men (68.02% vs 48.96%). Both genders have similar rates of stop breathing and BMI ≥ 35. There was a significant association between the OSA risk and type 2 diabetes in the unadjusted model (OR=2.44; 95% CI: 1.78-3.35; p-value

The utilization of agricultural machinery was fully mechanized for wheat production in Iraq. This study essentially aimed to inspect inputs – outputs energy for wheat production in Salah Al-Deen, Iraq. The data were obtained from 45 wheat farms by using face to face questionnaire method in 2022. The findings from this study were determined in five basic operations (i.e. tillage, sowing, fertilizing. spraying, and harvesting). Direct energy sources (fuel and human) accounted for about 51.39% of the total energy used in cultivation. Energy exemplified in fuel recorded the highest rate of the total expenditure of energy, with 51.09 % (6091.01MJ/ha). Farmers utilized nearly 879.11±39.77 MJ/ha of machinery energy, the highest rate of expenditure of machinery energy was in harvesting, which recorded 38.38 % (337.42 ± 23.89 MJ/ha) of the total energy of machinery used in the study. Results of analyzing the energy of fuel that farmers utilized indicated that operations of tillage were about 25.98 % (1582.29 ± 39.43 MJ/ha) of the total energy of fuel. This rate denoted the highest operation of fuel consumption. Harvesting operations followed it. These operations were implemented through the use of engines powered with diesel were about 23.43% (1427.05 ± 35.68 MJ/ha). The average energy input/output ratio was 4.40 for the wheat crop; while energy intensity was 1.79 MJ/kg for the wheat crop.

Key Clinical Message In pediatrics, a leukemoid reaction in severe DKA cases with cerebral edema has never been reported. The fluid management was challenging as it required balancing rates to ensure improvement of the condition while preventing neurological sequelae. Abstract The combination of diabetic ketoacidosis (DKA), cerebral edema, and leukemoid reaction in pediatrics has never been reported before in the literature. It may lead to significant morbidity and high mortality. Here, we report a case of DKA‐induced cerebral edema associated with severe leukocytosis (WBC 98 × 109/L), which had many challenges in fluid therapy.

Introduction A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tubularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient’s parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.

PURPOSEGermline genetic testing (GGT) significantly affects cancer care. While universal testing has been studied in Western societies, less is known about adoption elsewhere.MATERIALS AND METHODSIn this study, 3,319 unselected, pan-cancer Jordanian patients diagnosed between April 2021 and September 2022 received GGT. Pathogenic germline variant (PGV) frequency among patients who were in-criteria (IC) or out-of-criteria (OOC; 2020 National Comprehensive Cancer Network criteria) and changes in clinical management in response to GGT results were evaluated. Statistical analysis was performed using two-tailed Fisher's exact test with significance level P < .05.RESULTSThe cohort was predominantly female (69.9%), with a mean age of 53.7 years at testing, and 53.1% were IC. While patients who were IC were more likely than patients who were OOC to have a PGV (15.8% v 9.6%; P < .0001), 149 (34.8%) patients with PGVs were OOC. Clinical management recommendations in response to GGT, including changes to treatment and/or follow-up, were made for 57.3% (161 of 281) of patients with high- or moderate-risk PGVs, including 26.1% (42 of 161) of patients who were OOC.CONCLUSIONUniversal GGT of patients with newly diagnosed cancer was successfully implemented in Jordan and led to identification of actionable PGVs that would have been missed with guidelines-based testing.

Zero-emission energy sources like nuclear energy are taken into account worldwide due to the negative environmental consequences of fossil fuels and their limited availability over the years. Bangladesh plans to add nuclear energy to its portfolio of energy sources by 2024. Under the scope of this study, the country's nuclear energy strategy was looked at in terms of its strengths, weaknesses, opportunities, and threats. This was done using a method known as SWOT analysis. It has come to light that Bangladesh has a significant number of aspects in terms of strengths as well as opportunities that make the possibility of doing an investment in the construction of a nuclear power plant a realistic choice. Difficulties such as a culture of poor maintenance, financial burden, lack of skilled manpower, a poor power grid, radioactive waste management, and corruption are the weaknesses and threats to the effective construction, operation, and maintenance activities of the nuclear power plant in Bangladesh. By mitigating these difficult aspects, Bangladesh's journey to adopt nuclear energy can be more smooth.

Artificial Intelligence (AI) allows computers to self-develop decision-making algorithms through huge data analysis. In medical investigations, using computers to automatically diagnose diseases is a promising area of research that could change healthcare strategies worldwide. However, it can be challenging to reproduce or/and compare various approaches due to the often-limited datasets comprising medical images. Since there is no open access dataset for the Gallbladder (GB) organ, we introduce, in this study, a large dataset that includes 10,692 GB Ultrasound Images (UI) acquired at high resolution from 1,782 individuals. These UI include many disease types related to the GB, and they are organized around nine important anatomical landmarks. The data in this collection can be used to train machine learning (ML) and deep learning (DL) models for computer-aided detection of GB diseases. It can also help academics conduct comparative studies and test out novel techniques for analyzing UI to explore the medical domain of GB diseases. The objective is then to help move medical imaging forward so that patients get better treatment.

Abstract Global warming can profoundly influence the mean climate over the Arabian Peninsula, which may significantly influence both natural and human systems. The present study aims to investigate the changes in the precipitation regime in response to climate change over the Arabian Peninsula, with special emphasis on the United Arab Emirates (UAE). This work is performed using a sub-set of high-resolution NASA Earth Exchange Global Daily Downscaled Projections (NEX-GDDP) data derived from Coupled Model Intercomparison Project Phase 6 (CMIP6) Global Climate Models under three different Shared Socioeconomic Pathway (SSP) scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5). The changes are analyzed in three phases such as 2021–2050 (near future), 2051–2080 (mid future) and 2080–2100 (far future), with the period of 1985–2014 as the baseline. This study represents the first attempt to utilize data from NEX-GDDP models to project the regional patterns of precipitation regime across the Arabian Peninsula. Results suggest that the annual precipitation is expected to increase over most of the UAE by up to 30%, particularly intense from the mid-future onwards in all scenarios. Specifically, the spatiotemporal distribution of precipitation extremes such as intensity, 1-day highest precipitation, and precipitation exceeding 10 mm days are increasing; in contrast, the consecutive dry days may decrease towards the end of the century. The results show that the changes in extreme precipitation under a warming scenario relative to the historical period indicate progressive wetting across UAE, accompanied by increased heavy precipitation events and reduced dry spell events, particularly under the high emission scenarios. A high-resolution dataset is essential for a better understanding of changes in precipitation patterns, especially in regions where more detailed information is needed on a local scale to achieve water, food security, and environmental sustainability to formulate effective adaptation strategies for mitigating the potential risks and consequences associated with variations in wet and dry conditions.

Objective: Variable-view rigid scopes offer advantages compared to traditional angled laparoscopes for examining a diagnostic site. However, altering the scope’s view requires a high level of dexterity and understanding of spatial orientation. This requires an intuitive mechanism to allow an operator to easily understand the anatomical surroundings and smoothly adjust the scope’s focus during diagnosis. To address this challenge, the objective of this work is to develop a mechanized arm that assists in visualization using variable-view rigid scopes during diagnostic procedures.Methods: A system with a mechanized arm to maneuver a variable-view rigid scope (EndoCAMeleon - Karl Storz) was developed. A user study was conducted to assess the ability of the proposed mechanized arm for diagnosis in a preclinical navigation task and a simulated cystoscopy procedure.Results: The mechanized arm performed significantly better than direct maneuvering of the rigid scope. In the preclinical navigation task, it reduced the percentage of time the scope’s focus shifted outside a predefined track. Similarly, for simulated cystoscopy procedure, it reduced the duration and the perceived workload.Conclusion: The proposed mechanized arm enhances the operator’s ability to accurately maneuver a variable-view rigid scope and reduces the effort in performing diagnostic procedures.Clinical and Translational Impact Statement: The preclinical research introduces a mechanized arm to intuitively maneuver a variable-view rigid scope during diagnostic procedures, while minimizing the mental and physical workload to the operator.

Abstract Event-based cameras are commonly leveraged to mitigate issues such as motion blur, low dynamic range, and limited time sampling, which plague conventional cameras. However, a lack of dedicated event-based datasets for benchmarking segmentation algorithms, especially those offering critical depth information for occluded scenes, has been observed. In response, this paper introduces a novel Event-based Segmentation Dataset (ESD), a high-quality event 3D spatial-temporal dataset designed for indoor object segmentation within cluttered environments. ESD encompasses 145 sequences featuring 14,166 manually annotated RGB frames, along with a substantial event count of 21.88 million and 20.80 million events from two stereo-configured event-based cameras. Notably, this densely annotated 3D spatial-temporal event-based segmentation benchmark for tabletop objects represents a pioneering initiative, providing event-wise depth, and annotated instance labels, in addition to corresponding RGBD frames. By releasing ESD, our aim is to offer the research community a challenging segmentation benchmark of exceptional quality.

Purpose – The purpose of this study is to predict family takāful purchase intentions (FTPIs) using an extended theory of planned behavior (TPB) with relevant mediating and moderating factors. Design/methodology/approach – This study is based on a survey of 384 Muslim employees who work in both government and private organizations. This study used partial least square structural equation model (PLS-SEM) for hypothesis testing, predictive relevance and measuring the effect size of the model. Findings – The study found that attitude (ATT), subjective norms (SN), perceived behavioral control (PBC), saving motives (SM), promotional campaign (PC) and religiosity (RG) directly contribute to the prediction of FTPIs. Furthermore, ATT and SM partially mediate between PC and FTPI. Moreover, RG significantly moderates the association between ATT, SN, SM and FTPI, while RG insignificantly moderates the link between PBC and FTPI. Practical implications – This study provides insight into understanding the factors leading to an enhanced understanding of FTPI in a country where the industry is growing very fast. Further, the study suggests informative and persuasive promotions to encourage FTPI in Bangladesh and similar countries. Originality/value – This study provides insights into previously unaddressed FTPI among Muslim employees in Bangladesh and similar countries. Prior work on determining FTPI has not focused on promotional campaigns and saving motives, and thus, this study has extended TPB to understand the phenomenon.

Abstract Aims Patients with heart failure (HF) exhibit poor prognosis, which is further deteriorated by pulmonary hypertension (PH), with negative impact on morbidity and mortality. As PH due to left HF (LHF‐PH) is among the most common causes of PH, there is an urge according to the 2021 European Society of Cardiology HF guidelines to find new biomarkers that aid in prognostication of this patient cohort. Given the role of tumour necrosis factor‐alpha (TNF‐α) in HF progression, we aimed to investigate the prognostic value of plasma proteins related to TNF‐α in patients with LHF‐PH, in relation to haemodynamic changes following heart transplantation (HT). Methods and results Twenty TNF‐α‐related plasma proteins were analysed using proximity extension assay in healthy controls (n = 20) and patients with LHF‐PH (n = 67), before and 1 year after HT (n = 19). Plasma levels were compared between the groups, and the prognostic values were determined using Kaplan–Meier and Cox regression analyses. Plasma levels of lymphotoxin‐beta receptor (LTBR), TNF receptor superfamily member 6B (TNFRSF6B), and TNF‐related apoptosis‐inducing ligand receptors 1 and 2 (TRAIL‐R1 and TRAIL‐R2, respectively) were higher in LHF‐PH pre‐HT vs. controls (P

Groundwater depletion in Bangladesh’s Barind tract poses significant challenges for sustainable water management. This study aims to delineate groundwater recharge potential zones in this region using an integrated geospatial and Analytical Hierarchy Process (AHP) approach. The methodology combines remote-sensing data with GIS analysis, considering seven factors influencing groundwater recharge: rainfall, soil type, geology, slope, lineament density, land use/land cover, and drainage density. The AHP method was employed to assess the variability of groundwater recharge potential within the 7586 km2 study area. Thematic maps of relevant factors were processed using ArcGIS software. Results indicate that 9.23% (700.22 km2), 47.68% (3617.13 km2), 37.12% (2816.13 km2), and 5.97% (452.70 km2) of the study area exhibit poor, moderate, good, and very good recharge potential, respectively. The annual recharge volume is estimated at 2554 × 106 m3/year, constituting 22.7% of the total precipitation volume (11,227 × 106 m3/year). Analysis of individual factors revealed that geology has the highest influence (33.57%) on recharge potential, followed by land use/land cover (17.74%), soil type (17.25%), and rainfall (12.25%). The consistency ratio of the pairwise comparison matrix was 0.0904, indicating acceptable reliability of the AHP results. The spatial distribution of recharge zones shows a concentration of poor recharge potential in areas with low rainfall (1200–1400 mm/year) and high slope (6–40%). Conversely, very good recharge potential is associated with high rainfall zones (1800–2200 mm/year) and areas with favorable geology (sedimentary deposits). This study provides a quantitative framework for assessing groundwater recharge potential in the Barind tract. The resulting maps and data offer valuable insights for policymakers and water resource managers to develop targeted groundwater management strategies. These findings have significant implications for sustainable water resource management in the region, particularly in addressing challenges related to agricultural water demand and climate change adaptation.

Background/Objectives: Coronary artery bypass graft (CABG) is associated with inflammation and complications, potentially leading to prolonged ICU and hospital stays. Omega-3 PUFA has anti-inflammatory properties, thought to potentially reduce complications in CABG patients. This study aims to systematically review and meta-analyze the impact of perioperative omega-3 PUFA supplementation on total ICU and total hospital stays in CABG patients; Methods: Randomized controlled trials examining the effects of omega-3 PUFA supplementation (IV/oral) on ICU and hospital stays in CABG patients were included. Studies were searched for in PubMed, EMBASE, PsychINFO, CINAHL, and the Cochrane Central Register of Controlled Trial databases, along with hand searching of reference lists. The quality and risk of bias of the included studies were evaluated by two independent reviewers using the revised Cochrane risk-of-bias tool. Meta-analysis was performed using fixed or random effects models according to the level of heterogeneity by mean difference with their 95% confidence intervals; Results: Twelve studies were included in the qualitative analysis and seven in the meta-analysis. Omega-3 PUFA was associated with a significant reduction in days of hospital stay (−0.58 (95% CI −1.13, −0.04)). Subgroup analysis showed that only oral omega-3 PUFA supplementation resulted in a statistically significant reduction in length of hospitalization after subgroup analysis with MD −0.6 (95% CI −1.17, −0.04); Conclusions: This study suggests that perioperative omega-3 PUFA supplementation may reduce the length of hospitalization in CABG patients, especially when administered orally. However, the findings should be interpreted cautiously due to the high level of heterogeneity.

Background: Female sterilization remains a prevalent contraceptive method globally, despite a declining trend in prevalence over the past decades. Methods: To compare the outcomes of tubal ligation between laparoscopic and open surgical approaches, conducted at the Jordan University Hospital from 2010 to 2021. Results: 242 females underwent tubal ligation with 131 had open surgery and 111 had laparoscopic surgery. The median follow-up period for the cohort was 8 years. For the entire study cohort, the mean age at the time of surgery was 37.77 years (standard deviation (SD) = 4.589). A statistically significant (p < 0.0001) difference in age was found, with mean age being older in the laparoscopy group. However, there were no significant differences between the two groups in terms of gravidity (p = 0.9499) or parity (p = 0.4867). Remarkably, only two pregnancies were documented during the follow-up period, both of which were observed in the laparoscopic surgery group. Overall free-from-pregnancy rate at 8 years was 98.79%; 97.59% in the laparoscopy group and 100% in the open surgery group. Conclusions: Both open and laparoscopic tubal sterilization are equally effective permanent contraceptives. While our study contributes to the understanding of tubal ligation outcomes, further research, particularly in developing countries like Jordan, is warranted to address the unique needs and challenges of diverse populations in reproductive healthcare.

Background: A direct link between the tryptophan (Trp) metabolite kynurenine (Kyn) and the aryl hydrocarbon receptor (AhR) is not supported by metabolic considerations and by studies demonstrating the failure of Kyn concentrations of up to 100 μM to activate the receptor in cell culture systems using the proxy system of cytochrome P-450-dependent metabolism. The Kyn metabolite kynurenic acid (KA) activates the AhR and may mediate the Kyn link. Recent studies demonstrated down regulation and antagonism of activation of the AhR by Trp. We have addressed the link between Kyn and the AhR by looking at their direct molecular interaction in silico. Methods: Molecular docking of Kyn, KA, Trp and a range of Trp metabolites to the crystal structure of the human AhR was performed under appropriate docking conditions. Results: Trp and 30 of its metabolites docked to the AhR to various degrees, whereas Kyn and 3-hydroxykynurenine did not. The strongest docking was observed with the Trp metabolite and photooxidation product 6-Formylindolo[3,2-b]carbazole (FICZ), cinnabarinic acid, 5-hydroxytryptophan, N-acetyl serotonin and indol-3-yllactic acid. Strong docking was also observed with other 5-hydroxyindoles. Conclusions: We propose that the Kyn-AhR link is mediated by KA. The strong docking of Trp and its recently reported down regulation of the receptor suggest that Trp is an AhR antagonist and may thus play important roles in body homeostasis beyond known properties or simply being the precursor of biologically active metabolites. Differences in AhR activation reported in the literature are discussed.

Digital transformation (DT) is revolutionizing building facility management (FM) by streamlining operations, maximizing resources, and increasing performance. FM firms prioritize DT to stay competitive as speed and efficiency become more crucial in the corporate context. Traditional FM methods like manual record-keeping and reactive maintenance cannot meet recent corporate needs. Modern technologies such as IoT, AI, digital twins, and data analytics enable real-time building asset monitoring and optimization. This paper evaluates the digital transformation readiness level index of building facility management (DTRLIBFM), which includes critical success factors for DT development, using structural equation modeling (SEM). DTRLIBFM model determines the importance of key factors that contribute to the success of digital transformation initiatives, specifically focusing on the DT readiness level index of building facility management. Expert interviews and an intensive literature review were employed to identify the critical success factors for the DTRLIFMB. The Delphi technique was employed to validate these factors with 13 highly experienced professionals, and they were subsequently appraised for significance through an online questionnaire that was circulated to industry experts. To quantitatively evaluate the interconnectedness of different elements of DTRLIFMB and establish the impact of each construct on the overall digital transformation, data from 220 participants from around the world were analyzed using (SEM). The evaluation included reliability, validity, hypothesis testing, multivariate normality, and goodness-of-fit indexes. The DTRLIBFM model, with 20 indicators in three constructs, explains how DT readiness affects a building’s digitalization importance level. The research provides governments, organizations, contractors, consultants, suppliers, subcontractors, and facility managers with a current DT index and DT roadmap for building facility management.

Flood events are the most sophisticated and damaging natural hazard compared to other natural catastrophes. Every year, this hazard causes human-financial losses and damage to croplands in different locations worldwide. This research employs a combination of artificial neural networks and geographic information systems (GIS) to simulate flood-vulnerable locations in the Samangan Province of Afghanistan. First, flood-influencing factors, such as soil, slope layer, elevation, flow direction, and land use/cover, were evaluated as influential factors in simulating flood-prone areas. These factors were imported into GIS software. The Fishnet command was used to partition the information layers. Furthermore, each layer was converted into points, and this data was fed into the perceptron neural network along with the educational data obtained from Google Earth. In the perceptron neural network, the input layers have five neurons and 16 nodes, and the outputs showed that elevation had the lowest possible weight (R2 = 0.713) and flow direction had the highest weight (R2 = 0.913). This study demonstrated that combining GIS and artificial neural networks results in acceptable performance for simulating and modeling flood susceptible areas in different geographical locations and significantly helps prevent or reduce flood hazards.

More than 1 million transcatheter-based cardiovascular procedures across the spectrum of interventional cardiology are performed annually in the United States. With the expanded indications for and increased complexities associated with these procedures, interventional cardiologists are expected to possess the requisite expertise to complete these interventions safely and effectively. While the art of vascular access and closure remains a prerequisite and critical skillset in contemporary practice, there remain significant variations in the techniques employed, resulting in the bleeding and vascular complications encountered in clinical practice. With an increasing recognition of the potential merits to standardized approaches to vascular access and closure, cardiovascular societies have put forth recommendations around best practices for performing these procedures in the cardiac catheterization laboratories. In this review, we aim to: (1) Examine the evolving definitions of bleeding and vascular complications; (2) Review best practices for transradial and transfemoral access and closure, including for large bore procedures; and (3) Highlight knowledge gaps and proposed areas of clinical research pertaining to vascular access which may inform clinical practice and potentially optimize the outcomes of patients undergoing transcatheter-based cardiac and vascular interventions.