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BackgroundInfection prevention (IP) measures are designed to mitigate the transmission of pathogens in healthcare. Using large-scale viral genomic and social network analyses, we determined if IP measures used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were adequate in protecting healthcare workers (HCWs) and patients from acquiring SARS-CoV-2.MethodsWe performed retrospective cross-sectional analyses of viral genomics from all available SARS-CoV-2 viral samples collected at UC San Diego Health and social network analysis using the electronic medical record to derive temporospatial overlap of infections among related viromes and supplemented with contact tracing data. The outcome measure was any instance of healthcare transmission, defined as cases with closely related viral genomes and epidemiological connection within the healthcare setting during the infection window. Between November 2020 through January 2022, 12 933 viral genomes were obtained from 35 666 patients and HCWs.ResultsAmong 5112 SARS-CoV-2 viral samples sequenced from the second and third waves of SARS-CoV-2 (pre-Omicron), 291 pairs were derived from persons with a plausible healthcare overlap. Of these, 34 pairs (12%) were phylogenetically linked: 19 attributable to household and 14 to healthcare transmission. During the Omicron wave, 2106 contact pairs among 7821 sequences resulted in 120 (6%) related pairs among 32 clusters, of which 10 were consistent with healthcare transmission. Transmission was more likely to occur in shared spaces in the older hospital compared with the newer hospital (2.54 vs 0.63 transmission events per 1000 admissions, P < .001).ConclusionsIP strategies were effective at identifying and preventing healthcare SARS-CoV-2 transmission.

Willingness to communicate in a second language (L2-WTC) is a crucial factor influencing the success of language learning, particularly in the context of Arabic learning. This article presented the extent to which Arabic language learners' willingness to communicate (WTC) in a second language impacts their achievement in acquiring language skills. A quantitative approach was used and the study surveyed 33 undergraduate Arabic learners at UIN Bandung in 2023. Data were collected through questionnaires measuring WTC levels and the factors influencing them, such as motivation, speaking anxiety, and opportunities for language practice. Statistical analysis was conducted to identify the relationship between WTC and the Arabic language proficiency learners. The results indicated that a high level of WTC is positively associated with better communicative competence. Additionally, learning motivation and environmental support significantly contribute to enhancing students' WTC. On the other hand, speaking anxiety and limited practice opportunities were identified as barriers to achieving optimal WTC. This article recommends that Arabic language instructors focus on teaching strategies that can enhance WTC, such as creating supportive environments and reducing speaking anxiety. Further research is suggested to explore the role of technology in supporting WTC and to investigate other individual factors such as cultural and social backgrounds.

Abstract Trial design Parallel. Objectives To assess the effect of mini-screw assisted rapid palatal expansion (MARPE) with/without micro-osteoperforation (MOP) on the airway and pain intensity in non-growing patients with maxillary transverse deficiency. Method Two equal groups of twenty-four individuals aged ≥ 19 years old with maxillary transverse deficit were randomly assigned. MOP-facilitated MARPE was used to treat one group (MMG), and the other group was treated with MARPE without MOP (NMG). For airway evaluation, CBCT images were obtained 2 months before starting the palatal expansion and 3 months after finishing the expansion in 28 days. The Visual Analogue Scale (VAS) was used to measure the pain level. Results Significant suture opening was observed in both groups. All linear measurements of the nasal cavity and volumetric measurements of the nasal passage and oropharyngeal airway increased significantly in both groups, with no significant difference between them. Moderate pain was experienced in the first two weeks of expansion in MMG (5.11 ± 0.30), while more significant pain was recorded in NMG (6.87 ± 0.40). Pain decreased significantly in the following two weeks in MMG (2.77 ± 0.39) and in NMG (5.11 ± 0.32), with a significant difference between the two groups throughout the entire duration of expansion. Conclusion Transverse maxillary deficit was successfully treated with both expansion methods, with and without MOP, with comparable skeletal effects at the nasal levels and airway volumetric improvement. So, MOP did not provide any further advantage in improving the airway volume after maxillary expansion. However, it significantly reduced pain intensity throughout the entire duration of expansion. Trial registration The protocol registration and results system (PRS) of ClinicalTrials.gov has this RCT registered under the number NCT06502041 on 13/07/2024.

IntroductionAttention Deficit Hyperactivity Disorder (ADHD), a prevalent neurodevelopmental disorder affecting a significant portion of the population, is commonly managed with stimulant medications. These medications, while effective, have been associated with thermoregulatory dysfunction and an increased risk of heat-related adverse events. The current study sought to compare the incidence of such events in ADHD patients receiving stimulant medications with those not on these treatments.MethodsA retrospective cohort study was conducted utilizing de-identified electronic medical records from a Global Research Network. The study population comprised ADHD patients on stimulant medication aged 6-24 years, with a comparison group of ADHD patients not receiving stimulant medications. Patients were followed from the date of first cohort inclusion (index event) for one year to track heat-related illnesses, including dehydration, hyperthermia, heat stroke, and other heat-related conditions. Propensity score matching was employed to balance baseline characteristics (age, gender) between cohorts. Risk ratios, odds ratios, and hazard ratios were calculated to assess the incidence of heat-related illnesses between groups. Statistical analysis was performed on the TriNetX platform, with survival analysis conducted via Kaplan-Meier estimates.ResultsAnalysis revealed a decreased risk of heat-related illnesses in the stimulant medication group, with a risk ratio of 0.559(95% CI: 0.485, 0.644). The mean number of events was also lower in the stimulants medication group (p=0.028). Additionally, Kaplan-Meier survival analysis indicated a higher probability of remaining free from heat-related illnesses in the stimulant group over a one-year period, with a statistically significant difference (log-rank test, χ² = 93.035, p < 0.0001).DiscussionThese results suggest that stimulant medications may be associated with a reduced risk of heat-related illnesses in ADHD patients, potentially contributing to better overall outcomes in this population. Further research is warranted to explore the underlying mechanisms and to confirm these findings across larger and more varied patient populations.

This study explores the drivers and barriers of the Circular Economy (CE) in Tunis Village, a rural tourism destination, as a case study of emerging economics. We adopted an exploratory case study methodology. Telephone interviews (n = 10) with stakeholders were conducted, and a survey of employees (n = 123) was distributed. Qualitative data were thematically analyzed, and quantitative data were descriptively presented. The results show that improving relationships with the local community, gaining financial benefits, and improving relationships with suppliers were the top perceived drivers. The top perceived barriers are poor economic development, which makes the implementation of large-scale sustainability difficult; a lack of technology and advanced technologies; and the absence of effective and integrated waste management and recycling systems. Considering the exploratory nature and design of this study, the results cannot be generalized. However, the results can help plan future research on a larger scale in developing economies. Furthermore, the findings can inform policymakers on how to better apply CE practices in rural tourism destinations. The topic of CE has been under-researched in connection with developed countries, and this study is the first to examine CE in rural tourism destinations in emerging countries. This underlines the specific drivers and barriers related to CE as a sustainable development practice. Additionally, it contributes to the academic debate on this notion.

BackgroundAnorexia nervosa (AN) can significantly affect cognitive well-being. Cognitive remediation therapy (CRT) is regarded as one of the effective treatments for cognitive impairment in some mental illnesses such as schizophrenia, bipolar disorder, and attention deficit. For this reason, this systematic review and meta-analysis aim to assess the effectiveness of CRT in patients with AN.MethodsWe conducted a search of Medline, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews from the inception of each database through April 8, 2023. Randomized clinical trials evaluating the effectiveness of CRT in comparison to placebo or other psychological treatments in patients with AN were included. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool. For meta-analysis, effect sizes were measured using mean difference (MD) utilizing the random-effects model and inverse variance (IV) technique. To evaluate the certainty of the evidence, we applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. The study was registered in PROSPERO, ID: CRD42023411784.ResultsIn the systematic review, six studies were included, of which four underwent meta-analysis. Among these, three trials encompassing 413 participants showed that CRT was associated with improved cognitive flexibility compared to control at the end of treatment (MD = -0.21, 95% CI [-0.44, 0.02], P=0.81, I2 = 0%). In two trials with 143 patients, those who received CRT showed similar effects on the severity of AN symptoms compared to the control group in the self-reporting questionnaires: EDE-Q (MD = -0.25, 95% CI [-0.76, 0.27], P=0.77, I2 = 0%) and EDEQOL (MD = -0.19, 95% CI [-0.41, 0.03], P=0.84, I2 = 0%).ConclusionCRT did not show a statistically significant difference compared to the control group in improving abstract thinking skills and quality of life in individuals with AN. That indicates that CRT’s efficacy remains inconclusive. Further research with larger, more diverse samples is needed to determine its long-term effects and potential benefits.Systematic review registrationPROSPERO, identifier CRD42023411784.

Geometrical forming basics for designing residential Islamic interior spaces are deemed one of the most important environmental functional parameters that is a field of study in many kinds of research, the environmental functional parameters help us to solve existing problems to attain human comfort inside the house. The Geometrical forming provides the designer with the tools that he can use to achieve the environmental functional target through design parameters to reach the psychological and physical balance for human comfort in the space depending on natural resources in the house design without any artificial resources. All the house elements and spaces are planned to serve the functional target like the courtyard (the center of design), it is designed from the outside to the inside of the house and oriented according to its location and its shape (square or rectangle) and dimensions (L, W, H) are designed to specific ratios, also windows overlooking the courtyard, backyard or the main street is designed to be protruded from the walls to serve the functional parameters, also the geometrical forming emerges in the design of the house elements like Mushrabiya, Shukshieka, Malqaf and arches that proportion is proportioned with the space ratio; from here the effect of geometrical forming in Islamic house design is revealed and reflects the designer creative level in the scope of unchanged environmental functional design parameters; So the study of the form and design of the house and its elements in the Islamic ages enable the architectural to comprehend the mechanism of dealing with the geometrical forming tools to adapt the space to serve the environmental functional parameters.

Purpose – The purpose of this study is to examine both accruals and real earnings management in a large sample of private companies in the UK using data from 2002 to 2009 following the implementation of the UK Act of 2006. Design/methodology/approach – A panel data analysis using GMM has been adopted to examine the objectives of the study and answer the research questions. Findings – The results of this study showed that the imposition of the Companies Act of 2006, on its own, did lead to changes in earnings management behaviour, in both accruals-based earnings and real earnings management. Moreover, this study also found that firms that chose to provide IFRS financial statements tended to show less discretionary earnings management, however, it tended to have no impact on real earnings management. Practical implications – In accordance with the research findings, standard setters with some insight tend to determine how capital markets see the information provided under the legislation such as the UK Act of 2006 in developed countries and thereby ensure long-term sustainability in a modern and sophisticated financial world. This study provides an insight into the successful implementation of the UK act of 2006, and its influence on the aspect of financial reporting. Originality/value – The novel conclusion reached in the study is that there exists a strong and direct link between the smooth implementation of UK Act of 2006 and the practices of both accruals and real earnings management in real-world business and financial scenarios, particularly, in private companies.

Background. Root canals feature a high incidence of post-treatment flare-ups, characterized by pain, swelling, or discomfort following endodontic procedures, which remain a concern in dental practice. This study aims to evaluate the host-related factors behind the prevalence of post-endodontic flare-ups. Methodology. A retrospective study was conducted on the records of 93 patients who were treated endodontically between January 2017 and December 2021. Data extracted from records included age, medical conditions, diagnosis, and tooth type. SPSS 27.0 was used to analyze the data. Multivariate logistic regression analysis was employed to identify significant predictors while controlling for potential confounding factors. Results. The flare-up rate among patients who had received endodontic treatment was 31.2% in the study population. Multivariate logistic regression analysis demonstrated that age and the presence of a vital pulp were significant predictors of flare-ups. Older patients exhibited an increased likelihood of experiencing flare-ups (p 0.05). Conclusion. The study provided insights into the frequency of post-endodontic flare-ups and the impact of host-related factors on their occurrence. Age and vital pulp were found to be important predictors, highlighting the significance of individualized treatment planning. These results highlight the possibility of improved patient outcomes through a thorough understanding of post-endodontic problems and contribute to evidence-based endodontic practice.

Abstract Background The introduction of bone-anchored maxillary protraction eliminated the side effects of facemask in the early treatment of patients with maxillary retrusion. This study aimed to evaluate the effects of miniscrew-anchored maxillary protraction (MAMP) and compare them with the growth changes in an untreated control group in growing patients with Class III malocclusion. Methods Forty growing patients with Class III malocclusion and retrognathic maxilla were randomly allocated into two groups: treated and control groups. In the treated group, patients were treated with full-time intermaxillary Class III elastics (C3E) anchored by a hybrid hyrax (HH) in the maxilla and a bone-supported bar in the mandible. Protraction was stopped after obtaining a positive overjet. Cephalometric radiographs were acquired before and after the treatment. Data were statistically analyzed on an intention-to-treat basis. Intergroup comparisons were also made using analysis of covariance with the readings at T0 as a covariate. Results Forty patients agreed to participate, and 30 of them completed the study (treated group, n = 17; control group, n = 13). The average treatment duration was 11.9 months. MAMP resulted in a significant maxillary advancement (A-VR, 4.34 mm) with significant control over the mandibular growth. No significant increase in the mandibular plane angle was found in the treated group compared with the control group. The upper and lower incisors showed significant protrusion in the treated group. Conclusions Within the limitations of this study and high attrition rate, the MAMP protocol can effectively increase maxillary forward growth with good control over the growth of the mandible antero-posteriorly and vertically.

Conclusion: Gall bladder volvulus is an acute surgical emergency that is usually seen in the elderly population. It required a high index of suspicion especially in the absence of gallstones and must be differentiated from acalculous cholecystitis. Most cases are discovered at surgery. It must be managed with immediate detorsion and cholecystectomy, and the prognosis is excellent in most cases after an appropriate surgical intervention.

This paper establishes new blow-up criteria, in anisotropic Lorentz spaces, via one-directional derivatives of the velocity and magnetic fields for the Cauchy problem to the 3D magneto-micropolar model and via one-directional derivative of velocity for the Cauchy problem to the 3D nonlinear dissipative system.