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Abstract Background Biofilm formation is an essential virulence factor that creates a highly protected growth mode for Staphylococcus aureus (S. aureus) to survive in any hostile environment. Antibiotic sub-minimal inhibitory concentration (sub-MIC) may modulate the biofilm formation ability of bacterial pathogens, thereby affecting bacterial pathogenesis and infection outcomes. Intense antimicrobial therapy to treat biofilm-associated infections can control the pathogenic infection aggravation but cannot guarantee its complete eradication. Objective This study aimed to assess the sub-MICs effect of 5 different antimicrobial classes on biofilm-forming capacity among Staphylococcus aureus clinical isolates using three different biofilm quantitation techniques. Methods In this study, the effects of 5 different antimicrobial agents, namely, azithromycin, gentamicin, ciprofloxacin, doxycycline, and imipenem, at sub-MICs of 12.5%, 25%, and 50% were tested on 5 different clinical isolates of S. aureus. The biofilms formed in the absence and presence of different antimicrobial sub-MICs were then assessed using the following three different techniques: the crystal violet (CV) staining method, the quantitative PCR (qPCR) method, and the spread plate method (SPM). Results Biofilm formation was significantly induced in 64% of the tested conditions using the CV technique. On the other hand, the qPCR quantifying the total bacterial count and the SPM quantifying the viable bacterial count showed significant induction only in 24% and 17.3%, respectively (Fig. 1). The difference between CV and the other techniques indicates an increase in biofilm biomass without an increase in bacterial growth. As expected, sub-MICs did not reduce the viable cell count, as shown by the SPM. The CV staining method revealed that sub-MICs of imipenem and ciprofloxacin had the highest significance rate (80%) showing an inductive effect on the biofilm development. On the other hand, doxycycline, azithromycin, and gentamicin displayed lower significance rates of 73%, 53%, and 47%, respectively. Conclusion Exposure to sub-MIC doses of antimicrobial agents induces the biofilm-forming capacity of S. aureus via increasing the total biomass without significantly affecting the bacterial growth of viable count.

Introduction: Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas. Methods: Data routinely collected by NAS from 2004 to 2023 were analyzed, including structure and capacity (number of stations, ambulances, employees) and utilization and process of care (number of patients served, demographics, medical conditions, response site). Per population indicators of capacity and utilization were compared across Ghana's 16 regions. Results: From 64 emergency medical technicians (EMTs) and nine ambulances in 2004, NAS has grown to 3,473 EMTs and 356 ambulances. From covering three cities in 2004, NAS now has at least one station in each of Ghana's 261 districts. From transporting 205 patients in 2004, NAS transported 38,393 patients in 2022. There have been interruptions due to financial restrictions, with numbers of patients transported per year in 2017–2019 decreasing by over 50% from the prior peak (n = 20,236 in 2014). In 2022, there were 1.13 ambulances per 100,000 people and 0.33 transports/100,000/day. Most (81.3%) transports are inter-facility transfers. Among Ghana's 16 regions, there is moderate variation in utilization from 0.16 to 0.50 transports/100,000/day. However, the three lowest-income, remoter regions currently have utilizations of 0.16, 0.30, and 0.37 transports/100,000/day, mostly near the National average of 0.33. Conclusion: Despite periodic limitations due to finances, the NAS has expanded to cover all of Ghana's 261 districts and has largely achieved geographic equity. Sustainability has been aided by having a training school directly under NAS's control, assuring a steady supply of EMTs. Challenges include assuring financial stability and increasing utilization for emergencies at the scene, in addition to the current high utilization for inter-facility transfer.

Abstract The gas lift technique applies gas bubble injection into the vertical wells to raise production. Gas and liquid rates, shifts in flow regimes, and system equilibrium influence this process. This study explores the efficient implementation of gas lift techniques to maximize production from the Asmari Formation in the Abu Ghirab Field, southeastern Iraq, using a continuous gas lift for maximum production rate by PIPESIM TM software. The results of the gas lift design for the four wells (AGCS-33, 26, 28, and 36) show that the Vogel method provided the best results for the gas lift design, and faults and facies distribution impact the gas lift injection and oil production rates. These will become evident with wells AGCS-33 and 36 as their proximity to faults will increase oil production rates with a gas injection rate limit of 7 MMSCF/d. Conversely, for wells 26 and 28, the limit will marginally rise, starting at 5 MMSCF/d. In addition, the effect of gas lift is clearly in the middle western of the crest, which shows an increasing percentage of oil production of 136.6% at minimum rate and 198.5% at maximum for the well AGCS-26, 89.7% and 105.7% for the well AGCS-36. Wellhead pressure has a significant impact on gas-lift performance, and improving gas-lift efficiency can be accomplished using an electric control valve. The feasibility of implementing gas lift in the Asmari Formation depends on the water cut, well location, and water saturation distribution within the Formation.

Abstract The combination of hydrogel and fertilizer as slow release fertilizer hydrogel (SRFH) has become one of the most promising materials to overcome the shortcomings of conventional fertilizer by decreasing fertilizer loss rate, supplying nutrients sustainably, and lowering the frequency of irrigation. The hydrogel based on carboxymethyl cellulose (CMC) and polyacrylic acid (PAA) (CMC/PAA) was synthesized. All materials, Vinasse, hydrogel (CMC/PAA) and (Vinasse/CMC-PAA) were characterized by FTIR, XRD, and SEM. The formed hydrogel was applied to control the salinity of Vinasse to use it as a cheap and economical fertilizer. The results showed that using the prepared hydrogel with Vinasse (V/CMC-PAA) as a slow-release organic fertilizer decreased the EC value through the first six hours from 1.77 to 0.35 mmohs/cm. Also, using V/CMC-PAA can control and keep the potassium as fertilizer for 50 days. The productivity per feddan from the sugar cane crop increased by about 15%, and the number of irrigations decreased from 5 to 4 times.

The study investigated the beneficial effects of vitamin E-loaded nano-emulsion (NEVE) on hemato-biochemical changes, oxidative stress, inflammatory responses, immunological variables, and semen quality in heat-stressed rabbit bucks. Forty adult V-line rabbit bucks were randomly assigned to four groups and fed diets containing NEVE at 0 (NEVE0), 50 (NEVE50), 100 (NEVE100), and 200 (NEVE200) mg/kg for 12 weeks. The NEVE had a mean particle diameter of 32.6 nm, a polydispersity index of 0.6, and a zeta potential of −31.1 mV. The dietary NEVE significantly improved the hematological, blood protein, lipid profile, and liver functions of rabbit bucks (p

Abstract Aflatoxins (AFs) are hazardous carcinogens and mutagens produced by some molds, particularly Aspergillus spp. Therefore, the purpose of this study was to isolate and identify endophytic bacteria, extract and characterize their bioactive metabolites, and evaluate their antifungal, antiaflatoxigenic, and cytotoxic efficacy against brine shrimp (Artemia salina) and hepatocellular carcinoma (HepG2). Among the 36 bacterial strains isolated, ten bacterial isolates showed high antifungal activity, and thus were identified using biochemical parameters and MALDI-TOF MS. Bioactive metabolites were extracted from two bacterial isolates, and studied for their antifungal activity. The bioactive metabolites (No. 4, and 5) extracted from Bacillus cereus DSM 31T DSM, exhibited strong antifungal capabilities, and generated volatile organic compounds (VOCs) and polyphenols. The major VOCs were butanoic acid, 2-methyl, and 9,12-Octadecadienoic acid (Z,Z) in extracts No. 4, and 5 respectively. Cinnamic acid and 3,4-dihydroxybenzoic acid were the most abundant phenolic acids in extracts No. 4, and 5 respectively. These bioactive metabolites had antifungal efficiency against A. flavus and caused morphological alterations in fungal conidiophores and conidiospores. Data also indicated that both extracts No. 4, and 5 reduced AFB1 production by 99.98%. On assessing the toxicity of bioactive metabolites on A. salina the IC50 recorded 275 and 300 µg/mL, for extracts No. 4, and 5 respectively. Meanwhile, the effect of these extracts on HepG2 revealed that the IC50 of extract No. 5 recorded 79.4 µg/mL, whereas No. 4 showed no cytotoxic activity. It could be concluded that bioactive metabolites derived from Bacillus species showed antifungal and anti-aflatoxigenic activities, indicating their potential use in food safety.

Abstract Due to vincristine sulfate’s (VCR sulfate) toxicity and non-specific targeting, which might adversely damage healthy cells, its clinical application is restricted. In this study, we loaded VCR sulfate on exosomes generated from mesenchymal stem cells (MSCs) to enhance its targeted distribution. Exosomes are able to deliver molecules to specific cells and tissues and have therapeutic potential. In this study, we isolated exosomes from MSCs, and using probe-sonication approach loaded them with VCR sulfate. Using SRB assay, the cytotoxicity of VCR sulfate-Exo was assessed in T47D breast cancer cells, and the results were contrasted with those of free VCR sulfate. Then We labeled markers (CD44+/CD24−) in the cell line to assess the targeting effectiveness of VCR sulfate-Exo using flow cytometry. Our results showed that the cytotoxicity of VCR sulfate-Exo was nearly the same as that of VCR sulfate. Flow cytometry analysis revealed that VRC sulfate-Exo was more effectively targeted to MSCs than free VCR sulfate. Our study shows that loading VCR sulfate to MSCs-derived exosomes can improve their targeted delivery and lessen their side effects. Additional research is required to determine VCR sulfate-Exo’s in vivo effectiveness and safety and improve the loading and delivery strategies.

Sugeet K Jagpal,1,* Abdullah Alismail,2,3,* Erica Lin,4 Lauren Blackwell,5 Nayla Ahmed,6 May M Lee,7 Jared Chiarchiaro8 1Division of Pulmonary, Critical Care and Sleep Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 2Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, USA; 3Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 4Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA; 5Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA; 6Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; 7Division of Pulmonary, Critical Care and Sleep Medicine, University of South California, Los Angeles, CA, USA; 8Division of Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA*These authors contributed equally to this workCorrespondence: Abdullah Alismail, Department of Cardiopulmonary Sciences, School of Allied Health Professions, Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA, Email aalismail@llu.eduAbstract: Health profession educators readily identify with the goal of fostering healthcare providers who are critical thinkers focused on quality patient care. In the following paper, we aim to delve into critical thinking at the team level and help educators begin the process of creating a shared mental model focusing on cognition to identify gaps and opportunities for growth in their trainees. We will distinguish between microcognition (an individual’s own critical thinking process in a controlled environment), macrocognition (critical thinking process in a real-world environment), and team cognition (the interaction and relationship among team members to augment macrocognition). A common case example will be used to guide the discussion as well as provide a model framework to be used for clinician educators in the future.Keywords: medical education, cognition, shared mental models, clinician educators