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AbstractIntroduction Spirometry is the gold standard for COPD diagnosis and severity determination, but is technique-dependent, nonspecific, and requires administration by a trained healthcare professional. There is a need for a fast, reliable, and precise alternative diagnostic test. This study’s aim was to use interpretable machine learning to diagnose COPD and assess severity using 75-second carbon dioxide (CO2) breath records captured with TidalSense’s N-TidalTM capnometer.Method For COPD diagnosis, machine learning algorithms were trained and evaluated on 294 COPD (including GOLD stages 1–4) and 705 non-COPD participants. A logistic regression model was also trained to distinguish GOLD 1 from GOLD 4 COPD with the output probability used as an index of severity.Results The best diagnostic model achieved an AUROC of 0.890, sensitivity of 0.771, specificity of 0.850 and positive predictive value (PPV) of 0.834. Evaluating performance on all test capnograms that were confidently ruled in or out yielded PPV of 0.930 and NPV of 0.890. The severity determination model yielded an AUROC of 0.980, sensitivity of 0.958, specificity of 0.961 and PPV of 0.958 in distinguishing GOLD 1 from GOLD 4. Output probabilities from the severity determination model produced a correlation of 0.71 with percentage predicted FEV1.Conclusion The N-TidalTM device could be used alongside interpretable machine learning as an accurate, point-of-care diagnostic test for COPD, particularly in primary care as a rapid rule-in or rule-out test. N-TidalTM also could be effective in monitoring disease progression, providing a possible alternative to spirometry for disease monitoring.

Subdural empyema can be precipitated by a range of pathogens. Common clinical symptoms include fever, headache, seizures, and changed mental status. Yet, cerebral infections caused by Salmonella are relatively uncommon as it is rare for Salmonella to invade the central nervous system. We present the first reported case of Salmonella enterica serovar Dublin causing subdural empyema in an 83-year-old female, which was successfully managed with surgical burr hole and drainage in addition to prolonged targeted antimicrobial therapy consisting of 2 g of intravenous Ceftriaxone twice daily for a total of 56 days. This report demonstrates the course of her illness and the corresponding treatment plan; which may help guide medical providers when encountering similar cases.

The metabolic activity of microbial communities is central to their role in biogeochemical cycles, human health, and biotechnology. Despite the abundance of sequencing data characterizing these consortia, it remains a serious challenge to predict microbial metabolic traits from sequencing data alone. Here we culture 96 bacterial isolates individually and assay their ability to grow on 10 distinct compounds as a sole carbon source. Using these data as well as two existing datasets, we show that statistical approaches can accurately predict bacterial carbon utilization traits from genomes. First, we show that classifiers trained on gene content can accurately predict bacterial carbon utilization phenotypes by encoding phylogenetic information. These models substantially outperform predictions made by constraint-based metabolic models automatically constructed from genomes. This result solidifies our current knowledge about the strong connection between phylogeny and metabolic traits. However, phylogeny-based predictions fail to predict traits for taxa that are phylogenetically distant from any strains in the training set. To overcome this we train improved models on gene presence/absence to predict carbon utilization traits from gene content. We show that models that predict carbon utilization traits from gene presence/absence can generalize to taxa that are phylogenetically distant from the training set either by exploiting biochemical information for feature selection or by having sufficiently large datasets. In the latter case, we provide evidence that a statistical approach can identify putatively mechanistic genes involved in metabolic traits. Our study demonstrates the potential power for predicting microbial phenotypes from genotypes using statistical approaches.

Background: Testicular germ cell tumors (TGCTs) are the most common cancer in young adult males, and they represent one of the most curable solid tumors. The treatment modalities of different stages are variable among centers. Aim: To describe the management of TGCTs and its outcome in an Egyptian cancer center. Methods: The medical records of patients with TGCT treated between January 2012 and December 2016 were retrospectively reviewed. Thirty-two patients were included. Demographic, clinical, treatment, and outcome data were analyzed. Results: The median age of the patients was 34.5 years. The most common presentation was unilateral painless testicular mass (87.5%). Seminoma represented 53% of cases and almost half of them had Stage I disease. For all patients, the clinical stage and International Germ Cell Cancer Collaborative Group (IGCCC) risk classification were significantly associated with survival outcomes. Five-year overall survival for stage I patients was 100%, compared to 87.5% for stage II (p < 0.0001). Patients with good risk had a 5-year OS of 87.4% while none of the poor risk group survived for 5 years (p =0.002). The 5-year disease-free survival for stage I was 83% for those who remained under active surveillance versus 87.5% for those who received adjuvant carboplatin (p=0.364). Conclusions: Stage I TGCTs has an excellent overall survival regardless of the treatment modality received. In advanced disease, the clinical stage and IGCCC risk stratification remain valid prognostic risk factors.

Urbanization in recent decades faces great challenges, as a result of the rapid increase in population, whereas, The world's population will increase to be 9.2 billion in 2050, which means 2.2 billion more than now, therefore, that will affect directly in the countries infrastructure. Furthermore, the cost of the renewal and establishing new infrastructure will be too expensive and need huge budgets. This paper argues, smart governance through the context of cities infrastructure implementation, by activating citizens participation and using technology, in addition, the contribution of Public-Private Partnerships (PPPs) to provide smart solutions, funding, and improving the performance of operation and maintenance process for these projects, which considers the main pillar to face the urban growth challenges and achieving sustainable development. On another hand, and from analysis of the literature review for smart governance and (PPPs) approach, the study suggests a managerial governance model, which illustrate the role of the state, civil society, and the private sector, who play a critical role to achieve smart governance in infrastructure projects by (PPPs), to provide clear criteria to support the success of this type of projects, in addition, proposing indicators for smart governance in infrastructure projects to measure The extent of achieving effective participation between the parties to the suggested model.

Background Data: Treatment of thoracolumbar vertebral fractures is highly controversial. The most important factor determining treatment strategy is whether the patient has a neurological injury. Purpose: This work studied the results of the surgical treatment of thoracolumbar fractures admitted at the Neurosurgery Department of Benha University Hospital between January 2006 and June 2014 and tried to outline the indications of either the anterior or the posterior approach based on this experience. Study Design: Descriptive retrospective clinical case study. Patients and Methods: This is a retrospective study of the medical records of 72 patients who were hospitalized with the diagnosis of traumatic thoracolumbar spinal fracture and operated upon at the neurosurgical department of Banha University between January 2006 and June 2014. Sixty patients operated through the anterior approach, where 12 operated through the anterior approach. Results: Clinical outcome: Posterior group: no patient experienced neurological deterioration postoperatively. Preoperative low back/leg pain improved greatly in most patients (54 out of 60) and remained the same in 6 patients based on the VAS for pain. Anterior group: According to ASIA; patients grade A (N=6) and D (N=1), remained the same post-operatively, whereas, of the other patients with incomplete cord lesion (N=5), three improved one grade and two did not improve at the last follow-up. Radiological outcome: Posterior group: Preoperatively, most patients experienced loss of more than 40% of the vertebra body’s height and compromise of more than 40% in canal. Its overall mean values were 42.5±11.5% and 50.6±10.2%, respectively. No statistically significant correlation appeared between the canal compromise and loss of vertebral body height (P>0.05). However, the mean kyphotic deformities measured preoperatively and at within 12 months follow-up, were 19.2±5.5 degrees and 8.0±3.6 degrees. The mean mid-sagittal diameter improved from 9.2±3.1 mm before surgery to 15.1±0.8 mm at the 12 months follow-up visit, with a significant difference between preoperative and postoperative values (P

This study explores the impact of touch screen technology on users' sense of control and psychological ownership of electronic payment services. Through an examination of the influence of touch interface during transactions, this study investigates how enhancing feelings of influence and authority can increase motivation to reuse payment services. Dual surveys were conducted, revealing that increased touch input for the transaction amount enhances feelings of influence, which in turn augments the sense of authority. Additionally, the study found that the sense of belonging resulting from panel touch increases motivation for repeat transactions. [ABSTRACT FROM AUTHOR]

The main purpose of this study is to investigate the role of Lean and Six Sigma initiatives on continuous quality improvement in the Malaysian Society for Quality in Health (MSQH) accredited hospitals. In particular, it investigates the relationship between top management support and teamwork. It also examines the influence of teamwork on Lean and Six Sigma initiatives. In this study, 450 survey questionnaires were distributed to twelve MSQH-accredited hospitals' staff using the Stratified Random Sampling method and received 251 useable responses constituting a 55.78 per cent response rate. The reliability and validity of the research variables were tested based on internal consistency, construct validity and discriminant validity by applying the SmartPLS 3.3.4 software. The relationships among various variables in the model were tested using Partial Least Squares Structural Equation Modeling (PLS-SEM). Overall, the study's findings reveal that Lean and Six Sigma initiatives positively and significantly impact the continuous quality improvement of MSQH-accredited hospitals. The findings also indicate that top management support has a positive and significant relationship with teamwork and vice versa, i.e. teamwork significantly affects Lean and Six Sigma initiatives. [ABSTRACT FROM AUTHOR]

Entrepreneurial intention (EI) is one of the major contributing factors to the formation, growth and development of entrepreneurship. It promotes self reliance and brings about initiatives. Entrepreneurship on the other hand, has been considered as an engine of growth for economic growth and development of developed and emerging economies. Academic discussions and policy initiatives are increasing nowadays on the vital role of entrepreneurial development in a society. This has been buttressed by the recent loss of jobs due to 2008-2009 financial crisis as well as increasing unemployment across the globe. In Nigeria, the official rate of unemployment is around 24 percent while 46.5 percent of the youth population are unemployed. The unemployed rate among graduates has increased from 25.6 percent in 2003 to 42.7 percent in 2011. This unwelcome development requires a concerted effort at academic and governmental levels. The objective of this paper is to examine the entrepreneurial intention among University students in Nigeria. This will help to identify entrepreneurial intention which determines behaviour as well as the need to gauge entrepreneurial awareness among the respondents. The paper uses a modified version of Theory of Planned Behaviour (TPB) as the main framework of examining entrepreneurial intention. A sample size of 205 was drawn from Abubakar Tafawa Balewa University (ATBU). Data was analysed using structural equation modeling. The findings show that, entrepreneurial attitude, subjective norm and power of behavioural control are all significant predictors of EI. In addition, other indirect relationships were also found to be significant. Overall the result shows the model fits the the data well.

The study investigates the customers' intention to use app-based medicine services in an emerging economy. This study explores the indirect effects of perceived usefulness, perceived ease of use, perceived security and perceived delivery with the intention to use app-based medicine services through the mediating effect of perceived trust. The present study developed a self-administered survey questionnaire to collect data from 336 respondents who were using app-based medicine services in Bangladesh. The data was collected between March 2022 and May 2022. The collected data were analysed using SmartPLS-4 to determine the reliability and validity of the constructs. The study's findings indicate that perceived usefulness, perceived ease of use, perceived security, and perceived delivery positively and significantly (t > 1.96; P < 0.05) influence the perceived trust in app-based medicine services. The research findings also indicate that perceived ease of use, perceived delivery, and perceived trust significantly (t > 1.96; P < 0.05) impact the intention to use app-based medicine services. This study highlights to explore the success factors such as consumer perceived usefulness, perceived ease of use, perceived security, and perceived delivery that can increase customers' trust to use app-based medicine services in the developing economy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this research article is to explore the behavioural intention of consumers to use app-based shopping for green-tech products in the emerging economy of Bangladesh. The study investigates the indirect effects of perceived ease of use, usefulness, perceived delivery and perceived security on the behavioural intention to use app-based shopping for purchasing green-tech products by considering the mediating role of perceived trust. Design/methodology/approach: A quantitative research approach was applied to collect data from the respondents who had previously used app-based shopping for green-tech products in Bangladesh. An online, self-administered survey questionnaire was used to collect data from 348 respondents. The survey data was analysed using SmartPLS-4 to measure the reliability and validity of the constructs. In addition, partial least squares structural equation modelling (PLS-SEM) was employed to test the research model and hypotheses. Findings: The study's results reveal that perceived usefulness, ease of use, security and delivery positively and significantly influence perceived trust, leading to a higher behavioural intention to use app-based shopping for green-tech products. Additionally, perceived trust significantly mediates the relationship between the behavioural intention to use app-based shopping and perceived usefulness, perceived ease of use, perceived security and perceived delivery. Practical implications: The study's findings have important implications for app-based shopping services to support customers interested in purchasing green-tech products in an emerging economy. The results also indicate that green-tech product companies must adopt new service delivery channels and ensure consumers' convenience and cost and time savings. The present research findings suggest that green-tech product companies need to ensure that they integrate digital technologies into their services for secure and timely delivery of products, improving customer convenience. Originality/value: The study's findings can be insightful for app-based shopping service providers to foster their businesses by focussing on developing a positive trust perception in the consumer's mind, leading to a positive intention to use the app-based shopping services. The present study will enrich the current literature by investigating how consumers' perceived trust affects their behavioural intention to use app-based online shopping for purchasing green-tech products. It will also expand the existing knowledge on app-based shopping by exploring how perceived delivery impacts perceived trust, which subsequently affects customers' intentions to adopt the purchase of green-tech products. [ABSTRACT FROM AUTHOR]

Academic libraries are currently facing their greatest challenge since the explosion in tertiary education and academic publishing, which began after World War II. The global digital revolution is affecting both the traditional forms of the creation, organisation, and dissemination of knowledge, and the world of tertiary education itself. In the challenging environment, academic library only one way can survive in the volatile competitive market to improve their service quality to meet their customers' expectations. In this qualitative research explored the students' perceptions on IIUM library service quality from the perspective of five students' respond at the main campus of IIUM. Research data were collected through face to face interviews near to the IIUM library. In this study, three important issues were considered regarding the student's perception on IIUM library service quality: (i) Positive and negative perception on library service quality (ii) Perception on technology and human context and (iii) Satisfaction. These three key issues were analyzed based on Interpretative Phenomenological Analysis (IPA) procedures

The Lean Six Sigma is one the most effective methods of total quality management to continuously improve the quality performance of the organizations. This approach continuously improves the performance of healthcare organizations by reducing the number of errors towards patient safety. The present study investigates the influence of Lean Six Sigma on patient safety towards the quality improvement of Malaysian hospitals. This study applied a quantitative research approach and a stratified random sampling method to analyze 16 public and private hospitals. It was used a self-administered survey questionnaire to collect data from 364 respondents. This study developed a research model with four hypotheses. All hypotheses were tested using the Partial Least Squares – Structural Equation Modeling (PLS-SEM) method. The research findings indicate that Lean Six Sigma has a strong positive and significant effect on patient safety and quality improvement of the hospitals. The results of the study also indicate that the Lean Six Sigma method indirectly influences the quality improvement of the hospitals through the mediating effect of patient safety. The present research findings provide a guideline for the practitioners of the healthcare organizations to implement the Lean Six Sigma approach to ensure greater patient safety towards the continuous quality improvement of the healthcare services. [ABSTRACT FROM AUTHOR]

Ongoing rapid urbanization and socio-environmental changes are posing challenges to proper urban management. Cultural ecosystem services (CES) offered by urban green spaces play a crucial role in the well-being of urban residents through ecosystems' non-material benefits. However, these services, especially from the residents' perspective, are often neglected in urban management strategies because of their intangible nature, particularly in the Global South. In this study, conducted in Dhaka, Bangladesh, we investigated residents' perceptions of the importance of CES offered by green spaces and how green space should be managed. As a methodological tool, we used a questionnaire-based stated preference method where non-monetary statements were the basis. Questions in the survey included respondents' social background and visiting frequency to green space, perceived importance of CES and green space, and perceptions about the management of green space. We analyzed 405 questionnaires using descriptive and inferential statistics. Our results indicate that rooftop gardens and green parks are considered the most important areas that provide CES, and among different types of CES (i.e., recreation, aesthetic, mental satisfaction, social relations), recreation is considered the most important. The high importance respondents place on the CES categories of aesthetics, sense of place, and social cohesion was also revealed. CES categories tended to be positively linked with each other. The valuation of CES was diverse depending on gender, income, educational background, and visiting frequency. Respondents prioritized government and community roles over the role of individuals and international and national non-government organizations in managing CES. Collaboration between individual and organizations was deemed a high priority. Our results highlight that a better understanding of CES and how different people perceive their benefits can be used to foster public participation and increase support for green space management initiatives.