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Abstract Background Townes-Brocks Syndrome (TBS), an autosomal dominant disorder, is known to cause hearing loss amongst other expressions including anomalies that affect the external ear, hands, feet, anus, and kidneys. Case presentation This report describes a case of a four-year-old male of Iranian origin with TBS diagnosed with bilateral profound sensorineural hearing loss who underwent unilateral cochlear implantation in Tanzania. Along with sensorineural hearing loss, the child has dysplastic external ears, ulnar deviation of the thumbs, and overlapping toes. Radiological evaluation revealed cochlear hypoplasia with an enlarged vestibular aqueduct. This is the first known published case of TBS with a cochlear implant in East Africa and details the child’s history, audiological findings, surgical procedure, and post-surgical outcomes. The patient has shown a remarkable increase in Infant–Toddler Meaningful Auditory Integration Scale (IT-MAIS) scores and aided sound-field thresholds at 3 months and 6 months post-switch on. Conclusion This case advocates for encouraging intervention via cochlear implantation and increased awareness of such syndromes. It also adds to the literature on TBS, and its relation to sensorineural hearing loss and inner ear malformations.

The examination of the machining of 7075-T6 aluminum alloy polymer mold cavities using Taguchi optimization and analysis of variance is presented in this paper. This study identified the best CNC milling cutting parameters and used a mathematical model to quantify the surface roughness of the machined cavities. The findings showed that while using a flat endmill, the spindle speed multiplied by feed rate contributed 28.01% to surface roughness, and when using a ball endmill, the squared depth of cut contributed 41.27%. Using both flat and ball endmills, the depth of the cut contributed 98.53% to the material removal rate. A refined second-order linear regression model was employed to forecast the endmill-machined surface roughness. The Warp Surf Portable tester measured values that were outside the error range of approximately 0.257% and 2.8%, respectively, for the expected values. Surface roughness has a 99.97% correlation coefficient in the regression model, indicating a very significant link. Additionally, the study improved the cutting parameters for a ball endmill, which were 3005 Rpm, 726.7 mm/min, and 0.43 mm, and for a flat endmill, these were spindle speed (2500 Rpm), feed rate (650 mm/min), and axial cut depth (0.5 mm). The outcomes demonstrated how well the techniques enhanced mold cavity machining and cost estimation using Ra and MRR data. Consequently, these results can be applied to future academic studies and industrial applications.

In recent years, the growing interest in automatic speech recognition (ASR) has been driven by its wide-ranging applications across various domains. Integrating speech recognition technologies into smart systems highlights the pivotal role of human-machine interaction. This study introduces a robust ASR system that leverages convolutional neural networks (CNNs) in conjunction with Mel-frequency cepstral coefficients (MFCCs). The model's architecture was improved by extensively examining hyperparameters, effectively recognizing ten different spoken commands. The model conducted training and evaluation using the Google Speech dataset, comprising 65,000 audio clips collected from a wide range of speakers across the globe. This dataset accurately represents the natural variations in speech found in real-world scenarios. The design comprises eight storage layers, encompassing convolutional and fully connected layers. It consists of a total of 183,345 weights and utilizes ReLU activation. It is worth mentioning that the average F1-score obtained during the training, validation, and testing stages is 99.06 %, 94.68%, and 95.27%, respectively. Furthermore, the proposed model exhibits about 1.3% improvement in experimental test accuracy over existing methods, confirming its effectiveness in real-world applications.

A buffer solution of Britton-Robinson (B-R) pH 6.5 was utilized to validate and apply a square wave voltammetry (SWV) method for the electrochemical determination of Eszopiclone (ESP) in pharmaceuticals and biological samples. The cyclic voltammetry (CV) and differential pulse voltammetry (DPV) methods were employed in the initial study of the voltammetric behavior of the ESP compound. The rotating glassy carbon (GC) indicator electrode (2.0 mm2), Pt auxiliary electrode, and Ag/AgCl reference electrode were used for ESP determination. ESP was analyzed to produce a sharp reduction peak at a potential of −750 mV. The best shape and high sensitivity of SWV cathodic current for ESP, were observed using GC electrode, B-R, pH 6.5, accumulation time (tacc) of 60-second, accumulation potential (Eacc) of - 0.1 V, amplitude voltage of 150 mV, frequency of 15 Hz, scan rate of 150 mV s−1, and stirrer rate of 1000 round per minute (rpm). The electroanalytical performance of the SWV method was evaluated through study of repeatability, stability, calibration curve, recovery, and limits of detection and quantification (LOD,LOQ). Under the optimal conditions, the SWV response was linear in the range from 3 × 10−6 to 5 × 10−5 mol/L (n = 10). The SWV method achieved a LOD of 1.9 × 10-8 mol/L (7.5 ppb), and a LOQ of 6.41 × 10−8 mol L−1 (24.93 ppb). The validated SWV method was appeared the good repeatability, sensitivity and stability for the determination of ESP. It was given a very stable SWV current for 90 min, with a 0.141 % relative standard deviation (RSD%). The SWV method was applied to the determination of ESP in pharmaceutical tablets and biological samples.

In recent years, Microgrid has become more attractive. A combination of renewable energy resources with load at the distribution level appears preferable. However, such a combination is challenging to work correctly. Power system indices such as voltage and frequency appear difficult to be within an allowable limit. This research will use a STATCOM compensator to increase the voltage stability of the power system containing wind and solar energy generation systems. The STATCOM based modular multi-level converter is designed to increase the output voltage quality and reduce filter requirements. The proportional and integral (PI) and integral sliding mode (ISM) controller is designed in a MATLAB/SIMULINK environment. The results demonstrate the effectiveness of the STATCOM compensator in this hybrid system with both PI and ISM controllers.

Abstract In this research paper, the intelligent learning abilities of the gray wolf optimization (GWO), multi-verse optimization (MVO), moth fly optimization, particle swarm optimization (PSO), and whale optimization algorithm (WOA) metaheuristic techniques and the response surface methodology (RSM) has been studied in the prediction of the mechanical properties of self-healing concrete. Bio-concrete technology stimulated by the concentration of bacteria has been utilized as a sustainable structural concrete for the future of the built environment. This is due to the recovery tendency of the concrete structures after noticeable structural failures. However, it requires a somewhat expensive exercise and technology to create the medium for the growth of the bacteria needed for this self-healing ability. The method of data gathering, analysis and intelligent prediction has been adopted to propose parametric relationships between the bacteria usage and the concrete performance in terms of strength and durability. This makes is cheaper to design self-healing concrete structures based on the optimized mathematical relationships and models proposed from this exercise. The performance of the models was tested by using the coefficient of determination (R2), root mean squared errors, mean absolute errors, mean squared errors, variance accounted for and the coefficient of error. At the end of the prediction protocol and model performance evaluation, it was found that the classified metaheuristic techniques outclassed the RSM due their ability to mimic human and animal genetics of mutation. Furthermore, it can be finally remarked that the GWO outclassed the other methods in predicting the concrete slump (Sl) with R2 of 0.998 and 0.989 for the train and test, respectively, the PSO outclassed the rest in predicting the flexural strength with R2 of 0.989 and 0.937 for train and test, respectively and the MVO outclassed the others in predicting the compressive strength with R2 of 0.998 and 0.958 for train and test, respectively.

Investigations were made into the fatigue in the magnesium alloy AZ 91C cast in corrosive fluids and air at varied NaCl solution concentrations. Fatigue specimens will be subjected to surface stress testing in corrosive conditions with a stress amplitude of 75 MPa both after and before coating. To comprehend the behavior of the magnesium material, its fatigue life, corrosion product (X-ray spectra), and fracture properties will be examined. The corroding medium (NaCl) has been found to significantly shorten the fatigue life of the magnesium alloy AZ91C. Chemical conversion treatment was applied to the AZ91C alloy to improve corrosion resistance and corrosion fatigue resistance. MgSnO3 was found in the XRD patterns of the stannite-treated AZ91C alloy, and this treatment slightly improved the alloy's corrosion resistance in an alkaline stannite solution with a pH of 7. H2O and SEM images demonstrate that chloride ions can penetrate the substrate through porous structures.

Cathodic protection (CP) is the most effective method for protecting petroleum facilities against corrosion. As part of this protection, care should be taken to continuously evaluate the existing system in order to maintain the system in favorable conditions. The subject of the paper’s research is an oil plant for the transportation of oil derivatives located at the Brega company in Tobruk, Libya. In the present work, a case study on how to evaluate the CP system for an existing company for petroleum transportation is considered. The procedure was planned in three steps. The first step is a historical survey of the CP system from when the company started. The second was a diagnostic analysis study of the problem and how to fix it along the system. The third is the conclusions and recommendations regarding the measures for evaluating the CP system without stopping production.

IntroductionBreast cancer (BC) is the most common cancer affecting women in the United States. Ductal carcinoma in situ (DCIS) is the earliest identifiable pre-invasive BC lesion. Estimates show that 14 to 50% of DCIS cases progress to invasive BC.MethodsOur objective was to identify nuclear matrix proteins (NMP) with specifically altered expression in DCIS and later stages of BC compared to non-diseased breast reduction mammoplasty and a contralateral breast explant culture using mass spectrometry and RNA sequencing to accurately identify aggressive DCIS.ResultsSixty NMPs were significantly differentially expressed between the DCIS and non-diseased breast epithelium in an isogenic contralateral pair of patient-derived extended explants. Ten of the sixty showed significant mRNA expression level differences that matched the protein expression. These 10 proteins were similarly expressed in non-diseased breast reduction cells. Three NMPs (RPL7A, RPL11, RPL31) were significantly upregulated in DCIS and all other BC stages compared to the matching contralateral breast culture and an unrelated non-diseased breast reduction culture. RNA sequencing analyses showed that these three genes were increasingly upregulated with BC progression. Finally, we identified three NMPs (AHNAK, CDC37 and DNAJB1) that were significantly downregulated in DCIS and all other BC stages compared to the isogenically matched contralateral culture and the non-diseased breast reduction culture using both proteomics and RNA sequencing techniques.DiscussionThese genes should form the basis of, or contribute to, a molecular diagnostic panel that could identify DCIS lesions likely to be indolent and therefore not requiring aggressive treatment.

The purpose of this research is to examine the effects of depth variation and exposure duration on the combustion characterization of the Maple wood species (Acer platanoides L.) and Walnut (Juglans regia L.) according to ISO 5660–1 in case of exposing the specimens to a constant heating rate 50 kWm−2. The delivered experimental data by cone calorimeter apparatus is used to train, test, and validate the optimized cascade forward artificial neural network with topology 2–8–8–12–2. This structure is simulated to predict the target parameters: the heat release rate (HRR) and the mass burning rate (MBR). With real systems, it is possible to achieve a reasonable performance and the closest approximations for the cascade model. The experimental combustion parameters: time of flame out, average specific mass burning rate, total heat release, maximum average rate of heat emission, and fire growth index are considered to make a systematic analysis and assessment with change depth. Three regions are considered for investigation of output target curves, thermally thin (d ≤ 1.1 cm), thermally medium (1.1 cm < d< 1.5 cm), thermally thick (d≥ 1.5cm). The findings demonstrate that independent of exposure period, an increase in depth change causes a sizable reduction in the HRR and MBR. Beyond 1.5 cm of depth in thermally thick regions, there is no discernible effect of time instant on changes in target parameters. In contrast, HRR and MBR gradients across depth in thermally thin regions are striking.

Background: Several strategies were implemented during the Covid-19 pandemic to enhance residency training and patient care. Objective: This study aims to assess the post-pandemic landscape of neurosurgical training and practice. Method: A survey consisting of 28 questions examining the challenges faced in neurosurgery and the adaptive measures was conducted among US neurosurgery residents from May 2022 to May 2023. Results: This study encompassed 59 neurosurgical residents, predominantly male (72.9%) and in later years of training (66.1%) and were distributed across 25 states. Telemedicine and tele-education were pivotal during the pandemic, with virtual lecture series, standalone lectures, and virtual discussions highly favored. Remote didactic learning increased for nearly half of the residents, while 54.2% resumed in-person instruction. Telemedicine was deemed effective by 86.4% for evaluating neurosurgical patients. Access to teaching environments was restricted for 61.0% of residents, impacting their training. The pandemic significantly influenced elective surgeries, with complete cancellations reported by 42.4%. Reduced faculty engagement was noted by 35.6% of residents, while 47.5% reported a negative impact on the overall resident experience. The majority (76.3%) considered changes to their training reasonable given the global health situation. Conclusions: Strategies implemented during the peak of the pandemic remain crucial in shaping neurosurgery training. Telemedicine has become indispensable, with widespread adoption. Tele-education has also expanded, providing additional learning opportunities. However, traditional didactic courses and hands-on experiences remain essential for comprehensive training. Balancing technology-driven methods with established approaches is crucial for optimizing neurosurgical education and maintaining high-quality patient care.

This study aims to address the issue by providing valuable insights into the factors contributing to the wellbore instability and proposing effective measures to mitigate the problem in the southern part of the Rumaila oil field. A comprehensive one-dimensional mechanical earth model (1D MEM) was developed by utilizing various logs data from 4 wells across the south part of this field, including gamma ray, bit size, caliper, bulk density, and sonic compression and shear logs. The model was validated with laboratory tests, including Brazilin and Triaxial tests, as well as repeated formation tests. To analyze the wellbore stability, three different failure criteria, namely Mohr-Coulomb, Mogi-Coulomb, and Modified lade, were employed. The results indicated that the Mogi-Coulomb criterion was the most accurate failure criterion in predicting rock failure. Wellbore instability problems had been observed across the shale sections throughout the Rumaila oil field, particularly through Tanuma, Khasib, top and bottom of Ahmadi, Nahr Umr, and Upper Shale members and Middle Shale members of Zubair formations. The 1D MEM results indicated that Shaly formations exhibited low stiffness rocks (low Young's Modulus (YME)), low rock strength, and high Poisson's ratio (PR), suggesting potential challenges related to wellbore instability in the Tanuma, top and bottom of Ahmadi, Nahr-Umr, and Zubair formations. A sensitivity analysis was performed to determine the safest mud weight and the optimum well trajectory for future drilling operations. According to the updated mud window of this field in 2023, the pressure in the Mishrif and Zubair formations was reinforced by injection wells, as it was noted that the pressure behavior shifted from depletion (2000 Psi). Based on the findings of this study, the good inclination of (0-25°) can be drilled with the mud weight of 1.24-1.26 sg, while the good inclination of (25-40°) can be drilled with the mud weight of 1.28-1.30 sg in all directions (i.e., all azimuths). The stress regime in most of the formations was found to be a strike-slip to a normal fault regime. The findings of this study can significantly benefit the oil industry and enhance overall productivity.

Abstract Background Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone’s clinical and safety outcomes compared to methylprednisolone. Methods A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient’s age and MODS within 24 h of ICU admission. Results After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups. Conclusion Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.

Abstract The stiffness (K) and slenderness factor (λ) of a steel plate-based damper has been studied on the basis of elastic-inelastic-plastic buckling (EIP) modes and flexural/shear/flexural-shear failure mechanisms (FSF-S), which has been designed for the improvement of the behavior of concentrically braced frames. Steel plate-based dampers offer significant benefits in terms of mode shapes and failure mechanisms, contributing to improved dynamic performance, enhanced structural resilience, and increased safety of civil engineering structures. Their effectiveness in mitigating dynamic loads makes them a valuable tool for engineers designing structures to withstand extreme environmental conditions and seismic events. This study was undertaken by using the learning abilities of the response surface methodology (RSM), artificial neural network (ANN) and the evolutionary polynomial regression (EPR). Steel plate dampers are special structural designs used to withstand the effect of special loading conditions especially seismic effects. Its design based on the prediction of its stiffness (K) and slenderness factor (λ) cannot be overlooked in the present-day artificial intelligence technology. In this research work, thirty-three entries based on the steel plate damper geometrical properties were recorded and deployed for the intelligent forecast of the fundamental properties (λ and K). Design ratios of the steel plate damper properties were considered and models behavior was recorded. From the outcome of the model, it can be observed that even though the EPR and ANN in that order outclassed the other techniques, the RSM produced model minimization and maximization features of the desirability levels, color factor scales and 3D surface observation, which shows the real model behaviors. Overall, the EPR with R2 of 0.999 and 1.000 for the λ and K, respectively showed to be the decisive model but the RSM has features that can be beneficial to the structural design of the studied steel plate damper for a more robust and sustainable construction. With these performances recorded in this exercise, the techniques have shown their potential to be applied in the prediction of steel damper stiffness with optimized characteristic features to withstand structural stresses.

Abstract The use of tocilizumab for the management of COVID-19 emerged since it modulates inflammatory markers by blocking interleukin 6 receptors. Concerns regarding higher thrombosis risk while using tocilizumab were raised in the literature. The aim of this study is to investigate the association between tocilizumab therapy and the development of thromboembolic events in critically ill COVID-19 patients. A propensity score-matched, multicenter cohort study for critically ill adult patients with COVID-19. Eligible patients admitted to ICU between March 2020 and July 2021 were categorized into two sub-cohorts based on tocilizumab use within 24 h of ICU admission. The primary endpoint was to assess the incidence of all thrombosis cases during ICU stay. The secondary endpoints were 30-day mortality, in-hospital mortality, and the highest coagulation parameters follow-up (i.e., D-dimer, Fibrinogen) during the stay. Propensity score matching (1:2 ratio) was based on nine matching covariates. Among a total of 867 eligible patients, 453 patients were matched (1:2 ratio) using propensity scores. The thrombosis events were not statistically different between the two groups in crude analysis (6.8% vs. 7.7%; p-value = 0.71) and regression analysis [OR 0.83, 95% CI (0.385, 1.786)]. Peak D-dimer levels did not change significantly when the patient received tocilizumab (beta coefficient (95% CI): 0.19 (− 0.08, 0.47)), while there was a significant reduction in fibrinogen levels during ICU stay (beta coefficient (95% CI): − 0.15 (− 0.28, − 0.02)). On the other hand, the 30-day and in-hospital mortality were significantly lower in tocilizumab-treated patients (HR 0.57, 95% CI (0.37, 0.87), [HR 0.67, 95% CI (0.46, 0.98), respectively). The use of tocilizumab in critically ill patients with COVID-19 was not associated with higher thrombosis events or peak D-dimer levels. On the other hand, fibrinogen levels, 30-day and in-hospital mortality were significantly lower in the tocilizumab group. Further randomized controlled trials are needed to confirm our findings.

Designing a properly coordinated protection scheme for a multi-microgrid is very challenging because of their distinct characteristics. A microgrid can be operated in a grid-connected mode through direct connection to utility or through another grid-connected microgrid. It can also operate in an islanded mode or get connected with another independent microgrid. The various operation modes and topologies under which the system may operate bring major challenges such as the bi-directional flow of power and substantial variation in fault current. Such characteristics make protection schemes of conventional radial distribution systems unreliable options. In this paper, a centralized communication-assisted protection scheme based on artificial neural networks is proposed. The scheme operates in a cascaded process. In the first stage, a central protection controller is responsible of identifying and isolating the microgrid or tie line which has the fault. In the second stage, the local protection controller will be activated due to detection of islanding condition. It will then identify and isolate the faulty line accordingly. Identification of fault location is accomplished through neural networks trained with massive amount of three phase voltage and current measurements of all buses and lines during different fault scenarios using MATLAB/Simulink environment. The proposed scheme utilizes IEC 61850 based standardized communication to monitor the multi-microgrid and send the trip commands. Finally, the performance evaluation of the proposed scheme in terms of end-to-end delays including neural networks computational delay and communication network delay through extensive simulations is also presented which proves the effectiveness of the proposed protection scheme.

Abstract This study analyses the semiotics of proverbs by presenting the ideological portrayals of women in Jordanian folk proverbs. The content analysis of the proverbs shows that women are represented both positively and negatively, though they are preponderantly depicted negatively in the majority of the analysed proverbs. They are represented negatively as a symbol of feebleness, foolishness, disgrace, cunning, deception, jealousy and reproduction. Few are the proverbs that elevate the status of women, and if they do, it is on the condition that they are confined to particular restricted gender roles, such as mothers, sisters, wives and daughters providing kindness, help, motivation, and comfort to others. The findings uncover how socially dominant ideologies can influence the way power is practiced in the context of gender relations. They also show the immense significance of such proverbs as a social discourse that has been long used for perpetuating gendered roles and constructing and interpreting related realities, thus affecting social structures and relationships. The inferiority of women constitutes the basis of their assigned roles and responsibilities in various life domains. The proverbs have the ideological indexicals of underestimating women, showing their position in society and also reminding them of their roles.

Abstract This research investigated the main linguistic strategies used in President Biden’s inauguration speech presented in 2021. Data were analyzed in light of Fairclough’s CDA framework: macro-structure (thematic)—intertextually; microstructure in syntax analysis (cohesion); stylistic (lexicon choice to display the speaker’s emphasis); and rhetoric in terms of persuasive function. The thematic analysis of the data revealed that Biden used certain persuasive strategies including creativity, metaphor, contrast, indirectness, reference, and intertextuality, for addressing critical issues. Creative expressions were drawn highlighting and magnifying significant real-life issues. Certain concepts and values (i.e., unity, democracy, and racial justice) were also accentuated as significant elements of America’s status and Biden’s ideology. Intertextuality was employed by resorting to an extract from one of the American presidents in order to convince the Americans and the international community of his ideas, vision, and policy. It appeared that indirect expressions were also used for discussing politically sensitive issues to acquire a political and interactional advantage over his political opponents. His referencing style showed his interest in others and their unity. Significant ideologies encompassing unity, equality, and freedom for US citizens were stated implicitly and explicitly. The study concludes that the effective use of linguistic and rhetorical devices is important to construct meanings in the world, be persuasive, and convey the intended vision and underlying ideologies.

5-Fluorouracil (5-FU) is widely used in chemotherapy but poses serious risks of cardiotoxicity, which can significantly affect treatment outcomes. Identifying interventions that can prevent these adverse effects without undermining anticancer efficacy is crucial. This study investigates the efficacy of Thymoquinone (TQ) and Hesperidin (HESP) in preventing cardiotoxicity induced by 5-FU in Wistar rats and elucidates the molecular interactions through docking studies. We employed an experimental design involving multiple groups of Wistar rats exposed to 5-FU, with and without the concurrent administration of TQ and HESP. Cardiac function markers, oxidative stress indicators, and inflammatory markers were assessed. Additionally, molecular docking was used to analyze the interaction of TQ and HESP with key inflammatory proteins. Treatment with TQ and HESP not only lowered levels of cardiac enzymes but also improved antioxidant capacity and reduced inflammation in cardiac tissues. Notably, the combination of TQ and HESP provided more significant protective effects than either agent alone. Molecular docking supported these findings, showing effective binding of TQ and HESP to inflammatory targets. TQ and HESP demonstrate potential as protective agents against cardiotoxicity in 5-FU-treated rats, with their combined use offering enhanced protection. These findings suggest a viable strategy for reducing cardiac risks associated with 5-FU chemotherapy.

Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients.

Background: Dentures can cause pathological problems to the oral tissues known as denture-induced mucosal lesions; the most common type is denture stomatitis. Objective: To estimate the frequency of denture-induced mucosal lesions among denture wearer patients attending oral diagnosis clinic /Faculty of Dentistry in Tishk International University. Patients and Methods: A patient who uses either removable partial or complete dentures was included. The patient’s gender and age, denture-related data, and oral lesions induced by dentures were evaluated. The data were statistically analyzed using chi-square and multivariate logistic regression. Results: Oral lesions (23.5%) were more common in males; the lesions found include denture stomatitis, denture hyperplasia, traumatic ulcers, and angular cheilitis. Denture stomatitis was the most common type (7%). The correlation between vertical dimension state and oral lesions was very highly significant. Conclusion: The major cause of denture-induced mucosal lesions was a change in denture vertical dimension and mostly a reduction in vertical dimension.

Rhetoric, being among five arts of logic (i.e., Sana’at Khams), is a persuasive yet uncertain art. However, philosophers consider it as a non-philosophical and invalid art. In such a view, this art has no philosophical value and its users seek to deceive and influence the audience in order to attract their attention, so logical speech must be de-rhetorical. The study of early philosophers, especially Aristotle, shows that rhetoric is not one of the branches of uncertain logic, but it is a political tool and is a complementary art in practical philosophy, and because practical philosophy is one of the branches of philosophy, it is also related to philosophy. Plato considered rhetoric to be against the politics of society. Aristotle, ‌also under the influence of Plato, first criticized the common discourse of his time, which relied on the Forensic type and sophistic method. Then, he tries to teach a desirable version of rhetoric for the prosperity of society, considering the necessity of rhetoric in political societies. Aristotle uses enthymeme to relate rhetoric to premises and to highlight its political nature by emphasizing the deliberative rhetoric. This study aims to investigate this proposition in Aristotle’s thoughts, and clarify the political implications of rhetoric.

Background: Favipiravir is an oral antiviral, that might treat COVID-19 by enhancing viral eradication, particularly in patients with mild-to-moderate disease. Yet, the findings on the use of favipiravir in critically ill patients with COVID-19 are inconsistent. Therefore, this study aimed to assess the effectiveness and safety of favipiravir in critically ill patients with COVID-19. Method: A multicenter retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care units (ICUs) was conducted from March 2020 to July 2021. Patients were categorized based on favipiravir use (control vs. favipiravir). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation (MV) duration, 30-day mortality, ICU length of stay (LOS), hospital LOS, and complications during the stay. Results: After propensity score (PS) matching (1:1 ratio), 146 patients were included in the final analysis. A higher in-hospital and 30-day mortality were observed in patients receiving favipiravir compared to the control group at crude analysis (65.3% vs. 43.8%; P-value=0.009 and 56.3% vs. 40.3; P-value=0.06, respectively); however, no differences were observed using multivariable Cox proportional hazards regression analysis (HR 1.17; 95% CI 0.73, 1.87; P-value =0.51 and HR 0.86; 95% CI 0.53, 1.39; P-value=0.53, respectively). Conversely, the MV duration and ICU LOS were longer in patients who received favipiravir than the control group (β coefficient 0.51; CI 0.09, 0.92; P-value = 0.02, β coefficient 0.41; CI 0.17, 0.64; P-value = 0.0006, respectively). Complications during the stay were comparable between the two groups. Conclusion: The use of favipiravir in critically ill patients with COVID-19 did not demonstrate a reduction in mortality; instead, it was linked with longer MV duration and ICU stay. This finding suggests limiting favipiravir use to infections where it is more effective, other than COVID-19. Further randomized clinical trials are needed to confirm these findings.

The formation of an aneurysm in the false lumen (FL) is a long-term complication in a significant percentage of type B aortic dissection (AD) patients. The ability to predict which patients are likely to progress to aneurysm formation is key to justifying the risks of interventional therapy. The investigation of patient-specific hemodynamics has the potential to enable a patient-tailored approach to improve prognosis by guiding disease management for type B dissection. CFD-derived hemodynamic descriptors and geometric features were used to retrospectively assess individual aortas for a population of residual type B AD patients and analyze correlations with known outcomes (i.e., rapid aortic growth, death). The results highlight great variability in flow patterns and hemodynamic descriptors. A rapid aortic expansion was found to be associated with a larger FL. Time-averaged wall shear stress at the tear region emerged as a possible indicator of the dynamics of flow exchange between lumens and its effect on the evolution of individual aortas. High FL flow rate and tortuosity were associated with adverse outcomes suggesting a role as indicators of risk. AD induces complex changes in vessel geometry and hemodynamics. The reported findings emphasize the need for a patient-tailored approach when evaluating uncomplicated type B AD patients and show the potential of CFD-derived hemodynamics to complement anatomical assessment and help disease management.

Background: Vestibular migraine (VM) is a common cause of dizziness that is underrecognized, underdiagnosed, and challenging to effectively treat. The prevalence, appropriate diagnostic workup, and therapies for VM in low- and lower-middle-income countries (LLMICs) remain understudied. The objective of this scoping review is to evaluate the current state of VM research in LLMICs. Methods: PubMed, Embase, and Web of Science databases were searched to execute a scoping review of VM. Keywords “vestibular diseases” and “vertigo” were used in combination with terms referring to LLMICs as defined by the World Bank. Title and abstract screening, full-text review, and data collection were conducted by two authors independently. Results: Twenty-six studies were included in the scoping review. Most studies were cross-sectional (57.7%) or case studies/series (23.1%) and were conducted in urban settings only (92.3%). Geographic distribution of studies was skewed, with 65.4% of articles originating from India. The prevalence of VM among clinic patients ranged from 0.3% to 33.3%. VM most frequently presented as headache, nausea and vomiting, and photophobia. Radiographic imaging, audiometry, and electronystagmography/videonystagmography were the three most commonly utilized diagnostic modalities in the dizziness workup. The most studied pharmacotherapies included calcium channel blockers, followed by beta-blockers and antiepileptics. Case studies and series discussed less common VM pharmacotherapies, such as ayurvedic medicine. Conclusions: There is a need for more VM research in LLMICs, including innovative diagnostic approaches and therapies that can improve VM care globally. Equitable partnerships between LLMIC and high-income country researchers must expand vestibular research capacity and productivity in LLMICs.

Background: Oseltamivir has been used as adjunctive therapy in the management of patients with COVID-19. However, the evidence about using oseltamivir in critically ill patients with severe COVID-19 remains scarce. This study aims to evaluate the effectiveness and safety of oseltamivir in critically ill patients with COVID-19. Methods: This multicenter, retrospective cohort study includes critically ill adult patients with COVID-19 admitted to the intensive care unit (ICU). Patients were categorized into two groups based on oseltamivir use within 48 hours of ICU admission (Oseltamivir vs. Control). The primary endpoint was viral load clearance. Results: A total of 226 patients were matched into two groups based on their propensity score. The time to COVID-19 viral load clearance was shorter in patients who received oseltamivir (11 vs. 16 days, p = 0.042; beta coefficient: −0.84, 95%CI: (−1.33, 0.34), p = 0.0009). Mechanical ventilation (MV) duration was also shorter in patients who received oseltamivir (6.5 vs. 8.5 days, p = 0.02; beta coefficient: −0.27, 95% CI: [−0.55,0.02], P = 0.06). In addition, patients who received oseltamivir had lower odds of hospital/ventilator-acquired pneumonia (OR:0.49, 95% CI:(0.283,0.861), p = 0.01). On the other hand, there were no significant differences between the groups in the 30-day and in-hospital mortality. Conclusion: Oseltamivir was associated with faster viral clearance and shorter MV duration without safety concerns in critically ill COVID-19 patients.

Abstract The quality of olive fruit (OF) is widely affected due to geographical variation, affecting OF's chemical composition and biological properties. It is a novel and first-time study to evaluate the quality variation of 42 olive samples from different geographical origins based on phytochemical profile and their biological activities. The study reports the presence of unique chemical markers responsible for the difference in quality and biological activity of the olive samples. Biological activity (cytotoxic and antimicrobial) with GCMS phytochemical profile was evaluated. GCMS analysis confirmed the presence of 111 volatile compounds from various chemical classes with range (%) and average (%): esters (21.61–60.49) and 44.62, alcohols (20.73–49.2) and 38.06, hydrocarbons (3–38.88) and 15.39, ketones (0.16–3.87) and 0.75, acids (0.07–2.62) and 0.27, and aldehydes (0.12–1.47) and 0.45. The predominant ester was 13-methyl-pentadecanoic acid methyl ester, a differentiation marker between these samples. Cytotoxicity assay showed a significant inhibitory effect against MCF7 (8–64%) and HCT116 (0.11–44%) cell lines, whereas the extracts with the highest cytotoxicity observed were O17 (52.00 ± 2.00) and O25 (64.00 ± 4.88). The antimicrobial activity exhibited a range of zones of inhibition (mm) against P. aeruginosa (0.00–17.00), E. coli (0.00–15.00), S. aureus (0.00–13), and resistant S. aureus, i.e., MRSA (0.00–12.00). The extracts with the highest antimicrobial activity, i.e., O8 and O39 had identical MIC and MBC of 12.5 and 25 µg/ml against P. aeruginosa. In contrast, an MIC (50 and 25) and MBC (100 and 50) against E. coli were determined for O39 and O8. The statistical PCA and K-mean cluster analysis (P

BackgroundLung cancer is currently the most fatal form of cancer worldwide, ranking as the fourth most prevalent type in Saudi Arabia, particularly among males. This trend is expected to increase with growing population, lifestyle changes, and aging population. Understanding the awareness of the Saudi population regarding the risk factors and symptoms of lung cancer is necessary to attenuate the predicted increase in cases.MethodA cross-sectional, population-based survey was performed using a previously validated questionnaire (Lung CAM). Multiple linear regression analysis was used to assess variables associated with deficiency in knowledge and awareness of risk factors and symptoms of lung cancer.ResultsMajority of the 15,099 respondents were male (65%), aged between 18 and 30 years (53%), 50% of which were educated up to a bachelor’s degree level. Overall awareness of lung cancer signs and symptoms was 53%, with painful cough and coughing up blood being the best-known symptoms. Conversely, persistent shoulder pain (44%) and clubbing fingers (47%) were the least known lung cancer symptoms. Also, 60% of the respondents showed low confidence in identifying the signs and symptoms of lung cancer. The overall awareness of the risk factors for lung cancer development was 74%, with first-hand (74%) and second-hand (68%) smoking being the most known risk factors. However, only ≤ 62% know the other non-smoking risk factors. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital and employment status (p < 0.001).ConclusionPublic awareness of the risk factors and symptoms of lung cancer in Saudi Arabia is inadequate and heavily dependent on education and socio-economic status. Awareness can be improved through campaigns to raise awareness about other lesser-known lung cancer risk factors and symptoms.

Conclusion: The results clearly indicate that a high dosage of MPT showed antiobesity activity which was comparable to the same effects produced by the conventional drug orlistat.

Background: A substance that can affect DNA or chromosomes is defined as a genotoxin. DNA damage in a somatic cell may result in a somatic mutation (cancer). In contrast, damage to a germ cell (germline mutation) may result in a heritable changed characteristic.Omega-7 is a non-essential monounsaturated free fatty acid with anti-inflammatory, anti-obesity, and antidiabetic effects. Objectives: Evaluation of the possible protective effects of omega seven against methotrexate genotoxicity. Method: Two major equal groups were obtained from seventy mice, and five subgroups (each of seven) were created from these groups as follows: Group I received liquid paraffin orally for seven successive days. Group II: received liquid paraffin orally for seven successive days, followed by a single intraperitoneal dose of methotrexate (20 mg/kg) on the eighth day. Group III: received omega-7 (50mg/kg) orally for seven successive days, followed by a single intraperitoneal dose of methotrexate (20 mg/kg) on the eighth day. Group IV: received omega-7 (100mg/kg) orally for seven successive days, followed by a single intraperitoneal dose of methotrexate (20 mg/kg) on the eighth day. Group V: received omega-7 (100mg/kg) orally for seven successive days. The first major group was intraperitoneally injected with 1mg/kg colchicine, and then after two hours, all mice were killed by spinal dislocation. Bone marrow cells from the first major group were used to measure the mitotic index and chromosomal aberrations, and bone marrow cell of the second group was used to measure the appearance of the micronucleus. Statistical Package for Social Sciences (SPSS) and ANOVA test were used to compare groups. Results: Treatment of mice with omega-7 led to a significant decline in chromosomal aberration and micronucleus aberrance with a significant elevation of the mitotic index. Conclusion: Omega-7 has been shown to have a protective role against methotrexate genotoxicity. Received: April, 2023 Accepted: July, 2023 Published: Jan.2024

Background: Doxorubicin is considered one of the most effective anticancer drugs, yet it is use is limited by its side effect mediated by the generation of reactive oxygen species. Omega-7, an antioxidant has shown to have a cardioprotective effect. Aim of the study: evaluate a possible protective effect of omega-7 against doxorubicin-induced cardiotoxicity in male rats. Methods: twenty-eight male rats were divided into 4 groups (7 for each group). Group 1 (Negative control): healthy animals received normal saline orally as the vehicle for eight successive days and were sacrificed on day 9. Group 2 (positive control): animals that received a single dose of doxorubicin HCl (i.p 15mg/kg). Sacrificed the next day. Group 3: omega 7 was administered orally at a dose 100 mg/kg/day for eight days. On day 9, doxorubicin was administered IP (15mg/kg). Sacrificed on day 10. Group 4: omega 7 was administered orally at a dose 300 mg/kg/day for eight days. On day 9, doxorubicin was administered IP (15mg/kg) and sacrificed on day 10. Omega7 treatment started eight days before doxorubicin. The analysis was done on day 10. Results: In the present study, catalase, and glutathione peroxidase were significantly increased in the omega7 treated group when compared to the negative control group (p

The use of erythropoietin-stimulating agents (ESAs) as adjunctive therapy in critically ill patients with COVID-19 may have a potential benefit. This study aims to evaluate the effect of ESAs on the clinical outcomes of critically ill COVID-19 patients. A multicenter, retrospective cohort study was conducted from 01-03-2020 to 31-07-2021. We included adult patients who were ≥ 18 years old with a confirmed diagnosis of COVID-19 infection and admitted to intensive care units (ICUs). Patients were categorized depending on ESAs administration during their ICU stay. The primary endpoint was the length of stay; other endpoints were considered secondary. After propensity score matching (1:3), the overall included patients were 120. Among those, 30 patients received ESAs. A longer duration of ICU and hospital stay was observed in the ESA group (beta coefficient: 0.64; 95% CI: 0.31-0.97; P = < .01, beta coefficient: 0.41; 95% CI: 0.12-0.69; P = < .01, respectively). In addition, the ESA group's ventilator-free days (VFDs) were significantly shorter than the control group. Moreover, patients who received ESAs have higher odds of liver injury and infections during ICU stay than the control group. The use of ESAs in COVID-19 critically ill patients was associated with longer hospital and ICU stays, with no survival benefits but linked with lower VFDs.

Tocilizumab (TCZ) is recommended in patients with COVID-19 who require oxygen therapy or ventilatory support. Despite the wide use of TCZ, little is known about its safety and effectiveness in patients with COVID-19 and renal impairment. Therefore, this study evaluated the safety and effectiveness of TCZ in critically ill patients with COVID-19 and renal impairment. A multicenter retrospective cohort study included all adult COVID-19 patients with renal impairment (eGFR˂60 mL/min) admitted to the ICUs between March 2020 and July 2021. Patients were categorized into two groups based on TCZ use (Control vs. TCZ). The primary endpoint was the development of acute kidney injury (AKI) during ICU stay. We screened 1599 patients for eligibility; 394 patients were eligible, and 225 patients were included after PS matching (1:2 ratio); there were 75 TCZ-treated subjects and 150 controls. The rate of AKI was higher in the TCZ group compared with the control group (72.2% versus 57.4%; p = 0.03; OR: 1.83; 95% CI: 1.01, 3.34; p = 0.04). Additionally, the ICU length of stay was significantly longer in patients who received TCZ (17.5 days versus 12.5 days; p = 0.006, Beta coefficient: 0.30 days, 95% CI: 0.09, 0.50; p = 0.005). On the other hand, the 30-day and in-hospital mortality were lower in patients who received TCZ compared to the control group (HR: 0.45, 95% CI: 0.27, 0.73; p = 0.01 and HR: 0.63, 95% CI: 0.41, 0.96; p = 0.03, respectively). The use of TCZ in this population was associated with a statistically significantly higher rate of AKI while improving the overall survival on the other hand. Further research is needed to assess the risks and benefits of TCZ treatment in critically ill COVID-19 patients with renal impairment.

Due to the imbalance between their historic physical buildings and the requirements of its residents, heritage sites are subject to several urban pressures. However, the major potential for urban growth in such locations is in their historic assets.The purpose of this research is to provide an approach for conserving and enhancing urban history in a manner that is beneficial to the environment, society, culture, and economics. Heritage conservation is attempting to distinguish itself. This is due to the fact that conservation and sustainability objectives do not always coincide. The findings are based on research conducted in Mosul and a study of sustainable development's concepts and pillars. With the use of UNDP reports, the present condition in Mosul was determined. The results demonstrate the need of devising a strategy to safeguard historic cities while allowing residents to continue to reside there. This plan should include objectives, strategies, and instruments to ensure that the “historic living city” can adapt and evolve in accordance with the sustainable development principles and the sustainability cycles.The paper uses an inductive methodology to apply sustainable development to historic city centers worldwide.

In this article, jar and alum technologies were used as treatment materials. Similar synthetic models have been prepared for wastewater from dairy products. The chemical treatment was performed using the jar inspection method. The laboratory temperature, which was between 20-25 degrees Celsius, is a reference in completing the experiments. Experiments have shown that alum can remove phosphorous by up to 95% according to parameters such as the speed of rotation of the oar and the temperature reached in the research. The value of velocity gradient (G) was 1076.915 sec.-1, which represents the potential energy that could make a better crash between particles to achieve an increase in particle size and then settle. This resulted in an optimum aluminum dose equal to 0.5 mg / L at 20 ± 2 ° C. The role of calcium ions in the removal of pollutants has been observed as a catalyst to complete the treatment process, however, it will reduce the aluminum ion concentration necessary to achieve the treatment, it is not possible to risk adding salts over the salinity of water sources to achieve the treatment.

Duration, cost, and resources are defined as project constraints. Consequently, in each project, one of these constraints is received attention compared with another. Thus, the abilities of construction project manager should include balancing these constraints in a way that all the project objectives are fulfilled. Achieving this balance is conducted by determining the best alternative for each activity, while minimizing project total cost and duration and satisfies resources constraints as well as smoothing resource histograms. For that purpose, this study aims at optimizing project schedule to provide this balance by using multi construction methods which is mainly based on multiskilling strategy. As will be discussed, to achieve this goal, a model was developed and genetic algorithm is used to preform optimization. This study contributes to the body of knowledge a model able to produce schedules with appropriate project duration, cost, and quality, also satisfy resource constraints with most leveled histograms.

Despite the polymer industry's reliance on nylon polymers, numerous questions remain about their crystal structures, modeling, and other features. This work discusses the thermodynamic properties and molecular modeling of a polyamides nylon 66α, 610α, and 77γ crystal structure systems for use in various electronics and Nano-devices that feature distinct properties such as exceptional optoelectronic properties at a low cost compared to other structures. This study looked at the crystal structure of a linear polyamide chain made up of repeating units. The influence of the thermal expansion coefficient and thermodynamic parameters on crystal structures' characteristics at different temperatures has previously been explored. The findings of this study demonstrate, on the one hand, the influence of the amorphous phase on the final thermodynamic characteristics of semi-crystalline polymers and, on the other hand, pave the way for greater improvement in the durability of these polymers by increasing their crystalline features. The values of the thermodynamic parameters for nylon 66α, 610α and 77γ such as enthalpy (ΔHExp.) were 35.08, 40.25, and 1.44 kJ/mol, entropy (ΔSExp.) 113.75, 128.84, and 15.10 J/mol-K, free energy (ΔGExp.) was −44.57, −46.62, and −6.86 kJ/mol, respectively. When the nylon data is compared, the nylon 610α exhibits a significantly higher free energy, at high temperatures, the process is spontaneous and exergonic, making it a potentially viable material for use as fibers and engineering thermoplastics.

Background: Hypertension plays a critical role as a risk factor for cardiovascular mortality, encompassing conditions like coronary artery disease, organ damage, congestive heart failure, and cerebrovascular diseases. Furthermore, hypertension can lead to increased oxidation and peroxidation reactions due to elevated blood pressure and blood flow. Objective: This study aimed to evaluate the levels of superoxide dismutase in the sera of patients diagnosed with hypertension. Materials and Methods: The study involved 60 hypertensive patients who exhibited no significant abnormalities, such as liver disease, cardiomyopathy, renal disease, diabetes mellitus, congestive heart failure, or thyroid disease. Additionally, 25 healthy individuals, matched by age and sex to the patient group, were included in the study. The age range of the participants was between 32 and 70 years. The level of superoxide dismutase 1 in the sera was measured using an enzyme-linked immunosorbent assay (ELISA). Results: The results demonstrated a significant increase in the activity level of superoxide dismutase in hypertensive patients (732.91 ± 82.68 pg/ml) compared to the control group (590.63 ± 47.69 pg/ml). Conclusion: These findings have the potential to contribute to the diagnosis and management of hypertension, offering insights into the role of superoxide dismutase activity in the disease process.

The aim of the study was extraction of arial part of Euphorbia cyathophora constituents with methanol and evaluate its effect on mitotic index and total chromosomal aberration bone marrow cell and spleen cell in mice 200 gm of E. cyathophora fine powder was defatted then extracted by cold maceration 80% ethanol for seven days. The extract was filtered and dried in a rotary evaporator then the dried extract was suspended with water and consecutively extracted using chloroform, ethyl acetate for each. The aqueous layer was then mixed with 100ml methanol. These fractions are dried under reduced pressure to obtain the dry extract. Twenty-four Albino mice were used for the experiment. The animals were divided into four groups: Group 1: Mice were treated with distilled water. The dose was given daily for seven successive days. Group 2: Mice were treated with a single dose (20mg/kg) of methotrexate (positive control). Group 3: Mice were treated with (100mg/kg) of menthol fraction for seven successive days. Group 4: Mice were treated with (200mg/kg) of methanol fraction for seven successive days. Mice were sacrificed by (spinal dislocation). Samples of bone marrow cells and spleen cells were taken and genotoxic analyses. Methanol fraction of Euphorbia cyathophora at a dose of 100mg/kg demonstrated a significant decrease in mitotic index and a significant increase in total chromosomal aberrations as compared to distilled water in both bone marrow cells and spleen cells (p

Leadership is about having the capacity to make a vision a reality. In the context of transformational leadership, this study examines creative behavior as a key factor in Pakistan’s IT sector. Examining the relationship between transformational leadership and innovative behavior is the main goal of this study. While transformational leadership affects people because it inspires them, fosters morale, and boosts productivity. A moderated mediation model based on social cognitive theory was provided in this study. In contrast, the functions of mediation and moderation were played by knowledge sharing, organizational identification, and learning goal orientation. In this cross-sectional study, we implemented the convenience sample method and gathered 391 valid responses from the IT sector. Using the use of AMOS 26 and SPSS 23, the authors measured the latent variables and discussed their connection using a descriptive and correlational approach. The findings showed that transformational leadership has a favorable and substantial impact on innovative behavior. As a result, the mediation of knowledge exchange unites innovative behavior with transformational leadership. When two moderators’ organizational identification and learning goal orientation are effective, knowledge sharing mediates transformational leadership and innovative behavior. By highlighting the mediating function of knowledge sharing in promoting particular traits of innovative behavior, this research has broadened the scope of social cognition theory.

Abstract Background Previous studies have shown that non-critically ill COVID-19 patients co-infected with other respiratory viruses have poor clinical outcomes. However, limited studies focused on this co-infections in critically ill patients. This study aims to evaluate the clinical outcomes of critically ill patients infected with COVID-19 and co-infected by other respiratory viruses. Methods A multicenter retrospective cohort study was conducted for all adult patients with COVID-19 who were hospitalized in the ICUs between March, 2020 and July, 2021. Eligible patients were sub-categorized into two groups based on simultaneous co-infection with other respiratory viruses throughout their ICU stay. Influenza A or B, Human Adenovirus (AdV), Human Coronavirus (i.e., 229E, HKU1, NL63, or OC43), Human Metapneumovirus, Human Rhinovirus/Enterovirus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Parainfluenza virus, and Respiratory Syncytial Virus (RSV) were among the respiratory viral infections screened. Patients were followed until discharge from the hospital or in-hospital death. Results A total of 836 patients were included in the final analysis. Eleven patients (1.3%) were infected concomitantly with other respiratory viruses. Rhinovirus/Enterovirus (38.5%) was the most commonly reported co-infection. No difference was observed between the two groups regarding the 30-day mortality (HR 0.39, 95% CI 0.13, 1.20; p = 0.10). The in-hospital mortality was significantly lower among co-infected patients with other respiratory viruses compared with patients who were infected with COVID-19 alone (HR 0.32 95% CI 0.10, 0.97; p = 0.04). Patients concomitantly infected with other respiratory viruses had longer median mechanical ventilation (MV) duration and hospital length of stay (LOS). Conclusion Critically ill patients with COVID-19 who were concomitantly infected with other respiratory viruses had comparable 30-day mortality to those not concomitantly infected. Further proactive testing and care may be required in the case of co-infection with respiratory viruses and COVID-19. The results of our study need to be confirmed by larger studies.

BACKGROUND: Mental stigma occurs when patients with various mental disorders are labeled by their disorders. Little is known about the burden of mental stigma on patients with mental disorders. The aim of this study was to evaluate the incidence of mental stigma on patients with psychiatric disorder in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted among previously diagnosed patients with any psychiatric disorder attending King Khalid Hospital, Abha, Saudi Arabia. The patients were interviewed with a sociodemographic questionnaire and a validated Arabic version of the Internalized Stigma of Mental Illness (ISMI-29) scale. Chi-square test and t-test were used to assess the association between various demographic characteristics and presence of stigma. RESULTS: The study included 489 patients with different psychiatric disorders. The mean age of the participants was 32.8 years and 54.6% were females. About 39% participants showed no to minimal internalized stigma, 37.4% of total sample had mild stigma, 20% had moderate stigma, and 3.7% had severe stigma. A signficantly higher proportion (71.4%) of widowed patients had stigma (P = 0.032). CONCLUSION: Self-stigma is prevalent among patients with psychiatric disorders in Abha, Saudi Arabia, but lower than the prevalence in developing countries. Marital status has a significant impact on the prevalence and severity of the self-stigma of patients. There is a need for awareness program to reduce self-stigma. Psychiatric institutions should also focus on promotion of patients' social life and increase patient's awareness of certain issues that could prevent stigma.

The development of antipodal Vivaldi antenna with a fractal slot is presented in this paper due to its promising application as an element of possible multisensory systems of head stroke imaging. The fractal slot is applied to improve the directivity, bandwidth and gain of the antenna. Hence, this research mainly aims to create and optimise a compact Vivaldi antenna through the fractal slot for the detection of stroke in the human head. The antenna is designed with an overall dimension of $65\times 65\times1.6$ mm3 using Roger RO4350B as a substrate through the CST Studio Suite 2019 software. The proposed antenna will also be compared with an antipodal Vivaldi antenna without the fractal slot to observe differences in the result. The proposed antenna can produce a wide bandwidth of 1.44 GHz ranging from 2.35 GHz to 3.79 GHz at the maximum gain of 7.35 dBi. Furthermore, the prototype antenna has a directivity characteristic, which produces the unidirectional radiation necessary for microwave imaging procedures. The proposed antenna is also evaluated with the CST studio head model, thus providing satisfactory penetration results through the head tissue. A value of 0.0013 W/kg per 10 g is achieved for the maximum SAR. Thus, the proposed antenna met most of the requirements for the imaging process, which will affect its effectiveness during scanning of head stroke.

Abstract Background During the COVID-19 vaccination, the access to vaccines has been unequal among countries and individuals, for example low-income countries displayed significant low levels of vaccination. Furthermore, most refugees are living in developing low-income countries which struggling to access the essential health-care services including vaccination. Thus, the objective of this study was to assess the experiences and perceptions of COVID-19 infection and vaccination among Palestine refugees in Jerash camp compared to resident Jordanian citizens. Methods A face-to-face interview-based comparative cross-sectional study was carried out among Palestine refugees in Jerash camp located in northern Jordan and Jordanian citizens from different cities in Jordan from October, 2021 to March, 2022. A Chi-square test was used to determine the differences in the experiences and perceptions of COVID-19 infection and vaccination between Palestinian refugees and resident Jordanian citizens. Logistic regression analysis was performed to predict factors associated with the beliefs, barriers and hesitancy towards COVID-19 vaccines. Results The total number of participants was 992, with 501 (50.5%) Palestinian refugees and 491 (49.5%) Jordanian citizens. Most participants (64.1%) who have never been tested for COVID-19 were from the refugees (P

Abstract Background Thrombotic events are common in critically ill patients with COVID-19 and have been linked with COVID-19- induced hyperinflammatory state. In addition to anticoagulant effects, heparin and its derivatives have various anti-inflammatory and immunomodulatory properties that may affect patient outcomes. This study compared the effectiveness and safety of prophylactic standard-doses of enoxaparin and unfractionated heparin (UFH) in critically ill patients with COVID-19. Methods A multicenter, retrospective cohort study included critically ill adult patients with COVID-19 admitted to the ICU between March 2020 and July 2021. Patients were categorized into two groups based on the type of pharmacological VTE thromboprophylaxis given in fixed doses (Enoxaparin 40 mg SQ every 24 hours versus UFH 5000 Units SQ every 8 hours) throughout their ICU stay. The primary endpoint was all cases of thrombosis. Other endpoints were considered secondary. Propensity score (PS) matching was used to match patients (1:1 ratio) between the two groups based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analysis were used as appropriate. Results A total of 306 patients were eligible based on the eligibility criteria; 130 patients were included after PS matching (1:1 ratio). Patients who received UFH compared to enoxaparin had higher all thrombosis events at crude analysis (18.3% vs. 4.6%; p-value = 0.02 as well in logistic regression analysis (OR: 4.10 (1.05, 15.93); p-value = 0.04). Although there were no significant differences in all bleeding cases and major bleeding between the two groups (OR: 0.40 (0.07, 2.29); p-value = 0.31 and OR: 1.10 (0.14, 8.56); p-value = 0.93, respectively); however, blood transfusion requirement was higher in the UFH group but did not reach statistical significance (OR: 2.98 (0.85, 10.39); p-value = 0.09). The 30-day and in-hospital mortality were similar between the two groups at Cox hazards regression analysis. In contrast, hospital LOS was longer in the UFH group; however, it did not reach the statistically significant difference (beta coefficient: 0.22; 95% CI: -0.03, 0.48; p-value = 0.09). Conclusion Prophylactic enoxaparin use in critically ill patients with COVID-19 may significantly reduce all thrombosis cases with similar bleeding risk compared to UFH.

The cyclic voltammetry method was preliminarily used to study the reversibility nature of the electrochemical behaviour of budesonide (BDN) compound. The square wave-adsorptive stripping voltammetry (SW-AdSV) technique was applied to evaluate an electrochemical reduction of BDN in the phosphate buffer pH 2.5. The ultra-trace graphite working electrode was used to accumulate BDN onto its surface. An SW-AdSV reduction peak was observed in the potential of −0.98 V using Ag/AgCl reference electrode and Pt auxiliary electrode. Different parameters ,such as pH, buffer solutions, accumulations time and potential, frequency, amplitude and scan were investigated, and convection rates parameters were studied to acquire a high reduction response. The repeatability, stability, recovery, calibration curve and limit of detection and quantification parameters were studied to evaluate the analytical performance of the SW-AdSV technique. Repeatability and stability were monitored for 20 µM of BDN to give a 0.29% relative standard deviation (RSD%) that was achieved for five measurements and a very stable current for 120 min. The linearity was evaluated by studying the calibration curve over the range of 2 –25 µM (n = 8), given a linear relation between BDN concentrations and SW-AdSV signals. The limits of detection (LOD) and quantification (LOQ) were calculated to become 40 nM (0.017 ppm) and 0.134 µM (0.0577 ppm), respectively. The developed and validated method was successfully applied to the electrochemical study of BDN in pharmaceuticals and biological fluids.

Abstract Background Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. Methods This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. Results A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO2, FiO2 requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). Conclusion In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs.

Abstract The COVID‐19 pandemic coincided with an equally‐threatening scamdemic: a global epidemic of scams and frauds. The unprecedented cybersecurity concerns emerged during the pandemic sparked a torrent of research to investigate cyber‐attacks and to propose solutions and countermeasures. Within the scamdemic, phishing was by far the most frequent type of attack. This survey paper reviews, summarises, compares and critically discusses 54 scientific studies and many reports by governmental bodies, security firms and the grey literature that investigated phishing attacks during COVID‐19, or that proposed countermeasures against them. Our analysis identifies the main characteristics of the attacks and the main scientific trends for defending against them, thus highlighting current scientific challenges and promising avenues for future research and experimentation.

ABSTRACT: Objectives: Evidence supports tocilizumab (TCZ) benefit and safety in adult patients with severe COVID-19. However, its effectiveness in critically ill older adult patients remains questionable. Thus, the study aimed to evaluate the safety and effectiveness of TCZ in older critically ill patients with COVID-19. Methods: A multicenter, retrospective study for all critically ill older adults (aged ≥65 years) with confirmed COVID-19 infection and admitted to the intensive care units (ICUs). Eligible patients were categorized into two groups based on TCZ use during ICU stay (control vs TCZ). Propensity score (PS) matching was used (1:1 ratio) based on the selected criteria. The primary outcome was the in-hospital mortality. Results: A total of 368 critically ill older adult patients were included in the study. Fifty one patients (13.8%) received TCZ. The in-hospital mortality was lower in the TCZ group (HR 0.41; 95% CI 0.22–0.76, P-value = 0.005). Patients who received TCZ had lower odds of respiratory failure requiring mechanical ventilation (OR [95% CI]: 0.32 [0.10–0.98], P-value = 0.04). No statistically significant differences were found between the two groups for 30-days mortality, ventilator-free days, length of stay, and complications during ICU stay. Conclusion: Tocilizumab use in critically ill older adult patients with COVID-19 is associated with lower in-hospital mortality and a similar safety profile.