Search

Shukri Said Mohamed,1 Adem Küçük,2 Omar Adam Sheikh,3 Ahmet SARAÇ,4 Mesut Kayse Adam,1 Ismail Gedi Ibrahim,5 Marian Muse Osman,6 Naima Abukar Ali,7 Abdirahman Ahmed Mohamud8 1Department of Pediatric Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; 2Düzce Atatürk Devlet Hastanesi, Düzce, Turkey; 3Faculty of Medicine, Department of Basic Medical Science, Somali National University, Mogadishu, Somalia; 4Department of Pediatric Surgery, Samsun Training and Research Hospital, Samsung, Turkey; 5Department of Radiology, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; 6Department of Public Health, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; 7Department of Pediatric, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia; 8Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Shukri Said Mohamed, Email sagalsaid2@gmail.comBackground: Birth defects of the digestive system are a phenotypically and etiologically different category common birth defects caused by various causes during fetal development.Objective: The study’s goal was to evaluate patient demographics, related abnormalities, atresia location, operational management, postoperative care, and results of patients with gastrointestinal atresia and compare them with other research.Methods: A 5-year retrospective study in cases with gastrointestinal atresia at a tertiary hospital in Mogadishu, Somalia, was carried out by the pediatric surgery department from January 2017 to January 2022.Results: A165 cases were operated due to gastrointestinal atresia in five-year period., 105 were male (63.6%) and 60 were female (36.4%), giving the male to female ratio of 1.75:1. According to the age group of the study population, the majority of cases (48.5%) were aged less than 1 month. The esophageal atresia, duodenal atresia, high jejunal atresia, jejunoileal atresia, and colon atresia, anorectal malformations were 9.7%, 9.1%, 0.6%, 7.3%, 73.3%, respectively; the anorectal malformations has resulted in the majority of cases (73.3%). 20 % of cases had no follow-up, while 80% arrived as planned. 52.1% got well and had no complications and some developed different complications like peristomal skin irritation (14%), rectal and urethral fistula (4.8%), rectal prolapse (1.8%), rectal stenosis (2.4%), rectal adhesions (1.2%), esophageal stricture (1.2%), wound infection (3.6%), anastomosis dehiscence (0.6%), abdominal distension (0.6%), recto-perineal fistula (1.2%), urethral damage and urinary retention (0.6%). Mortality for this study was 24.8% (41 patients).Conclusion: Children with gastrointestinal atresia present late in the course of their illness, with substantial morbidity and death due to poor economic conditions, poor nutrition, surgical problems, and likely related anomalies, rather than surgical morbidity alone.Keywords: birth defects, fetal development, digestive system, intestinal obstruction

Farah Abdullahi Ismail,1 Yasir Khalif Ali,1 Ahmed Mohamed Ali,2 Ibrahim Mohamed Hirsi,1 Naima Abukar Ali,1 Mohamed Mukhtar Kassim,1 Farah Ali Ahmed,1 Mohamed Nur Ali1 1Pediatric Department of Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 2Department of Infectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Farah Abdullahi Ismail; Ahmed Mohamed Ali, Email Farahbucul96@gmail.com; ahmedorey22@gmail.comAbstract: Congenital rubella syndrome (CRS) is a serious condition with a high rate of morbidity. It is currently a rare disorder, especially in developed countries, because of universal vaccination campaigns. However, it remains a public health concern in developing countries. Here, we report a case of congenital rubella syndrome in a mother who did not receive any prenatal care or had a known history of vaccination. He is a term male infant, and the infant’s positive rubella IgM confirmed the diagnosis. The baby had a bilateral cataract, convulsions, Patent ductus arteriosus (PDA)-related cardiomegaly, and bilateral hearing loss. The only known preventive measure for congenital rubella syndrome is vaccination.Keywords: congenital rubella syndrome, vaccine, prenatal care

Abstract A future in which scientific discoveries are valued and trusted by the general public cannot be achieved without greater inclusion and participation of diverse communities. To envision a path towards this future, in January 2019 a diverse group of researchers, educators, students, and administrators gathered to hear and share personal perspectives on equity, diversity, and inclusion (EDI) in the plant sciences. From these broad perspectives, the group developed strategies and identified tactics to facilitate and support EDI within and beyond the plant science community. The workshop leveraged scenario planning and the richness of its participants to develop recommendations aimed at promoting systemic change at the institutional level through the actions of scientific societies, universities, and individuals and through new funding models to support research and training. While these initiatives were formulated specifically for the plant science community, they can also serve as a model to advance EDI in other disciplines. The proposed actions are thematically broad, integrating into discovery, applied and translational science, requiring and embracing multidisciplinarity, and giving voice to previously unheard perspectives. We offer a vision of barrier‐free access to participation in science, and a plant science community that reflects the diversity of our rapidly changing nation, and supports and invests in the training and well‐being of all its members. The relevance and robustness of our recommendations has been tested by dramatic and global events since the workshop. The time to act upon them is now.

Naeem A Ali1, David Gutteridge2, Sajid Shahul3, William Checkley4, Jonathan Sevransky4, Greg S Martin2 1The Ohio State University Medical Center, Columbus, OH; 2Emory University, Atlanta, GA; 3Beth Israel Deaconess Medical Center, Boston, MA; 4Johns Hopkins University, Baltimore, MD, USA Abstract: Individual intensive care unit (ICU) characteristics including staffing, expertise, continuity, and team structure, have been associated with patient outcomes. Separately, some aspects of care in ICUs have been implemented through treatment protocols. The United States Critical Illness and Injury Trials Group-Critical Illness Outcomes Study (USCIITG-CIOS) was designed to determine whether the extent of protocol use in ICUs is associated with hospital survival in a large number of US ICUs. Here, we describe the study protocol and analysis plan approved by the USCIITG-CIOS steering committee. USCIITG-CIOS is a prospective, observational, ecological, multicentered study of mixed ICUs in the US. The data to be collected include organizational information for the ICU (eg, protocol availability and utilization, multidisciplinary staffing assessment), and patient level information (eg, demographics, acute and chronic medical conditions). The primary outcome is all-cause hospital mortality, with the objective being to determine whether there is an association between protocol number and hospital mortality for ICU patients. USCIITG-CIOS is powered to detect a 3% difference in crude hospital mortality between high-protocol and low-protocol use ICUs, dichotomized according to protocol number at the median. The analysis will utilize multivariable regression approaches to adjust for outcome clustering by ICU, with secondary linear analysis of protocol number and mortality and a variety of a priori planned ancillary studies. We anticipate at least 60 ICUs participating in USCIITG-CIOS to enroll approximately 6000 study subjects. USCIITG-CIOS is a multicenter study examining the effect of ICU protocols on patient outcomes. These results will inform our understanding of the relationship between protocol availability, use, and patient outcomes in the ICU. Given the shortage of intensivists worldwide, the results of USCIITG-CIOS can be used to promote more effective and reproducible ICU care and outcomes. Keywords: intensive care, critical care, outcomes, protocols, organization

As English is one of the most spoken languages in the globally interconnected world of today, many Saudi universities are enrolling their EFL students in summer intensive English programs at US universities. The main purpose is to enhance their EFL students' oral competencies. This new policy is, in fact, the result of the failure of CLT practices in local universities (Liao, 2004; Nunan, 2003), large EFL classes and students' low proficiency (Yu, 2001; Li, 1998) and EFL teachers' preference for using traditional methods rather than communicative ones (Chowdhry, 2010; Littlewood, 2007). However, Saudi students, upon arrival to the US, encounter challenging communicative situations. The present study, therefore, advocates the implementation of four-week language software program in Jazan University prior to the later four-week language program in US universities. The aim is to prepare EFL Saudi students for the communicative and academic situations and cultural norm they would be encountering and experiencing in the USA. The project includes two modalities; online learning and in class learning. The online learning entails a language software content-based program with emphasis on listening, vocabulary, writing, grammar and reading skills. The in-class learning includes only speaking activities that are paralleled and compatible to the online thematic content. Thus, the main focus of the present paper will primarily be directed to providing a detailed description of the online language software and the different elements involved in constituting it.

Abstract Xeroderma Pigmentosum C is a dermal hereditary disease caused by a mutation in the DNA damage recognition protein XPC that belongs to the Nucleotide excision repair pathway. XPC patients display heightened sensitivity to light and an inability to mend DNA damage caused by UV radiation, resulting in the accumulation of lesions that can transform into mutations and eventually lead to cancer. To address this issue, we conducted a screening of siRNAs targeting human kinases, given their involvement in various DNA repair pathways, aiming to restore normal cellular behavior. We introduced this siRNA library into both normal and XPC patient-derived fibroblasts, followed by UVB exposure to induce DNA damage. We assessed the reversal of the XPC phenotype by measuring reduced photosensitivity and enhanced DNA repair. Among the 1292 kinase-targeting siRNAs screened, twenty-eight showed significant improvement in cellular survival compared to cells transfected with non-targeting siRNA after UV exposure in XPC cells. From these candidates, PIK3C3 and LATS1 were identified as particularly effective, promoting over 20% repair of 6-4 photoproduct (6-4PP) DNA lesions. Specifically targeting the autophagy-related protein PIK3C3 alone demonstrated remarkable photoprotective effects in XPC-affected cells, which were validated in primary XPC patient fibroblasts and CRISPR-Cas9 engineered XPC knockout keratinocytes. PIK3C3 knock down in XP-C cells ameliorated in UVB dose response analysis, decreased apoptosis with no effect on proliferation. More importantly, PIK3C3 knock down was found to induce an increase in UVRAG expression, a previously reported cDNA conveying lower photosensitivity in XP-C cells. Thus, attempts to improve the XPC photosensitive and deficient repair phenotype using PIK3C3 inhibitors could pave a way for new therapeutic approaches delaying or preventing tumor initiation.

Abstract Women’s career progression and empowerment in STEM (science, technology, engineering, and mathematics) sectors are critical to attaining SDG 5: Gender Equality because they promote equal access to education, job prospects, and leadership roles, building a more inclusive and equitable society. The purpose of this study is to look into the impact of perceived overqualification (POQ) on career anxiety and career decidedness (CD) among women in STEM disciplines while also considering the function of career identity (CI) and leadership support. With a total sample size of 1,045 participants, two distinct investigations were conducted, one in the educational field (N = 530) and one in an industry setting (N = 515 time-lag). To test the model, the analysis was carried out using the AMOS-24 software program. Our findings show a favorable association between women’s perceptions of overqualification in STEM and their CI. Furthermore, our research shows that a stronger CI among women in STEM corresponds to decreased career anxiety and increased CD. Additionally, we find that a CI is a mediator between POQ and both career anxiety and CD. Our findings also highlight the moderating effect of leadership support in this mediation process. We discuss the theoretical and practical ramifications of these findings.

Abstract This paper presents a new structure of a high step‐up DC–DC converter. The proposed converter has one input and two outputs with different voltage levels, suitable for applications that require multiple voltage levels such as photovoltaic systems, electric vehicles and DC microgrids. The proposed converter is expandable to more outputs and has a higher voltage conversion ratio compared to similar converters. The operational modes of the proposed converter are investigated and the conversion ratio of the converter is obtained. Additionally, small‐signal equations of the converter are derived, and using state‐space matrices, transfer functions of the converter are obtained and the controller is designed. Also, the proposed converter is compared with similar converters and power losses equations of the converter are derived. To investigate the converter's performance, simulations are done using MATLAB/Simulink software. Moreover, to validate the theoretical analysis, a laboratory prototype is implemented. The obtained results confirm the operation of the proposed converter.

The aim of this study is to examine the entropy generation (EG) associated with the transfer of mass and heat in a concentration-dependent fluid with thermal radiation and activation energy, specifically in the context of an unsteady Riga Plate with gyrotactic microorganism. It is important to solve the ordinary differential equations generated from the controlling partial differential equations using Lie symmetry scaling to verify their quality and reliability. The system’s anticipated physical behavior is compared to Mathematica’s Runge–Kutta–Fehlberg numerical solution. Source parameters are essential for validation since they offer accurate results. Methodically change these values as a percentage to determine how they affect the unsteady fluid’s density, mass, and heat transfer over the Riga plate. Velocity, temperature, nanoparticle concentration and microorganism concentration profiles decrease with varying values of the unsteadiness parameter. EG increases with increasing values of concentration difference, thermal radiation, and Reynold number parameters. The Nusselt number experiences a 26.11% rise as a result of radiation when the unsteadiness parameter is A=−0.25A=-0.25, in comparison with the scenario without radiation. Mass transfer upsurges with increasing values of the Brownian motion parameter and reduces with increasing values of thermophoresis parameter. To verify our conclusions, we compare calculated data, specifically the skin friction factor, to theoretical predictions. Tabular and graphical data can show how physical limits affect flow characteristics.

Abstract We aimed to look at the potential relationship between patterns of protein intake and risk of death in adults with type 2 diabetes. We included 4646 adults with type 2 diabetes participating in NHANES (1999–2018). We estimated intake of proteins from 11 animal- and plant-based food groups and then, used principal component analysis to explore data-driven patterns of protein intake. All-cause mortality was ascertained through linkage to National Death Index until December 31, 2019 (n = 969 deaths). Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Four dietary protein patterns were identified: “healthy” (high in proteins from legumes, fruits, nuts, seeds, and fish and low in red meat protein), “red meat and egg” (high in red meat and egg proteins and low in fish and poultry proteins), “vegetables/fish” and “dairy/nuts” patterns. The HRs of all-cause mortality for the highest compared to the lowest quartile of “healthy” and “red meat and egg” protein patterns were, respectively, 0.77 (95%CI: 0.62, 0.97; Ptrend = 0.014) and 1.28 (95%CI: 1.06, 1.54; Ptrend = 0.033). Greater adherence to a healthy protein pattern may be associated with a reduced risk of death in patients with type 2 diabetes, while greater adherence to a dietary pattern rich in red meat and egg proteins and low in fish and poultry proteins may be associated with a higher risk.

Abstract Background Postpartum hemorrhage is a preventable cause of maternal mortality all over the world and a significant contributor to post-traumatic stress among women. Methods This quasi-experimental study was conducted in 2023 on 60 primiparous women with postpartum hemorrhage in Zahedan, Iran. The participants were identified and randomly assigned to two groups. The intervention group received face-to-face individual counseling based on Gamble’s counseling model, conducted by a midwife. The counseling lasted from 40 to 60 min and took place over two sessions; one within the first 48 to 72 h in the ward, and a follow-up telephone session two weeks postpartum. Assessments were made using the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) and the Perinatal Post-Traumatic Stress Disorder Questionnaire-II (PPQ-II) before the intervention and four weeks after the last post-test session for the two groups, either in person or by phone. Results Following the intervention, the post-traumatic stress score (PCL-5) in the intervention group significantly decreased compared to the control group (P

Background: Hypertension (HTN), a major public health concern, poses a significant burden on healthcare systems worldwide. One of the objectives of the Iranian national blood pressure (BP) measurement campaign (INBPMC) executed in 2019-2020, was the detection of hypertensive patients who were unaware of their disease. This study investigated the effectiveness of the program in the Southeast and East of Iran. Methods: In a cross-sectional analytical study, we collected the required data from 936 individuals participating in the INBPMC, using the cluster sampling method. People over 30 years old, without neuropsychiatric or sensorimotor disorder, with at least four years of education were included. The required data were collected through a checklist. Results: The Mean±SD age of the participants was 45.5±12.77 years, with 62.1% of the participants being male. The prevalence of HTN in this study was 36.2%, of which 16.2% were newly diagnosed. Among those previously diagnosed, 59 individuals (31.5%) had uncontrolled HTN. The Mean±SD age of the total hypertensive cases was 50.59±13.480 years, while the mean age of newly diagnosed cases was 43.39(11.246) years. There were significant associations between HTN and age (P

Abstract Over 50% of the original oil in place (OOIP) is immobile or trapped in the reservoir. Therefore, today, more efficient methods have been introduced in the tertiary oil recovery sector as a scheme of enhanced oil recovery (EOR). Due to the decline of conventional hydrocarbon reserves, polymers are increasingly used in EOR methods, such as surfactant-polymer (SP) and alkaline-surfactant-polymer (ASP) flooding. SP flooding has a complex formulation and design, leading to undesirable phase separation if improperly mixed. Polymeric surfactants are a promising alternative to SP flooding. They consist of hydrophobic groups attached to hydrophilic polymers, which help to improve the mobility ratio and reduce interfacial tension (IFT). This paper examines the rheological and synthesis properties of a new polymeric surfactant produced through bond co-polymerization reaction using different hydrolyzed polyacrylamide (HPAM) ratios and a zwitterion hydrophobic group. The synthesized hydrophobically modified zwitterionic polyacrylamide (HMZPAM) was characterized by FTIR and HMNR analysis. HMZPAM performed better than other substances in IFT, viscosity, wettability, oil recovery, and resistance to different one and two-valence cations. The results indicate that HPAM reduced the IFT to 13.65, while HMZPAM reduced it to 0.441 mN/m. Wettability change evaluated on a rock carbonate/crude oil/HMZPAM system that changed the water-wet state of the primary oil-wet rock carbonate to strongly water-wet state as wettability change measurements showed a decrease in contact angle from 62.76 to 21.23 degree. Comparative studies on the effectiveness of HPAM and HMZPAM were also conducted according to the measurement of viscosity and shear rate in the presence of salt, which indicates the higher shear rate and viscosity of HMZPAM. Core flooding tests revealed that HMZPAM resulted in better additional recovery due to microscopic displacement, resulting in a total oil recovery of 84%, compared to 48% of residual oil saturation for HPAM. Also, salts decreased oil recovery in HPAM injection but increased oil recovery in HMZPAM injection.

Abstract The significance of democratic commitment is highlighted on a global scale by the importance placed on offering a multitude of chances to establish enduring ecosystems and foster economic progress. Social finance, capital formation, and green finance have recently received a lot of attention from this perspective. Past studies mainly examined social finance and green finance in isolation. When investigating the individual impact of these important variables on economic growth in the occurrence of important events like the COVID-19 pandemic and other environmental pollution issues, most studies have mainly focused on developed countries, ultimately ignoring the different dynamics in emerging economies. The purpose of the research is to investigate the joint interaction between social finance (Social Impact Bonds), capital formation, and green finance (green loans, green investments, and green security) on economic development in BRICS economies. This research employed a longitudinal dataset from 2013 to 2023. The generalized method of moments (GMM) and fixed effect model (FEM) were employed in this research as statistical techniques for estimating parameters. The findings of this study revealed a positive joint relationship between green finance, capital formation, and social financing on economic development of BRICS economies. Therefore, measures that jointly promote social and green finance amidst environmental challenges or economic risks could present opportunities to mitigate the vulnerability of a country's economic prosperity. This research will surely guide policymakers in developing economies on how to give considerable attention to sustainable aspects while formulating policies and strategies aimed at economic development.

Abstract Background The operating room is a high-risk environment where proper patient positioning is crucial for minimizing injury and ensuring optimal access to surgical sites. This process requires effective collaboration among surgical team members, particularly operating room nurses who play a vital role in patient safety. Despite advancements in technology, challenges such as pressure injuries persist, with a significant incidence rate. Video-based training (VBT) emerges as a promising educational tool, enhancing knowledge retention and fostering a learner-centered approach. This study aims to evaluate the impact of VBT on adherence to surgical positioning standards, highlighting its potential to improve safety protocols in the operating room. Methods In this clinical trial, 62 qualified operating room nurses (50 women, 12 men, average age: 28.90 ± 3.75 years) were randomly divided into control and intervention group (n = 31 in each group). The control group only received positioning recommendations, but in the intervention group, in addition to the recommendations, video-based surgical positioning training was performed for 1 month, at least 3 times a week. The performance of nurses in both groups was evaluated through a researcher-made checklist at baseline and post-intervention. Results Based on findings, there was no significant difference between the two groups in compliance with surgical positioning standards at baseline (p = 0.07). However, after the intervention, compliance scores significantly improved in the VBT group compared to the control group (p

Abstract Exosomes which are membrane vesicles released by cells have gained significant interest in the field of cancer therapy as a novel means of intercellular communication. Their role in immune activation and their pathophysiological functions in cancer therapy have been recognized. Exosomes carry diverse bioactive components including proteins, mRNA, microRNAs, and bioactive lipids. These molecules have therapeutic potential in promoting tissue regeneration, supporting stem cell activity, preventing cell death, modulating immune responses, and promoting the growth of new blood vessels. However, the precise roles of exosomes derived from mesenchymal stem cells (MSCs) in the treatment of various cancers are still not fully understood. Consequently, cancer stem cells (CSCs) can self-renew and differentiate into various cell types. Understanding the mechanisms that sustain their persistence is crucial for developing effective therapies. Exosomes have recently gained interest as vehicles for intercellular communication between CSCs and non-CSCs, influencing cancer progression and the microenvironment. Research is ongoing on the utilization of exosomes derived from cancer stem cells (CSC-Exosome) for cancer treatment. The composition of extracellular vesicles is influenced by the specific type and condition of the cells from which they are secreted. Circulating exosomes contain stable RNA molecules such as mRNAs, microRNAs, and long non-coding RNAs (lncRNAs). In this review, we will explore the significance of exosomes and their diverse cellular combinations in the context of cancer therapy. Graphical Abstract

This study investigated the mechanical and microstructural properties of lightweight aggregate geo-polymer concrete (LWAGC) produced by alkali-activating glass powder (GP) and Fly Ash (FA) at elevated temperatures ranging from 200 to 800°C. It also examined the effects of incorporating crushed foam masonry (RFA) and crushed porcelanite rock aggregates (PA) into FA and GP-based geo-polymer concrete, both before and after exposure to ambient and high temperatures. A low-calcium type of FA was used as a binder in the geo-polymer concrete paste, with a 10 % replacement of glass powder. The concrete samples were heated at temperatures of 200°C, 400°C, 550°C, and 800°C for a duration of 60 minutes, with a heating rate of 7°C per minute. It was observed that the inclusion of weaker coarse aggregate resulted in a reduction of the compressive strength of the concrete. The geo-polymer concrete was subjected to tests for water absorption, mass loss, cracking, and microstructure analysis at elevated temperatures. The findings indicate that at heating temperatures of 400°C and above, the geo-polymer concrete underwent degradation and dehydration. The test findings also revealed residual compressive strengths of 104.9 %, 97.2 %, 81.8 %, and 64.2 % for the (RFA) types, and 107.3 %, 94.8 %, 78.3 %, and 58.8 % for the (PA) types. Additionally, the density decreased by 1.02 %, 4.88 %, 8.10 %, and 13.88 % for (RFA) and (PA) types, respectively, and by 0.27 %, 1.91 %, 4.67 %, and 10.79 % overall. The results indicate that the compressive strength of the concretes increased after exposure to elevated temperatures of 35°C and 200°C. However, when exposed to temperatures ranging from 400°C to 800°C, the strength of the LWAGC started to degrade and decline. Based on the obtained findings, the present study recommends performing laboratory tests on construction waste generated during demolition while developing and evaluating numerical models that predict the behavior of the resulting demolition materials when incorporated in the production of geo-polymer concrete.

BACKGROUND: Pernicious anemia is an autoimmune disorder causing vitamin B12 deficiency resulting from impaired absorption caused by intrinsic factor absence. Positive parietal cell and intrinsic factor antibodies confirm the diagnosis. Intravenous vitamin B12 effectively treats Pernicious anemia. Severe cytopenias (anemia, thrombocytopenia, neutropenia) may result, sometimes requiring emergency care and hospitalization. CASE PRESENTATIONS: Case A: A 54-year-old male presented with six months of generalized fatigue and dyspnea on exertion. Laboratory tests revealed severe macrocytic anemia (Hb: 4.7 g/dL, MCV: 120 fL), with a peripheral blood smear showing hyper-segmented neutrophils and macro-ovalocytes, suggestive of megaloblastic anemia. Bone marrow biopsy demonstrated decreased cellularity with megaloblastic changes. Despite six-weeks of intravenous vitamin B12 therapy, there was no improvement in hematological parameters. Endoscopy revealed atrophic gastritis, and biopsy showed anti-parietal cell antibodies. Following a trial of immunosuppressive therapy with cyclosporine, no significant response was observed. Bone marrow transplantation was recommended. Case B: A 62-year-old male presented with epigastric pain, dyspepsia, fatigue, and a three-month history of anorexia. He was diagnosed with macrocytic anemia (Hb: 6.7 g/dL, MCV: 100 fL), and peripheral blood smear indicated megaloblastic changes. Bone marrow biopsy confirmed decreased cellularity and megaloblastic anemia. Despite standard intravenous vitamin B12 therapy, the patient showed no hematological improvement. Endoscopic findings revealed atrophic gastritis. Immunosuppressive therapy with cyclosporine also failed, leading to the recommendation of bone marrow transplantation. CONCLUSION: Continued efforts in understanding the pathophysiology of Pernicious anemia and autoimmune-mediated bone marrow failure syndromes may pave the way for innovative therapeutic approaches in the future.

AbstractObjective: It is important for investors and traders to be aware of the stock price in listed companies, so it is important to identify the factors affecting Stock price informativeness. The purpose of the current research is to interpret the structural modeling of factors influencing Stock price informativeness in companies listed on the Iranian Stock Exchange.Methods: The identification of factors affecting informativeness through research background and semi-structured interviews with qualitative content analysis method based on theoretical saturation technique was done with 17 professors and financial managers. The validity of the qualitative part of the research was confirmed by the method of relative content validity and reliability using Cohen's kappa index. Coding of the interviews using MAXQDA software led to the identification of 41 effective factors, after referring to experts and drawing a pie chart, 34 factors were determined as the most important factors affecting Stock price informativeness. In order to stratify and model the structural interpretation of the identified factors, the opinions of 41 financial managers of listed companies were used with the available non-probability sampling method and with the help of a paired comparison questionnaire. The validity of the questionnaire was confirmed using the content validity and its reliability using the test-post-test method.Results: Interpretive structural modeling of the factors affecting Stock price informativeness led to the formation of thirteen levels, where economic factors and financial macroeconomic policies were the most effective, and transparency of financial information, auditors' management letter, and the type of auditor's comments were the most effective factors.Conclusion: Identifying factors affecting awareness and information disclosure by companies in the financial sector is essential, it helps investors and other stakeholders to make more informed decisions.

The urban development planning process in Tehran municipality has been implemented for about two decades in the form of compiling four medium-term urban development plans of Tehran. Despite the efforts made, there are challenges to achieving the goals. This research has analyzed the barriers and identified solutions to improve the system of the development plan of Tehran by formulating the mess and using soft systems methodology during a systemic intervention by planning the learning process in practice. The innovative research method is the embedding of mess formulation in soft systems methodology. Formulating the mess analyses the barriers to identifying inefficiencies about aspects of how power, wealth, knowledge, value, and aesthetics are produced and distributed in a social system. Soft systems methodology is an action-research approach for learning human systems in complex problem situations. After a thematic review by referring to the key actors involved in formulating Tehran's urban development plan, first, the problem situation was analyzed, and a rich picture of the problem was drawn. According to formulating the mess, the obstacles were presented and discussed through some sessions in five subsystems of generation and distribution of power, wealth, knowledge, value, and aesthetics. Later, a conceptual model of the ideal system of urban development planning was designed. Then, desirable and executable system changes were identified based on a comparison of the ideal system and the current system, and they were proposed in the form of purposeful activities toward system improvement. Tehran's urban development planning requires a major change in the approach toward planning and solving complex urban problems. This study is an application of systems thinking approaches in learning in practice and managing the complexity of the diversity of views of urban planners in the experience of urban development planning in Tehran.

Abstract Grit, a non-cognitive skill that indicates perseverance and passion for long-term goals, has been shown to predict academic achievement. This paper provides evidence that grit also predicts student outcomes during the challenging period of the Covid-19 pandemic. We use a unique dataset from a digital learning platform in the United Arab Emirates to construct a behavioral measure of grit. We find that controlling for baseline achievement, students who were grittier according to this measure before the pandemic, register lower declines in math and science scores during the coronavirus period. Using machine learning, behavioral data obtained from the platform prior to the pandemic can explain 77% of the variance in academic resilience. A survey measure of grit coming from the same students, on the other hand, does not have significant predictive power over performance changes. Our findings have implications for interventions on non-cognitive skills, as well as how data from digital learning platforms can be used to predict student behavior and outcomes, which we expect will be increasingly relevant as AI-based learning technologies become more common.

Abstract DC microgrids are integral to smart grids, enhancing grid reliability, power quality, and energy efficiency while enabling individual grid independence. They combine distributed and renewable energy sources, reducing overall energy consumption. High-gain DC–DC converters are crucial for elevating voltages from low-voltage DC sources like solar panels and wind turbines in DC microgrids. This paper introduces a non-isolated DC–DC converter designed to achieve ultra-high step-up (UHSU) voltage conversion utilizing a two-winding coupled inductor (CI). The propounded UHSU configuration achieves a substantial voltage increase by employing low duty cycles and a decreased turn ratio for the CI, resulting in a smaller core size. Moreover, this UHSU circuit incorporates soft-switching capabilities for both power switches and diodes, enhancing its efficiency. By keeping the voltage stress on the switches low, the design minimizes losses and improves overall efficiency. The operational modes are thoroughly analyzed, and comparisons with other topologies are presented to demonstrate the effectiveness of the proffered UHSU circuit. Finally, the performance of the UHSU circuit is validated through the construction and testing of a 150-W laboratory prototype operating at a switching frequency of 50 kHz, with Vin = 20 V and Vout = 300 V.

This study aimed to investigate the effect of TiC and TiB2 nano-inoculants addition on the microstructure and tribological behavior of PH13-8Mo stainless steel processed through wire arc additive manufacturing (WAAM). The incorporation of TiC/TiB2 inoculants demonstrated notable efficiency in mitigating the anisotropic wear and scratch response and enhancing wear resistance observed in the as-printed state. This improvement was ascribed to the refinement of the grain structure, disruption of the columnar structure, and increased content of the retained austenite. Notably, TiB2 inoculation exhibited superior grain refinement and achieved the highest hardness. However, the TiC-inoculated condition demonstrated the best wear resistance, attributed to its excellent combination of hardness and fracture resistance, and a higher contribution of strain-induced martensite transformation during wear testing. Additionally, the implementation of post-printing solutionizing and aging treatment was found to improve the scratch and wear resistance of the alloy, attributed to the formation of nano-sized β-NiAl precipitates. The main wear mechanism observed involved oxidation wear, adhesive wear, and three-body abrasive wear. The findings of this study highlight the significant potential of incorporating ceramic-based nano-particles for improving the wear resistance of WAAM PH13-8Mo components, particularly in demanding applications like injection molding dies where superior abrasion resistance is paramount.

Neuroblastoma is an aggressive malignancy commonly found in children, with adult patients being quite rare. Pancreatic neuroblastoma, even among adult cases, is especially rare. We present a case of a 26-year-old woman presented with mild abdominal pain and a palpable mass diagnosed as neuroblastoma affecting the pancreas. After initial diagnostic challenges, a biopsy confirmed the diagnosis of neuroblastoma. The patient thereafter underwent a course of neoadjuvant chemotherapy, followed by a complex surgical resection. This case highlights the importance of a comprehensive diagnostic approach, including repeated biopsies and the involvement of a multidisciplinary team in the management of rare presentations of adult neuroblastoma.

IntroductionIntercropping, the agricultural practice of cultivating two or more crops in the same space at the same time, is an old and commonly used cropping practice which aims to match efficiently crop demands to the available growth resources. The practice of growing two or more crops simultaneously in the same field is called intercropping and it is a common feature in traditional farming of small landholders. It provides farmers with a variety of returns from land and labour, often increases the efficiency with which scarce resources are used and reduces the failure risk of a single crop that is susceptible to environmental and economic fluctuation. Intercropping of chickpea with linseed reduced the chickpea yield by 60.3%, although linseed occupied only 33% of the total area. The loss of chickpea yield was compensated by the additional yield of linseed, and thus the system productivity of chickpea + linseed intercropping was increased by 43.4% compared with sole chickpea. Of this increase in system productivity, 65.3 and 34.7% were contributed by higher seed yield and higher minimum prices of linseed, respectively as compared to chickpea. The objectives of the present study were to study the competition indices of chickpea and quinoa intercropping such as land equivalent ratio, relative crowding coefficient, aggressivity, chickpea equivalent yield and effects of nitrogen and different intercropping arrangements on yield of sole chickpea, sole quinoa and intercropping yield of two plants. The objectives of the present study was to determine the best appropriate treatment of sole cropped, replacement and additive series of chickpea and quinoa in terms of yield and investigation of competition indices in intercropping replacement and additive chickpea and quinoa. Materials and MethodsIn order to study the effect of planting pattern and nitrogen application on yield and competitive indicators of chickpea and quinoa, a factorial experiment based on randomized complete block design (RCBD) was conducted with three replications at Gonbad Kavous University farm during the 2020-2021 growing season. Nitrogen factor was included three levels of non-application and application of 25 and 50 kg N.ha-1 and the treatments of intercropping were included 9 levels of sole cropped of chickpea and quinoa, 67% chickpea + 33% quinoa, 50% chickpea + 50% quinoa, 33% chickpea + 67% quinoa, 100% chickpea + 33% quinoa, 100% chickpea + 50% quinoa, 100% chickpea + 67% quinoa and 100% chickpea + 100% quinoa. For analysis variance of data software of SAS Ver. 9.4 was used and treatment mean differences were separated by the least significant difference (LSD) test at the 0.05 probability level. Results and DiscussionResults showed that the effects of planting pattern and nitrogen consumption on yield were significant at confidence level of 1%. The maximum total yield belonged to the treatment sole cropped of chickpea with 3529 kg.ha-1, which was not significantly different from the 67% chickpea + 33% quinoa treatment. With increase of nitrogen fertilizer consumption, total yield was increased. The lowest chickpea crop equivalent yield related to the treatment sole cropped of chickpea and mixed crop was 33% increase of quinoa to chickpea crop with 3529 and 3551 kg.ha-1, respectively, and the highest was related to sole cropped of quinoa with 8876 kg.ha-1. Land equivalent ratio was higher than one in all the additive mixed cropping treatments and alternative mixed cropping treatments. The maximum proportion of land belonging to the treatment of 100% chickpeas + 67% quinoa was 1.10. The relative coefficient of total density in all treatments was more than one, which indicates the desirability of mixed cultivation of chickpea and quinoa. The examination of the aggressivity index showed that quinoa was dominant in the mixed cropping treatments, increasing and replacing the plant. As a result, the dominance index of quinoa was positive despite the favorable yield of both plants. ConclusionsOf the two plants of chickpea and quinoa, quinoa plant produced more yield than chickpea plant. The maximum total yield belonged to the treatment sole cropped of chickpea with 3529 kg.ha-1, which was not significantly different from the 67% chickpea + 33% quinoa treatment. With increasing of nitrogen fertilizer consumption, yield was increased. According to the results, it seems that it is not possible to increase the density of two plants in mixed cultivation to obtain the maximum yield.

Objectives: This study aimed to assess the clinical features, Electroencephalography (EEG) findings, and brain imaging results in psychiatric patients diagnosed with epilepsy at Razi Psychiatric Hospital. Methods: This retrospective descriptive-analytical study was carried out on patients with epilepsy and psychiatric disorders admitted to Razi Psychiatric Hospital over two years. A total of 94 patient files seizure and epilepsy comorbidity, recorded in the hospital’s health information system (HIS), were reviewed. Data collection involved a demographic checklist and an epilepsy scale; the latter, developed by DiIorio, Colleen, et al., encompassed personal characteristics, mental disorders, epilepsy, and seizures. The Kruskal-Wallis and Mann-Whitney non-parametric tests were utilized to compare the mean scores of variables, with SPSS software, version 21 facilitating the analysis. Results: Out of 94 patients with seizure and epilepsy, 9.6% had focal seizure, 26.6% had generalized epilepsy, 36.1% had focal-generalized seizure, and 26.8% had unknown seizure. About 12% had a structural etiology, while the remaining 88% had an etiology that remained unidentified. Conclusion: The findings indicate that epilepsy, affecting individuals from adolescence through to old age, can lead to psychiatric disorders. For many patients, the etiology of their condition remains elusive, and EEG findings and brain imaging appear normal in the majority of cases.

AbstractBackground: Inborn errors of metabolism (IEM) are rare genetic disorders that usually cause the disease by blocking a metabolic pathway. Delayed diagnosis is usually due to nonspecific manifestations. In this study, we aim to evaluate the demographic and clinical characteristics of pediatric patients with IEM admitted in Nemazi hospital, a referral center in southern Iran.Methods: All 1-month- to 18-year-old patients who were admitted in the pediatric ward in Nemazi hospital, a referral center in southern Iran, with the diagnosis of IEM were enrolled. Patients with incomplete information were excluded. We collect demographic and clinical data including age, sex, parents’ consanguinity, family history of IEM, presenting symptoms, number of hospitalization, age of onset, and diagnosis of the disease. All the data were entered into SPSS ver.22 and analyzed.Results: 200 patients were enrolled in the study. 53.5% were male and 46.5% female. The most clinical symptoms were lethargy and vomiting. The most prevalent IEM were aminoacidopathies, organic acidemia, and mitochondrial disease. Consanguinity was seen in 57.5% of them, while the family history of metabolic diseases was observed in 16.5%. There was a statistically significant relationship between consanguinity and the type of the disease.Conclusion: The clinical symptoms of IEM are nonspecific and may be misdiagnosed as other diseases like septicemia. We should always keep IEM in mind to detect the disease earlier and prevent significant morbidities and mortality by appropriate timely treatment. Due to the prevalence of consanguinity marriage in Iran, we should also consider metabolic screening.

Panentheism and pantheism represent one of the most profound, even startling parallels across the world’s great metaphysical traditions about which the present article seeks to explore and carry out a comparative study of certain Eastern and Western philosophers with special reference to the views of two chief exponents of Advaita Vedanta of Indian philosophy, Shankara and Ramanuja. Both these terms, touch on the relation of God and the universe with the difference that the former seems to be rigid, motionless, and abstract and lacks a kind of religious fervor in its approach, while the latter is presumed to be concrete and palpable and seeks to reconcile philosophical thinking with the demands of religious feelings as well. God in pantheism is compared to the God of Spinoza, the Neutrum of Schelling, and Shankara's concept of indeterminate Brahman. In contrast, in the West Hegelian Absolute, and Ramanuja's qualified Brahman in Indian tradition, both are accredited with panentheism in which a personal God, identity-in-and-through-difference, has all auspicious qualities. Though these philosophers are from totally different temperaments and cultures, their philosophical method has certain similarities that have been examined in this work.

Abstract Tumor-associated macrophages (TAMs) residing in the tumor microenvironment (TME) are characterized by their pivotal roles in tumor progression, antitumor immunity, and TME remodeling. However, a thorough comparative characterization of tumor-TAM crosstalk across IDH-defined categories of glioma remains elusive, likely contributing to mixed outcomes in clinical trials. We delineated the phenotypic heterogeneity of TAMs across IDH-stratified gliomas. Notably, two TAM subsets with a mesenchymal phenotype were enriched in IDH-WT glioblastoma (GBM) and correlated with poorer patient survival and reduced response to anti-PD-1 immune checkpoint inhibitor (ICI). We proposed SLAMF9 receptor as a potential therapeutic target. Inference of gene regulatory networks identified PPARG, ELK1, and MXI1 as master transcription factors of mesenchymal BMD-TAMs. Our analyses of reciprocal tumor-TAM interactions revealed distinct crosstalk in IDH-WT tumors, including ANXA1-FPR1/3, FN1-ITGAVB1, VEGFA-NRP1, and TNFSF12-TNFRSF12A with known contribution to immunosuppression, tumor proliferation, invasion and TAM recruitment. Spatially resolved transcriptomics further elucidated the architectural organization of highlighted communications. Furthermore, we demonstrated significant upregulation of ANXA1, FN1, NRP1, and TNFRSF12A genes in IDH-WT tumors using bulk RNA-seq and RT-qPCR. Longitudinal expression analysis of candidate genes revealed no difference between primary and recurrent tumors indicating that the interactive network of malignant states with TAMs does not drastically change upon recurrence. Collectively, our study offers insights into the unique cellular composition and communication of TAMs in glioma TME, revealing novel vulnerabilities for therapeutic interventions in IDH-WT GBM.

Abstract The detection and characterisation of electromagnetic signals within a specific frequency range, known as spectrum sensing, plays a crucial role in Cognitive Radio Networks (CRNs). The CRNs aim to adapt their communication parameters to the surrounding radio environment, thereby improving the efficiency and utilisation of the available radio spectrum. Spectrum sensing is particularly important in device‐to‐device (D2D) communication when operating independently of the cellular network infrastructure. The Medium Access Control (MAC) protocol coordinates device communication and ensures interference‐free operation of the CRN coexisting with the primary cellular network. A spectrum sensing strategy at the MAC layer for cognitive D2D communication. The strategy focuses on reducing the overall sensing period allocated at the MAC layer by having each Cognitive D2D User (cD2DU) sense a smaller subset of available channels while maintaining the same sensing time for cellular user detection at the physical layer. To achieve this, the concept of concurrent groups of D2D devices is introduced in proximity, which are formed by using unique IDs of cD2DUs during the device discovery stage. Each concurrent group senses a specific portion of the cellular user band in a shorter time, resulting in a reduced overall sensing period. In addition to mitigating traffic congestion through data diversion from the cellular network, the proposed strategy facilitates the concurrent sensing of multiple channels by cD2DUs within the underutilised cellular user band. This leads to extended data transmission periods, increased network throughput, and effective offloading of the cellular network. The effectiveness of the proposed work is evaluated by considering factors, such as network throughput and transmission time. Simulation results confirm the effectiveness of the approach in improving spectrum utilisation and communication efficiency in multi‐channel Cognitive D2D Networks (cD2DNs).

Background:Nursing staff must take adequate precautions and implement appropriate practices to substantially reduce the risk of workplace transmission of blood-borne infections to patients and staff within dialysis units. This study aimed to evaluate the intervention measures for staff nurses in the dialysis unit. Materials and Methods:A descriptive cross-sectional design was used to conduct the study from December 1, 2021, to April 1, 2022, in three Mosul City hospitals. A convenience sample was selected. Sixty nurses participated in the study. Results:The study findings show that 41.7% of the study sample was within the 25–29 year age group, and the highest percentage was of males (51.7%). Regarding qualifications, 43.3% of nurses had a bachelor’s degree, and 76.7% of them had less than 5 years of experience working in the dialysis unit. All the subjects received vaccination against the hepatitis virus. There are limitations in some nurses’ practices, such as wearing a face shield, cleaning and disinfecting the beds and chairs, and external surfaces of the machines during pre- and post-dialysis. Conclusion:The study concludes that there are clear defects in the application of some nursing procedures and measures to control the transmission of infections inside hemodialysis units in Mosul city hospitals.

Given the critical role of human papillomavirus (HPV) in the cause of cervical cancer and other malignancies, there is aneed for innovative approaches to preventing this infection. It has been shown that immunoinformatics is an importantstrategy in computational vaccinology. It is used to design new multi-epitope vaccines against different types of HPVand subsequent cervical cancer. This paper reviews the scope of the entire computational pipeline of HPV vaccinedesign, starting from data analysis at the genomic and proteomic levels and continuing to epitope predictions of theinnate and adaptive immune systems. The search strategy was based on investigating original articles published in“Google Scholar" and “PubMed" from 2015 to 2023-2024. The terms "Immunoinformatics", "Bioinformatics", "Humanpapillomavirus (HPV)", "Vaccine design", "In silico vaccine design", "Multi-epitope vaccine design", "Vaccinology" and"HPV vaccine" were used to for this purpose. We discussed various essential tools involved in the computationaldesign of the vaccine process, e.g., sequence analysis, epitope prediction, conservancy analysis, tertiary structuremodeling, refinement, molecular docking, molecular dynamics (MD) simulation, and in silico cloning. This reviewarticle describes immunoinformatics methods that facilitate the design of a multi-epitope vaccine against HPV.However, this pipeline can also be used to design novel chimeric vaccines for other pathogens.

Abstract This paper presents a novel topology for Z-source inverters (ZSI). The new Z-Source network is based on the coupled-inductors and active switched boost. Features of the topology include high voltage boost ability, single magnetic-core, low voltage stress on the active switch, and capacitors. The principles of operation, analysis, voltage and current equations of each component, and the converter voltage gain in the steady-state are presented. A comparison with other topologies has also been performed to determine the advantages and disadvantages of the proposed ZSI. Finally, experimental results of the laboratory prototype are presented to confirm the performance of the proposed topology.

Introduction: This study aimed to develop a psychological-emotional empowerment educational package based on the lived experiences of single-parent male adolescents and subsequently test its effectiveness on their cognitive fusion.Methods: The research method was qualitative, employing a phenomenological-descriptive approach, while the quantitative part was semi-experimental with a pre -test-post-test design, a control group, and a two-month follow-up period. The statistical population included male teenagers from single-parent families in the first period of secondary school in Abadeh city in 2022-2023. In the qualitative part, 15 single-parent male adolescents were purposefully selected and subjected to in-depth interviews. In the quantitative part, 35 adolescents were selected through purposive sampling and randomly assigned to experimental and control groups (18 in the experimental and 17 in the control group). The adolescents in the experimental group received the psychological-emotional empowerment training package over ten weeks in ten 90-minute sessions. A pre-test was performed before the intervention, a post-test after the intervention, and a follow-up phase two months later. The Cognitive Fusion Questionnaire (Gillanders et al., 2014) was used in this study. The data were analyzed using mixed ANOVA and a post hoc Bonferroni test via SPSS23 software.Results: According to experts, the results showed that the psychological-emotional empowerment training package has sufficient content validity. Additionally, this training package impacted the cognitive fusion (P

Despite the global trend toward the legalization of homeschooling, it remains illegal in Lebanon. This study aims to explore the multifaceted realities of homeschooling in Lebanon and the motives driving its adoption according to homeschooled children's parents, and the perspectives of educational stakeholders in Lebanon on homeschooling. The study participants included 10 parents homeschooling their children and three public-sector education experts. Data were collected through semi-structured interviews and focus groups with parents, and document analysis. For the homeschooling experience and its motives from parental perspectives, seven key themes were identified: (1) Factors to consider in homeschooling, (2) Motives behind homeschooling, (3) Effects of homeschooling, (4) Curriculum selection, (5) Child's interaction with the homeschooling experience, (6) Homeschooling outcomes, and (7) Parents' agreement on homeschooling their child. Four themes emerged from the discussions with the stakeholders: (1) The legal status of homeschooling in Lebanon, (2) The lack of studies or reports on homeschooling in Lebanon, (3) The stakeholders' approach to homeschooling, and (4) The eventual legislation of homeschooling in Lebanon. The findings of this study highlight the urgent need for legal frameworks that accommodate homeschooling, suggesting its potential to diversify and enrich Lebanon's educational landscape.

Abstract Heterogeneous networks (HetNets) refer to the communication network, consisting of different types of nodes connected through communication networks deploying diverse radio access technologies like LTE, Wi‐Fi, Zigbee, and Z‐wave, and using different communication protocols and operating frequencies. Vertical handover, is the process of switching a mobile device from one network type to another, such as from a cellular network to a Wi‐Fi network, and is critical for ensuring a seamless user experience and optimal network performance, within the handover process handover triggering estimation is one of the crucial step affecting the overall performance. A mathematical analysis is presented for the handover triggering estimation. The performance evaluation shows significant improvement in the probability of successful handover using the proposed handover triggering condition based on speed, distance, and different mobility models. The handover triggering condition is optimised based on the speed of the mobile node, handover completion time, and the coverage range of the current and the target networks of the HetNet node, with due consideration of the mobility model.

Abstract The incidence of inflammatory bowel disease (IBD) is increasing annually. Children with IBD often suffer significant morbidity due to physical and emotional effects of the disease and treatment. Corticosteroids, often a component of therapy, carry undesirable side effects with long term use. Steroid-free remission has become a standard for care-quality improvement. Anticipating therapeutic outcomes is difficult, with treatments often leveraged in a trial-and-error fashion. Artificial intelligence (AI) has demonstrated success in medical imaging classification tasks. Predicting patients who will attain remission will help inform treatment decisions. The provided dataset comprises 951 tissue section scans (167 whole-slides) obtained from 18 pediatric IBD patients. Patient level structured data include IBD diagnosis, 12- and 52-week steroid use and name, and remission status. Each slide is labelled with biopsy site and normal or abnormal classification per the surgical pathology report. Each tissue section scan from an abnormal slide is further classified by an experienced pathologist. Researchers utilizing this dataset may select from the provided outcomes or add labels and annotations from their own institutions.

Background: Retinopathy of prematurity (ROP) is one of the common complications in premature neonates. ROP examination is one of the most important examinations for premature babies, which is associated with pain and can be very annoying. This study aimed to compare the effectiveness of pharmacological and non-pharmacological methods in reducing the pain of ROP examination. Materials and Methods: This study was conducted as a double-blind, randomized control trial on 300 ROP examinations of patients who were hospitalized in the NICU department of Mahdieh Hospital in Tehran. The neonates were randomly selected into three groups, and ketamine 2mg/kg nasally, fentanyl two µg/kg nasally10minutes before an examination, and acetaminophen 2drop/kg orally 30 minutes before each examination were given to each neonate as two pharmacological groups. In the non-pharmacological group, infants received saddling-pacifier oral sucrose 25% 0.5cc 2 minutes before examination. Pain was assessed based on PIPP (premature infant pain index). Results: The amount of pain after using oral sucrose was significantly lower than the ketamine-acetaminophen (P-value=0.011) and fentanyl-acetaminophen (P-value=0.027) groups, but there was not a statistically significant difference between the two groups of ketamine-acetaminophen and fentanyl-acetaminophen (P-value=0.953). The hypoxia was more prevalent in the ketamine-acetaminophen group (18.8%), and the least hypoxia occurred in the oral sucrose treatment group (7%) (P-value=0.028). Conclusion: It is concluded that the effect of non-pharmacological drugs is greater than pharmacological drugs in reducing the pain of neonates during ROP examination. The effect of oral sucrose in reducing pain was more significant than ketamine-acetaminophen and fentanyl-acetaminophen. However, there was no significant difference between the two groups of ketamine-acetaminophen and fentanyl-acetaminophen.

Beta-blockers are commonly used medications for cardiovascular diseases. Beta-blockers are effective antiarrhythmic agents, and they are class 2 agents in the Vaughan-Williams classification. In this review, we first attempt to mention the physiology of beta-adrenergic activation in the myocardium and the role of excessive beta-adrenergic activation in arrythmiagenesis. Then, we will summarize the pharmacological properties of beta blockers and their use in specific arrhythmias. Special emphasis will be given to nebivolol, a new generation cardioselective beta-blocker with vasodilator activity, given the limited data regarding its use in arrhythmias.

This research discusses the critical role of kyai's charismatic leadership in mitigating religious intolerance and radicalism in pesantren. Kyai, as the primary leader in pesantren, has a significant influence in shaping the attitudes and thoughts of the santri. This research was conducted based on a field analysis study, followed by literature research incorporating various scientific arguments and information from relevant literature sources. This research was implemented at Pondok Pesantren Sabilurrosyad Gasek as a sample object, involving kyai, santri, and the surrounding community. Through his charisma and authority, the kyai can effectively convey the values of religious moderation to the santri. The approach taken by the kyai, which emphasizes the values of deliberation, balance, and tolerance, helps the santri understand religious teachings in a balanced manner and avoid radical attitudes. Islamic boarding schools also play a role in instilling religious moderation values through a well-structured religious education curriculum. Thus, the charismatic leadership of kyai is at the forefront of reducing religious intolerance and radicalism in pesantren, forming a generation of santri who understand religious teachings comprehensively and moderately, and contributing to creating an inclusive and peaceful society.

Abstract Background Cholangiocarcinoma (CCA) is an aggressive malignancy with a poor prognosis of less than 20% five-year survival rate. Early diagnosis is typically challenging due to asymptomatic characteristics at the earliest stages of the disease. This study aims to assess the potential utility of cytokeratin 7 (CK7) as a CCA diagnostic biomarker in bile. In total, 100 participants were included in this case-control study. Moreover, Group I had 30 CCA patients with malignant obstruction, and Group II had 20 patients with malignant biliary obstruction other than CCA formed. Group III included 20 patients with benign biliary obstruction, and 30 individuals undergoing cholecystectomy with no evidence of biliary obstruction made up the control group (Group IV). Bile samples were collected during endoscopic retrograde cholangiopancreatography or cholecystectomy for the control group. The CK7 levels in bile samples were measured using the enzyme-linked immunosorbent assay. Results The bile level of CK7 was significantly higher in cholangiocarcinoma patients (1555.4 ± 302.7 pg/mL) than those of the patients with malignancies other than CCA (581.9 ± 227.5 pg/mL), patients with benign obstruction (439.5 ± 255.7 pg/mL), and the control group (53 ± 26.4 pg/mL) (p value < 0.001). Furthermore, CK7 was significantly higher in CCA patients than in those with other malignancies (p value < 0.001). Patients with CCA with hilar lesions had the highest values compared to those with distal lesions. ROC curve analysis revealed that bile CK7 at a cut point of >1030 pg/mL yielded an area under a curve of 1 (95% CI: 1.000–1.000) in differentiating CCA from other groups. Conclusion The bile level of CK7 demonstrates outstanding performance that could help in diagnosing CCA.

Abstract Accurate river streamflow prediction is pivotal for effective resource planning and flood risk management. Traditional river streamflow forecasting models encounter challenges such as nonlinearity, stochastic behavior, and convergence reliability. To overcome these, we introduce novel hybrid models that combine extreme learning machines (ELM) with cutting-edge mathematical inspired metaheuristic optimization algorithms, including Pareto-like sequential sampling (PSS), weighted mean of vectors (INFO), and the Runge–Kutta optimizer (RUN). Our comparative assessment includes 20 hybrid models across eight metaheuristic categories, using streamflow data from the Aswan High Dam on the Nile River. Our findings highlight the superior performance of mathematically based models, which demonstrate enhanced predictive accuracy, robust convergence, and sustained stability. Specifically, the PSS-ELM model achieves superior performance with a root mean square error of 2.0667, a Pearson’s correlation index (R) of 0.9374, and a Nash–Sutcliffe efficiency (NSE) of 0.8642. Additionally, INFO-ELM and RUN-ELM models exhibit robust convergence with mean absolute percentage errors of 15.21% and 15.28% respectively, a mean absolute errors of 1.2145 and 1.2105, and high Kling-Gupta efficiencies values of 0.9113 and 0.9124, respectively. These findings suggest that the adoption of our proposed models significantly enhances water management strategies and reduces any risks.

Abstract Background Despite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited. Methods A standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020–2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted. Results Only Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs—and registered—in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia). Conclusion These findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines’ availability were permitted under national law and where culturally acceptable.

Abstract Aim Manipulation of the intestinal microbiome and supplying vitamin D can attenuate psychiatric symptoms in schizophrenic patients. The current study tried to evaluate the effects of probiotic/vitamin D supplementation on the cognitive function and disease severity of schizophrenic patients. Methods In the present study, 70 patients (aged 18–65) with schizophrenia were recruited. Participants were randomly allocated to the placebo (n = 35) and intervention (probiotic supplements+400 IU vitamin D, n = 35) groups. Severity of disease and cognitive function (primary outcomes) were evaluated by Positive and Negative Syndrome Scale (PANSS) and Montreal Cognitive Assessment (MoCA) tests, respectively. Moreover, lipid profile, body mass index (BMI), gastrointestinal (GI) problems, serum C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated as secondary outcomes. Results A total of 69 patients completed the study. The MoCA score was increased by 1.96 units in the probiotic‐containing supplement group compared to the placebo (p = 0.004). Also, the percentage of subjects with MoCA score ≥ 26 rose significantly in the intervention group (p = 0.031). Moreover, TC (p = 0.011), FBS (p = 0.009), and CRP (p

The present study aims to investigate the effect of financial development on energy intensity (EI) at different levels of innovation and technology. In addition, this study seeks to answer whether financial development affects EI and how such effect alters in the presence of varying levels of innovation and technology. To this aim, a panel smoothing transition regression (PSTR) method was used on a sample of OPEC + countries during 2000–20. Sectors of financial development affect EI at various levels of innovation and technology differently. Based on the results, the development of the banking sector and stock market increases EI to a certain level of the threshold variable (0.28 and 0.21 %, respectively), which is research and development (R&D) expenditure as a percentage of gross domestic production (GDP). Total financial development affects EI slightly differently. The above-mentioned process reduces EI up to a certain level of the threshold (0.25 %). Then, the process decreases EI more significantly. The present study aims to assess the specific effect of financial development on EI based on the level of innovation and technology. The results indicate that the behavior of the evaluated countries, which plays a significant role in proven oil reserves, crude oil production, and oil trade in the world, becomes similar to that of developed countries after reaching a certain threshold level of innovation and technology.

Resumo Fundamento O infarto do miocárdio com artérias coronárias não obstrutivas (MINOCA) constitui um subconjunto significativo de infartos agudos do miocárdio (IAM) com marcadores prognósticos incertos. A avaliação precoce do risco é crucial para identificar pacientes MINOCA em risco de resultados adversos. Objetivos Este estudo teve como objetivo avaliar a capacidade preditiva do escore PRECISE-DAPT na avaliação do prognóstico de curto e longo prazo em pacientes MINOCA que apresentam infarto do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) ou com supradesnivelamento do segmento ST (IAMCSST). Métodos Entre 741 pacientes MINOCA, o escore PRECISE-DAPT foi calculado para analisar sua associação com eventos cardiovasculares adversos maiores (MACE) intra-hospitalares e de acompanhamento. Os parâmetros que apresentaram significância nos grupos MACEM (+) foram submetidos à análise estatística: regressão logística univariada para eventos intra-hospitalares e regressão univariada de Cox para eventos de seguimento. Para significância estatística, foi adotado nível pré-definido de α = 0,05. Os parâmetros que demonstraram significância foram submetidos à regressão logística múltipla para eventos intra-hospitalares e à regressão multivariada de Cox para eventos de seguimento. Resultados Os MACE intra-hospitalares ocorreram em 4,1% dos pacientes, enquanto 58% apresentaram MACE no acompanhamento. Os níveis de hemoglobina e o escore PRECISE-DAPT foram identificados como parâmetros independentes para MACE intra-hospitalar. Além disso, a fração de ejeção (FE%) e o escore PRECISE-DAPT surgiram como preditores independentes de MACE no acompanhamento. Conclusões O estudo revelou que um escore PRECISE-DAPT mais alto foi significativamente associada a riscos aumentados de eventos cardiovasculares adversos maiores tanto intra-hospitalares quanto de longo prazo em pacientes MINOCA que apresentam síndrome coronariana aguda (SCA), ressaltando o potencial do escore na estratificação de risco para esta coorte de pacientes.

Summary: Inhibition of the ceramide synthetic pathway with myriocin or an antisense oligonucleotide (ASO) targeting dihydroceramide desaturase (DES1) both improved hepatic insulin sensitivity in rats fed either a saturated or unsaturated fat diet and was associated with reductions in both hepatic ceramide and plasma membrane (PM)-sn-1,2-diacylglycerol (DAG) content. The insulin sensitizing effects of myriocin and Des1 ASO were abrogated by acute treatment with an ASO against DGAT2, which increased hepatic PM-sn-1,2-DAG but not hepatic C16 ceramide content. Increased PM-sn-1,2-DAG content was associated with protein kinase C (PKC)ε activation, increased insulin receptor (INSR)T1150 phosphorylation leading to reduced insulin-stimulated INSRY1152/AktS473 phosphorylation, and impaired insulin-mediated suppression of endogenous glucose production. These results demonstrate that inhibition of de novo ceramide synthesis by either myriocin treatment or DES1 knockdown protects against lipid-induced hepatic insulin resistance through a C16 ceramide-independent mechanism and that they mediate their effects to protect from lipid-induced hepatic insulin resistance via the PM-sn-1,2-DAG-PKCε-INSRT1150 phosphorylation pathway.

Purpose: This research is to design a comprehensive strategy to improve employability of graduates who have disabilities in the business sector of Negri Sembilan in Malaysia. Notwithstanding their relevant qualities, these people encounter considerable obstacles to employment, such as attitudinal prejudices, insufficient workplace accommodations, and discrepancies between their skills and employer expectations. The study used a mixed-methods approach to identify significant obstacles and evaluate the readiness of private sector firms to employ handicapped graduates. Findings: The study indicates that while several private sector businesses are inclined to employ graduates with impairments, they encounter obstacles concerning accessibility, knowledge, and preparation. Identified key impediments are inadequate training opportunities, adverse views toward disability, and the absence of support structures inside enterprises. The suggested strategy includes specialized training programs, promotion of inclusive hiring practices, and strategic alliances with disability groups, designed to align the abilities of handicapped graduates with corporate needs. Implications/Values: The results underscore the need for systemic reform in employment processes to promote diversity and fairness throughout the workforce. This concept, by aligning with the United Nations Sustainable Development Goals—especially in fostering decent work and mitigating inequalities—has the potential to cultivate a more inclusive job environment in Negri Sembilan. The results are anticipated to provide significant insights for policymakers, employers, and disability advocacy organizations, facilitating improved socio-economic inclusion and empowerment with disabilities in the labor market.