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We present the first global inventory of the spatial distribution and density ofconstructed impervious surface area (ISA). Examples of ISA include roads, parking lots,buildings, driveways, sidewalks and other manmade surfaces. While high spatialresolution is required to observe these features, the new product reports the estimateddensity of ISA on a one-km2 grid based on two coarse resolution indicators of ISA – thebrightness of satellite observed nighttime lights and population count. The model wascalibrated using 30-meter resolution ISA of the USA from the U.S. Geological Survey.Nominally the product is for the years 2000-01 since both the nighttime lights andreference data are from those two years. We found that 1.05% of the United States landarea is impervious surface (83,337 km2) and 0.43 % of the world’s land surface (579,703km2) is constructed impervious surface. China has more ISA than any other country(87,182 km2), but has only 67 m2 of ISA per person, compared to 297 m2 per person in theUSA. The distribution of ISA in the world’s primary drainage basins indicates that watersheds damaged by ISA are primarily concentrated in the USA, Europe, Japan, China and India. The authors believe the next step for improving the product is to include reference ISA data from many more areas around the world.

Abstract Objective A calcium antagonist, nifedipine, causes gingival overgrowth as a side effect. It has been confirmed that the Japanese traditional medicine, Saireito, inhibits the nifedipine-induced proliferation of gingival fibroblasts in vitro. We performed an in vivo experiment to determine whether Saireito has a therapeutic use in the treatment of nifedipine-induced gingival overgrowth. Methods The rats had significant gingival overgrowth induced by the administration of nifedipine. The space between the submandibular incisors and the width of buccal gingiva of maxillary left first molar were macroscopically measured. The buccal gingiva was microscopically examined. Results Eight weeks after Saireito was administrated together with nifedipine, Saireito decreased both the incisor space and the gingiva width which had been enlarged by nifedipine and furthermore, the area of connective tissue of nifedipine + Saireito group was significantly smaller than that of nifedipine alone. Conclusion In conclusion, Saireito may be clinically effective in therapy for calcium antagonist-induced gingival overgrowth.

Abstract Objective Macrolide antibiotics are reported to modulate the production of cytokines in various type of cells. We examined the effect of macrolide antibiotics on inflammatory cytokines (IL-6 and IL-8) and chemical mediator (PGE2) and also matrix metalloproteinases (MMPs) productions by human gingival fibroblasts (HGFs) treated with lipopolysaccharide (LPS). Methods The effect of macrolide antibiotics [erythromycin (EM), azithromycin (AZM) and josamycin (JOM)] on HGFs proliferation were examined by MTT assay. HGFs were treated with LPS from Porphyromonas gingivalis (PgLPS) and macrolide antibiotics, and IL-6, IL-8 and PGE2 levels were evaluated by ELISA. MMPs were detected by gelatin zymography. Results AZM slightly but significantly decreased HGFs proliferation, while EM and JOM did not affected. AZM increased PgLPS-induced IL-8 production dose-dependently, while AZM did not alter IL-6 and PGE2 productions. EM and JOM did not altered PgLPS-induced IL-6, IL-8 and PGE2 productions. All macrolide antibiotics did not alter MMPs production. These results indicate that macrolide antibiotics have no direct anti-inflammatory effect. However, the use of the inhibitors of cell signaling pathway failed to reveal the mechanism that AZM enhanced PgLPS-induced IL-8 production. Conclusion These results suggest macrolide antibiotics have an indirect anti-inflammatory effect as a result of their antimicrobial properties. Because AZM increased LPS-induced IL-8 production by HGFs, the possibility is considered that neutrophils may be migrated to periodontal tissue and phagocytize the periodontopathic bacteria more efficiently.

Introduction: Modeling energy demand in different energy consuming sectors is a crucial measure for effective management of the energy sector and appropriate policies to increase productivity. The rising importance of energy resources in economic development is evident. Sustainable energy use is crucial for environmental protection and social progress. Understanding the factors affecting energy consumption is essential for effective energy management. Therefore, the purpose of the current study is to investigate the impact of environmental factors on household electricity consumption in Yazd city. Materials and Methods: In the present research, various environmental factors affecting electricity consumption, including air pollution, air temperature in homes, ground surface temperature, and green space were investigated. The effects of these factors on electricity consumption of subscribers were investigated with ANN and apriori methods. Results: Among the environmental factors, the distance to the regional park, the area of the park, and the amount of vegetation at a distance of 300m have the greatest impact, respectively, and the average summer air temperature, the amount of vegetation at a radius of 500 m, the distance from the local park, and the average summer NDVI have had the smallest effect. Unlike neural network methods, apriori presents relationships between parameters affecting electricity consumption transparently in the form of rules. Conclusion: It's used to identify the most frequently occurring elements and meaningful associations in a dataset. Greenspace can be a mitigation strateegy for reduction of energy consumption.

This study evaluates the renewable energy potential in northern Afghanistan by employing the Analytical Hierarchy Process (AHP) and a genetic optimization algorithm. Eleven geodata layers, including factors like solar radiation, elevation, and proximity to various infrastructures, were considered for assessing suitable solar energy development sites across nine provinces. The research combines AHP and genetic algorithm approaches to determine optimal locations for solar energy projects, aiming to aid policymakers and investors in decision-making. Morphological factors such as slope, elevation, and solar radiation were identified as significant determinants of site suitability for solar photovoltaic systems. The study revealed that Afghanistan's northwest and western regions have the most promising areas for solar PV systems due to their lower topographic complexity. The genetic algorithm accurately outperformed AHP, identifying over 29,000 square kilometers of suitable land for solar power plants in northern Afghanistan. The outputs of genetic algorithm are classified into strongly suitable (4504 km²), moderately suitable (5899 km²), and suitable (7088 km²) categories for solar energy development. Balkh province demonstrated the highest potential with an area of 7960 km², while Badakhshan showed the lowest capacity. These findings offer valuable insights for stakeholders interested in solar energy development in northern Afghanistan, aiding them in making well-informed decisions and investments.

Investigation of the three reactants of the FGF system, the basic fibroblast growth factor (bFGF), the FGF receptor, FGFRI, and the cofactor heparin/heparan sulfate (HS), by molecular modeling isothermal titrating calorimetry and ultracentrifugation helps determine their binding reactions. The investigation involves separation of the binding reactions into three binary interactions. The reactions exhibit an enthalpy domination characterized by a single equilibrium constant, K1.

Introduction. The effectiveness of spaced and massed strategies can be evaluated by examining how educational experts (faculty members) transfer their learning skills to real-life educational contexts, such as with their undergraduate students in Saudi Arabia. It is necessary to consider the respective benefits of these strategies for faculty members to maintain standards and capabilities, fulfilling their learning and development needs. Aim. This study aimed to compare the effectiveness of spaced and massed practice programs for faculty members in transferring their acquired assessment skills to their students. To achieve this goal, we used a mixed methodological approach, integrating both qualitative and quantitative methods into the study design. Methods. This study was carried out at the Faculty of Medicine, King Abdul-Aziz University (KAU), Jeddah, Saudi Arabia. Focus group discussions were employed for the qualitative approach, while the paired-sample t-test and Chi-square test of independence were used for the quantitative approach. Results. The results of the focus group discussion indicated that participants from both groups preferred the spaced learning approach, considering the busy schedules of medical doctors and students. In terms of cost effectivity, both group participants preferred the massed learning technique. Two (25%) participants from the spaced technique group and five (62.5%) participants from the massed technique group succeeded in applying all parts of the assessment cycle without significant help from other experts. Three (37.5%) participants in the spaced groups agreed that the pathway of applying the standards was confusing and entailed extra work requirements, while five (62.5%) participants in the massed group responded that it increased the feeling of being overwhelmed. Furthermore, the statistical results did not provide a clear indication of which program faculty members should adopt to facilitate their students in a better way. The lack of statistically significant differences between the findings of both programs suggests that the results do not confirm the superiority of spaced or massed practice, as is often assumed in medical education. Conclusions. Both spaced and massed learning strategies were found to be broadly effective in transferring assessment skills, with no significant qualitative and qualitative differences. Their effectiveness depended on the specification of modules.

Abstract Background Safe and effective physician-to-physician patient handoffs are integral to patient safety. Unfortunately, poor handoffs continue to be a major cause of medical errors. Developing a better understanding of challenges faced by health care providers is critical to address this continued patient safety threat. This study addresses the gap in the literature exploring broad, cross-specialty trainee perspectives around handoffs and provides a set of trainee-informed recommendations for both training programs and institutions. Methods Using a constructivist paradigm, the authors conducted a concurrent/embedded mixed method study to investigate trainees’ experiences with patient handoffs across Stanford University Hospital, a large academic medical center. The authors designed and administered a survey instrument including Likert-style and open-ended questions to solicit information about trainee experiences from multiple specialties. The authors performed a thematic analysis of open-ended responses. Results 687/1138 (60.4%) of residents and fellows responded to the survey, representing 46 training programs and over 30 specialties. There was wide variability in handoff content and process, most notably code status not being consistently mentioned a third of the time for patients who were not full code. Supervision and feedback about handoffs were inconsistently provided. Trainees identified multiple health-systems level issues that complicated handoffs and suggested solutions to these threats. Our thematic analysis identified five important aspects of handoffs: (1) handoff elements, (2) health-systems-level factors, (3) impact of the handoff, (4) agency (duty), and (5) blame and shame. Conclusions Health systems, interpersonal, and intrapersonal issues affect handoff communication. The authors propose an expanded theoretical framework for effective patient handoffs and provide a set of trainee-informed recommendations for training programs and sponsoring institutions. Cultural and health-systems issues must be prioritized and addressed, as an undercurrent of blame and shame permeates the clinical environment.

Background: In recent years, the need for competency-based medical education has been emphasised. Each country needs a defined set of physiotherapy competencies from the associations and governing bodies. Objectives: Our review aimed to map competencies of undergraduate physiotherapy education and propose a context-specific competency framework for Namibia. Method: This scoping review was conducted following the Joanna Briggs Institute framework and was reported using the Preferred Reporting for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. Qualitative direct content analysis utilising the five main competency domains from the WHO Rehabilitation Competency Framework was adapted. Results: Five main competency domains were proposed: practice, professional growth and involvement, learning and development, management and leadership, and research. Nineteen potential competencies were identified, and each competency has a set of knowledge and skills activities that is expected of each student. Conclusion: The proposed competencies still need to undergo expert consensus and content validation before they can be adopted and implemented in Namibia. Future studies can explore the perspectives and experiences of the faculty, students and clinicians on the current status of competency-based education of undergraduate physiotherapy programme in Namibia. Similarly, future studies can focus on possible assessment strategies that can be used for each competency and an evaluation framework for assessing milestones in student competencies from entry into clinical education to graduation. Clinical implications: The review proposed a context-specific competency framework for Namibia with a set of knowledge and skills activities that is expected of each student. The faculty can adopt these competencies and improve on their competency-based physiotherapy education.

Supplying energy demands in Afghanistan is a serious problem, providing demanded energy for consumption is mostly provided by neighboring countries, especially Iran, Turkmenistan, Uzbekistan, and Tajikistan. Domestic production of energy covers only an only small portion of energy demands in the country. In this regard, the energy supply in this country is extremely vulnerable and indicates non-sustainability. This study was intended to review available conducted research and published articles and reports. the results obtained from these reviews show that the utilization of renewable energy, especially, solar and wind energy, resources in Afghanistan is the only reliable and sustainable solution for the energy problem in this country. The results of the review of the previous research indicate that Afghanistan has great potential for renewable energy sources. the country has sources of renewable energy, including solar, wind, and geothermal energy.

Background Globally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched.Methods The process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of ‘High’ or above were added to an operational watchlist and assistance was deployed as needed.Results Since June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%–67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available.Conclusions The system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators.

Blood transfusion services maintain quality practice through adherence to guidelines but are faced with blood component wastage due to multiple factors. One factor, in particular, is poor ordering and utilization practices followed by physicians who may not be familiar with the indications and the optimal conditions for the handling of blood products. This study evaluates whether an educational intervention would help reduce ordering of plasma and improve wastage rates after thawing. The study followed a quasi-experimental pre-test post-test design. A multifaceted educational intervention was introduced at a tertiary hospital-based combining predisposing, enabling, and reinforcing activities, based on the literature of effective continuous professional development. The activities included a brief survey to evaluate participant knowledge about indications of plasma and its storage condition, a lecture, and periodic reports and reminders sent to all department heads in the hospital. Respondents to the survey and lecture attendees included physicians in adult critical care and anesthesia departments. Monthly plasma utilization and wastage rates were compared before and after introducing the intervention. Sixty physicians participated in the survey. The questions were answered correctly by less than half. After introducing the intervention, monthly plasma transfusion rates decreased; however, wastage rates did not improve. There is a knowledge gap among physicians who order plasma. The educational intervention resulted in lower plasma transfusion rates but did not affect wastage rates. Future interventions would benefit from including physicians in other departments as well as nurses.

Objective: To explore knowledge, attitudes and practices of laypersons and health professionals towards foetal programming, and factors affecting it. Method: The mixed methods study was conducted at the Aga Khan University, Karachi, from January 20 2021 to May 13, 2022, and comprised adults of either gender with access to social media platforms. Data was collected using an online survey questionnaire in English and Urdu developed to capture responses from a diverse pool of participants. The survey tool was circulated through WhatsApp, Facebook and Instagram. Two focus group discussions were conducted; one with laypersons in group A and the other with health and allied professionals in group B. Data was analysed using SPSS 21, while data related to focus group discussions was subjected to thematic analysis. Results: Of the 358 participants, 173(48.3%) were in group A and 185(51.7%) were in group B. There were 34(18.4) subjects in group A and 27(15.6) in group B who had knowledge of foetal programming (p>0.05). Only factors related to father’s health and dietary elements on the foetus were significantly different between the groups (p

Introduction In psychiatry, several converging factors are impacting the recruitment of residents: the increased competitiveness of the specialty, the national trend to take active steps to improve diversity and inclusion, and the decision from USMLE to change Step 1 to a pass/fail result. Methods We developed a workshop for psychiatry residency program directors to meet these challenges and transition into using a holistic review model during recruitment. The workshop included (1) a didactic session providing background on the AAMC holistic review model; (2) a small-group exercise to determine and prioritize experiences, attributes, competencies, and metrics (EACMs) aligned with the program's mission and aims; (3) a review of the rankings from the previous exercise, selection of two “very important” criteria for each of the four domains of the EACM model, and operationalization of these criteria based on the recruitment process; and (4) a discussion focused on application of program criteria with example applicants. Results The holistic review workshop was conducted at the American Association of Psychiatry Residency Directors conference in 2021 with 48 self-selected attendees. Following the workshop, 74% of attendees reported a likelihood of implementing holistic applications during their next application cycle, 78% were able to leave with at least one actionable item, 100% thought that the session was interactive, and 78% felt that the session met their expectations. Discussion Implementing a holistic review for psychiatry residency recruitment can assist programs in responding to the rapidly changing landscape and achieve aims for improving diversity and inclusion.

Natural phenomena boundaries and complexity of features in an urban area due to the low spatial resolution, lead to more pixels of satellite images included in reflectance of multiple land-cover/object components. The sub-pixel information extracting model outputs are fractional cover maps of interested class (end-member), with membership values between zero and one. These maps represented gradient change in only one fuzzy phenomenon boundaries such as vegetation cover. However, in multiple fuzzy class area or complex fuzzy phenomena such as mangrove forests, in the northwest of the Qeshm Island, Hormozgan, Iran, displaying several fractional covers may cause confusion and misunderstanding for the end-user. In this study, an additive color composite and spectral mixture analysis method is utilized for multiple fractional cover representation. The proposed method is implemented on images acquired from Operational Land Imager (OLI) sensor in the Landsat 8 satellite to extract three fractional covers (water, vegetation, and soil). An RGB color composite was used for each type and percentage of fractional cover for given pixel to display fractional cover separately. Based on such RGB color composite represented both quantitative and qualitative information, we used the RGB color solid cube as map legend for better understanding and map interpretation. The result of this study showed that suggested sub-pixel visualization method, gives new vision to the end-user understanding of fuzzy phenomena.

This study aimed to evaluate the quality of the American Association of Colleges of Pharmacy Core Entrustable Professional Activities (Core EPAs) for New Pharmacy Graduates according to standards outlined in competency-based education literature utilizing the Queen’s EPA Quality (EQual) rubric. A cohort of pharmacists with EPA expertise rated Core EPA quality with the EQual rubric and provided recommendations for revisions. A generalizability study determined the reliability of the EQual ratings with pharmacist users. Nine pharmacists responded (4.4%). Most EPAs (9/15) did not reach the overall cut-off score, indicating low quality. EPAs 1 through 5 and EPA 14 (fulfill a medication order) were deemed high quality. EPA 12 (use evidence-based information to advance patient care) scored the lowest at 3.47 (SEM 0.29). EPA 14 scored the highest at 4.60 (SEM 0.14). EPA 15 (create a written plan for continuous professional development) was the only EPA to fail to reach the cut-off across all EQual domains. EPAs in the Patient Care Provider Domain received significantly higher ratings than other EPAs. On average, three respondents recommended revision for each. Most comments aligned with the EPA’s EQual rubric performance. The generalizability study analysis revealed excellent reliability (G = 0.80). Determining EPA quality utilizing objective measurement tools should drive EPA development and revisions to more accurately reflect the roles, responsibilities, and expectations of pharmacists on the healthcare team.

Background Among the different aims of medical education, the provision of society with skilled, professional, and knowledgeable healthcare workers who maintain and develop their expertise over a lifetime career is important. The achievement of this goal is linked with the professional development of both faculty members and healthcare workers. This study aims to measure the perception of faculty members regarding their views about the goals of faculty development programs, practices and activities, and factors that determine their achievement. Methods A cross-sectional survey was conducted in multiple universities in the Western region of Saudi Arabia. The participants were given a pre-designed self-administered questionnaire generated from literature. The survey questionnaire consisted of three sections that were designed to assess the faculty members’ perception on the faculty development program. Results A total of 210 faculty members participated in the study. The most important perceived goal was to motivate teachers to become better teachers. The most important perceived practice was establishing a positive climate for teaching and learning. The most important perceived factor was skilled and dedicated staff support. Conclusion The results of this study demonstrate that faculty members have positive perceptions regarding all aspects of faculty development programs. This study will raise awareness regarding the importance of faculty development programs in sustaining educational vitality. We recommend the implementation and maintenance of comprehensive faculty development programs in Saudi universities.

Abstract Background Digital assessment is becoming more and more popular within medical education. To analyse the dimensions of this digital trend, we investigated how exam questions (items) are created and designed for use in digital medical assessments in Germany. Thus, we want to explore whether different types of media are used for item creation and if a digital trend in medical assessment can be observed. Methods In a cross-sectional descriptive study, we examined data of 30 German medical faculties stored within a common assessment platform. More precise, 23,008 exams which contained 847,137 items were analysed concerning the exam type (paper-, computer- or tablet-based) and their respective media content (picture, video and/or audio). Out of these, 5252 electronic exams with 12,214 questions were evaluated. The media types per individual question were quantified. Results The amount of computer- and tablet-based exams were rapidly increasing from 2012 until 2018. Computer- and tablet-based written exams showed with 45 and 66% a higher percentage of exams containing media in comparison to paper-based exams (33%). Analysis on the level of individual questions showed that 90.8% of questions had one single picture. The remaining questions contained either more than one picture (2.9%), video (2.7%), audio (0.2%) or 3.3% of questions had picture as well as video added. The main question types used for items with one picture are TypeA (54%) and Long_Menu (31%). In contrast, questions with video content contain only 11% TypeA questions, whereas Long_Menu is represented by 66%. Nearly all questions containing both picture and video are Long_Menu questions. Conclusions It can be stated that digital assessment formats are indeed on the raise. Moreover, our data indicates that electronic assessments formats have easier options to embed media items and thus show a higher frequency of media addition. We even identified the usage of different media types in the same question and this innovative item design could be a useful feature for the creation of medical assessments. Moreover, the choice of media type seems to depend on the respective question type.