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Rotator cuff (RC) and long head of the biceps tendon (LHBT) tears are common shoulder problems presented to the orthopedic clinic. The aim of this study was to assess the association between RC and LHBT tears among a Saudi population sample. A total of 243 patients who were diagnosed with shoulder pain due to RC or LHBT tear between 2016 and 2018 using a magnetic resonance imaging scan were included in this study. Females comprised 66% of the sample, and 59% (n = 143) of the shoulders were on the right side. The mean age of the patients was 58 ± 11 years, ranging from 23 to 88 years. A significant association was detected between the LHBT and RC tears (P < 0.001). Out of 26 cases showing RC and LHBT tears, 81% had a full thickness tear, whereas 19% had a partial tear. The LHBT tears were presented significantly in 48% of cases with at least two completely torn RC compared to 10% in cases with one completely torn RC (P < 0.001). The LHBT tear was significantly observed in shoulders with RC tears including the tendons of subscapularis, supraspinatus, and infraspinatus, but not the teres minor (P < 0.001). Both types of tears were presented significantly in senior patients aged more than 65 years compared to younger patients (P < 0.01). Thus, the LHBT should be assessed carefully in shoulders with more than one RC tear or in chronic cases.

Background: Improving the performance of marine terminals is one of the major concerns of both researchers and decision-makers in the maritime transportation sector. The problem of container storage planning and the berth allocation problem (BAP) are the two mainstays of optimizing port operations. Methods: In this work, we address these two issues, proposing two mathematical models that operate sequentially and are applicable to both static and dynamic cases. The first developed model is a mixed-integer linear problem model aimed at minimizing vessel traffic time in the port. The second model developed is a multi-objective optimization model based on goal programming (GP) to minimize both container transfer time and the number of storage areas (minimizing container dispersion). Results: The robustness of the proposed models has been proven through a benchmark with tests using data from the literature and real port data, based on the IBM ILOG CPLEX 12.5 solver. Conclusions: The two developed mathematical models allowed the both minimization of the transfer time and the number of used storage areas, whatever the number of operations handling companies (OHCs) operating in the seaport and for both static and dynamic cases. We propose, as prospects for this work, the development of a heuristic model to deal with the major instances relating to the case of large ports.

Study Region: The Upper Blue Nile (UBN) basin, Ethiopia. Study Focus: In efforts to accurately close the water balance equation for the UBN basin using remote sensing products, river runoff is calculated as a residual from the water balance equation by incorporating Gravity Recovery and Climate Experiment (GRACE) terrestrial water storage (TWS) and remote sensing products for precipitation (P) and evapotranspiration (ET). The calculated river runoff is then compared to the gauge records located at the basin’s outlet. The best performing combination among the various combinations is chosen by aggregating rankings attributed to both error and linear fit metrics. The errors associated with each satellite product were assessed by forcing the In-Situ runoff to estimate the P, ET, and TWS. This methodology helps in addressing the uncertainty linked with each hydrological component. New Hydrological Insights for the Region: The best P, ET, and TWS combination performance products to estimate runoff are SM2RAIN-CCI, GLEAM, and GRACE Spherical Harmonic products, respectively. The statistical results for the six metrics are R2 = 0.7, slope = 1.6, y-intercept = - 0.5 cm, RMSE = 3 cm, MAE = 2.8 cm, and PBIAS = 36%. The uncertainty from each hydrological component was quantified and showed that improving the accuracy of P and ET estimation is a crucial step to successfully close the water balance.

Objectives The aim of the global DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) Study was to provide a comprehensive real world assessment of the treatment pattern changes for patients with type 2 diabetes. The aim of this analysis was to assess the metabolic control and the annual incidence of hypoglycaemia, hospitalisation and complications among Saudi patients with type 2 diabetes initiating second-line therapy.Design This study is part of the observational, longitudinal, prospective multinational DISCOVER Study.Setting Governmental and private health sectors from different regions within Saudi Arabia.Participants The study recruited 519 patients with type 2 diabetes aged ≥18 years who were switching to second-line therapy. Patients who were already using insulin/injectable agents, patients with type 1 diabetes, pregnant women, and patients undergoing dialysis or with a history of renal transplantation were excluded.Primary and secondary outcome measures Metabolic control among patients with type 2 diabetes mellitus; fear of hypoglycaemia; quality of life; and the incidence of complications, hypoglycaemic events and/or hospitalisations. Data were analysed using descriptive statistics.Results A total of 519 patients were recruited with a mean age of 52.4±11 years. Of these participants, 54.7% were male and 45.3% were female. The incidence of hypoglycaemia was 56.72/1000 patient-years. The Hypoglycemia Fear Survey II showed a significant increase in patient worry related to hypoglycaemia from 6.4±11.9 at baseline to (p=0.0446) at the 36-month follow-up. The incidence of hospitalisation was 30.81/1000 patient-years. There was a moderate improvement in glycaemic control, represented as an HbA1c reduction from 8.8% at baseline to 8.2% at the 36-month follow-up. The incidence of macroangiopathy was 24.51/1000 patient-years and the incidence of microvascular complications such as retinopathy and albuminuria was 47.00/1000 patient-years and 221.71/1000 patient-years, respectively. The mean score of fear of hypoglycaemia showed an increase with 13.0±21.5 at baseline to 16.1±22.2 at the 36-month follow-up. When assessing the patients’ quality of life, there was an improvement in the mental component score from 47.4±9.1 at baseline to 53.0±6.7 at the 36-month follow-up.Conclusions Treatment intensification decisions should be made individually, weighing the benefit of good glycaemic control against the risk of hypoglycaemia.Trial registration number NCT02322762 and NCT02226822.

The current study deals with how floods affect the social and economic lives of villagers in the lower basin of the Khazir River (northern Iraq), where the villages Kazkan, Tal al-Laban, and Wardak are located within active floodplains close to the riverbed. The aim of this paper is to perform both spatial and temporal analysis of floods affecting society and economic activities in the river basin and to assess ways of preventing them. In this study, qualitative and quantitative methods were used to analyze the results, and we relied on hydrological data and field studies that included oral interviews and personal observations on the phenomenon of floods. The first main study findings indicate through a statistical analysis of a sample of 100 people that floods in the study area are an expected and recurring phenomenon; they occur every year, with damage and losses varying from year to year and from one region to another. The second main study findings indicate that frequent flooding in the study area has a negative impact on growth in all economic and social sectors. These floods affect the agricultural sector more than other sectors as a result of agricultural land being located within flat plain areas with little slope. Based on the effects of floods, improved engineering solutions have been suggested to better control floods and handle emergencies. This is done using GIS models (HEC-GeoRAS) and HEC-RAS models to build a number of hydraulic designs on the riverbed according to different scenarios. The findings of this study should serve as an inspiration for water policy makers to make every effort to implement all feasible and effective preventive measures before floods occur as well as to allow rapid reaction, recovery, and reconstruction after a flood.

Background: Diabetes is influenced by changes in the body's iron levels. Because iron deficiency anemia is common in diabetes, this study examines the link between iron, glycemic control, and complication in patients with type 2 diabetes mellitus (T2DM). Methods: The study is a cross-sectional study conducted from October 2019 to June 2020 at Najran university hospital in the Najran area, Saudi Arabia. All T2DM patients (N = 201) during the study were recruited by simple random sampling. A checklist was completed to extract the study variables from each patient's medical record. Results: There is a positive poor correlation between hemoglobin (Hb) and diabetic foot (r = 0.186, P < 0.05), but not with other diabetic microvascular complications (i.e., retinopathy, nephropathy, and peripheral neuropathy) or glycemic indicators fasting blood sugar, random blood sugar and hemoglobin A1C (i.e., FBS, RBS, and HbA1C). No link is found between ferritin and glycemic indicators or diabetic microvascular complications. Conclusion: The study suggests that particular attention be paid to regular monitoring of iron levels before modifying the treatment plans for type 2 diabetes mellitus (T2DM) patients. It raises critical inquiry about the reality of iron role in diabetes mellitus either in pathogenesis or treatment. It recommends accurately assessing body iron status with careful interpretation for better clinical judgment, encouraging large-scale and long-term epidemiological as well as interventional trials examining the effect of lowering iron in controlling glycemia.

INTRODUCTION: Differential diagnosis of hemoglobin (Hb) variants eluting in the A2 window on high-performance liquid chromatography (HPLC) is of particular importance. Of particular importance is Hb E, which is the most common and the most significant variant. The aim of this study was to study a rare variant infrequently seen in our countries during the routine work. METHODS: Sixteen Bengali workers at Najran University Hospital, Saudi Arabia, came to the laboratory for routine investigation. CBC, routine blood chemistry, and Hb separation by HPLC were performed. RESULTS: Three cases out of 16 showed an abnormal Hb peaked on the A2 window on HPLC consistent with the diagnosis of Hb E. Two of them had Hb E of 29.1% of each. The third case had Hb E around 86%. In addition, one case was consistent with β thalassemia trait had increased Hb A2 of 5.7%. Five cases were borderline. CONCLUSION: HbE could be adequately differentiated from other Hb variants eluting in the A2 window on HPLC by the percentage of the variant, its retention time, the mild clinical presentation, and the ethnic origin of the patient.

Liver diseases are among the most common diseases worldwide. Because of the high incidence and high mortality rate, these diseases diagnoses are vital. Several elements harm the liver. For instance, obesity, undiagnosed hepatitis infection, and alcohol abuse. This causes abnormal nerve function, bloody coughing or vomiting, insufficient kidney function, hepatic failure, jaundice, and liver encephalopathy.. The diagnosis of this disease is very expensive and complex. Therefore, this work aims to assess the performance of various machine learning algorithms at decreasing the cost of predictive diagnoses of chronic liver disease. In this study, five machine learning algorithms were employed: Logistic Regression, K-Nearest Neighbor, Decision Tree, Support Vector Machine, and Artificial Neural Network (ANN) algorithm. In this work, we examined the effects of the increased prediction accuracy of Generative Adversarial Networks (GANs) and the synthetic minority oversampling technique (SMOTE). Generative opponents’ networks (GANs) are a mechanism to produce artificial data with a distribution close to real data distribution. This is achieved by training two different networks: the generator, which seeks to produce new and real samples, and the discriminator, which classifies the augmented samples using supervised classifications. Statistics show that the use of increased data slightly improves the performance of the classifier.

The solvability of the fractional partial differential equation with integral overdetermination condition for an inverse problem is investigated in this paper. We analyze the direct problem solution by using the “energy inequality” method. Using the fixed point technique, the existence and uniqueness of the solution of the inverse problem on the data are established.

The aim of this research is to demonstrate the existence and the uniqueness of the weak solution for a semilinear fractional parabolic problem with the special case of the second integral boundary condition. For this aim, we split the proof into two parts; to study the main linear problem part, we used the variable separation method, and concerning the semilinear problem part, we apply an iterative method and a priori estimate for the study of the weak solution.

Objectives: The DISCOVER study is a global, prospective, three- year- observational (non-interventional) study that was conducted in 37 countries throughout the world including Saudi Arabia and aimed to assess variations in treatment patterns and therapeutic outcomes in type 2 diabetic patients. The current manuscript is reporting data of DISCOVER study across different health sectors of various provinces in the Kingdom of Saudi Arabia. Methods: In this study, 519 Saudi type 2 diabetics, non-insulin users, aged 18 years or older, initiating second line therapy, were selected from nine health institutes, in four out of five provinces in Saudi Arabia. Data was collected at baseline (initiation of 2nd line therapy) by the treating physician using an electronic case report form (eCRF) via a web-based data capture system. Each selected subject was asked to complete four self-administered questionnaires. Results: The mean age of the studied population was 52.4 ± 11 years. Among the subjects selected from the nine medical centers, 55% were men, with almost 65% between the ages of 46 and 65 years. The oral agent used as 1st line in the majority of patients was metformin, prescribed in 89.2% of the study cohort. In the second line, sitagliptin was the most frequently used, at 61.8%. followed by gliclazide, glibenclamide, and glimepiride at 35.6%, 13.1%, and 12.7%, respectively. Conclusion: Metformin, with or without sulfonylureas, is the most commonly prescribed first-line treatment for patients with type 2 diabetes, managed either in governmental institutions, or in the private sector. The most common second line drugs were DPP4 inhibitors, mainly sitagliptin, followed by the third and second generation of sulfonylureas. Drug affordability was not an issue, since the vast majority of the patients received medication free of charge. Keywords: Discover Type 2 diabetes, First line management, Second line management

Garret Weber, Kenneth Saad, Motaz Awad, Tiffany H Wong Department of Anesthesiology, New York Medical College, Valhalla, NY, USACorrespondence: Garret WeberDepartment of Anesthesiology, New York Medical College, Westchester Medical Center, 100 Woods Road, Macy Room 2391, Valhalla, NY 10595, USAEmail garret.weber@wmchealth.orgAbstract: Postherpetic neuralgia is a common and potentially debilitating neuropathic pain condition. Current pharmacologic therapy can be inadequate and intolerable for patients. We present a case of a gentleman with refractory postherpetic neuralgia in the intercostobrachial nerve distribution that was successfully treated with cryoneurolysis/cryoanalgesia therapy.Keywords: cryoneurolysis, cryoablation, postherpetic neuralgia, intercostobrachial neuralgia, neuropathic pain

Safety stock (SS) is an appropriate tactic to deal with demand and supply uncertainty with the aim of preventing inventory shortages. In the literature, previous work on SS estimation assumes that the forecast error distributions (FED) are independent and identically distributed (i.i.d) following the normal distribution. In order to assess violations of this assumption, there are many solution methods in the recent literature that include the following: (1) Consider the FED as other distribution models, such as gamma distribution or log-normal distribution, etc. (2) Use the Generalized Auto-Regressive Conditional Heteroskedasticity (GARCH) model to consider the Heteroskedasticity phenomena, (3) Use the extreme value theory (EVT) to take into consideration the occurrence of extreme demands, etc. However, the performance of these methods is not guaranteed because there is an absence of comparative studies. Indeed, the estimation of SS is based on the approximation of quantiles of the FED. Such quantiles are related to the cycle service levels (CSL) that are important to achieve company goals. Accordingly, the aim of this research is to propose two combined empirical methods to determine the SS in a more robust fashion and compare them with traditional methods under different supply chain parameters. The first combined method, named Filtered Historical Simulation (FHS), consists of combining the GARCH model with the simulation method. The second combination named Conditional Extreme Value Theory (CEVT) is the GARCH model with EVT. To validate these proposed combined methods, the SS is also estimated using traditional methods, such as simple exponential smoothing (SES), simulation, and kernel density estimation (KDE). The methodology is illustrated with both simulation data and real case study data for different lead times. For the FED, two cases are studied: lognormal distribution and gamma distribution. The results show the superiority of the two proposed combination methods with respect to the tick loss function (TLF) for the different CSL targets and for shorter and longer lead times. Results are confirmed using the ANOVA test.

Seaports are important infrastructures to support international trade. Therefore, it is vital that port efficiency and productivity are continuously evaluated and improved. In this context, the objective of this article is to evaluate both the technical efficiency and the change in productivity of the six most important Tunisian commercial seaports, Bizerte, Rades, Sousse, Sfax, Gabes, and Zarzis, over a period of twelve years from 2005 to 2016. To achieve this objective, the data envelopment analysis (DEA) method is applied. The first output-oriented DEA application is about efficiency evaluation, which, for each seaport, allows the estimation of overall technical efficiency, pure technical efficiency, and scale efficiency. The second application concerns the evolution of the productivity of Tunisian seaports during the study period using the Malmquist DEA-based productivity index. The productivity analysis is performed according to the year (period) and according to each studied seaport. The first output-oriented DEA method provides that the overall technical efficiency in the above-mentioned ports is 69.4% while the pure technical efficiency is 83.3%. Furthermore, the average scale efficiency is about 82.6%, which implies that the decreasing type of returns to scale dominates in this study. Regarding the second DEA application for productivity evolution, the obtained results from the data analysis revealed that it fell by 6.7%, mainly due to the degradation of the technological change (8.3%). The results obtained provide useful basic criteria for establishing efficiency improvement strategies for each studied seaport.

The main objective discussed in this research was to determine the structural characteristics of carob kibble water-soluble polysaccharide (KWSP), extracted from Ceratonia siliqua L., and to assess its in vitro antioxidant activities, as well as its effect on whipped cream. The results obtained through 13C, 1H, and the hetero-nuclear single quantum coherence (HSQC) nuclear magnetic resonance (NMR) and Fourier transform infrared spectroscopy (FT-IR) analysis indicated that KWSP had the characteristic bands of polysaccharides. Thin layer chromatography (TLC) and high performance liquid chromatography (HPLC) suggested that KWSP is a hetero-polysaccharide composed of glucose and fructose, with an average molecular weight (Mw) amounting to 65 KDa. In addition, KWSP showed a good water holding capacity (WHC), a good oil holding capacity (OHC), and an emulsification stability, rated as 3.14 ± 0.05 g/g, 0.87 ± 0.02 g/g, and 71 ± 0.01%, respectively. The antioxidant activity of KWSP was investigated in vitro, demonstrating important DPPH and ABTS⋅+ radical scavenging activities and a good total antioxidant capacity. KWSP exhibited antibacterial activity against Listeria monocytogenes, Staphylococcus aureus, and Salmonella enterica. On the other hand, the incorporation of KWSP in whipped cream was investigated, to enhance its antioxidant capacity and consequently to extend its expiration date. Moreover, KWSP reduces the formation of conjugated dienes and trienes in cream fat.

Flat-slab system is widely used nowadays. Major and critical problem of this system is its sudden brittle failure is called punching shear failure. To overcome the punching failure problem, there are many ways to increase the punching shear strength of concrete slabs, increasing slab thickness in the area adjacent to the column, increasing column thickness which is against the architectural desire, and finally providing slab with shear reinforcement. Shear reinforcement is more advanced from both the structural and economical point of view.An experimental program includes seven full scale square flat slab interior column specimens tested under gravity loads. All slabs have same dimensions of 1700 mm × 1700 mm with thickness 160 mm and reinforcement ratio of 1.2%. Column was square of 200 mm length and 250 mm height. Elongated steel strips of 25 mm width and 1.5 mm thickness undulated into the slab in different ways to investigate punching shear resistance.The program is divided into five groups. First group investigates the effect of installing the shear-band reinforcement (hanged up on top mesh, knit the top and bottom mesh together). The second group investigates the effect of inclination of shear reinforcement (shear band with vertical leg, with bended leg 45°). The third group investigates the effect of concentrating the shear reinforcement by increasing the quantity around the column. The fourth group investigates effect of radial distribution of shear-band system around the column. Finally, the fifth group investigates the effect of box distribution of shear-band system around the column. Keywords: Flat slab, Shear band, Punching shear, Failure load

BACKGROUND: Zika virus (ZIKV) is a teratogenic flavivirus that can cause microcephaly. Its main vector, Aedes aegypti, has been previously identified in Saudi Arabia, but no ZIKV infection has yet been reported. Nevertheless, the country is at risk from ZIKV because it receives many travelers throughout the year, including pilgrims from ZIKV-endemic countries. OBJECTIVES: Screen asymptomatic pregnant mothers and their newborns attending a major hospital in the Najran region for subclinical or past infections with ZIKV, using ELISA and RT-PCR. DESIGN: Cross-sectional. SETTING: Najran Maternity and Children Hospital (NMCH). SUBJECTS AND METHODS: All pregnant women admitted to NMCH in labor between November 2016 and July 2017 were included in the study. Clinical and demographic data were collected by pre-validated physician-administered questionnaires. Paired umbilical and maternal serum samples were collected and frozen at –60°C, using ELISA to measure anti-ZIKA IgG and IgM antibodies and RT-PCR to further investigate positive samples. MAIN OUTCOME MEASURES: Maternal and newborn serum anti-ZIKV IgM and IgG and ZIKV RT-PCR. SAMPLE SIZE: 410 mother-newborn pairs. RESULTS: The median gestational age was 38.5 weeks (range 33–42). Most (n=342, 83.41%) of the women were from Najran city. All of the newborns had normal growth parameters with no congenital malformations. None of the mothers had symptoms suggestive of ZIKV infection; 3 (0.7%) exhibited a low-grade fever (38°C), but did not test positive for anti-ZIKV antibodies. Thirty-five (8.53%) of mothers had travelled inside Saudi Arabia, but none outside the country. Twenty-four (5.85%) mothers tested positive for anti-ZIKV IgM and 52 (12.68%) tested positive for anti-ZIKV IgG, but all infant samples were negative. All seropositive ZIKV IgM were also ZIKV IgG positive, but RT-PCR testing of all seropositive samples was negative. CONCLUSION: Although previous (resolved) ZIKV infection and cross-reactivity of the ELISA method with other flaviviruses cannot be excluded, the study found no confirmed cases of acute ZIKV infection. However, given the presence of the vector in Saudi Arabia, the presence of presumptive positive serology and the ongoing risk of ZIKV entry via a regular influx of travelers from endemic areas, we propose that continuous surveillance be conducted for ZIKV as well for other flaviviruses. Larger-scale nationwide studies are strongly recommended to gain a broader view of the potential threat from ZIKV in the country. LIMITATIONS: Small sample size, unavailability of plaque reduction neutralization tests to confirm serology results, and RT-PCR was only conducted on ELISA-positive serum samples, due to resource constraints. CONFLICT OF INTEREST: None.

This study intends to examine different dynamics of the chaotic incommensurate fractional-order Hopfield neural network model. The stability of the proposed incommensurate-order model is analyzed numerically by continuously varying the values of the fractional-order derivative and the values of the system parameters. It turned out that the formulated system using the Caputo differential operator exhibits many rich complex dynamics, including symmetry, bistability, and coexisting chaotic attractors. On the other hand, it has been detected that by adapting the corresponding controlled constants, such systems possess the so-called offset boosting of three variables. Besides, the resultant periodic and chaotic attractors can be scattered in several forms, including 1D line, 2D lattice, and 3D grid, and even in an arbitrary location of the phase space. Several numerical simulations are implemented, and the obtained findings are illustrated through constructing bifurcation diagrams, computing Lyapunov exponents, calculating Lyapunov dimensions, and sketching the phase portraits in 2D and 3D projections.

One of the basic components of Industry 4.0 is the design of a flexible manufacturing system (FMS), which involves the choice of parameters to optimize its performance. Discrete event simulation (DES) models allow the user to understand the operation of dynamic and stochastic system performance and to support FMS diagnostics and design. In combination with DES models, optimization methods are often used to search for the optimal designs, which, above all, involve more than one objective function to be optimized simultaneously. These methods are called the multi-objective simulation–optimization (MOSO) method. Numerous MOSO methods have been developed in the literature, which spawned many proposed MOSO methods classifications. However, the performance of these methods is not guaranteed because there is an absence of comparative studies. Moreover, previous classifications have been focused on general MOSO methods and rarely related to the specific area of manufacturing design. For this reason, a new conceptual classification of MOSO used in FMS design is proposed. After that, four MOSO methods are selected, according to this classification, and compared through a detailed case study related to the FMS design problem. All of these methods studied are based on Design of Experiments (DoE). Two of them are metamodel-based approaches that integrate Goal Programming (GP) and Desirability Function (DF), respectively. The other two methods are not metamodel-based approaches, which integrate Gray Relational Analysis (GRA) and the VIKOR method, respectively. The comparative results show that the GP and VIKOR methods can result in better optimization than DF and GRA methods. Thus, the use of the simulation metamodel cannot prove its superiority in all situations.

Port risk management (PRM) during port operations is a current problem that can negatively affect the environment, people, and economic issues. In the literature, there is an enormous amount of research related to supply chain risk management (SCRM) in various areas and with various objectives. However, PRM has not received the same degree of attention. In fact, port terminals are crucial links in most supply chain networks and an important pillar of international trade. Therefore, for better risk mitigation efficiency, a risk assessment and prioritization step are vital. Recently in the literature, researchers have applied prospective methods such as structural analysis methods to risk prioritization in SCRM. The aim of this research is to prioritize various man-made risk variables in PRM using a qualitative structural modeling-based approach, specifically, the MICMAC method (referring to its French acronym: Matrice d’Impacts Croisés Multiplication Appliquée à un Classement). An empirical study was conducted to assesses and prioritize risk variables of the seaport terminals of Sfax (Tunisia). The main contributions of the empirical research are twofold. First, to prioritize the key risk variables to define the most critical ones that require immediate intervention. Second, to analyze the structure of the influences between all identified risk variables. The results for the port terminals of Sfax show that the highest-priority risk variables are the manual handling (Ph3), disregard for safety aspects (Ph4), unsafe storage of goods (Inc1), absence of a prevention system and a rescue organization (Inc2), neglect of the regulatory aspects of handling equipment (M1), ignorance of good handling practices during the operation of loading and unloading (Cho2), and inadequate lifting accessories (Cho3). These risk variables must be the subject of urgent risk reduction strategies.

Internet traffic classification is a beneficial technique in the direction of intrusion detection and network monitoring. After several years of searching, there are still many open problems in Internet traffic classification. The hybrid classifier combines more than one classification method to identify Internet traffic. Using only one method to classify Internet traffic poses many risks. In addition, an online classifier is very important in order to manage threats on traffic such as denial of service, flooding attack and other similar threats. Therefore, this paper provides some information to differentiate between real and live internet traffic. In addition, this paper proposes a hybrid online classifier (HOC) system. HOC is based on two common classification methods, port-base and ML-base. HOC is able to perform an online classification since it can identify live Internet traffic at the same time as it is generated. HOC was used to classify three common Internet application classes, namely web, WhatsApp and Twitter. HOC produces more than 90% accuracy, which is higher than any individual classifiers.

This study investigated the outgoing and pollen-gathering foraging activities of Apis mellifera jemenitica (AMJ) and Apis mellifera carnica (AMC) under a hot-arid environment in the presence of nectar-rich melliferous Ziziphus nummularia flora. The data revealed the differential effects of weather conditions and Z. nummularia flora on the foraging activities of the studied honey bee subspecies in the Rawdat-Khuraim oasis in central Saudi Arabia. Z. nummularia exhibited two flowering seasons, from June–July (season I) and August–October (season II), with a significantly higher mean flowering density observed during season II (404 flowers/m2) than during season I (235 flowers/m2). AMJ showed significantly higher foraging activities (outgoing and pollen-gathering) than AMC (exotic bees) during all months in each flowering season. The mean outgoing and pollen-gathering foraging rates of AMJ (32.40 ± 0.67 and 4.88 ± 0.40 workers/colony/min, respectively) were significantly higher than those of AMC (15.93 ± 1.20 and 2.39 ± 0.23 workers/colony/min, respectively). The outgoing and pollen-gathering foraging activities of the two subspecies fluctuated throughout the different times of day. Foraging activities were considerably high at sunrise (SR) and low at noon (N) during both flowering seasons. We also observed seasonal variations in the foraging activities of both bee subspecies. The mean foraging activities (outgoing and pollen-gathering) were slightly higher in season I (27.43 ± 1.21 and 4.46 ± 0.45 workers/colony/min, respectively) than in season II (21.71 ± 0.86 and 3.02 ± 0.22 workers/colony/min, respectively). The thermal window analysis revealed a significant difference between the flight activities (bees exiting and returning to the nest throughout the day) of AMJ and AMC; AMJ had a higher temperature threshold than AMC. The outgoing and pollen-gathering foraging activities within each bee subspecies were positively correlated. The present study can help researchers understand the performances of honeybees and the association of their performances with weather and nectar-rich flora conditions.

Upper Gastro Intestinal Endoscopy (UGIE) is a commonly performed diagnostic and/or therapeutic procedure for evaluation of patients with various abdominal complaints. UGIE complications vary including; pneumonia, mediastinitis, oesophago-pleural fistula. The reported complications of UGIE are diverse and vary from one center to another. Aim: The study aimed to report the thoracic complications in patients underwent UGIE during the period between July and December 2016. Patients and methods: One hundred and twenty patients, candidates for UGIE were included in the study. All patients were subjected to: thorough medical history, complete general and local chest and abdominal examination, routine laboratory investigations, chest X-ray and chest computed tomography (CT) if needed, spirometric pulmonary function tests (PFT), arterial blood gases (ABGs), pre and post UGIE. Results: Patients were 84 males and 36 female, age ranged from 25 to 70 years old, hematemesis and/or melena was the most common presentation (65%). Oesophageal varices was the most common endoscopic finding (50% of cases). Chest pain, cough and bronchitis were more common among Oesophageal Varices Sclerotherapy (OVS) patients. Pneumonia, atelectasis, pleural effusion and mediastinitis were reported after OVS. There was significant difference regarding spirometric parameters before, 2 days and 3 weeks after the procedure in patients underwent OVS and Gastric Varices Sclerotherapy (GVS), while no significant difference was reported in patients underwent Oesophageal Varices (OV) band ligation and peptic ulcer diagnosis before, 2 days and 3 weeks after the procedure. Conclusions: Thoracic complications were more common in OVS and GVS than in OV band ligation.

Using an adaptive Mamdani fuzzy inference system model (MFSIM), the purpose of this paper is mainly to assess and rank the assessment and ranking of water quality for irrigation occurring in the Hammamet-Nabeul (Tunisia) shallow aquifer. This aquifer is under Mediterranean climate conditions and affected by intensive and irrational agricultural activities. In the current study, the Mamdani fuzzy logic-based decision-making approach was adapted to classify groundwater quality (GW) for irrigation. The operation of the fuzzy model is based on the input membership functions of electrical conductivity (EC) and sodium absorption ratio (SAR) and on the output membership function of the irrigation water quality index (IWQI). Validation of the applied MFISM showed a rate of about 80%. Therefore, MFISM was shown to be reliable and flexible in quality ranking for irrigation in an uncertain and complex hydrogeological system. The results demonstrated that water quality contamination in the aquifer is affected by the overlaying of three types of negative anthropogenic practices: the excess use of water for irrigation and chemical fertilizers, and the rejection of partially treated wastewater in some areas. The implemented approach led to identifying the spatial distribution of water quality for irrigation in the studied area. It is considered a helpful tool for water agri-environmental sustainability and management.

In recent years, the evaluation of several energy sources is an extremely significant issue that affects socio-environmental development and techno-economic growth in different sectors. To tackle this concern, many researchers have concentrated on preferring desirable energy sources and adopting multi-criteria group decision-making (MCGDM) approaches for only a single type of user (e.g., agricultural, industrial, tourism, or domestic users). However, every energy user plays an important role in shaping energy policy. In fact, for sustainable energy, it is important to include all main energy users at the same time in energy decision-making. The main objective of this work was to propose a fuzzy MCGDM approach to evaluate and prioritize energy sources in Tunisia from various sectors’ point of views. Many criteria are combined, including the following: technical, economic, social, political and environmental. After applying the fuzzy Delphi method, the proposed approach consists of applying a fuzzy TOPSIS method as a multi-criteria approach. Finally, a sensitivity analysis is performed to evaluate the results of the proposed approach and to study how the optimal solution is affected by the objective function coefficients.

Healthcare facilities are facing major issues and challenges. Hospitals continuously search approaches to improve operations quality, optimize performance, and minimize costs. Specifically, an efficient hospital sterilization process (HSP) allows reusable medical devices (RMDs) to be more quickly available for healthcare activities. In this context, this paper describes an integrated approach developed to analyze HSP and to identify the most critical improvement actions. This proposed approach integrates four quality tools and techniques. Firstly, a structured analysis and design technique (SADT) methodology is applied to describe HSP as a hierarchy of activities and functions. Secondly, the failure modes and effects analysis (FMEA) method is used as a risk assessment step to determine which activity processes need careful attention. Thirdly, a cause–effect analysis technique is used as a tool to help identify all the possible improvement actions. Finally, priority improvement actions are proposed using the quality function deployment (QFD) method. To validate the proposed approach, a real sterilization process used at the maternity services of Hedi-Cheker Hospital in the governorate of Sfax, Tunisia, was fully studied. For this specific HSP, the proposed approach results showed that the two most critical activities were (1) improving the coordination between the sterilization service and the surgery block and (2) minimizing the average duration of the sterilization process to ensure the availability of RMDs in time.

Hemolymph osmolarity has great effect on honey bee health, especially in arid and semi-arid zones. It regulates water and nutrients in stressed tissues. Osmotic concentration in three races (Apis mellifera ligustica, A. m. carnica and A. m. jemenitica) of Apis mellifera was tested in central Saudi Arabia during spring and summer seasons in 2015. Newly emerged bee workers were first marked and later their hemolymph was extracted after intervals of 1, 5, 10, 15, 20 and 25 days. A significant positive correlation between age and osmolarity was found in all three races during spring and summer seasons. The lowest combined osmotic concentration for all three races was found after 1 day interval, while the highest osmotic concentration was recorded after 25 days. Among all races, A. m. ligustica showed significantly high osmotic concentration after 25 days in spring and summer seasons as compared to the other two races. Only A. m. jemenitica showed similar osmotic concentration after 10 and 15 days in both spring and summer seasons compared to other two races. Mean osmotic concentration of all three races was significantly different after 20 and 25 days in spring and summer seasons. Overall mean recorded during summer was significantly higher than the mean of spring season. Combined osmotic concentration in young drones of all races was significantly lower than that of old drones during spring and summer seasons.

The contribution of a bee plant species to honey production depends on the plant’s nectar secretion quality and quantity, which is mainly governed by biotic and abiotic factors. The aim of the current study, was to investigate the nectar secretion dynamics and honey production potential of 14 major bee plant species of the target area. We examined the quantity and dynamics of nectar sugar per flower five times a day using a nectar sugar washing technique and direct measuring of nectar with calibrated capillary tubes. The average nectar sugar amount of the species varied from 0.41 mg/flower to 7.7 mg/flower (P

Inventory-pooling (IP) is an effective tool to mitigate demand uncertainty and variability, to reduce operational costs, and consequently to increase the profit. The major assumptions of the previous works in literature on IP include the following: (1) Independents demand, which satisfy the typical normal independent and identically distributed (iid) random variables; (2) dependents (correlated) symmetric demands, which follows to a multivariate normal distribution. The effect of the dependent asymmetric demand is not yet studied. The aim of this paper is to consider this more realistic case. Indeed, the contribution of this paper is twofold. Firstly, it analyzes both the sensitivity of dependence structure and the levels of skewness of distributions on IP policies in terms of optimal total cost and demand satisfaction constraint. Secondly, both symmetric and asymmetric demand distributions are modeled using various beta distribution and the dependance between demands are modeled using various copulas. A newsvendor problem inspired by the literature, with two decentralized locations and two centralized locations, is considered the empirical study. For each dependance situation, three IP models are considered: inventory centralization, regular transshipments, and independent systems. The results suggest divergences in the decisions in about 9% of cases. Bad choice of marginal distributions given that the copula is appropriate can lead to divergences that vary between 2.2% and 4%, depending on whether the demand distributions are symmetric or asymmetric.

Deficiency of the 5-α-reductase enzyme has been found to affect male sexual development. We report an 18-year-old patient who was referred to an endocrinology clinic in Jizan, Saudi Arabia, in April 2014 with primary amenorrhoea, virilisation and a lack of secondary sex characteristics. As female external genitalia were present at birth, she had been raised as a female. Magnetic resonance imaging revealed no uterine or ovarian tissue in the pelvis and the presence of a scrotal sac. She was diagnosed with 5-α-reductase type 2 deficiency, a 46,XY disorder of sexual development. Typically, affected males have pseudovaginal perineoscrotal hypospadias and ambiguous genitalia at birth. Individuals who have been raised as female manifest characteristics of virilisation at puberty, including deepening of the vocal tone, phallus enlargement, scrotal hyperpigmentation and increased muscle mass.

Two corn genotypes, Var-113 (high phytate) and TL-98B-6225-9×TL617 (low phytate) were germinated for 6 days. The germinated seeds were dried and milled. Phytic acid, polyphenols, and hydrochloric acid (HCl) extractable minerals were determined at intervals of two days of germination. Phytic acid decreased significantly (P ⩽ 0.05) with a concomitant increase in HCl extractable minerals, while polyphenol contents increased significantly (P ⩽ 0.05) with an increase in germination time. However, the major mineral content was initially decreased and then increased while that of trace minerals was increased with germination time. After 6 days of germination, the high phytate sample (Var-113) exhibited higher extractable calcium compared to the other genotype, whereas the low phytate sample (TL-98B-6225-9×TL617) showed higher extractable phosphorus. Iron extractability was higher for the low phytate samples, while that of magnesium was higher for the high phytate sample. High correlation between lower phytate and higher extractable minerals was noted as a function of longer germination time. Nevertheless, no correlation was observed between polyphenol content and mineral extractability level.

Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied, the closure of the fistula is a challenging problem. We present a simple surgical procedure, posterior urethral incision technique [PUIT] to close the fistula in our department. Between February 2001 and December 2004 we prospectively evaluated 32 patients, 26 patients with initial hypospadias fistulas and 6 with recurrent fistulas who underwent closure of urethrocutaneous fistula after hypospadias repair. The mean age of patients was 5 years, the operation consisted of trimming the fistula edge after mobilization of the skin all-around then a midline posterior urethral incision was done 2 mm above and 2 mm below the fistula opening then re-approximation of the urethral edges using 6/0 vicryl sutures with loop magnification. The timing of fistula repair was between 6 and 13 months after it was formed, all of these were effectively closed except three cases with stricture and fistula. Of these, two were completely relieved after repeated urethral dilatation, three times a week for 2 weeks. The third failed case will need another sitting after 6 months. The posterior midline urethral incision gives a good opportunity for repair without tension with a good cosmetic outcome. This may be done under local anesthesia in adults. The procedure is considered simple rapid and easy to be done for variable fistulas types whatever of its site and the age.