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BACKGROUND: High-power short-duration (HPSD) ablation has emerged as an alternative to conventional standard-power long-duration (SPLD) ablation. We aim to assess the efficacy and safety of HPSD versus SPLD for atrial fibrillation (AF) ablation. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL were performed through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023471797. RESULTS: We included six RCTs with a total of 694 patients. HPSD was significantly associated with a decreased total procedure time (MD: -22.88 with 95% CI [-36.13, -9.63], P = 0.0007), pulmonary vein isolation (PVI) time (MD: -19.73 with 95% CI [-23.93, -15.53], P

Abstract The insulators of overhead power lines play a crucial role in maintaining the reliability of transmission and distribution networks. Because they are exposed to harsh and dynamic environmental conditions, it is essential to investigate the impact of environmental parameters such as pollution, inclined angle with the cross arm, and temperature on the dielectric performance of the insulators of overhead lines. Conventionally, the effect of such parameters can be investigated through experimental measurements of the insulator flashover voltage. However, this approach is costly and time-consuming and calls for the isolation of the lines to conduct the test, causing interruption to the entire grid. As such, there is an essential need to develop a new methodology to quantify the flashover voltage of overhead insulators operating under various environmental conditions, which is the main aim of this paper. The Central Composite Design is employed to develop a mathematical correlation between the insulator flash over voltage as a dependent variable and three environmental parameters: pollution level, inclined angle, and temperature as independent variables. The robustness of the developed equation is validated through extensive experimental measurements of the insulator’s flash overvoltage under various conditions. Results reveal a good agreement between the actual and predicted flashover voltage using the developed correlation, as the absolute error for all investigated samples is less than 6%.

Abstract The removal of pollutants from the environment has become a global demand. The current study aimed to relieve the Ni toxicity effect on the germination, growth, and grain yield of maize by using Azolla pinnata as a phytoremediator. Azolla-treated and untreated nickel solutions [0 (control), 24, 70, 140 and 190 ppm] were applied for germination and pot experiments. Electron microscope examination cleared the Ni accumulation in Azolla’s cell vacuole and its adsorption on the cell wall. The inhibition of the hydrolytic enzyme activity reduces maize germination; maximal inhibition was 57.1% at 190 ppm of Ni compared to the control (100%). During vegetative growth, Ni stimulated the generation of H2O2 (0.387 mM g−1 F Wt at 190 ppm of Ni), which induced maximal lipid peroxidation (3.913 µMDA g−1 F Wt) and ion leakage (74.456%) compared to control. Chlorophyll content and carbon fixation also showed significant reductions at all Ni concentrations; at 190 ppm, they showed maximum reductions of 56.2 and 63%, respectively. However, detoxification enzymes’ activity such as catalase and antioxidant substances (phenolics) increased. The highest concentration of Ni (190 ppm) had the most effect on constraining yield, reaching zero for the weight of 100 grains at 190 ppm of Ni. Azolla-treated Ni solutions amended all determinant parameters, indicating a high percentage of changes in hydrolytic enzyme activity (125.2%) during germination, chlorophyll content (77.6%) and photosynthetic rate (120.1%). Growth measurements, carbon fixation, and yield components showed a positive association. Thus, we recommended using Azolla as a cost-effective and eco-friendly strategy to recover Ni-polluted water.

Abstract Background Gastroesophageal reflux disease (GERD) is a frequent digestive illness in North America, causing symptoms and complications. It affects 18.1–27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. The study aims to assess the role of screening of patients proven to have GERD by upper gastrointestinal endoscope for early detection of interstitial lung diseases. Subjects and methods This research was cross-sectional research. The study will be conducted at the Chest Diseases Department of Ain Shams University hospitals. This prospective cross-sectional research will be performed on 90 randomly selected cases diagnosed with GERD by upper gastrointestinal endoscopy. For 1 year. Result The findings of chest HRCT for enrolled patients are 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scans. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender, and reticular infiltration. no statistically significant association between CT findings and each of the chest symptoms and GERD symptoms. Conclusion CT chest screen of patients diagnosed with GERD by upper gastrointestinal endoscopy plays a favorable role in the early detection of ILD to help in early management and treatment them. In patients diagnosed with GERD by upper gastrointestinal endoscopy, we revealed that: reticular infiltration is more prevalent in female gender. Reticular infiltration and fibrosis increase with older age. Reticular infiltration and atelectasis increase in patients who have a hiatus hernia. Cough, dyspnea, and wheezes increase in older age.

Introduction: Chronic allograft nephropathy (CAN) is a poorly understood clinico-pathological entity associated with chronic allograft loss due to immunologic and non-immunologic causes. It remains the leading cause of late allograft loss. Bone marrow derived stem cells are undifferentiated cells typically characterized by their capacity for self renewal, ability to give rise to multiple differentiated cellular population, including hematopoietic (HSCs) and mesenchymal stem cells (MSCs). Characterization of HSCs includes their multipotency, expression of typical surface markers such as CD34 and CD45, while characterization of MSC includes their multipotency, expression of typical surface markers such as CD90 and CD105, and the absence of hemopoietic lineage markers. Aim & methods: The aim of the present work was to study the role of bone marrow-derived HSCs and MSCs, renal progenitor cells and SCF in chronic renal allograft nephropathy in relation to renal hemodynamics and histopathological changes. We studied 30 patients with kidney transplantation for more than 6 months, divided into 15 patients with stable serum creatinine and 15 patients who developed CAN. Detection of HSCs and MSCs in the peripheral blood using flow cytometry via detection of CD34, CD45, CD117 and CD106, as well as immunohistochemical detection of CD34, CD133, VEGF and αSMA in transplanted kidney biopsies of patients with CAN were done. Results: There was a significant increase in the levels of SCF, number of peripheral blood HSCs and MSCs in both transplanted patient groups than the controls and they were higher in patients of group Ia than patients of group Ib, (F = 39.73, P < 0.001), (F = 13.28, P < 0.001), (F = 11.94, P < 0.001), respectively and this was accompanied by evident expression of markers of renal repair. Conclusion: Stem cells might have a role in renal regeneration in CAN and this may pave the way toward the use of stem cells in correction of CAN. KEYWORDS: Chronic allograft nephropathy, Hematopoietic stem cells, Mesenchymal stem cells, Stem cell factor, Renal regeneration

The environmental conditions significantly impact the performance of the transmission line insulators. The current work investigated some variables that influence the flashover and breakdown voltages, such as insulator pollution (P), insulator inclined angles with the cross-arm (A), and insulator temperature (T). A prediction equation can be developed using Box-Behnken Design (BBD) to relate the input variables (P, A, and T) and the flashover voltage (VFO). BBD is a rotatable second-order design requiring three levels of each variable, influencing a specific experiment response. A statistical analysis was carried out to identify the significant variables affecting voltage VFO. So, the main objective of the work is to investigate the effect of P, A, and T on the VFO and use Box Behnken Design (BBD) to predict the value of VFO when the information about P, A, and T is available without requiring any experimental works. The results illustrated a prediction equation that facilitates the prediction of the voltage VFO if new values of the input parameters are known. The prediction error of the constructed equation was less than 5 % for a total number of 21 new data samples used to test and verify the robustness of the prediction equation.

Substance abuse, particularly opioid intoxication, presents a significant public health challenge, leading to severe cardiovascular complications. This case-control study assessed the cardiac profile and clinical outcomes of 51 patients with confirmed acute opioid toxicity, compared to 51 control participants, in general hospitals across Port Said and Damietta governorates, Egypt. The study revealed that opioid-intoxicated patients exhibited significant cardiovascular abnormalities, including hypotension (39.2 %) and electrocardiogram (ECG) changes (72.5 %), with sinus bradycardia (51 %) being the most common. Additionally, echocardiographic abnormalities were found in 40 % of cases, with abnormal regional wall motion and valvular defects observed in several patients. Elevated levels of cardiac enzymes, such as Troponin-I and CK-MB, were significantly correlated with increased ICU stay length and higher mortality rates. The most common morbidities included coma (64.7 %) and shock (39.2 %). The study underscores the critical need for early cardiac assessment in opioid-intoxicated patients to predict clinical outcomes and guide therapeutic interventions.

ABSTRACT: Cryopreservation of rooster semen is essential for conserving genetic resources, genetic improvement, and increasing productivity. However, the nature of avian sperm presents a global issue in ensuring superior frozen semen for artificial insemination. Thus, the present study aimed to evaluate the impact of using dimethylacetamide (DMA), dimethyl sulfoxide (DMSO), and ethylene glycol (EG) as cryoprotectants on post-thawed sperm motility, quality, antioxidant indicators, and fertilizing capacity. Twice a week, fresh semen ejaculates were collected from 15 adult roosters and immediately evaluated to constitute a pool from clean and qualified samples. The pooled semen was further diluted at a ratio of 1:2 (v/v) with an extender and then subjected to a freezing protocol in a liquid nitrogen vapor after adding a cryoprotectant solution containing 6% of either DMA, DMSO, or EG, respectively. After thawing, characteristics of sperm motion, quality, antioxidants, and fertilizing ability were evaluated and compared to fresh and cooled semen as controls. The results demonstrated that semen cooling negatively affected some parameters of sperm motility, quality, antioxidant biomarkers, and fertility. In comparison to the DMSO and EG groups, employing DMA considerably (P < 0.05) raised the percentages of sperm progressive motility, viability, plasma membrane intactness, and DNA integrity. The DMA group showed a significant increase in the catalase and glutathione reduced antioxidant enzyme activity and a reduction in nitric oxide and lipid peroxidation. After artificial insemination, the DMA and DMSO groups exhibited considerably (P < 0.05) better rates of hatchability and fertility than the EG group. It is concluded that freezing extenders containing 6% DMA is better than DMSO or EG to improve the post thaw semen quality and fertility in chickens.

Abstract The potential use of PVA-mixed-valent tunnel structured manganese oxide nano-composite in the removal of multi-contaminants form aqueous solutions was assessed by studying the continuous simultaneous removal of lead, caesium, and cobalt. Within this context, the morphology and the nature of nanoparticle inclusion into the PVA matrix was assessed using SEM–EDX analysis. The nanoparticles are homogenously distributed in the polymeric matrix with some agglomerated inclusions of these particles. The thermal and chemical stability analyses prove the stability of the material up to 180 °C and in slightly acidic to slightly alkaline solutions. The analysis of the gravimetric thermal data shows that the thermal treatment is a feasible end of life management route for this material. The values of percentage uptake and bed capacity indicate the feasibility of the use of this material in the simultaneous removal of lead, caesium and cobalt. The breakthrough curves analyses provide insights into the breakthrough characteristics and underlying removal mechanisms. It was found that the removal reaction follows Langmuir kinetics of adsorption–desorption and that the rate driving forces follow second order reversible reaction kinetics, where the sorption occur at energetically equal sites.

Abstract To use a Hybrid Excitation Synchronous Machine (HESM) in a hybrid electrical vehicle (HEV), its performance indicators such as back-EMF, inductance and unbalanced magnetic force should be computed preferably by an analytical method. First, the back-EMF is calculated by considering alternate-teeth and all-teeth non-overlapping and overlapping windings. The effects of three types of magnetization patterns including the radial, parallel and Halbach magnetizations on the back-EMF waveform have also been investigated. Then, the self-inductance of the stator and rotor windings, the mutual inductance between the stator and rotor windings, and the mutual inductance between the stator phases are computed. Next, the components of the unbalanced magnetic force (UMF) in the direction of the x and y axes and its amplitude are computed. Moreover, the effects of the magnetization patterns on those magnetic pulls are investigated. To minimize the UMFs, symmetry must be implemented in the excitation sources; therefore, first the stator winding then the permanent magnet and rotor winding are modified in such a way that the UMFs are reduced. Increasing the temperature leads to a weakening of the magnet’s residual flux density, which strongly affects the performance characteristics of the electric machine such as Back-EMF and UMF. Finally, the ratio of the permanent magnet flux to the rotor flux is determined in such a way that the average torque is maximized. In this section, the effects of three magnetization patterns will be investigated.

Abstract Background Clinical decision support systems (CDSS) have been utilized as a low-cost intervention to improve healthcare process measures. Thus, we aim to estimate CDSS efficacy to optimize adherence to oral anticoagulant guidelines in eligible patients with atrial fibrillation (AF). Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) with a 95% confidence interval (CI). PROSPERO ID: CRD42023471806. Results We included nine RCTs with a total of 25,573 patients. There was no significant difference, with the use of CDSS compared to routine care, in the number of patients prescribed anticoagulants (RR: 1.06, 95% CI [0.98, 1.14], P = 0.16), the number of patients prescribed antiplatelets (RR: 1.01 with 95% CI [0.97, 1.06], P = 0.59), all-cause mortality (RR: 1.19, 95% CI [0.31, 4.50], P = 0.80), major bleeding (RR: 0.84, 95% CI [0.21, 3.45], P = 0.81), and clinically relevant non-major bleeding (RR: 1.05, 95% CI [0.52, 2.16], P = 0.88). However, CDSS was significantly associated with reduced incidence of myocardial infarction (RR: 0.18, 95% CI [0.06, 0.54], P = 0.002) and cerebral or systemic embolic event (RR: 0.11, 95% CI [0.01, 0.83], P = 0.03). Conclusion We report no significant difference with the use of CDSS compared to routine care in anticoagulant or antiplatelet prescription in eligible patients with AF. CDSS was associated with a reduced incidence of myocardial infarction and cerebral or systemic embolic events.

Flow measurements in pipes and open channels are critical for successful water resource management as the economic value of water has increased. Orifice meters are typically used as flow-measuring devices in pipes because they are cheap and simple compared to other devices. Also, orifices are used as energy dissipation methods in water hammer protection devices and hydroelectric power tunnels. Although traditional circular orifice meters have been extensively studied, many points need to be studied. So, experimental and numerical research is carried out to study the effect of orifice geometry on energy loss and the discharge coefficient. The experimental tests are carried out using two different types of orifice plates: circular and triangular, for each one the cross-sectional area is changed four times. The orifice is installed on a 10 cm diameter transparent pipe. The flow rate is changed ten times for each orifice ranging from 13.8 to 49.2 m3/hr. A general correlation equation for the coefficient of discharge is deduced. It was found that the triangular orifice shapes are better than the circular orifice shapes in terms of performance, with reduced head loss and a larger discharge coefficient. By using computational fluid dynamics techniques, the flow behavior through the orifice is analyzed by ANSYS Fluent software. The numerical results confirmed the experimental ones where the pressure head loss for the triangular orifice is lower than the circular orifice and vena contracta is located at a distance equal to half the pipe diameter downstream of the orifice plate.

Abstract Background Nursing education presents unique challenges, including high levels of academic stress and varied learning approaches among students. Understanding the relationship between academic stress and learning approaches is crucial for enhancing nursing education effectiveness and student well-being. Aim This study aimed to investigate the prevalence of academic stress and its correlation with learning approaches among nursing students. Design and Method A cross-sectional descriptive correlation research design was employed. A convenient sample of 1010 nursing students participated, completing socio-demographic data, the Perceived Stress Scale (PSS), and the Revised Study Process Questionnaire (R-SPQ-2 F). Results Most nursing students experienced moderate academic stress (56.3%) and exhibited moderate levels of deep learning approaches (55.0%). Stress from a lack of professional knowledge and skills negatively correlates with deep learning approaches (r = -0.392) and positively correlates with surface learning approaches (r = 0.365). Female students showed higher deep learning approach scores, while male students exhibited higher surface learning approach scores. Age, gender, educational level, and academic stress significantly influenced learning approaches. Conclusion Academic stress significantly impacts learning approaches among nursing students. Strategies addressing stressors and promoting healthy learning approaches are essential for enhancing nursing education and student well-being. Nursing implication Understanding academic stress’s impact on nursing students’ learning approaches enables tailored interventions. Recognizing stressors informs strategies for promoting adaptive coping, fostering deep learning, and creating supportive environments. Integrating stress management, mentorship, and counseling enhances student well-being and nursing education quality.

Abstract Textile industry wastewater containing toxic dyes and high COD poses environmental hazards and requires treatment before discharge. This study addresses the challenge of treating complex textile wastewater using a novel integrated system. The system combines sedimentation, screening, adsorption, and an optimized solar photo-Fenton process to provide a sustainable treatment solution. A novel parabolic collector with a larger absorber tube diameter enhances solar radiation utilization at lower catalyst concentrations. This design is versatile, treating all types of wastewaters, especially those that contain colors, smells, solid and suspended materials, in addition to its importance for the treatment of difficult substances that may be present in industrial and sewage wastewaters that are difficult to dispose of by traditional treatment methods. Multivariate experiments optimized key photo-Fenton parameters (pH, catalyst dose, etc.) achieving significant pollutant removal (85% COD, 82% TOC, complete color) under specific conditions (pH 3, 0.2 g/L Fe(II), 1 mL/L H2O2, 40 °C and 100 L/h flow rate after 60 min irradiation). Kinetic modeling revealed second-order reaction kinetics, and multivariate regression analysis led to the development of models predicting treatment efficiency based on process factors. The key scientific contributions are the integrated system design combining conventional and advanced oxidation technologies, novel collector configuration for efficient utilization of solar radiation, comprehensive process optimization through multivariate experiments, kinetic modeling and predictive modeling relating process factors to pollutant degradation. This provides an economical green solution for textile wastewater treatment and reuse along with useful design guidelines. The treatment methodology and modeling approach make valuable additions for sustainable management of textile industry wastewater.

OBJECTIVES: The goal of treatment is to establish a band of attached keratinized tissue to facilitate pain free oral hygiene and to eliminate the muscle attachment in order to help mitigate future recession. METHODS: A 62yo white female presented with RT2 recession on teeth numbers 24,25. Due to extensive use of antiplatelet medication, the decision to limit surgical sites to one was made, ruling out free tissue grafts. The surgical plan consisted of preparing two partial thickness flaps and securing them over the deficient sites of 24,25. To maintain good adaptation of the flap to the periosteum, a 4.0 PTFE suture was used to secure the flaps by using the adjacent periosteum and teeth as anchors points. To obtain hemostasis, microfibrillar collagen was used directly on the site. The patient was followed up at one week and one month for post operative evaluation. RESULTS: The evaluation at one month revealed elimination of the aberrant frenum and the re-establishment of a 4mm healthy band of attached keratinized tissue. During the healing there was no evidence of any flap necrosis as the flap was adequately secured against the periosteum. CONCLUSIONS: Using the Periosteal-Tooth Anchor suture technique, the laterally positioned flaps were able to be secured in a manner that ensured survivability of the flaps and established a band of attached keratinized gingiva. IMPLICATIONS: By informing clinicians of this suture technique, it will improve the predictability of these demanding and technique sensitive cases.

Insulated cross-arms (ICA) allow for the compaction or enhancement of transmission lines. This study presents a comprehensive approach to designing and evaluating insulated cross-arm (ICA) grading devices to control electric fields for insulated cross-arms on a 132 kV lattice tower. A ring-shaped grading device is designed for the low voltage (LV) end of the insulator. A novel grading device is designed for the high voltage (HV) end—a single piece that controls the field for all four ICA members. Finite element analysis (FEA) simulations assess the electric field stress near the HV and LV ends of the ICAs, ensuring that it remains below the critical threshold of 18 kV/cm and effectively improves electric field stress at both ends of compression insulator by 70 % electric field stress at LV end and 80 % improved at HV end. The study outlines a thorough design methodology and provides valuable guidelines for utilising FEA in developing complex geometries. By adopting this approach, the researchers aim to enable the adequate compaction and upgrading of new and existing 132 kV overhead transmission lines, ultimately contributing to optimising power grid infrastructure. The findings of this study demonstrate the importance of integrating comprehensive design strategies and advanced simulation techniques to enhance the reliability and performance of ICA.

Purpose: Cognitive load theory (CLT) is receiving increased recognition in medical education and it was cited as an important theoretical framework for simulation-based medical education. Simulated learning environments can place a high demand on the cognitive resources of the learners, hence, we aimed to design an instructional framework to optimise the total cognitive load imposed on the medical students during their clinical skills training in the clinical skills laboratory. Method: This study is a quasiexperimental post-test design. The sampling technique was purposive sampling, which included year 2 students at the Faculty of Medicine-Suez Canal University population. The study was conducted in the clinical skills and simulation laboratory. The intervention group received a developed instructional design framework based on CLT. The control group learned with the ordinary teaching method without any intervention. The cognitive load was measured using the Cognitive Load Inventory (CLI) immediately after the training session for both groups. Furthermore, students' achievement in the clinical skill laboratory was compared in both groups. Findings: The total cognitive load is lower in the group that received the developed instructional design than that of the control group, and this result was statistically significant. Also, the performance of the intervention group is higher than in the control group. Implications for research and practice: The developed instructional design framework is a potentially useful guide for managing students' cognitive load in the clinical skills training session.