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Introduction: In the nursing profession, a suitable level of moral reasoning increases the quality of care for patients and boosts job satisfaction among nurses. Professional identity increases self-confidence, the feeling of belonging to the profession, and establishing interpersonal communication in people. This study was conducted to determine the relationship between Kohlberg's level of ethical reasoning and the professional identity of nursing students. Method: In this correlation study, 231 undergraduate nursing students of nursing faculties affiliated with Birjand University of Medical Sciences were selected by stratified random sampling based on ratio. Data were collected using a Demographic profile form, Hao et al.'s professional identity questionnaire, and Kohlberg's moral reasoning. Data were analyzed using statistical tests of Pearson correlation, regression, independent t-test, and one-way analysis of variance at a significance level of 0.05. Result: The average score of moral reasoning and professional identity in nursing students was 47.04 ± 5.21 and 61.98 ± 11.16, respectively. The results showed a positive and significant relationship between moral reasoning and professional identity in nursing students (r = 0.55, P < 0.001). Conclusion: Based on the results, moral reasoning has a positive and significant relationship with professional identity in nursing students. Therefore, teaching ethical concepts to nursing students, enhances their ethical reasoning. As a result, their professional identity can be improved.

Chemical stabilization is a commonly used technique for ground improvement. Traditional methods of chemical soil stabilization rely on additives such as cement and lime, which are relatively expensive and not environmentally friendly. Therefore, using accessible natural pozzolans, such as zeolite, in soil stabilization is an effective and economical option. This study investigated the effect of zeolite and nano-magnetite on the geomechanical behavior of fine-grained clayey soil. Unconfined compressive strength (UCS), ultrasonic pulse velocity (UPV), and electrical conductivity (EC) tests were performed on both stabilized and unstabilized samples. The samples were cured under standard curing conditions (SCC) and accelerated curing conditions (ACC). The UCS and UPV results for the clay sample containing 5% zeolite and 1% nano-magnetite showed significant increases of 85% and 48% under SCC and 174% and 59% under ACC, respectively, compared to untreated clayey soil. Additionally, the clay mixture containing 5% zeolite and 1% nano-magnetite, which achieved the highest UCS and UPV values under ACC, exhibited increases of 166 kPa and 100 m/s, respectively, compared to SCC. Moreover, the EC value decreased by approximately 51% and 60% for the samples with the highest strength in SCC and ACC, respectively. Based on Scanning Electron Microscope (SEM) imaging and Energy Dispersive Spectroscopy (EDS) analysis, the impact of zeolite and nano-magnetite on improving compaction and promoting hydrothermal reactions was evident, supporting the higher geomechanical results obtained. Overall, the findings suggest that using zeolite and nano-magnetite offers a cost-effective and eco-friendly solution for stabilizing clayey soil in civil engineering projects.

Inherent (fabric) anisotropy is one of the most important properties of earthen materials that significantly influences their strength and stiffness characteristics. In this study, a comprehensive series of unconfined and constrained compression tests is performed on normally consolidated (NC) clay samples with different plasticity indices to examine the effect of inherent anisotropy on their mechanical characteristics. Accordingly, several cylindrical clay samples with different proportions of kaolinite and bentonite are reconstituted at a wide range of deposition angles, and then subjected to both unconfined and constrained compressive loadings. The experimental results reveal that, for a clay sample with a particular plasticity index, the highest and lowest values of unconfined compressive strength (UCS), secant modulus (E50), and constrained Young's modulus (Eoed) are associated with deposition angles of 0° and 90°, respectively. The results also show that at a certain bedding plane angle, the sample containing 30 % bentonite (PI = 110 %) exhibits the highest UCS, E50, and Eoed values. Several practical empirical correlations are developed to estimate the strength and stiffness properties of NC clays based on their plasticity indices and bedding plane directions. Furthermore, Scanning Electron Microscopy (SEM) analysis is conducted to explore the microstructure of samples containing varying percentages of kaolinite and bentonite.

Abstract Choosing appropriate tillage methods and applying the right amount of chemical fertilizers are pivotal for optimizing wheat management and enhancing wheat quality. This study investigated the influence of conservation agriculture and phosphorus levels on nutrient content, yield components, and quality traits of wheat in a corn-wheat rotation. Conducted over five years in field conditions, the study employed a randomized complete block design with tillage treatments (conventional tillage, CT; minimum tillage, MT; and no tillage, NT) and phosphorus levels (no fertilizer use, P0; and 100% fertilizer recommendation, PR) as factors. Soil samples were collected during the fourth year (2021–2022). Results revealed significant impacts of tillage methods and phosphorus levels on wheat straw and grain nutrient composition, yield components, and quality traits. Conventional tillage yielded the highest values for protein content (12%), Zeleny sedimentation volume (20.33 mL), hardness index (45), water absorption (64.12%), and wet gluten content (25.83%). Additionally, phosphorus fertilizer application positively influenced protein percentage, gluten weight, and gluten index. The study highlights the potential of strategic soil management, particularly conventional tillage combined with phosphorus fertilization, to enhance wheat quality and yield. By elucidating these relationships, the findings contribute to optimizing wheat cultivation practices and advancing the development of superior wheat cultivars for baking applications.

Liposarcoma, a malignant tumor originating from fat cells, is a rare occurrence in the retroperitoneal region. Surgical resection is the standard method for treating this cancer. This type of tumor is classified into common subtypes, which include well-differentiated liposarcoma and dedifferentiated liposarcoma. A 53-year-old male patient presented with lower left quadrant (LLQ) pain and melena for two weeks. Further diagnostic evaluation, including colonoscopy, revealed a 50 mm polyp in the hepatic flexure or distal of the ascending colon. The pathological assessment of the mass demonstrated a lipomatous lesion with a nuclear atypical lipomatous tumor, which was diagnosed as well-differentiated liposarcoma. The patient underwent surgical treatment and was discharged following his recovery. Liposarcoma, a malignant tumor originating from fat cells, is a rare occurrence in the retroperitoneal region. Surgical resection is the standard method for treating this cancer. This type of tumor is classified into common subtypes, which include well-differentiated liposarcoma and dedifferentiated liposarcoma. A 53-year-old male patient presented with lower left quadrant (LLQ) pain and melena for two weeks. Further diagnostic evaluation, including colonoscopy, revealed a 50 mm polyp in the hepatic flexure or distal of the ascending colon. The pathological assessment of the mass demonstrated a lipomatous lesion with a nuclear atypical lipomatous tumor, which was diagnosed as well-differentiated liposarcoma. The patient underwent surgical treatment and was discharged following his recovery.

This study analyzes the role of the Penta Helix in developing social innovation to address poverty in the coastal areas of the Riau Islands. Using a qualitative research method with a case study approach, problem mapping and previous studies were conducted using VOS Viewer. Data collection techniques included observation, in-depth interviews, Focus Group Discussions (FGDs), and documentation, while the analysis used the Miles and Huberman method. The results show that high poverty rates in several coastal areas, such as Lingga Regency and Tanjung Pinang City, have led to social problems such as crime, social instability, and migration. Limited access to education, healthcare, and employment opportunities worsens the situation. Although empowerment programs have been implemented, their results remain limited. A collaborative innovation approach involving various stakeholders through the Penta Helix proves to be effective in creating more sustainable solutions to empower coastal communities. Cross-sector collaboration between the government, private sector, academia, and local communities is expected to improve welfare and reduce the impact of social disasters caused by poverty.

Optimisasi portofolio merupakan pendekatan yang sangat penting dalam pengelolaan investasi yang bertujuan untuk mencapai keseimbangan optimal antara risiko dan imbal hasil. Salah satu model optimisasi portofolio yang terkenal adalah Model Markowitz, yang dikembangkan oleh Harry Markowitz pada tahun 1952. Dalam artikel ini, kami menerapkan Model Markowitz pada perusahaan-perusahaan yang terdaftar di Bursa Efek Indonesia LQ-45, yang merupakan indeks yang mencakup 45 perusahaan terbaik di Indonesia. Tujuan dari penelitian ini adalah untuk mengidentifikasi portofolio yang optimal dengan tingkat risiko minimal atau tingkat pengembalian maksimal, berdasarkan data historis saham perusahaan-perusahaan yang terdaftar di LQ-45. Abstract Portfolio optimization is a very important approach in investment management that aims to achieve the optimal balance between risk and return. One of the well-known portfolio optimization models is the Markowitz Model, which was developed by Harry Markowitz in 1952. In this article, we apply the Markowitz Model to companies listed on the Indonesia Stock Exchange LQ-45, which is an index that includes 45 of the best companies in Indonesia. The objective of this study is to identify the optimal portfolio with minimal risk or maximum return, based on historical stock data of companies listed in LQ-45.

Background: For many reasons, some care services may be missed. This study was conducted to investigate missed care, the related factors, and solution for decreasing them. Materials and Methods: A descriptive, cross-sectional study was performed on 122 nurses. A multi-part tool was used to gather information, which included demographic information, the Missing Nursing Care and Related Organizational Factors, and Missed Nursing Care Reduction Strategies Questionnaire. Descriptive and inferential statistical tests including ANOVA, independent t-test, and the Pearson correlation were used. Results: The mean score (SD) of the Missing Nursing Care Questionnaire was 82.04 (8.50); thus, the amount of missed nursing care is very high. Additionally, the mean score (SD) of the Organizational Factors Questionnaire related to it was 30.98 (9.35). Considering the maximum score of the questionnaire (80), the role of organizational factors in the incidence of missing nursing care is relatively moderate. There was also a weak and inverse correlation between organizational factors and missed nursing care (r = −0.30, p < 0.01, df = 120). Based on the results, increasing the number of nurses and their level of knowledge has the greatest 67.21 (%) and least 34.42 (%) impact on reducing the incidence of missed nursing care. Conclusions: According to the results, the prevalence of missed nursing care was high. However, the contribution of organizational factors to it is relatively little. This suggests that from the perspective of nurses, factors other than organizational factors related to the workplace can lead to missing care.

الملخص: أهداف البحث: تم اقتراح العلاج غير الجراحي لسرطان القولون والمستقيم، الذي يشكل ثالث أكثر أنواع السرطانات انتشارا في جميع أنحاء العالم، باستخدام العلاج الكيميائي الإشعاعي لتحقيق هدأة كاملة. في هذا الصدد، تم استخدام المستضد السرطاني الجنيني كعلامة مرشح. تهدف هذه الدراسة إلى تقييم قابلية تطبيق مستويات المستضد السرطاني الجنيني في التنبؤ بالاستجابة للعلاج الكيميائي الإشعاعي، وخاصة الاستجابة المرضية الكاملة. طرق البحث: تم تصميم دراسة مستعرضة بأثر رجعي، من خلال استخراج مرحلة الورم ومستويات CEA قبل وبعد العلاج الكيميائي الإشعاعي الجديد من السجلات الطبية للمرضى الذين يعانون من أورام المستقيم الذين خضعوا للعلاج الكيميائي الإشعاعي الجديد قبل الجراحة في مستشفى سينا، طهران، إيران من 2010م-2015م. النتائج: ارتبطت مستويات المستضد السرطاني الجنيني ما قبل العلاج الكيميائي الإشعاعي بشكل إيجابي بمرحلة الورم، كما أدى العلاج الكيميائي الإشعاعي إلى خفض مستويات المستضد السرطاني الجنيني بشكل كبير. في حين أن المستويات المنخفضة من المستضد السرطاني الجنيني قبل العلاج الكيميائي الإشعاعي ومرحلة الورم كانت مرتبطة بشكل كبير بالاستجابة الكاملة للعلاج الكيميائي الإشعاعي، ولم تظهر مستويات المستضد السرطاني الجنيني اللاحقة للعلاج الكيميائي الإشعاعي أي ارتباط مع الاستجابة الكاملة. بالإضافة إلى ذلك، في تحليل منحنى خصائص فعل المستقبلات، تم إظهار القيمة الحدية البالغة 2.6 لمستوى المستضد السرطاني الجنيني للتنبؤ بالاستجابة الكاملة للعلاج الكيميائي الإشعاعي (الخصوصية = 82.6٪ ، الحساسية = 40.5٪). الاستنتاجات: على الرغم من أن العديد من العوامل الأخرى غير مستويات المستضد السرطاني الجنيني ومرحلة الورم مهمة أيضا في تحديد الاستجابة للعلاج الكيميائي الإشعاعي، فقد أظهرت هذه الدراسة أنه يمكن استخدام مستويات المستضد السرطاني الجنيني الأولية ومرحلة الورم كعوامل لتحديد الاستجابة الكاملة للعلاج الكيميائي الإشعاعي الجديد في سرطان المستقيم. Abstract: Objectives: Nonsurgical treatment of colorectal cancer, the third most prevalent cancer worldwide, through chemoradiotherapy (CRT) has been suggested to induce complete remission. Carcinoembryonic antigen (CEA) has been used as a candidate marker to predict treatment response. In this study, we aimed to assess the applicability of plasma levels of CEAs in predicting the response to CRT, particularly complete pathological response. Methods: We designed a retrospective, cross-sectional study in which tumor stage and plasma levels of CEAs before and after neoadjuvant CRT were extracted from the medical records of patients with rectal tumors who underwent neoadjuvant chemoradiotherapy before surgery at Sina Hospital, Tehran, Iran from 2010 to 2015. Results: Pre-CRT plasma levels of CEA positively correlated with tumor stage, and chemoradiotherapy significantly decreased plasma levels of CEA. Whereas lower pre-CRT plasma levels of CEA and tumor stage were significantly associated with complete response to CRT, post-CRT plasma levels of CEA showed no association with complete response. In addition, in ROC curve analysis, a CEA cut-off value of 2.6 ng/mL predicted complete response to CRT (specificity = 82.6%, sensitivity = 40.5%). Conclusion: Although several factors other than plasma levels of CEA and tumor stage are important in determining the response to CRT, preliminary plasma levels of CEA and tumor stage can be used as factors for determining complete response to neoadjuvant chemoradiotherapy in rectal cancer.

Key Clinical Message The study reports a rare case of pelvic solitary fibrous tumor (SFT) that was initially considered as a peri‐anal gastrointestinal stromal tumor due to similar radiologic/pathologic features. SFT diagnosis can be challenging due to its rarity and wide range of diagnoses that must be ruled out precisely. Abstract Solitary fibrous tumors (SFTs) are rare tumors that can occur in any part of the body. Although usually benign, malignant SFTs have been reported, especially outside the lungs. Radiology can help with diagnosis, but immunohistochemistry is necessary to distinguish SFTs from other possible diagnoses such as gastrointestinal stromal tumors (GISTs). This study presents a rare case of pelvic SFT initially considered to be a peri‐anal GIST, highlighting the importance of accurate diagnosis given the rarity of SFTs and the need to rule out other potential diagnoses.

Abstrak - Penelitian ini menggunakan metode penelitian kuantitatif, dan sumber data yang digunakan adalah data konsumen keju WINCheez di kota Bandung yang diambil dari PT. Bangun Rasaguna Lestari dan pengumpulan data dari hasil penyebaran kuisioner kepada konsumen keju WINCheez. Analisis data menggunakan analisis deskriptif, uji asumsi klasik, analisis asosiatif dan analisis verifikatif. Dalam penelitian ini yang menjadi populasi adalah konsumen WINCheez di kota Bandung periode tahun 2020. Perhitungan sampel menggunakan Sample Random Sampling dengan rumus Slovin. Berdasarkan analisis tersebut dapat dikatakan bahwa brand image keju WINCheez pada PT. Bangun Rasaguna Lestari di Bandung dengan skor rata-rata 3,56 termasuk dalam kategori baik, harga keju WINCheez di PT. Bangun Rasaguna Lestari di Bandung dengan skor rata-rata 3,52 termasuk kategori baik dan keputusan pembelian konsumen WINCheez pada PT. Bangun Rasaguna Lestari di kota Bandung dengan skor rata-rata 3,31 termasuk dalam kategori cukup baik. Citra merek berpengaruh positif dan signifikan secara parsial terhadap keputusan pembelian. Harga WIN Cheez-Cheese Bandung sebagian besar positif dan merupakan keputusan penting untuk membeli, dan pada saat yang sama merupakan keputusan positif dan penting untuk membeli. Hal ini didukung dengan hasil beberapa pengujian yang dilakukan. Abstract - This study uses quantitative research methods, and the source of the data used is consumer data of WINCheez cheese in the city of Bandung taken from PT. Bangun Rasaguna Lestari and data collection from the results of distributing questionnaires to consumers of WINCheez cheese. Data analysis used descriptive analysis, classical assumption test, associative analysis and verification analysis. In this study, the population is WINCheez consumers in the city of Bandung for the period 2020. The sample calculation uses Sample Random Sampling with the Slovin formula. Based on this analysis, it can be said that the brand image of WINCheez cheese at PT. Bangun Rasaguna Lestari in Bandung with an average score of 3.56 is included in the good category, the price of WINCheez cheese at PT. Bangun Rasaguna Lestari in Bandung with an average score of 3.52 including the good category and WINCheez consumer purchasing decisions at PT. Bangun Rasaguna Lestari in the city of Bandung with an average score of 3.31 is included in the fairly good category. Brand image has a positive and significant effect partially on purchasing decisions. The price of WIN Cheez-Cheese Bandung is mostly positive and is an important decision to buy, and at the same time a positive and important decision to buy. This is supported by the results of several tests carried out.

Penelitian ini bertujuan untuk menginvestigasi implementasi Merdeka Belajar Kampus Merdeka (MBKM) terhadap minat dan kendala mahasiswa Program Studi S1 Manajemen dan S1 Akuntansi di Fakultas Ekonomi Universitas Sangga Buana Bandung. Metode survei digunakan dalam penelitian ini dengan melibatkan populasi mahasiswa Program Studi tersebut. Penelitian ini menggunakan pendekatan penelitian kuantitatif. Hasil penelitian ini diharapkan dapat memberikan pemahaman yang lebih dalam tentang sejauh mana MBKM mempengaruhi minat mahasiswa dan kendala yang dihadapi dalam implementasinya. Temuan penelitian ini dapat menjadi evaluasi internal terhadap pelaksanaan MBKM di Universitas Sangga Buana Bandung serta memberikan rekomendasi untuk perbaikan dan penyesuaian kebijakan tersebut. Penelitian ini memiliki signifikansi dalam mendukung pengembangan sistem pendidikan tinggi yang lebih adaptif dan relevan dengan memberikan wawasan tentang pengaruh MBKM pada minat dan kendala mahasiswa di Program Studi S1 Manajemen dan S1 Akuntansi

Objective: Perianal fistulas in Crohn’s disease (CD) are the main challenges in inflammatory bowel diseases (IBDs). Some of the fistulas are refractory to any therapeutic strategy. The aim of this study was to evaluate the therapeutic effects of mesenchymal stromal cells (MSCs) as a novel promising modality for the treatment of fistulizing CD. Materials and Methods: This case series clinical interventional study was conducted from 2014 to 2017 at Shariati Hospital, an IBD referral center in Tehran, Iran. Refractory adult patients with CD who had draining perianal fistulas were enrolled in this study. All patients were examined by a colorectal surgeon and the fistula imaging studies were performed by pelvic magnetic resonance imaging (MRI). After autologous bone marrow(BM) aspiration and MSCs isolation, the cells were cultured and passaged under current good manufacturing practice (cGMP) conditions. Four intra-fistula injections of cells, each containing 40×106 MSCs suspended in fibrin glue, were administered by an expert surgeon every 4 weeks. Procedure safety, feasibility and closure of the perianal fistulas at week 24 were assessed. Clinical examination and MRI findings were considered as the primary end points. Results: In total, 5 patients (2 males and 3 females) were enrolled in this study. No adverse events were observed during the six-month follow-up in these patients. Both the Crohn’s Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI) scores decreased in all patients after cell injections and one patient achieved complete remission with closure of fistulas, discontinuation of fistula discharge, and closure of the external opening. Conclusion: Local injection of MSCs combined with fibrin glue is potentially a safe and effective therapeutic approach for complex perianal fistulas in patients with CD.

Introduction: Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor. Materials and Methods: During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed. Results: Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions). Conclusion: In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.

Introduction: Back pain is one of the most important occupational problems among health care workers that have detrimental effects on their personal and professional life. Therefore, this study aimed to investigate the relationship between low back pain and quality of life in prehospital emergency staff and the role of demographic variables in this regard. Materials and Methods: This is a descriptive correlational study. The population was a prehospital emergency staff that entered to study by using the census method at 2020. Data gathering instruments were demographic characteristics, low back pain, and quality of life questionnaires. Data were entered into SPSS 22 and were analyzed using descriptive and analytical statistics. Results: The results showed that the related to the low back pain score of emergency medical technicians was 51.34± 4.149, which is high. In addition, the quality of life mean and standard deviation was 30.35± 4.851, which shows a low level. There is a significant relationship between back pain and quality of life (p = 0.001, R = 0.723). Conclusion: Low back pain is so common among emergency medical personnel that the issue may affect a person's life and work and creates many problems in terms of personal, family, socially, economically, and professionally, which reduce their quality of life.

Background & objectives: Carbapenems are the main antibiotics for the treatment of infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). The aims of this study were to determine the prevalence of gene encoding outer membrane porin protein (OprD) in carbapenem-resistant P. aeruginosa strains as well as to assess the role of insertion sequence (IS) elements in the inactivation of OprD porin and the emergence of carbapenem resistance. Methods: In this study, 103 clinical isolates of P. aeruginosa including 58, 42 and 23 strains resistant to imipenem, meropenem, and doripenem were used, respectively. The isolates were collected from patients referred to Ardabil hospitals. The presence of oprD gene and IS elements were investigated using polymerase chain reaction (PCR) and sequencing methods. P. aeruginosa PAO1 standard isolate was used as the positive control strain for oprD gene. Results: The frequency of oprD gene among carbapenem-resistant P. aeruginosa strains isolated from Ardabil hospitals was 96.5%. Furthermore, IS elements were not observed in the investigated isolates. Conclusion: Based on the results of this study, the presence of IS elements did not involve in the inactivation of outer membrane porin OprD and resistance to carbapenems among P. aeruginosa clinical strains in Ardabil. Therefore, an investigation of the role of other mutations in reducing the expression of oprD gene and increasing P. aeruginosa resistance to carbapenems is recommended.

Background: Using hematologic profiles including leukocyte count have been considered as prognostic factor for some cancers. We have been assessed the predictive value of leukocytosis before surgery in colorectal cancers. Methods: This cross-sectional study has been conducted on patients with colorectal cancer who underwent surgery from 2017 to 2019 in Sina hospital, Tehran. The patients were divided in two groups based on high and low leukocyte count before surgery. Results: A total of 84 patients were studied with colorectal cancers including 46 males (55.4%) and 37 females (44.6%) with the average age of 55.2 (± 13.63) years. 36.1% of patients had leukocytosis in laboratory data before surgery. There was a significant association between tumor’s grade and the incidence of leukocytosis before surgery (P

Abstrak - Pertumbuhan sektor properti di Indonesia semakin berkembang pesat, dimana hal ini bisa dilihat dengan banyaknya perusahaan yang berdiri dan menjalankan operasionalnya dalam bentuk proyek-proyek. Hal ini peneliti lakukan untuk membantu menganalisa perusahaan-perusahaan induk yang anak-anak perusahaannya mendapatkan penghargaan dari warta ekonomi berupa beberapa kategori dalam memperoleh property award pada tahun 2018 dan bertujuan membandingkan perusahaan-perusahaan tersebut dan dikatakan layak berinvestasi di perusahaan-perusahaan tersebut. Dalam penelitian ini, peneliti hanya memperoleh sebanyak 23 saham perusahaan yang terpilih sebagai sampel penelitian dengan menggunakan purposive sampling. Hasil yang didapat oleh peneliti dalam analisis ini terdapat 5 saham efisien dan 18 saham tidak efisien berdasarkan perhitungan CAPM. Saham efisien adalah saham undervalued dengan nilai > nilai . Saham-saham efisien tersebut yakni : PPRO, EMDE, JSPT, DMAS dan PWON. Sedangkan saham yang tidak efisien adalah saham yang memiliki nilai < nilai dan dikatakan sebagai saham overvalued. Saham-saham tidak efisien tersebut yakni : APLN, DILD, ELTY, KIJA, SMDM, LPKR, BSDE, SMRA, CTRA, MDLN, COWL, ASRI, MTLA, GPRA, RODA, GWSA, LPCK dan BEST. Dilain sisi peneliti memperoleh penjelasan bahwa tingkat risiko tidak selalu berhubungan linier dengan tingkat pengembalian, dimana hal ini terlihat ketika peneliti menganalisa hasil risiko sistematis β (beta) yang hubungannya terbalik dengan ekspektasi pengembalian , dengan adanya perubahan posisi perusahaan yang memiliki risiko paling tinggi ternyata ekspektasi pengembaliannya rendah dan perusahaan yang memiliki risiko paling rendah justru ternyata ekspektasi pengembaliannya menjadi tinggi, hal ini terjadi pada perusahaan BEST dan ELTY. Hasil pengambilan hipotesis yaitu tidak semuanya perusahaan yang dapat peraih property award yang bisa dibeli sahamnya tetapi hanya sebagian saja. Abstract - The growth of the property sector in Indonesia is growing rapidly, where this can be seen with the number of companies that stand up and run operations in the form of projects. This is done by researchers to help analyze the parent companies whose subsidiaries received awards from the journalists in the form of several categories in obtaining property awards in 2018 and aimed at comparing these companies and said to be worth investing in those companies. In this study, researchers only obtained as many as 23 company shares that were selected as research samples by using purposive sampling. The results obtained by researchers in this analysis there are 5 efficient shares and 18 inefficient stocks based on the CAPM calculation. An efficient stock is an undervalued stock with a value of R_i> value E (R_i). These efficient stocks are: PPRO, EMDE, JSPT, DMAS and PWON. While inefficient stocks are stocks that have a value of R_i

Introduction: Recently, rate of journals and published article in the medical sciences has grown, but the quality of these journals and published articles should be criticized. Therefore, this study was conducted with the aim of criticizing quality of published studies in the qualitative research in health sciences journal based on the CASP scale. Methods: This study has been done with a cross-sectional descriptive method. In this study, the quality assessment of qualitative articles published in the Journal of Qualitative Research in Health Sciences in two steps was performed. In the first stage, the quantity of published studies by descriptive statics has been investigated. In the second stage, based on CASP scale evaluation was perform. Results: The highest percentage of published articles related to content analysis with 52.9% and the lowest percentage of published articles related to ethnography and mixed method with 0.42%. In the 83.1 percentage of published articles, CASP-related indicators are also observed. The highest compliance rate of CASP scale indicators is related to the index of the clarity of the research goals, which is observed in 100% of published articles. The least observance of the indexes in the published articles is related to ethical questions which 65.5 percentage of published articles has been followed. In general Conclusion: Based on findings, recently the quality and quantity of published articles in Qualitative Research in Health Sciences journal is growing, but rate of some types of published studies and their quality is low, which these items should be improved.

Introduction: The most prominent causes of coma are traumatic brain injuries (TBIs), which have high incidence. However, little research about the caring aspects of these patients has been done, and the notion of caring experiences is unknown. Therefore, this study was conducted to describe the care-taking experiences of coma patients and their families during and after treatment. Methods: This study is a qualitative content analysis. Participants in this study were improved TBI patients and their families. Participants were selected purposefully. The method of data collection was 16 interviews that were held with 14 of the participants. Data were analyzed using Elo and Kyngäs conventional content analysis guidelines with MAXQDA software, version 10. Results: The results showed four main themes and eight categories. Themes included “crisis,” “comprehensive support,” communication,” and “unprofessional care.” Conclusion: Patients and families experience a crisis during hospitalization and after discharge. Therefore, patients and families need psychological support. Informing families and communication decrease the conflicts between healthcare personnel and the family. Medical staff must be careful about their statements and behaviors during comatose patients' care because they understand the care process.

Background & Objective: The present study aimed to identify the barriers in the current system of organizational performance measurement and determine the educational challenges within the framework of Stufflebeam and Coryn (2014) meta-evaluation model in 14 educational offices in Zanjan province, Iran. Materials and Methods: This exploratory study was performed using a qualitative approach and conventional content analysis. Interviews were based on the Stufflebeam and Coryn (2014) meta-evaluation model. In total, 154 codes were verified by 10 participators. Results: Among 154 acquired codes, the most important themes were deduced through the assessment of organizational performance measurement in the educational system. These themes included the ‘mutual incompetency between the individual and organization’, ‘individual factors affecting the assessment’, ‘organizational factors affecting the assessment’, ‘imaginary-cognitive factors’, and ‘results and consequences of establishing a system for organizational performance evaluation’. In addition, four themes emerged regarding the problems associated with the measurement of organizational performance, including the ‘individual and structural problems of the organization’, ‘problems associated with the organizational culture and climate’, ‘ conceptual (perceptional) challenges’, and ‘functional problems’. Some research suggestions have also been provided. Conclusion: According to the results, the efficiency of the organizational performance measurement system reduces due to barriers such as the low professional competency of the staff, poor technical skills in quantitative analysis, and inattention to the methodology of organizational performance evaluation within the context of organizing and coordinating the weaknesses of an organization without using the necessary tools to address the lack of priority in performance evaluation and poor organizational accountability.

Objective: To investigate antibiotic resistance pattern of ventilator-associated pneumonia (VAP) generating microorganisms, and quantitative culture and determining antibiotic sensitivity. Methods: This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital, Babol, Iran during 2014–2015. VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards. Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them. Afterwards by microdilution method, minimal inhibitory concentration based on respective microorganisms, considering clinical pulmonary infection score were determined. Results: From 50 investigated samples in this study, the most common microorganisms were Acinetobacter baumannii (A. baumannii) (70%) then Pseudomonas aeruginosa (12%), Staphylococcus aureus (8%) and Klebsiella pneumonia (3%). In our study A. baumannii showed approximate 100% resistance to all antibiotics, in a way that A. baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%. The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin. Staphylococcus aureus showed 75% resistance to nafcillin, cloxacillin and resistance in case of vancomycin was not seen. Conclusion: In current study, A. baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics. Using ceftazidime, cefepime and clavulanate/ticarcillin, in treatment of the patients suffering VAP is not reasonable.

We assessed breastfeeding knowledge, attitudes and practices of 3413 Iraqi mothers and adult female relatives in the same household and their association with sociodemographic characteristics. The majority of the women (73.1%) initiated breastfeeding early after delivery, 92.9% believed colostrum was good for their baby and 64.6% breastfed on demand. However, knowledge was lacking about full exclusive breastfeeding until 6 months postpartum, signs of good positioning and latch-on and the correct to introduce supplements. Nearly 35% believed that breast milk was not enough for their infants. Rural and less educated women knew less about breastfeeding concepts than more educated urban women but more continued breastfeeding longer and introduced supplements later. [ABSTRACT FROM AUTHOR]

Dengue fever is a dangerous infectious endemic disease that affects over 100 nations worldwide, from Africa to the Western Pacific, and is caused by the dengue virus, which is transmitted to humans by an insect bite of Aedes aegypti. Millions of citizens have died as a result of dengue fever and dengue hemorrhagic fever across the globe. Envelope (E), serine protease (NS3), RNA-directed RNA polymerase (NS5), and non-structural protein 1 (NS1) are mostly required for cell proliferation and survival. Some of the diterpenoids and their derivatives produced by nature possess anti-dengue viral properties. The goal of the computational study was to scrutinize the effectiveness of diterpenoids and their derivatives against dengue viral proteins through in silico study. Methods: molecular docking was performed to analyze the binding affinity of compounds against four viral proteins: the envelope (E) protein, the NS1 protein, the NS3 protein, and the NS5 protein. Results: among the selected drug candidates, triptolide, stevioside, alepterolic acid, sphaeropsidin A, methyl dodovisate A, andrographolide, caesalacetal, and pyrimethamine have demonstrated moderate to good binding affinities (−8.0 to −9.4 kcal/mol) toward the selected proteins: E protein, NS3, NS5, and NS1 whereas pyrimethamine exerts −7.5, −6.3, −7.8, and −6.6 kcal/mol with viral proteins, respectively. Interestingly, the binding affinities of these lead compounds were better than those of an FDA-approved anti-viral medication (pyrimethamine), which is underused in dengue fever. Conclusion: we can conclude that diterpenoids can be considered as a possible anti-dengue medication option. However, in vivo investigation is recommended to back up the conclusions of this study.

BACKGROUND: This study was designed to assess the clinical judgment of medical students in surgery clinical decision-making by a standard examination after lecture-based learning (LBL) or problem-based learning (PBL). MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students whom were randomly allocated to three groups was performed during November 2017 and January 2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by an intern. Chi-squared test and independent student t-test were used to compare between the two groups. All the analyses were performed by the two-sided method using the Statistical Package for the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set as statistically significant. RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple-choice examination, compared to the LBL group (P = 0.048). However, there was no significant difference between the PBL group led by an attending and the PBL group led by an intern (P = 0.892). CONCLUSION: We concluded that PBL remarkably increased the students' scores in the problem-solving examination, as compared to the conventional method. We found no significant differences in PBL facilitated by an attending or an intern.

Introduction: Personnel job satisfaction, facilities and welfare are among the most important factors affecting quality of service. To date, no study has been done in the field of Emergency medical service (EMS) personnel satisfaction regarding facilities and welfare in Iran. Therefore, the present study was designed to evaluate the level of satisfaction among EMS personnel regarding facilities and welfare. Methods: In the present cross-sectional study, 68 of the EMS personnel of Northern Khorasan, Iran, were selected by simple randomization and their level of satisfaction was evaluated using a 23-question questionnaire. Afterwards, their satisfaction level was divided into 2 groups of desirable and non-desirable and the findings were reported as frequency and percentage. Results: The lowest satisfaction level regarding facilities were reported to be linked to the physicians being out of reach (14.7%), presence of help (27.0%), comfortableness of nurse’s chair (29.8%), and ability of patients’ bed to be positioned (32.3%). Minimum satisfaction regarding welfare was also seen concerning the time of receiving their wage (4.4%) and place for rest (5.9%). Based on the classifications done, only 22 (32.4%) of the personnel were satisfied with the facilities and 5 (7.4%) were satisfied with the welfare conditions. Conclusion: The findings of the present study showed that satisfaction rate of the EMS personnel regarding facilities and welfare is low. All the factors leading to this decrease in satisfaction level of the personnel could be prevented and relieved, therefore intervention in these regards can improve satisfaction rate among the personnel.

مقدمه: از مهمترین مولفه هایی که بر کیفیت خدمات تاثیر گذار است میزان رضایت پرسنل از شغل، امکانات و شرایط رفاهی می باشد. اما تاکنون مطالعه ای در زمینه بررسي رضايت پرسنل اورژانس پیش بیمارستانی از شرايط و امكانات رفاهي آمبولانس و اعزام در ایران انجام نشده است. بر این مبنا پژوهش حاضر با هدف ارزیابی سطح رضایت پرسنل از شرایط و امکانات رفاهی آمبولانس اعزام تبیین گردید. روش کار: در پژوهش مقطعی حاضر 68 نفر از پرسنل اورژانس پیش بیمارستانی بیمارستان‌های استان خراسان شمالی، به طور تصادفی ساده انتخاب و سطح رضایتمندی آن بر اساس یک پرسشنامه 23 سوالی مورد ارزیابی قرار گرفت. سپس سطح رضایت نمونه های مورد بررسی به دو گروه مطلوب و نامطلوب تقسیم و یافته ها به صورت فراوانی و درصد گزارش گردید. يافته ها: کمترین میزان رضایت از امکانات و تجهیزات آمبولانس در زمینه عدم دسترسی به پزشک (7/14 درصد)، وجود کمکی (0/27 درصد)، راحتی صندلی پرستار (8/29 درصد) و پوزیشن گرفتن تخت بیمار (3/32 درصد) گزارش گردید. حداقل رضایتمندی نیز در زمینه شرایط رفاهی در بخش زمان وصول حق الزحمه (4/4 درصد) و محل استراحت (9/5 درصد) مشاهده شد. بر اساس طبقه بندی انجام شده تنها 22 (4/32 درصد) فرد از امکانات اعزام و 5 (4/7 درصد) نفر از شرایط رفاهی اعزام رضایت داشتند. نتيجه گيری: یافته های پژوهش حاضر نشان داد میزان رضایتمندی پرسنل اورژانس پیش بیمارستانی از امکانات و شرایط رفاهی آمبولانس پایین می باشد. تمامی عوامل تاثیر گذار بر کاهش سطح رضایتمندی پرسنل قابل رفع و پیشگیری بود لذا مداخله در این موارد می تواند باعث بهبود سطح رضایت پرسنل اعزام گردد.

Thymus is one of the famous medicine herbs of Lamiaceae genus. Due to the high potential of hybridization and introgression among thymus species, they have high genetic variability and study of genetic variability is difficult in this genus. According to the existing problems in the field of breeding of this medicine herb, use of molecular markers could be a valuable tool for evaluation and exploitation of germplasm. In this study, for assessment of genetic diversity among 70 Iranian Thymus, 30 semi-random ISJ (Intron-exon Splicing Junction) primers were used. Total primers produced 694 bands that 683 bands were polymorphic. Average band number per primer and per genotype was 23.13 and 9.91, respectively. Cluster analysis using DARwin5 software and UPGMA method based on Dice's similarity matrix divided accessions into 6 clusters. The highest similarity was estimated between T. kotschyanus and T. transcaucasius and lowest similarity was estimated between T. lancifolius and T. fedtschenkoi. The highest and lowest of polymorphic information content (PIC) revealed by IT15-36 and IT18-2 primers, respectively. The highest and lowest marker index (MI) included ET15-33 and ET18-6 primers, respectively. Results showed that clustering based on cluster analysis partly adapted with geographical origin dispersion. Totally, application of semi-random primers could be useful in assessment of genetic diversity of Thymus accessions.

Background: Gastrointestinal stromal tumors are gastrointestinal tract mesenchymal tumors with gene mutations. The most common site of gastrointestinal stromal tumors is in stomach (40-60%) and small intestine (30-40%), and rare cases about 3-5% of them occur in the duodenum. Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitotic

The Research Objectives : - Designing and constructing some physical and skillful tests for futsal females players - Setting standard degrees and levels of the physical and skillful tests for futsal female players. The Research Fields : Man field : The female players of the Northern region clubs ( Tal-Esqaf, Battnaya,Qaraqoush,Bashiqah , Al-Qoush, and Dohuk ). Time field : The period from 5/7/2011 – 2/10/2011. Place field : The stadiums of the above mentioned clubs. The research community consists of the futsal female players of the Northern region which involves ( Tal-Esqaf, Battnaya,Qaraqoush,Bashiqah , Al-Qoush, and Dohuk ) . So, the sample of the construction consists of (57) female players, while the application sample consists of (35) female players of an origin (107) female players . The following statistical means have been used : The arithmetic mean, the standard deviation, simple correlation coefficient (Person) , t-Tests for the independent sample , percentage, and modulated standard degree (6-segma). The most important results obtained by the research are : - Achieving constructing a test for measuring the power distinguished by the speed of the leg muscles of the futsal female players. - Constructing a test of measuring the shooting skills for the futsal female players. The most important recommendations are as follows : - Adopting the test of power distinguished by the speed for the futsal female players. - Adopting the test of shooting for the futsal female players.

Background: Internet addiction is one of the harmful effects of the Internet. The findings of several studies have indicated a relationship between general health and Internet addiction. Metacognition, which includes the knowledge, processes, and strategies to evaluate, and monitor or control the cognition, can play a significant role in this regard. The present research aimed to assess the mediating role of metacognitive variables in the relationship between Internet addiction and general health. Methods: This correlational study included 94 male and female users with different nationalities at Internet cafés in Abu Dhabi (the United Arab Emirates). All subjects aged at least 18 years and were proficient in English. The research tools included the General Health Questionnaire (with a reliability of 0.89), Metacognition Questionnaire (with a reliability of 0.82), and Kimberly Young's Internet Addiction Test (with a reliability of 0.88). The hypothesis was tested applying SPSS18 and Amos18. Findings: The results indicated a significant positive relationship between all aspects of metacognition and Internet addiction (r = 0.30; P < 0.01). A significant positive relationship was also observed between Internet addiction and general health (r = 0.47; P < 0.01). Path analysis revealed the mediating role of metacognition in the relationship between low general health and Internet addiction. Among the metacognitive variables, the mind control had the highest correlation coefficient (r = 0.80). Conclusion: The Internet and digital technologies have caused unwanted and negative effects which are classified as emerging damages. The relationship between Internet addiction and general health has been confirmed in this research. In addition, metacognitive processes can have a positive and mediating role on this relationship. Keywords: Internet, Internet addiction, General health, Metacognition

Through this research paper, the efficiency of ١٤١ Mazandaranbranches of Bank Saderat in ٢٠٠٤ is evaluated using DataEnvelopment Analysis which is a linear programming and nonparametric method.The variants considered here are categorized into two groupsconsisting of; inputs (number of staff, terminals and book value ofbranches), and outputs (weighted sums of deposits, the average of ١٢months of private sector facilities (loans), and adjusted deferredclaims.That hypothesis in which more than ٥٠٪ of bank Saderat branchesare inefficient has been analyzed. There, it is indicated that how thebranches can receive the frontier of efficiency by modifying theirinputs or outputs.The study shows that ٧٠٪ of branches are inefficient, whereas thevarying return scale is different from the constant return scale.Misallocation of personnel in branches is known as an importantfactor for inefficiency. To Make the branches more efficient, we musteconomize on using resources (Inputs) at least to ٣٦٪.

Objectives: The purpose of this multi-center study was to investigate the probable predictive factors of mortality and morbidity in elderlypopulation. Methods & Materials: The descriptive prospective study was conducted based on the data gathered from trauma cases older than 65 years admitted to Sina, Shohada and Fayaz-Bakhsh trauma centers during years 1997-98. A pre-prepared questionnaire including the demographic data of the cases and information on the mechanism and the severity of the injury was filled for all the patients upon their arrival in the emergency department it was, thereafter, completed in terms of the therapeutic measures and procedures performed for the patients and the outcomes (discharge, death, …) following their admission. Thegathered data were then analyzed. Results: A total of 296 patients with the mean age of 71.8 met inclusion criteria. Motor vehicle accident was the most frequent mechanism of injury. Overall 18 patients (6.1%) died, which mostlyhappened in the ICU. Conclusion: The type and severity of the injury assessment based on ISS and GCS scores were the most important factors to predict mortality. The statistics showed that there was not a significant correlation between general surgery and the rate of mortality, whilethe orthopedic operation had a significant role in decreasing mortality.

No. 66 in a regular educational series of brief illustrated descriptions of interesting or unusual diabetes-related cases and conditions. [ABSTRACT FROM AUTHOR]

The distinct molecular states - single molecule, assembly, and aggregate - of two ionic macromolecules, TPPE-APOSS and TPE-APOSS, are easily distinguishable through their tunable fluorescence emission wavelengths, which reflect variations in intermolecular distances. Both ionic macromolecules contain aggregation-induced emission (AIE) active moieties whose emission wavelengths are directly correlated to their mutual distances in solution: far away from each other as individual molecules, maintaining a tunable and relatively long distance in electrostatic interactions-controlled blackberry-type assemblies (microphase separation), or approaching van der Waals close distance in aggregates (macrophase separation). Furthermore, within the blackberry assemblies, the emission wavelength decreases monotonically with increasing assembly size, indicative of shorter intermolecular distances at nanoscale. The emission changes of TPPE-APOSS blackberry assemblies can even be visually distinguishable by eyes when their sizes and intermolecular distances are tuned. Molecular dynamics simulations further revealed that macromolecules are confined in various conformations by controllable intermolecular distances within the blackberry structure, thereby resulting in fluorescence emission with tunable wavelength., (© 2024 The Author(s). Small published by Wiley‐VCH GmbH.)

Introduction: Catheter ablation of persistent atrial fibrillation yields sub-optimal success rates partly due to the considerable heterogeneity within the patient population. Identifying distinct patient phenotypes based on post-ablation prognosis could improve patient selection for additional therapies and optimize treatment strategies., Methods: We studied all patients who underwent catheter ablation of persistent atrial fibrillation in the DECAAF II trial. Out of 44 participating centers, 25% were randomly chosen as a validation set. A Gradient Boosting Method determined essential features for arrhythmia recurrence prediction and the number of clusters was determined according to the average silhouette width. K-medoids cluster analysis identified subgroups based on these features, and Kaplan-Meier curves were further compared among different clusters., Results: Among 815 patients, 570 served as a training set and 245 as a validation set. Using the training set, the GBM model achieved an AUC of 0.874. K-medoids cluster analysis used LA volume, BMI, baseline fibrosis, and age, resulting in two clusters. Cluster 1 patients were older, had higher baseline fibrosis, higher BMI, and greater LA volume compared to Cluster 2. Atrial arrhythmia recurrence rates were significantly higher in Cluster 1 (51.7% vs. 35.0%, p = 0.0002), and survival analysis showed a significant difference in primary recurrence outcomes (HR = 1.71, p < 0.0001). The validation set confirmed these findings., Conclusion: Utilizing machine learning, we identified a high-risk cluster for procedural failure in catheter ablation of persistent atrial fibrillation within the DECAAF II trial population. The primary differentiating factors of this high-risk cluster include older age, high left atrial fibrosis, elevated BMI, and increased left atrial volume., (© 2024 Wiley Periodicals LLC.)

Introduction: We sought to assess the variations in practice metrics and billing practices among US Medical Graduates (USMGs) and International Medical Graduates (IMGs) in surgical oncology who serve a fee-for-service population., Methods: Medicaid Services Medicare fee-for-service provider utilization and payment files were used to obtain publicly available data between January 1, 2021, and December 31, 2021. Comparisons were conducted using the t-test for parametric variables and Wilcoxon rank-sum for nonparametric variables., Results: A total of 952 surgical oncologists (IMGs: n = 102 [10.7%]) were included in the analytic cohort. The average risk score among beneficiaries treated by IMGs was higher than USMGs (1.70 [0.04] vs. 1.46 [0.02], p < 0.001) and IMGs also had a higher total number of unique codes (47.0 [IQR: 36.0-69.0] vs. 38.0 [IQR: 24.0-60.0], p < 0.05). IMG surgical oncologists had higher payment-per-service amounts ($236.56 [10.34] vs. $196.20 [$2.65]; p < 0.05), charge-per-service amounts ($1242.48 [$83.14] vs. $1014.89 [$26.13]; p < 0.05), and higher total submitted charges ($400,373.26 [$342,978.45] vs. $360,020.29 [$523,675.91]; p < 0.05). IMGs provided a higher percentage of procedural services (34.1% vs. 27.9%; p < 0.001) and treatment services (2.1% vs. 1.9%; p < 0.001) versus USMGs. Female surgical oncologists, particularly female IMGS, billed lower annual mean Medicare charges (female IMGS: $295,383 vs. male IMGs: $424,407 vs. female USMGs: $294,168 vs. male USMGs: $414,543; p < 0.001)., Conclusions: IMGs provided more procedural services, cared for patients with a higher average risk score, and performed a greater variety of procedures compared with USMGs. Consequently, IMGs had higher mean annual charges, payment-per-service, and charge-per-service amounts., (© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Importance: Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness., Objective: To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients., Design, Setting, and Participants: In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021., Intervention: An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening., Main Outcomes and Measures: The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile., Results: Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile., Conclusions and Relevance: Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality., Trial Registration: ClinicalTrials.gov Identifier: NCT04078594.

Object detection is an essential computer vision task that identifies and locates objects within images or videos and is crucial for applications such as autonomous driving, robotics, and augmented reality. Light Detection and Ranging (LiDAR) and camera sensors are widely used for reliable object detection. These sensors produce heterogeneous data due to differences in data format, spatial resolution, and environmental responsiveness. Existing review articles on object detection predominantly focus on the statistical analysis of fusion algorithms, often overlooking the complexities of aligning data from these distinct modalities, especially dynamic environment data alignment. This paper addresses the challenges of heterogeneous LiDAR-camera alignment in dynamic environments by surveying over 20 alignment methods for three-dimensional (3D) object detection, focusing on research published between 2019 and 2024. This study introduces the core concepts of multimodal 3D object detection, emphasizing the importance of integrating data from different sensor modalities for accurate object recognition in dynamic environments. The survey then delves into a detailed comparison of recent heterogeneous alignment methods, analyzing critical approaches found in the literature, and identifying their strengths and limitations. A classification of methods for aligning heterogeneous data in 3D object detection is presented. This paper also highlights the critical challenges in aligning multimodal data, including dynamic environments, sensor fusion, scalability, and real-time processing. These limitations are thoroughly discussed, and potential future research directions are proposed to address current gaps and advance the state-of-the-art. By summarizing the latest advancements and highlighting open challenges, this survey aims to stimulate further research and innovation in heterogeneous alignment methods for multimodal 3D object detection, thereby pushing the boundaries of what is currently achievable in this rapidly evolving domain.

Background/objectives: Chest disease identification for Tuberculosis and Pneumonia diseases presents diagnostic challenges due to overlapping radiographic features and the limited availability of expert radiologists, especially in developing countries. The present study aims to address these challenges by developing a Computer-Aided Diagnosis (CAD) system to provide consistent and objective analyses of chest X-ray images, thereby reducing potential human error. By leveraging the complementary strengths of convolutional neural networks (CNNs) and vision transformers (ViTs), we propose a hybrid model for the accurate detection of Tuberculosis and for distinguishing between Tuberculosis and Pneumonia., Methods: We designed a two-step hybrid model that integrates the ResNet-50 CNN with the ViT-b16 architecture. It uses the transfer learning on datasets from Guangzhou Women's and Children's Medical Center for Pneumonia cases and datasets from Qatar and Dhaka (Bangladesh) universities for Tuberculosis cases. CNNs capture hierarchical structures in images, while ViTs, with their self-attention mechanisms, excel at identifying relationships between features. Combining these approaches enhances the model's performance on binary and multi-class classification tasks., Results: Our hybrid CNN-ViT model achieved a binary classification accuracy of 98.97% for Tuberculosis detection. For multi-class classification, distinguishing between Tuberculosis, viral Pneumonia, and bacterial Pneumonia, the model achieved an accuracy of 96.18%. These results underscore the model's potential in improving diagnostic accuracy and reliability for chest disease classification based on X-ray images., Conclusions: The proposed hybrid CNN-ViT model demonstrates substantial potential in advancing the accuracy and robustness of CAD systems for chest disease diagnosis. By integrating CNN and ViT architectures, our approach enhances the diagnostic precision, which may help to alleviate the burden on healthcare systems in resource-limited settings and improve patient outcomes in chest disease diagnosis.

Monkeypox is a zoonotic disease caused by the orthopox virus, a double-stranded DNA virus that belongs the Poxviridae virus family. It is known to infect both animals (especially monkeys and rodents) and humans and causes a rash similar to smallpox. Humans can become infected with monkeypox virus (MPXV) when they get in close contact with infected animals (zoonotic transmission) or other infected people (human-human transmission) through their body fluids such as mucus, saliva, or even skin sores. Frequently observed symptoms of this disease include fever, headaches, muscle aches, and a rash that initially looks like a tiny bump before becoming a lump that is filled with fluid. Monkeypox symptoms also include an incubation period of 5-21 days, divided into prodromal and eruption phases. Several contributing factors, such as smallpox vaccine discontinuation, widespread intake of infected animal products as a source of protein, and high population density, amongst others, have been linked to an increase in the frequency of monkeypox outbreaks. The best course of action for diagnosing individuals who may be suffering from active monkeypox is to collect a sample of skin from the lesion and perform PCR molecular testing. Monkeypox does not presently have a specific therapy; however, supportive care can assist in managing symptoms, such as medication to lower body temperature and pain. Three major orthopoxvirus vaccines have been approved to serve as a preventive measure against monkeypox: LC16, JYNNEOS, and ACAM2000. The discovery that the monkeypox outbreak is communicable both among humans and within a population has sparked new public health worries on the possibility of the outbreak of another viral pandemic. Research and studies are still being conducted to gain a deeper understanding of this zoonotic viral disease. This review is therefore focused on deciphering monkeypox, its etiology, pathogenesis, transmission, risk factors, and control., Competing Interests: The authors declare that there is no conflict of interest.

Avian pathogenic Escherichia coli (APEC) causes colibacillosis in poultry; this type of bacteria is an extraintestinal pathogen E. coli . Unlike other E. coli pathogen groups, the characteristics of APECs cannot be identified by a single group. Serotyping and biotyping are frequently performed for isolates found in colibacillosis infections. The establishment, transmission, and persistence of this pathogenic strain in chicken populations are determined by the intricate interactions of multiple elements that make up the epidemiology of APEC. APEC employs many virulence and pathogenesis factors or mechanisms to infect chickens with colibacillosis. These factors include invasives, protectins, adhesins, iron acquisition, and toxins. In addition, the pathogenicity of APEC strains can be evaluated in 2-4 week -old chicks. The impact of unfavorable environmental conditions has also been documented, despite direct contact being demonstrated to be a significant element in transmission in APEC. Chickens are immunized against colibacillosis using a variety of vaccines. Nevertheless, commercially available vaccinations do not offer sufficient immunity to protect birds from APEC strains. Hatching egg contamination is one of the main ways that APECs spread throughout chicken flocks. Farmers also need to be mindful of storing discarded materials near the manure-watering area, removing them when necessary, and replacing wet materials with dry materials when needed. This review aimed to explain the characteristics, epidemiology, virulence, pathogenesis, diagnosis, pathophysiology, transmission, vaccination, and control of APEC., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Khairullah, et al.)

Background: There is a strong relationship between left atrial (LA) remodeling and ischemic stroke (IS) risk in atrial fibrillation (AF) patients. The Efficacy of Delayed Enhancement MRI-Guided Ablation vs. Conventional Catheter Ablation of Atrial Fibrillation (DECAAF-II) is the biggest MRI-based, randomized, multicenter clinical trial performed on persistent AF patients. The aim of this study is to evaluate the relationship between history of stroke and atrial fibrosis in the DECAAF II population., Methods: Persistent AF patients who underwent Late Gadolinium Enhancement Magnetic Resonance Imaging (LGE-MRI) were included in the study and divided into two different groups: those with a history of stroke and those without. Propensity score matching was performed to adjust for covariates. Atrial fibrosis was compared in both groups. Then, patients were divided into different fibrosis groups, using three different cut-offs of baseline atrial fibrosis: ≥ 15%, ≥ 20%, and ≥ 25%. Univariate logistic regression and adjusted multivariate analysis were performed to assess the effect of clinical characteristics and risk factors on baseline fibrosis., Results: Eight-hundred forty-three patients were recruited in DECAAF II, of whom 70 (8.3%) had a history of stroke. Patients with history of stroke had a higher prevalence of hypertension (p = 0.043), diabetes (p = 0.014), and hyperlipidemia (p = 0.001). Seventy patients with no history of strokes were matched with patients with history of stroke to adjust for covariates using propensity score analysis. Patients in the stroke group had a significantly higher level of fibrosis than those without (20.2% vs. 8.1%, p = 0.017). Increased age was a significant predictor of all three baseline fibrosis classes (≥ 15%, ≥ 20%, and ≥ 25%). Additionally, history of stroke was found to be a predictor of baseline fibrosis ≥ 25% even after adjusting for other clinical characteristics and risk factors (OR = 1.98 [1.14-3.43], p = 0.01)., Conclusions: Left atrial fibrosis level greater than 25% correlates with the history of previous stroke episodes in patients with persistent atrial fibrillation., Competing Interests: Declarations. Conflict of interest: NM reports having received consulting fees from Biosense Webster, Boston Scientific, and AtriCure. NM also reports being a speaker for Abbott, Biosense Webster, AtriCure, and Sanofi. NM also reports receiving research support Abbott, Medtronic, Biosense Webster, Siemens, GE, Boston Scientific, Sanofi, and Samsung. NM also reports having a family member as the CEO of Cardiac Designs. NM also reports being the founder of Marrek, being named in a patent issued for MRI fibrosis imaging, and being a previous shareholder of Cardiac Designs. All other co-authors have no relevant conflict of interest. The DECAAF II trial was funded by Medtronic, GE, Siemens, Boston Scientific, Biosense Webster, and Abbott., (© 2024. The Author(s).)

Optic neuritis (ON) is defined as an acquired disorder of the optic nerve that may be associated with demyelinating diseases or infectious or inflammatory processes. In children, the manifestation of this condition differs from that in adults, where it typically presents with bilateral papillitis subsequent to a preceding viral illness. Nonetheless, the main concern for practitioners is the possibility of its conversion to multiple sclerosis (MS). In recent years, there has been increased awareness regarding differentiating MS from other demyelinating ON phenotypes, namely, neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Despite the clinical similarities among these three entities, they vary in terms of pathophysiology, clinical course, treatment approaches, and prognostication. In this paper, we highlight the case of a child with MOGAD ON who was clinically severe at presentation and has typical features of ON and the appropriate investigation and treatment done to achieve complete visual recovery., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmad Fauzi et al.)

Background and Objective: Tricuspid valve replacement (TVR) is required when repair is not feasible, and it continues to be a relatively high-risk procedure owing to the complex medical and/or surgical profile of patients. The choice between mechanical and biological prostheses for TVR remains a subject of debate owing to their distinct advantages and disadvantages. This study aimed to analyse and compare the clinical outcomes of these two types of prostheses in the tricuspid position., Methods: PubMed, EMBASE, Web of Science, and the COCHRANE library were searched from 1995 to April 2023 for studies comparing clinical outcomes of mechanical versus biological valves in the tricuspid position. Data on 30-day mortality, reoperations, 5-year valve failure rates, thrombotic/thromboembolic events, and long-term survival were extracted, pooled, and analysed. Forest plots were generated using a random-effects model., Results: From an initial pool of 4716 citations, 37 studies meeting our inclusion criteria were assessed, collectively encompassing 8316 prostheses (3796 mechanical, 4520 bioprostheses). Our analysis revealed that mechanical valves exhibited a non-significant trend towards diminished 30-day mortality (RR = 0.85, 95% CI = 0.69-1.06). A distinct disparity emerged in valve durability, with mechanical valves demonstrating a significantly increased risk of 5-year valve failure (RR = 2.21, 95% CI = 1.38-3.56). Strikingly, mechanical valves displayed a substantial six-fold elevated risk of thrombotic events (RR = 6.29, 95% CI = 3.98-9.92). In contrast, the long-term survival and reoperation rates demonstrated no statistically significant differences between the two valve types., Conclusions: This systematic review and meta-analysis provides insights into the selection of mechanical and bioprosthetic valves for TVR. These findings highlight the potential advantages and disadvantages of mechanical and bioprosthetic valves in terms of early mortality, valve durability, and thrombotic risk. Our analysis provides clinicians with evidence-based guidance for optimizing outcomes in TVR, offering a foundation for informed decision-making in this intricate surgical landscape. Despite these insights, clinicians must overcome the limitations of retrospective studies, evolving healthcare, and anticoagulant disparities to ensure careful consideration in tricuspid valve replacement decisions., Competing Interests: Declarations. Ethics approval and consent to participate: Not Applicable. Competing interests: The author Sameh M. Said is a consultant for Artivion, Abbott, and JOMDD., (© 2024. The Author(s).)

This work examines the functional dependence of the efficiency of separation of oil-water emulsions on surfactant adsorption abilities of high surface area polymer gels. The work also develops an understanding of the factors and steps that are involved in emulsion separation processes using polymer gels. The work considers four polymer gels offering different surface energy values, namely, syndiotactic polystyrene (sPS), polyimide (PI), polyurea (PUA), and silica. The data reveal that surfactant adsorption abilities directly control the emulsion separation performance. The gels of sPS and PI destabilize the emulsions due to significant surfactant adsorption. The surfactant-lean oil droplets are then absorbed in the pores of sPS and PI gels due to the preferential wettability of the oil phase. The PUA and silica gels are more hydrophilic and show a lower surfactant adsorption ability. These gels cannot effectively remove the surfactant molecules from the emulsions, leading to a poor emulsion separation performance. The study uses simulation data to understand the adsorption characteristics of two poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block copolymer surfactants. The simulation results are used for the interpretation of emulsion separation performance by the gels.

Anaphylaxis can induce life-threatening coagulopathy by releasing various mediators from activated mast cells. These mediators directly affect coagulation and fibrinolytic pathways, increasing the bleeding risk. Diagnosis and management of anaphylaxis-induced coagulopathy remain challenging. We report a unique case of a 44-year-old man with undiagnosed systemic mastocytosis who developed peanut-induced anaphylactic shock, resulting in cardiac arrest. Laboratory tests revealed elevated serum tryptase and severe coagulopathy. Thromboelastography, a point-of-care viscoelastic monitoring (VEM) test identified the presence of heparin-like anticoagulants within minutes. Bone marrow examination subsequently confirmed isolated mastocytosis. This case highlights the potential of VEM for rapid diagnosis and management of coagulopathy in patients with anaphylaxis, potentially aiding in the identification of mast cell degranulation in undifferentiated shock. We suggest that VEM should be considered in the investigation of patients with suspected anaphylaxis-induced coagulopathy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Telehealth applications are growing in the fields of obstetrics and gynecology. Strong scientific analysis and clinical recommendations are necessary for these innovative advancements. The purpose of this study was to conduct a thorough evaluation of how telehealth interventions can enhance obstetric and gynecologic health outcomes. Using pre-established inclusion and exclusion criteria, we searched the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 968 pertinent research articles were found in these databases, and Endnote software checked them for duplication. Only fifty-two of these articles were deemed relevant after a thorough text examination. Every study that was included had its risk of bias evaluated using the Newcastle-Ottawa Scale (NOS). Overall, telehealth interventions enhanced breastfeeding and smoking cessation obstetric outcomes. While preserving mother and fetal outcomes, telehealth interventions reduced the requirement for high-risk obstetric monitoring office visits. According to one study, women with gestational hypertension had lower rates of preeclampsia diagnoses. For continued use of injectable and oral contraceptives, telehealth treatments proved successful; one text-based study discovered higher rates of oral contraception after six months. When medication abortion services were provided via telehealth, access to early abortion was enhanced, and clinical outcomes were comparable to those of in-person care. Few studies have indicated the value of telehealth in improving the notification of test results for sexually transmitted infections and in improving the symptoms of urine incontinence with app-based interventions. Early availability of medical abortion services, breastfeeding, perinatal smoking cessation, telehealth therapies, and high-risk obstetrics schedule optimization were all linked to better obstetric outcomes. More carefully planned research is required to look at these and other interventions in order to produce data that can guide choices regarding the integration of more recent telehealth technology into obstetrics and gynecology practices., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abdalla Elsheikh et al.)