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Ejaz Cheema,1 Khalil McGuinness,1 Muhammad Abdul Hadi,1 Vibhu Paudyal,1 Mohammed Hassan Elnaem,2 Abdullah A Alhifany,3 Mahmoud E Elrggal,3 Abdullah Al Hamid1 1School of Pharmacy, University of Birmingham, Birmingham, UK; 2Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan, Malaysia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi ArabiaCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Room 356, Robert Aitken Building, Edgbaston, Birmingham B15 2TT, UKEmail e.cheema@bham.ac.ukPurpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl-associated deaths using case studies and case series in peer-reviewed published literature.Methods: Four electronic databases including Embase, Medline (via Ovid), Scopus and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively.Results: Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, < 1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 μg/mL.Conclusion: Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths.Keywords: fentanyl, death, nature, cause, toxicology

Sajid Mahmood, 1 Zahraa Jalal, 2 Muhammad Abdul Hadi, 2 Hasan Orooj, 3 Kifayat Ullah Shah 1 1Department of Pharmacy, Quaid-e-Azam University, Islamabad 45320, Pakistan; 2School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; 3Directorate of Health Services, Metropolitan Corporation Islamabad, Islamabad, PakistanCorrespondence: Kifayat Ullah ShahDepartment of Pharmacy, Quaid-e-Azam University, Islamabad 45320, PakistanTel +92-3325542722Email kushah@qau.edu.pkObjective: This study aimed to assess the prevalence and predictors of non-adherence to antihypertensive medication among patients with hypertension attending various healthcare settings in Islamabad, Pakistan.Methods: A questionnaire-based cross-sectional study was conducted in selected healthcare facilities between September 2017 and December 2018. The study was conducted in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Sociodemographic and clinical data of recruited patients were collected through a structured questionnaire. Binary logistic regression analysis was performed to determine covariates significantly associated with medication adherence and blood pressure control.Results: A total of 776 hypertensive patients were invited and 741 (95%) completed the questionnaire. The mean ± SD age of participants was 53.6± 12.6 years; 284 patients (38.3%) had high adherence, 178 (24%) had moderate adherence and 279 (37.7%) were non-adherent to the prescribed antihypertensive therapy. Binary regression analysis revealed that old age (OR 1.783 [95% CI: 1.172– 2.712]; P=0.013), being educated (OR 2.018 [95% CI: 1.240– 3.284]; P=0.036), entitlement to free medical care (OR 1.369 [95% CI: 1.009– 1.859]; P=0.044), treatment duration (OR 2.868 [95% CI: 1.913– 4.299]; P=0.001), number of medications (OR 1.973 [95% CI: 1.560– 2.495]; P=0.001), presence of any comorbidity (OR 2.658 [95% CI: 1.836– 3.848]; P=0.001) and blood pressure control (OR 3.103 [95% CI: 2.268– 4.247]; P=0.001) were significantly associated with good adherence. Similarly, age (OR 1.998 [95% CI: 1.313– 3.040]; P=0.004), entitlement to free medical care (OR 1.498 [95% CI: 1.116– 2.010]; P=0.007), treatment duration (OR 1.886 [95% CI: 1.143– 3.113]; P=0.013), presence of any comorbidity (OR 1.552 [95% CI: 1.123– 2.147]; P=0.008) and adherence level (OR 3.103 [95% CI: 2.268– 4.247]; P=0.001) had significant association with controlled blood pressure. The following were the main reasons for non-adherence to prescribed antihypertensive medication: “don’t feel need for regular use“ (24.7%), “Carelessness“ (13.4%) and “adverse effects“ (11.2%).Conclusion: The prevalence of non-adherence to antihypertensive medications was high in the study population and poor medication adherence could potentially explain poor blood pressure control. Evidence-based targeted interventions on both medication adherence and blood pressure control should be introduced and implemented for better treatment outcomes.Keywords: cross-sectional study, adherence, hypertension, Asia, antihypertensives, blood pressure control, Pakistan

Myriam Jaam,1 Muhammad Abdul Hadi,2 Nadir Kheir,3 Mohamed Izham Mohamed Ibrahim,1 Mohammad Issam Diab,1 Samya Ahmad Al-Abdulla,4 Ahmed Awaisu1 1College of Pharmacy, Qatar University, Doha, Qatar; 2Leicester School of Pharmacy, De Montfort University, Leicester, UK; 3Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; 4Family Medicine, Primary Healthcare Corporation, Doha, Qatar Purpose: To develop an in-depth understanding of the barriers to medication adherence among patients with uncontrolled diabetes attending primary health care (PHC) centers in Qatar by exploring and integrating patients’ and health care providers’ perspectives. Participants and methods: A descriptive qualitative methodology was used in this study. A trained researcher conducted semi-structured face-to-face interviews at two PHC centers. Patients with uncontrolled diabetes (with varied sociodemographic characteristics) and their respective health care providers (physicians, pharmacists, nurses, dieticians, and others) were purposively selected from the two PHC centers. All interviews were audio recorded, transcribed verbatim, and analyzed using thematic content analysis. Results: Thirty interviews (14 patients and 16 health care providers) were conducted. A number of barriers to medication adherence were identified and classified broadly under three main themes: 1) patient-related factors, which included patients’ individual characteristics and patients’ perception, attitude, and behavior; 2) patient–provider factors, which included communication and having multiple health care providers caring for the patient; and 3) societal and environmental factors, which included social pressure and traveling to visit friends and relatives. Conclusion: Patients with uncontrolled diabetes face multiple barriers to medication adherence. Similar themes emerged from both patients and their care providers. This research highlights the need for concerted multidimensional efforts and series of interventions to overcome these barriers. One vital intervention is expanding the scope of pharmacists’ role within the PHC centers through providing medication reconciliation, patient-tailored medication counseling, and medicines use review, which may improve treatment outcomes among patients with diabetes. Keywords: medication adherence, Middle East, primary health care, qualitative research, uncontrolled diabetes

Yaser Mohammed Al-Worafi,1,2 Yaman Walid Kassab,3 Wafa Mohammed Alseragi,4 Masaad Saeed Almutairi,5 Ali Ahmed,6 Long Chiau Ming,7 Ali Saleh Alkhoshaiban,8,9 Muhammad Abdul Hadi10 1Faculty of Pharmacy, University of Science and Technology, Sana’a, Yemen; 2Clinical Pharmacy Department, College of Pharmacy, Ajman University, Ajman, United Arab Emirates; 3Hospital and Clinical Pharmacy Department, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Selangor, Malaysia; 4Faculty of Arts, Ibb University, Ibb, Yemen; 5College of Pharmacy, Qassim University, Qassim, Saudi Arabia; 6Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia; 7School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia; 8College of Medicine, Qassim University, Qassim, Saudi Arabia; 9Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia; 10Leicester School of Pharmacy, De Montfort University, Leicester, UK Objective: The aim of this study was to compare the knowledge, attitude and barriers of pharmacy technicians and pharmacists toward pharmacovigilance, adverse drug reactions (ADRs) and ADR reporting in community pharmacies in Yemen.Methods: This cross-sectional survey was conducted among community pharmacists and pharmacy technicians in the capital of Yemen, Sana’a. A total of 289 community pharmacies were randomly selected. The validated and pilot-tested questionnaire consisted of six sections: demographic data, knowledge about pharmacovigilance, experience with ADR reporting, attitudes toward ADR reporting, and the facilitators to improve ADR reporting.Results: A total of 428 pharmacy technicians and pharmacists were contacted and 179 went on to complete a questionnaire (response rate: 41.8%). Of the 179 respondents, 21 (11.7%) were pharmacists and 158 (88.3%) were pharmacy technicians, of which, 176 (98.3%) were male and 3 (1.7%) were female. The mean age of the respondents was 25.87±2.63 years. There was a significant difference between the pharmacists and pharmacy technicians in terms of knowledge scores (P

Muhammad Abdul Hadi,1 Chin Fen Neoh,2 Rosdi M Zin,3 Mahmoud E Elrggal,4 Ejaz Cheema4 1School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK; 2Collaborative Drug Discovery Research Group, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Salangor, 3Pharmacy Department, Malacca Hospital, Malacca, Malaysia; 4Faculty of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia Abstract: Globally, adverse drug reactions (ADRs), one of the leading causes of morbidity and mortality, will continue to pose a threat to public health as long as drugs are being used to treat various ailments. Prompt ADR reporting is crucial in ensuring drug safety. The aim of this narrative review was to highlight the role of pharmacists in pharmacovigilance and to identify barriers and facilitators toward ADR reporting documented in the literature. The perspective of pharmacy students on pharmacovigilance and ADR reporting has also been discussed with an aim to highlight the need to improve content related to ADR reporting and pharmacovigilance in undergraduate pharmacy curriculum. Globally, although the role of pharmacists within national pharmacovigilance systems varies, it is very well recognized. In general, pharmacists acknowledge that ADR reporting is part of their professional responsibility and have a positive attitude toward reporting ADRs. However, current research evidence suggests that there are still critical knowledge gaps with regard to ADR reporting among pharmacists, especially in countries where the role of pharmacists within the health care system is limited. These knowledge gaps can be fulfilled through continuous professional development programs and reinforcing theoretical and practical knowledge in undergraduate pharmacy curriculums. Without adequately identifying and fulfilling training needs of pharmacists and other health care professionals, the efficiency of national pharmacovigilance systems is unlikely to improve which may compromise patient’s safety. Keywords: pharmacist, adverse drug reaction, pharmacovigilance, patient safety

Kok-Yuen Ho,1 Mohamed Abdul Hadi,2 Koravee Pasutharnchat,2 Kian-Hian Tan21Pain Management Centre, Raffles Hospital, 2Pain Management Centre, Singapore General Hospital, SingaporeBackground: Sacroiliac joint pain is a common cause of chronic low back pain. Different techniques for radiofrequency denervation of the sacroiliac joint have been used to treat this condition. However, results have been inconsistent because the variable sensory supply to the sacroiliac joint is difficult to disrupt completely using conventional radiofrequency. Cooled radiofrequency is a novel technique that uses internally cooled radiofrequency probes to enlarge lesion size, thereby increasing the chance of completely denervating the sacroiliac joint. The objective of this study was to evaluate the efficacy of cooled radiofrequency denervation using the SInergyTM cooled radiofrequency system for sacroiliac joint pain.Methods: The charts of 20 patients with chronic sacroiliac joint pain who had undergone denervation using the SInergyTM cooled radiofrequency system were reviewed at two years following the procedure. Outcome measures included the Numeric Rating Scale for pain intensity, Patient Global Impression of Change, and Global Perceived Effect for patient satisfaction.Results: Fifteen of 20 patients showed a significant reduction in pain (a decrease of at least three points on the Numeric Rating Scale). Mean Numeric Rating Scale for pain decreased from 7.4 ± 1.4 to 3.1 ± 2.5, mean Patient Global Impression of Change was "improved" (1.4 ± 1.5), and Global Perceived Effect was reported to be positive in 16 patients at two years following the procedure.Conclusion: Cooled radiofrequency denervation showed long-term efficacy for up to two years in the treatment of sacroiliac joint pain.Keywords: ablation, chronic low back pain, intervention, neurotomy, sacroiliitis

Breast cancer is the most common cancer and the leading cause of cancer death among women of all ethnic and age groups in Malaysia. Objective: The objectives of this study were to evaluate the knowledge of breast cancer risk factors, symptoms and methods of screening among female university students and their perception towards the disease treatment outcomes. Methods: A cross-sectional survey was conducted from February to March 2008 at Universiti Sains Malaysia. Two hundred participants from 10 randomly selected faculties were interviewed face to face by a trained pharmacist using a validated questionnaire. In addition to their demographic characteristics, participants were required to answer 22 questions concerning knowledge of breast cancer and five questions related to their perception of breast cancer management and treatment outcomes. Data were analyzed using SPSS version 15. Results: The mean age of the respondents was 26.7 (SD=1.9) years. The results showed that the vast majority of the female university students had inadequate knowledge of breast cancer. The mean total knowledge score of the students was 60.7%. Indian students had significantly less knowledge of breast cancer compared to their Chinese and Malay counterparts (p

Programmed, systematic and structured curriculum review isessential to ensure quality professional education. Curriculumevaluation enables the institution to validate the compliance ofdidactic and experiential strategies with the current needs andfuture demand of the profession. The four conceptions ofcurriculum as highlighted by Ewell namely designedcurriculum, expectational curriculum, delivered curriculumand the experienced curriculum must be evaluated for aneffective curriculum review [1]. Involvement of stakeholders incurriculum review is essential.In Malaysia, Universiti Teknologi MARA (UiTM) is the onlypublic sector university together with 19 private collegesoffering a three year (six-semester) Diploma in Pharmacyaccredited by Malaysian Qualifications Agency (MQA)[2]. Theprogram was first started in 1996. The construct of first twoyears is didactic and laboratory practical based. However, inthe final year (3rd year) students are exposed to theexperiential hospital based training and research projects.Faculty of Pharmacy, UiTM reviews the curriculum every threeyears. In an attempt to develop a “Needs Based” curriculum across sectional survey was undertaken to assess knowledgeand skills required to become a competent Pharmacy assistant.Structured validated questionnaires were mailed torandomly chosen 8 hospitals across Malaysia along with adetailed cover letter explaining the purpose of the study. Thesample consisted of pharmacists and pharmacy assistants whowere willing to participate in the study.

Abstract Treatment of bacterial infections with antibiotic resistance is complicated. For this reason, new therapeutic methods are needed to control bacterial infections. Therefore, it is necessary to discover new antibiotics from medicinal plants that can destroy drug-resistant bacteria. Essential oils (EO) of some medicinal plants have antimicrobial effects and can be used as antimicrobial agents in the treatment of infections and food industries. The aim of this study was to determine the EO composition and antimicrobial effects of EO and polyphenols profile of Salvia Sahendica roots for the first time. Chemical compounds and antibacterial activity of EOs against Staphylococcus aureus and Bacillus cereus as gram-positive and Escherichia coli and Pseudomonas aeruginosa as gram- negative bacteria were evaluated using microtiter broth dilution method. Studied organs of S. sahendica showed significant diversity in terms of type and percentage of essential oil and polyphenol compounds. Overall, 44, 46, 42, and 45 compounds were identified in the essential oil of leaves, flowers, stems, and roots of this plant, which constituted 99.6, 99.3, 98.2, and 99.4% of total oil composition, respectively. The current study collectively demonstrated inhibitory effects ranged from strong (S. aureus) to low inhibition (P. aeruginosa). According to the HPLC result, the amounts of coumaric acid, chlorogenic acid, and gallic acid compounds in the root are higher than in other plant parts, which indicate that the root can be a suitable source for the production of these valuable polyphenol compounds. Due to the results, it is possible to hope for the application of EO from S. sahendica as natural antibacterial in the pharmaceutical and food industries.

Background and Purpose: Influenza remains a significant global health concern, necessitating continuous research to understand its clinical manifestations and prognostic indicators. While the accurate diagnosis of pneumonia etiology is based on microbiological tests, clinical and radiological data can help narrow the differential diagnosis. This study, conducted at the Razi Educational and Medical Center in Ghaemshahr, aimed to comprehensively evaluate the radiological findings among patients diagnosed with influenza. Additionally, it sought to explore potential correlations between these radiological manifestations and various demographic and clinical characteristics. Materials and Methods: Using a prospective cohort design, the study enrolled individuals who were admitted to Razi Hospital in Ghaemshahr with symptoms indicative of influenza from 2018 to 2019. Upon admission, all patients underwent comprehensive CT scans within 24 hours to assess the extent and nature of pulmonary involvement. The data collected from these evaluations were analyzed statistically using SPSS software, with a significance level set at P

Abstract Vitrinite reflectance (VR) is a critical measure of source rock maturity in geochemistry. Although VR is a widely accepted measure of maturity, its accurate measurement often proves challenging and costly. Rock–Eval pyrolysis offers the advantages of being cost-effective, fast, and providing accurate data. Previous studies have employed empirical equations and traditional machine learning methods using T-max data for VR prediction, but these approaches often yielded subpar results. Therefore, the quest to develop a precise method for predicting vitrinite reflectance based on Rock–Eval data becomes particularly valuable. This study presents a novel approach to predicting VR using advanced machine learning models, namely ExtraTree and XGBoost, along with new ways to prepare the data, such as winsorization for outlier treatment and principal component analysis (PCA) for dimensionality reduction. The depth and three Rock–Eval parameters (T-max, S1/TOC, and HI) were used as input variables. Three model sets were examined: Set 1, which involved both Winsorization and PCA; Set 2, which only included Winsorization; and Set 3, which did not include either. The results indicate that the ExtraTree model in Set 1 demonstrated the highest level of predictive accuracy, whereas Set 3 exhibited the lowest level of accuracy, confirming the methodology's effectiveness. The ExtraTree model obtained an overall R2 score of 0.997, surpassing traditional methods by a significant margin. This approach improves the accuracy and dependability of virtual reality predictions, showing significant advancements compared to conventional empirical equations and traditional machine learning methods.

Paget's disease of bone is a metabolic bone disorder characterized by localized areas of increased bone production and cycle with excessive and irregular bone formation. Rapid bone resorption and formation lead to irregular bone tissue. Most cases are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. Primary sclerosing cholangitis is a chronic progressive disorder of unknown etiology characterized by inflammation, fibrosis, and narrowing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree. The association of both diseases with other diseases has been reported, but there are few reports of the association of these two diseases together. This association can present the physician with an important challenge for both diseases because both diseases lead to an increase in alkaline phosphatase. Here, we present a 52-year-old man who was also diagnosed with Paget's disease of the femur on evaluation for abdominal pain and elevated alkaline phosphatase. Zoledronic acid 5 mg was prescribed for the patient. Six months later, the patient did not complain of hip pain. The femur graph remained unchanged and the patient's alkaline phosphatase decreased and reached the normal range. Laboratory findings, imaging, and histology of the patient were explained. It seems that in patients with high alkaline phosphatase and primary biliary cirrhosis, the presence of pain or deformity of bones and joints should be checked with imaging to detect the presence of co-morbidities.

Background and purpose: Leptospirosis is a common disease between humans and animals, the source of which is rodents, canines, etc., the disease is transmitted by scratching the skin and getting it contaminated with water contaminated with animal urinary waste and is currently an endemic disease in neighboring northern provinces of Iran. The purpose of this study was to investigate the findings of chest X-ray and lung CT scans in leptospirosis with or without pulmonary symptoms. Materials and methods: The current descriptive and retrospective research examined the findings of chest X-ray and CT scan of the lungs in patients with leptospirosis with or without pulmonary manifestations in Razi Ghaemshahr Hospital. In this study, 49 hospitalized patients were randomly selected from the records of leptospirosis patients in Razi Ghaemshahr Hospital during the spring and summer of 2017 from an information form based on clinical epidemiological characteristics and risk factors for leptospirosis patients using the mentioned characteristics. The disease was prepared in the infectious reference books and articles published in Farsi and English about this disease, and help was taken from a radiologist colleague to interpret the findings of the chest X-ray and CT scan of the lungs. After recording in SPSS 16 software, the data were analyzed through a Q_Q graph and skewness index. The clinical and epidemiological findings of leptospirosis were considered as inclusion criteria in the study, and the absence of serological tests to confirm leptospirosis was considered as exclusion criteria. Results: Among 49 hospitalized patients with leptospirosis, 11 patients had abnormal radiological findings and 38 patients had normal X-rays. Among 11 patients with abnormal radiological findings, 6 patients had respiratory symptoms, which included 54.54% cough and 18.18% bloody sputum. Among 38 patients with normal radiography, 11 patients had pulmonary symptoms, which included 29.94% cough and 2.63% bloody sputum. The amount of cough was significantly higher. Abnormal findings in chest X-ray, alveolar infiltration, ground glass opacity, and consolidation were the most frequent in the CT scan of the lung. Conclusion: Considering the significant percentage of normal chest radiographs in patients suffering from rice field fever with pulmonary symptoms, it is essential to perform a CT scan of the chest and decide on more effective therapeutic interventions. Therefore, it is considerable that usually changes in the chest CT scan in the severe form of the disease that causes vasculitis and alveolar bleeding appear before the appearance of severe symptoms such as bloody sputum and make a decision to start more effective drugs in the patient's treatment plan. As a result, pulmonary involvement in patients with leptospirosis is of special importance and it should be given special attention due to the endemicity of leptospirosis in the province, considering the associated complications and high mortality and the possibility of its occurrence even in patients who do not have respiratory complaints at the time of presentation. It is suggested to conduct more extensive research based on the population in this field.

Abstract Background Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients’ Deaths during their missions in 2023. Methods This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith’s approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran. Results Seventeen emergency personnel with the age range of 24–60 (average = 39) years and with a history of confronting patients’ deaths during their services were interviewed. Their lived experiences of being exposed to patients’ deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes. Conclusion While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.

Abstract Introduction : This study aimed to investigate the work problems and challenges of male prehospital emergency technicians when faced with female medical emergencies. Given that qualitative research has not been done in this field, planning to find the weak points and improve the quality of prehospital emergency as the first line of treatment for female emergency patients, which is considered an important part of the health care system, is considered important and valuable. Therefore, this phenomenological study was conducted in 2023. Methods This study was conducted using a qualitative method of phenomenology in 2023. The environment of the research was urban and road prehospital emergency centers in Iran and the data were collected through interviews with EMS technicians. The collected data were analyzed using Smith’s approach to explain the lived experiences of EMS technicians facing female emergencies or women’s emergencies in Iran. Results All the 15 participants were men. Their mean age was 35 years, with a range of 25 to 45 years, and with a mean work experience of 10.54 years with a range of 4 to 20 years. The lived experiences of 115 emergency technicians in facing women’s emergencies in Iran were placed in four main themes cultural-social factors, organizational factors, human resources-related factors, and administrative-legal factors. Conclusion EMS personnel face various obstacles in carrying out missions related to women’s emergencies, Considering the critical nature of women’s emergencies, it is recommended that policymakers and clinical educators improve the level of community culture, communication skills, theoretical and practical training, respecting privacy, hiring female personnel, adding specialized equipment, amending and changing laws, removing road-traffic obstacles and to support personnel, patients and their families psychologically to optimize performance in women’s emergencies.

Cardiovascular disease (CVD) remains the leading cause of global morbidity and mortality. Extensive efforts have been invested to explicate mechanisms implicated in the onset and progression of CVD. Besides the usual suspects as risk factors (obesity, diabetes, and others), the gut microbiome has emerged as a prominent and essential factor in the pathogenesis of CVD. With its endocrine-like effects, the microbiome modulates many physiologic processes. As such, it is not surprising that dysbiosis-by generating metabolites, inciting inflammation, and altering secondary bile acid signaling- could predispose to or aggravate CVD. Nevertheless, various natural and synthetic compounds have been shown to modulate the microbiome. Prime among these molecules are flavonoids, which are natural polyphenols mainly present in fruits and vegetables. Accumulating evidence supports the potential of flavonoids in attenuating the development of CVD. The ascribed mechanisms of these compounds appear to involve mitigation of inflammation, alteration of the microbiome composition, enhancement of barrier integrity, induction of reverse cholesterol transport, and activation of farnesoid X receptor signaling. In this review, we critically appraise the methods by which the gut microbiome, despite being essential to the human body, predisposes to CVD. Moreover, we dissect the mechanisms and pathways underlying the cardioprotective effects of flavonoids.

This study evaluates the performance of a 36 Volt 10 Ah battery in an electric bicycle with a 350-Watt Brushless DC (BLDC) motor as an environmentally friendly alternative to overcome the negative impacts of motorized vehicle use in Indonesia. In addition, this study measured the State of Health battery’s value of internal resistance, which is different from other studies that use capacity fading. With a focus on maximum travel distance and travel time, experiments were conducted without load and with a 70kg load. The no-load test was conducted only once, resulting in a travel time of 600 minutes and a distance of 330.1 Km. Although the battery was not discharged, the results were not in line with expectations, so the no-load test was only conducted once. In the 70kg load test, six trials were conducted with variable measurements of distance, battery voltage, and battery resistance. Results showed variations in distance between 50.7 km and 53.1 km, and travel time between 151 and 160 minutes. The battery voltage varied from 31.316 Volts to 31.850 Volts. The resistance in the battery also showed an increase of about 0.0001 ohms from 0.1132 ohms to 0.1139 ohms. Overall, the results from the study showed that as time and usage progressed, the battery voltage and internal resistance values tended to increase, while the distance and travel time tended to decrease. The internal resistance measurement method proved to be effective in assessing battery health as the State of Health value decreased throughout the experiment.

This study investigates the impact of economic sanctions on exchange rate volatility, with a specific focus on the role of foreign reserves in mitigating these effects across 21 countries from 2002 to 2022. Employing advanced econometric models, including Panel-Corrected Standard Errors (PCSE) and Feasible Generalized Least Squares (FGLS), our analysis identifies a positive correlation between economic sanctions and increased exchange rate volatility. A significant finding is that high reserves-to-GDP ratios do not fully stabilize exchange rate volatility in the presence of economic sanctions, challenging the traditional view of reserves as reliable stabilizers. It also demonstrates an inverse relationship between heightened reserves-to-GDP ratios and economic growth during periods of sanctions, indicating that larger reserves may reflect economic difficulties rather than strength. These findings implicitly call for a reevaluation of economic policies in favor of adopting strategies that mitigate global economic uncertainties. Supported by previous literature, the importance of international cooperation and governance that foster economic and trade diversification is highlighted. This approach can provide alternative sources of foreign exchange and reduce economic vulnerability to sanctions, enhancing overall economic resilience and stability.

Abstract Background The combination of radiotherapy and immunotherapy (immunoradiotherapy) has been increasingly used for treating a wide range of cancers. However, some tumors are resistant to immunoradiotherapy. We have previously shown that MER proto-oncogene tyrosine kinase (MerTK) expressed on macrophages mediates resistance to immunoradiotherapy. We therefore sought to develop therapeutics that can mitigate the negative impact of MerTK. We designed and developed a MerTK specific antisense oligonucleotide (ASO) and characterized its effects on eliciting an anti-tumor immune response in mice. Methods 344SQR cells were injected into the right legs on day 0 and the left legs on day 4 of 8-12 weeks old female 129sv/ev mice to establish primary and secondary tumors, respectively. Radiation at a dose of 12 Gy was given to the primary tumors on days 8, 9, and 10. Mice received either anti-PD-1, anti-CTLA-4 or/and MerTK ASO starting from day 1 post tumor implantation. The composition of the tumor microenvironment and the level of MerTK on macrophages in the tumor were evaluted by flow cytometry. The expression of immune-related genes was investigated with NanoString. Lastly, the impact of MerTK ASO on the structure of the eye was histologically evaluated. Results Remarkably, the addition of MerTK ASO to XRT+anti-PD1 and XRT+anti-CTLA4 profoundly slowed the growth of both primary and secondary tumors and significantly extended survival. The ASO significantly reduced the expression of MerTK in tumor-associated macrophages (TAMs), reprograming their phenotype from M2 to M1. In addition, MerTK ASO increased the percentage of Granzyme B+ CD8+ T cells in the secondary tumors when combined with XRT+anti-CTLA4. NanoString results demonstrated that the MerTK ASO favorably modulated immune-related genes for promoting antitumor immune response in secondary tumors. Importantly, histological analysis of eye tissues demonstrated that unlike small molecules, the MerTK ASO did not produce any detectable pathology in the eyes. Conclusions The MerTK ASO can significantly downregulate the expression of MerTK on TAMs, thereby promoting antitumor immune response. The combination of MerTK ASO with immunoradiotherapy can safely and significantly slow tumor growth and improve survival. Graphical Abstract

Objective: Most polycystic ovary syndrome (PCOS) patients have metabolic abnormalities in which insulin resistance (IR) plays a pivotal role. Cinnamon is a herbal medicine with insulinotropic properties. This pilot study aimed to evaluate the effects of cinnamon on ovarian volume, androgenic profile, and metabolic and anthropometric parameters in women with PCOS.Materials and Methods: A single-center, double-blind, randomized, placebo-controlled trial was carried out on 39 overweight / obese women with PCOS. For six months, subjects in the cinnamon (500 mg) (n=19) and placebo (n=20) groups were given three capsules daily. Before and after the intervention, the variables were assessed. The data was analyzed using the GraphPad Prism software.Results: After the intervention, the two intervention and control groups had significant differences in abdominal subcutaneous fat and ovarian volume, but they did not differ significantly in terms of body mass index (BMI). Also, after the intervention, no significant difference was observed between the two groups in terms of lipid profile and the concentration of androgenic biomarkers of insulin resistance.Conclusion: Cinnamon supplementation improves ovarian volume and subcutaneous abdominal fat but has no effect on anthropometric parameters, lipid profile, insulin resistance, or androgen hormones.

Abstract We report a rare regime of Earth's magnetosphere interaction with sub‐Alfvénic solar wind in which the windsock‐like magnetosphere transforms into one with Alfvén wings. In the magnetic cloud of a Coronal Mass Ejection (CME) on 24 April 2023, NASA's Magnetospheric Multiscale mission distinguishes the following features: (a) unshocked and accelerated low‐beta CME plasma coming directly against Earth's dayside magnetosphere; (b) dynamical wing filaments representing new channels of magnetic connection between the magnetosphere and foot points of the Sun's erupted flux rope; (c) cold CME ions observed with energized counter‐streaming electrons, evidence of CME plasma captured due to by reconnection between magnetic‐cloud and Alfvén‐wing field lines. The reported measurements advance our knowledge of CME interaction with planetary magnetospheres, and open new opportunities to understand how sub‐Alfvénic plasma flows impact astrophysical bodies such as Mercury, moons of Jupiter, and exoplanets close to their host stars.

Abstract In recent decades, the role of tumor biomechanics on cancer cell behavior at the primary site has been increasingly appreciated. However, the effect of primary tumor biomechanics on the latter stages of the metastatic cascade, such as metastatic seeding of secondary sites and outgrowth remains underappreciated. This work sought to address this in the context of triple negative breast cancer (TNBC), a cancer type known to aggressively disseminate at all stages of disease progression. Using mechanically tuneable model systems, mimicking the range of stiffness's typically found within breast tumors, it is found that, contrary to expectations, cancer cells exposed to softer microenvironments are more able to colonize secondary tissues. It is shown that heightened cell survival is driven by enhanced metabolism of fatty acids within TNBC cells exposed to softer microenvironments. It is demonstrated that uncoupling cellular mechanosensing through integrin β1 blocking antibody effectively causes stiff primed TNBC cells to behave like their soft counterparts, both in vitro and in vivo. This work is the first to show that softer tumor microenvironments may be contributing to changes in disease outcome by imprinting on TNBC cells a greater metabolic flexibility and conferring discrete cell survival advantages.

The semiconductor industry has adopted heterogeneous integration (HI), incorporating modular intellectual property (IP) blocks (chiplets) into a unified system-in-package (SiP) to overcome the slowdown in Moore’s Law and Dennard scaling and to respond to the increasing demand for advanced integrated circuits (ICs). Despite the manifold benefits of HI, such as enhanced performance, reduced area overhead, and improved yield, this transformation has also led to security vulnerabilities in the SiP supply chain and in-field operations, ranging from chiplet piracy and SiP reverse engineering (RE) to information leakage. Although conventional countermeasures provide the desired robustness for monolithic ICs, they are insufficient for addressing these challenges in the context of HI. To address these concerns, this paper presents a novel root-of-trust architecture, augmenting the process of integration using a centralized chiplet hardware security module (CHSM), aiming to provide comprehensive and robust protection throughout the SiP supply chain and in-field operations. Also, the proposed architecture equipped with the CHSM effectively addresses potential security breaches while providing robust protection against zero-day attacks through its reconfigurable capabilities. Throughout five detailed case studies, this paper performs a comprehensive security analysis to illustrate the resilience of CHSM against contemporary attack scenarios in the HI domain.

Handling and quantifying two types of uncertainties, spatial and inherent, in land-cover segmentation using multiple satellite images constitutes a primary concern within the domain of segmenting multiple remote sensing images. Despite the comprehensive examination of the spatial uncertainty, the lack of a mathematical model addressing the inherent uncertainty in satellite images is notable. This article endeavors to address this gap by considering and focuses on the latter. Leveraging multiple high-resolution panchromatic remote sensing images as input data, the study aims to model all procedures in the image formation and preprocessing stages (applied to each input image before segmentation) as the producing factors of inherent uncertainty in the segmentation process. The input images, conceptualized as events in random processes, undergo fusion using the mean estimator, referred to as the proposed “ultrafusion” method in this article. The study demonstrates that the results of ultrafusion can be effectively modeled by normal-type fuzzy numbers. The parameters of these fuzzy numbers are estimated using the maximum likelihood method. Subsequently, fuzzy C-means, as the most renowned clustering method, is employed for segmentation. Analytical comparisons reveal the notable performance of the proposed algorithm in terms of accurate segmentation and computational efficiency. Affirming the efficacy of the proposed approach, simulation results validate the advantages by improving the overall accuracy, Kappa, and F1-score indices by about 0.86%, 0.52%, and 1.03%, respectively, in comparison with the most recent and similar method.

The expansion of cities and urban areas has resulted in an increased demand for environmental and economic transport and services infrastructure. Tunneling, as one of mankind's engineering underground constructions, is taking place close to buried and surface structures such as gas, water, and wastewater pipelines. This paper reviews soil-pipe interaction behavior, tunneling-induced ground settlement, governing equations of soil-pipe settlement, the effects of tunnel depth, size, soil relative density, and volume loss on vertical and horizontal displacement, settlement, shear strain, dilation, pipe bending, and gap formation. A comprehensive literature review, analysis of published papers, and investigations were conducted to study the effect of various parameters on pipeline behavior. The results were obtained by studying the effect of tunneling on ground and pipeline settlement, soil-pipe interaction mechanism, and centrifuge physical modeling. The achieved results of investigations show that the settlement profile follows a Gaussian curve with a wider settlement trough in clay compared to sand. When the tunnel and pipeline are perpendicular to each other, maximum bending strain in the pipeline occurs and the pipeline settlement is symmetrical. The friction effect and formation of contraction and expansion zones lead to the difference between soil volume loss near the surface and tunnel volume loss. When the pipe-soil relative stiffness increases, the pipe bending is less than the maximum soil bending. Also, ground settlement, shear strain, pipeline displacement, and pipeline bending are greater in flexible pipes than in rigid pipelines. This is due to the low resistance of flexible pipelines against bending and settlement caused by tunnel excavation. Positive pipeline bending (downward) occurs near the tunnel axis, which is marked by sagging, but negative bending (upward) occurs at a distance from the tunnel axis, which is known as hogging. In twin tunnels, by increasing the tunnel spacing the pipeline settlement profile changes from a V-shape to a U-shape and finally a W-shape. Understanding soil-pipe interaction behavior, tunneling-induced ground settlement, and the effects of different parameters on displacement, strain field, settlement, pipe bending, and gap formation beneath pipelines is crucial for engineers evaluating pipeline behavior. Additionally, comprehending these issues can help designers make informed decisions during tunnel construction.

Urinothorax is a rare cause of pleural effusion and often occurs unilaterally. In a urinothorax, the pleural fluid has the color and odor of urine, and the ratio of pleural fluid creatinine to serum creatinine is greater than one. In this report, a case of urinothorax after prostate cancer is presented. The patient is a 79-year-old man with a history of BPH who presented with urinary retention, nausea, and dyspnea. Laboratory tests revealed high serum creatinine, hypercalcemia and hyperkalemia. Ultrasound revealed moderate left-sided hydronephrosis, moderate ascites and massive left-sided pleural effusion on chest X-ray. Thoracentesis and aspiration of ascitic fluid were performed, and the ratio of creatinine in pleural fluid and ascitic fluid to serum creatinine was greater than one. The patient underwent bilateral nephrostomy, after which the pleural effusion and ascites resolved without further aspiration. A prostate examination revealed an enlarged and firmer prostate than normal. The patient's PSA level was checked and found to be over 100, and a prostate biopsy diagnosed adenocarcinoma of the prostate. The patient received the first cycle of chemotherapy and was discharged from hospital in good general health.

Takayasu's arteritis is a chronic, idiopathic, inflammatory disease that mainly affects large blood vessels such as the aorta and its branches, and is mostly prevalent among women younger than 40 years old. Although involvement of the central nervous system and stroke may occur during the course of the disease, it is uncommon as the initial manifestation of the patient. Here, a 58-year-old patient is presented with stroke symptoms and occlusion of the left and right carotid and left vertebral arteries since 7 years ago. The patient was subjected to laboratory examination, imaging, and additional investigations, and with Takayasu's diagnosis, she underwent treatment with corticosteroids, cyclophosphamide (and then methotrexate), and antiplatelet therapy. In addition to the occurrence of stroke as the first manifestation of the disease, the development of symptoms at the age of 51 indicated that the inflammatory process had probably started more than a decade before the symptoms.

IntroductionThis experiment was performed to investigate the effect of microbial inoculation and urea fertilizer on Echinacea purpurea under water stress in two cropping years 2017-2018 and 2018-2019 in Ijan village located in Khondab city of Markazi province.Materials and methodsThe experiment was performed in the form of 2 split plots with 3 replications. The first factor included the lack of irrigation in the main plot at 3 levels of 60, 90 and 120 mm evaporation from the Class A evaporation pan. The second factor included animal manure (cattle) in the sub-plot at two levels, no fertilizer and 20 tons per hectare. The third factor of biofertilizer and urea fertilizer in the sub-plot in four levels of application of biofertilizer was Azotobacter+Azospirillum, Mycorrhiza, Aztobacter+Azospirillum+Mycorrhiza and application of urea fertilizer (300 kg ha-1). Flower number and weight, total dry matter yield, chlorophyll, relative water content, proline, catalase, carotenoid, chicoric acid and electrical conductivity of cytoplasmic membrane were measured.Results and discussionThe results showed that the interaction effect of manure and biofertilizer on flower weight was significant. The highest flower weight was obtained in the treatment of combined use of Azotobacter+Azospirillium+ Mycorrhiza and application of animal manure (295.9 and 236.3 g m-2, respectively), which was significantly different from urea consumption. The lowest flower weight was obtained in the treatment of separate mycorrhizal application and non-application of animal manure (0.216 236.3 g.m-2). The difference between the highest flower weight in the mentioned treatment with the lowest value was 36%. In the treatment of non-use of manure, the highest flower weight was obtained in the treatment of Azotobacter+Azospirillium+Mycorrhiza (236.3 g m-2). The interaction effect of manure and biofertilizer on chicory acid was significant. The highest chicoric acid was obtained in the treatment of combined use of Azotobacter+Azospirillium+Mycorrhiza and application of animal manure (7.53 mg g-1 fresh leaf weight). The lowest chicoric acid was obtained in the treatment of separate application of mycorrhiza and no application of animal manure (5.76 mg g-1 fresh leaf weight). The difference between the highest chicoric acid in the mentioned treatment with the lowest amount was equal to 30%. In the treatment of non-application of animal manure, the highest chicoric acid was obtained in the treatment of Azotobacter+Azospirillium+Mycorrhiza (7.17 mg g-1 fresh leaf weight).ConclusionIn general, microbial inoculation was able to achieve close quantitative and quantitative performance and sometimes more than urea fertilizer treatment, which can be a guide for identifying soil strains and producing biofertilizers compatible for areas with similar climates or soils.AcknowledgmentsThanks to all lecturers and staff of farm and laboratory department of agriculture department of Islamic Azad University, Varamin branch.

Recombinant proteins are essential in various industries, and scientists employ genetic engineering and synthetic biology to enhance the host cell's protein production capacity. Stress response pathways have been found effective in augmenting protein secretion. Cold atmospheric pressure plasma (CAP) can induce oxidative stress and enhance protein production. Previous studies have confirmed the applicability of CAP jets on Phytase and green fluorescent protein (GFP) production in Pichia pastoris hosts. This study investigates the effect of CAP treatment on another valuable recombinant protein, Endoglucanase II (EgII), integrated into the Pichia pastoris genome. The results demonstrated that plasma induction via two different ignition modes: sinusoidal alternating current (AC) and pulsed direct current (DC) for 120, 180, and 240 s has boosted protein secretion without affecting cell growth and viability. The AC-driven jet exhibited a higher percentage increase in secretion, up to 45%. Simulation of plasma function using COMSOL software provided a pattern of electron temperature (Te) and density distribution, which determine the plasma cocktail's chemistry and reactive species production. Furthermore, electron density (ne) and temperature were estimated from the recorded optical spectrum. The difference in electron properties may explain the moderately different impressions on expression capability. However, cell engineering to improve secretion often remains a trial-and-error approach, and improvements are, at least partially, specific to the protein produced.

Collisionless shocks are ubiquitous structures throughout the Universe. Shock waves in space and astrophysical plasmas convert the energy of a fast-flowing plasma to other forms of energy, including thermal and magnetic energies. Plasma turbulence and high-amplitude electric and magnetic fluctuations are necessary for effective energy conversion and particle acceleration. We survey and characterize in situ observations of reflected ions and magnetic field amplification rates at quasiperpendicular shocks under a wide range of upstream conditions. We report magnetic amplification rates as high as 25 in our current data set. Reflected ions interacting with the incoming plasma create magnetic perturbations that cause magnetic amplification in upstream and downstream regions of quasiperpendicular shocks. Our observations show that, in general, magnetic amplification increases with the fraction of reflected ions, which itself increases with Mach number. Both parameters plateau once full reflection is reached. Magnetic amplification continuously increases with the inverse of the magnetization parameter of the upstream plasma. We find that the extended foot region upstream of shocks and nonlinear processes within that region are key factors for intense magnetic amplification. Our observations at nonrelativistic shocks provide the first experimental evidence that below a certain magnetization threshold, the magnetic amplification efficiency at quasiperpendicular shocks becomes comparable to that at the quasiparallel shocks.

AbstractClimate change carries risks that need to be mitigated by all parties, including companies because it affects company value. Many studies find that voluntary disclosure positively affects firm value in developing countries. This study aims to examine the effect of voluntary disclosure (CSR and carbon disclosure on firm value) in the developing country of Indonesia. Researchers suspect that voluntary disclosure practice in developing countries is still low, so that investors respond negatively. To test the hypothesis using regression with a total of 72 observations from the energy sector companies. The results of the study show that voluntary disclosure has a negative effect on firm value. The level of voluntary disclosure in Indonesia is still low, just complying with government regulations, and it is still considered a cost that affects the firm’s value. The implication of this research is to encourage the government to immediately make regulations and concrete steps to mitigate the impact of climate change.

Abstract Lung mast cells are important in host defense, and excessive proliferation or activation of these cells can cause chronic inflammatory disorders like asthma. Two parallel pathways induced by KIT–stem cell factor (SCF) and FcεRI–immunoglobulin E interactions are critical for the proliferation and activation of mast cells, respectively. Here, we report that mast cell-expressed membrane protein1 (MCEMP1), a lung-specific surface protein, functions as an adaptor for KIT, which promotes SCF-mediated mast cell proliferation. MCEMP1 elicits intracellular signaling through its cytoplasmic immunoreceptor tyrosine-based activation motif and forms a complex with KIT to enhance its autophosphorylation and activation. Consequently, MCEMP1 deficiency impairs SCF-induced peritoneal mast cell proliferation in vitro and lung mast cell expansion in vivo. Mcemp1-deficient mice exhibit reduced airway inflammation and lung impairment in chronic asthma mouse models. This study shows lung-specific MCEMP1 as an adaptor for KIT to facilitate SCF-mediated mast cell proliferation.

The aim of this study was to investigate the effect of under electro slag re-melting (ESR) process on the fatigue behavior of GTD-450 steel used for manufacturing gas turbin blades. These parts are always at risk of failure due to fatigue. Refining of steel by ESR process is one of the most important modern methods of steelmaking in order to achieve a homogeneous structure, minimal elemental and structural segeregation, as well as reducing non-metallic impurities in terms of their number and size and most importantly their uniform distribution in the steel structure. Due to dependency of fatigue properties of steels on structural factors of steel, the role of ESR process using different slag compositions on this important property of GTD-450 steel was investigated. Microstructural studies by optical and electron microscopes showed that grain size of ESR samples were averagely 10% finer than non-ESR ones. As well as performing various mechanical tests including tensile and fatigue on samples prepared in different conditions, showed that although ESR had a minor effect on tensile properties of steel but impact energy of steel in ESR condition were averagely 16% more than non-ESR condition. Finally, the core finding of this paper is that, fatigue life of GTD-steel turbine blade produced via ESR method can be improved by 30%.

Abstract Sigmoid volvulus accounts for 20%–50% of colonic obstructions in Eastern countries. This occurs mostly in patients with a lack of mobility and a history of chronic constipation. There are some very known complications of a undescended intra‐abdominal testicle such as cancer, ischemia, and infertility; But the rotation of the colon around the spermatic cord of one UDT is a very rare phenomenon that there is no similar report. A 67‐year‐old man came to the emergency department with a complaint of abdominal pain and obstipation. On examination, patient was febrile (T: 38.5) and had mild general tenderness. According to the appearance of coffee beans in the X‐ray, the diagnosis of sigmoid volvulus was made. In the requested tests, leukocytosis was observed. Rectosigmoidoscopy was unsuccessful. The patient underwent laparotomy. After manual untwisting, a tubular structure at the base of the meso‐sigmoid was noticed. With further exploration, the testis was observed intra‐abdominally. Orchidectomy and sigmoidectomy were performed by Hartmann's method. Sigmoid volvulus is one of the common cases that surgeons frequently encounter. The case scenarios are often the same, and from experience, most cases result from a long meso and an elongated sigmoid secondary to prolonged constipation. Therefore, it is clear that a scrotal examination would not be part of the routine examination of a patient with sigmoid volvulus. In this article, by reporting a very rare etiology for a very common pathology, we tried to point out the importance of head‐to‐toe examination in all patients.

In this paper, we propose an active control method to adjust the resonance frequency of a capacitive energy harvester. To this end, the resonance frequency of the harvester is tuned using an electrostatic force, which is actively controlled by a voltage source. The spring softening effect of the electrostatic force is used to accommodate the dominant frequency of the ambient mechanical vibration within the bandwidth of the resonance region. A single degree of freedom is considered, and the nonlinear equation of motion is numerically integrated over time. Using a conventional proportional–integral–derivative (PID) control mechanism, the results demonstrated that our controller could shift the resonance frequency leftward on the frequency domain and, as a result, improve the efficiency of the energy harvester, provided that the excitation frequency is lower than the resonance frequency of the energy harvester. Application of the PID controller in the resonance zone resulted in pull-in instability, adversely affecting the harvester’s performance. To tackle this problem, we embedded a saturation mechanism in the path of the control signal to prevent a sudden change in motion amplitude. Outside the pull-in band, the saturation of the control signal resulted in the reduction of harvested power compared to the non-saturated signal; this is a promising improvement in the design and analysis of energy harvesting devices.

Abstract Background Rare diseases are a new global health priority, requiring evidence-based estimates of the global prevalence of diseases to inform public policymakers and provide a serious challenge to the healthcare system that must not be ignored. The purpose of this study is to investigate Iranian future healthcare professionals' knowledge and opinions about rare diseases. Results A total of 6838 students responded to the questionnaire. Nursing and medical students had the highest participation. Almost 85% of participants rated their knowledge about rare diseases as poor or insufficient. While nearly 70 percent of participants took courses about rare diseases at university. Finally, 72.7% of future healthcare professionals did not feel ready to take care of a patient with a rare disease. Conclusion The present study has indicated a gap in Iranian medical students’ knowledge of rare diseases. The researchers believe that health science policymakers should make a joint effort to improve knowledge about rare diseases. Including courses with regard to rare diseases would be of benefit to future healthcare professionals.

تم في هذا البحث دراسة تأثير المواد الرابطة العضوية الراتنجية (نوفولاك، نوفولاك+ريزول، ريزول) على خواص الاهتراء، لأقراص الجلخ المصنعة محلياً. حيث تم تصنيع أقراص جلخ باستخدام المواد الرابطة المستخدمة. أظهرت نتائج الاختبارات وجود تأثير لنوع المادة الرابطة ولاسيما على مقدار الفقد الوزني، حيث تم الحصول على أفضل النتائج في أقراص الجلخ المصنعة باستخدام المادة الرابطة العضوية الراتنجية (نوفولاك+ريزول).

Honey bee ecology demands they make both rapid and accurate assessments of which flowers are most likely to offer them nectar or pollen. To understand the mechanisms of honey bee decision-making, we examined their speed and accuracy of both flower acceptance and rejection decisions. We used a controlled flight arena that varied both the likelihood of a stimulus offering reward and punishment and the quality of evidence for stimuli. We found that the sophistication of honey bee decision-making rivalled that reported for primates. Their decisions were sensitive to both the quality and reliability of evidence. Acceptance responses had higher accuracy than rejection responses and were more sensitive to changes in available evidence and reward likelihood. Fast acceptances were more likely to be correct than slower acceptances; a phenomenon also seen in primates and indicative that the evidence threshold for a decision changes dynamically with sampling time. To investigate the minimally sufficient circuitry required for these decision-making capacities, we developed a novel model of decision-making. Our model can be mapped to known pathways in the insect brain and is neurobiologically plausible. Our model proposes a system for robust autonomous decision-making with potential application in robotics.

Brillouin microscopy has recently emerged as a new bio-imaging modality that provides information on the microscale mechanical properties of biological materials, cells and tissues. The data collected in a typical Brillouin microscopy experiment represents the high-dimensional set of spectral information, i.e. each pixel within a 2D/3D Brillouin image is associated with hundreds of points of spectral data. Its analysis requires non-trivial approaches due to subtlety in spectral variations as well as spatial and spectral overlaps of measured features. This article offers a guide to the application of Principal Component Analysis (PCA) for processing Brillouin imaging data. Being unsupervised multivariate analysis, PCA is well-suited to tackle processing of complex Brillouin spectra from heterogeneous biological samples with minimal a priori information requirements. We point out the importance of data pre-processing steps in order to improve outcomes of PCA. We also present a strategy where PCA combined with k -means clustering method can provide a working solution to data reconstruction and deeper insights into sample composition, structure and mechanics.

Calcium alginate (Ca-alginate) beads have attracted considerable attention as carriers for the controlled release of volatile compounds due to their biocompatibility and tunable properties. This study aimed to compare the release of ethylene and carbon dioxide gas from Ca-alginate beads. Ca-alginate beads were prepared from a sodium alginate solution containing ethephon and calcium carbonate as the gas-forming agent. The resulting solution was then extruded into a calcium chloride solution. The gas release behavior was studied by monitoring the concentration of released gases over time using gas detectors. Extrusion tip diameter, alginate concentration and gas-releasing agent concentration were systematically varied to assess their effect on the gas release rate. The results indicated distinct release patterns for ethylene and carbon dioxide gas. Ethylene gas exhibited a relatively slower and sustained release, while carbon dioxide gas exhibited a more rapid release. Moreover, the bead size influenced the gas release, with larger beads displaying faster release rates for ethylene and carbon dioxide gas. The concentration of alginate also played a role in modulating the release kinetics, with higher alginate concentration resulting in slower gas release. The findings have implications for designing and optimizing Ca-alginate-based systems for agricultural applications, including plant hormone delivery and modified atmosphere packaging.

The astonishing behavioural repertoires of social insects have been thought largely innate, but these insects have repeatedly demonstrated remarkable capacities for both individual and social learning. Using the bumblebee Bombus terrestris as a model, we developed a two-option puzzle box task and used open diffusion paradigms to observe the transmission of novel, nonnatural foraging behaviours through populations. Box-opening behaviour spread through colonies seeded with a demonstrator trained to perform 1 of the 2 possible behavioural variants, and the observers acquired the demonstrated variant. This preference persisted among observers even when the alternative technique was discovered. In control diffusion experiments that lacked a demonstrator, some bees spontaneously opened the puzzle boxes but were significantly less proficient than those that learned in the presence of a demonstrator. This suggested that social learning was crucial to proper acquisition of box opening. Additional open diffusion experiments where 2 behavioural variants were initially present in similar proportions ended with a single variant becoming dominant, due to stochastic processes. We discuss whether these results, which replicate those found in primates and birds, might indicate a capacity for culture in bumblebees.