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Abstract Aims Cardiac amyloidosis (CA) is a potentially fatal multisystemic disease that remains significantly underdiagnosed, particularly in the Middle East. This study aims to evaluate the prevalence and clinical characteristics of CA in a high‐risk population at a tertiary centre in Saudi Arabia. Methods This cross‐sectional, retrospective, single‐centre study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. We reviewed the medical records of heart failure patients seen between August 2018 and July 2022 who exhibited red flags for CA and subsequently underwent CA screening. Red flags that prompted the workup included at least two of the following factors: the presence of unilateral or bilateral carpal tunnel syndrome, a family history of transthyretin amyloid (ATTR) amyloidosis and specific electrocardiographic features (relative/absolute low QRS voltage, pseudoinfarct pattern and atrioventricular/interventricular conduction abnormalities). Echocardiographic red flags included mainly increased wall thickness (≥12 mm), significant diastolic dysfunction, reduced left ventricular (LV) longitudinal function, right ventricular (RV) dysfunction and elevated right atrial (RA)/pulmonary artery (PA) pressure. Cardiac magnetic resonance (CMR) red flags included aspects similar to those in an echocardiogram as well as a subendocardial or transmural late gadolinium enhancement (LGE) pattern. These patients were assessed for CA through technetium‐99m pyrophosphate ([99mTc]Tc‐PYP) bone scintigraphy, serum and urine protein electrophoresis with immunofixation and a serum‐free light chain assay. Results A total of 177 patients were screened, of which 21.0 (11.9%) patients were diagnosed with transthyretin amyloid CA (ATTR‐CA) and 13 (7.3%) patients were diagnosed with light chain CA (AL‐CA). Compared with patients with negative/equivocal [99mTc]Tc‐PYP scans (grades 0–1), patients with positive [99mTc]Tc‐PYP scans (grades 2–3) were older (78.0 vs. 68.0 years, P

Developing learner autonomy (LA) has been the teachers' focus in addressing the problems of second language pedagogy (Oxford 2003; Benson 2007; Little 1995) for a long time. The research, however, shows that the traditional pedagogical culture does not favor this idea, especially in the Asian context (Borg and Al-Busaidi 2012). The teachers' beliefs, moreover, may affect their classroom practices for the development of English language learner autonomy. In keeping with this view, we have gathered the data from 64 university teachers of Pakistan through a survey-based questionnaire to find out if teachers' positive beliefs about learner autonomy result in the rejection of teacher-centered authoritarian classroom practices or if the teachers give attention to those teaching practices that help in the development of learner autonomy, although this study cannot ascertain if learner autonomy is linked to the development of English language skills.

Study Design Retrospective cohort study. Purpose To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries. Overview of Literature 3COs are often required to correct severe, rigid ASD presentations. However, controversy remains on the utility of 3COs, particularly in primary surgery. Methods Patients ASD having 2-year data were included and divided into 3CO and non-3CO (remaining ASD cohort) groups. For the subanalysis, patients were stratified based on whether they were undergoing primary (P3CO) or revision (R3CO) surgery. Multivariate analysis controlling for age, Charlson comorbidity index, body mass index, baseline pelvic incidence–lumbar lordosis, and fused levels evaluated the complication rates and radiographic and patient-reported outcomes between the 3CO and non-3CO groups. Results Of the 436 patients included, 20% had 3COs. 3COs were performed in 16% of P3COs and 51% of R3COs. Both 3CO groups had greater severity in deformity and disability at baseline; however, only R3COs improved more than non-3COs. Despite greater segmental correction, 3COs had much lower rates of aligning in the lumbar distribution index (LDI), higher mechanical complications, and more reoperations when performed below L3. When comparing P3COs and R3COs, baseline lumbopelvic and global alignments, as well as disability, were different. The R3CO group had greater clinical improvements and global correction (both p

Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by neurointerventionalists. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers. The primary outcome included a composite of the 30‐day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage, and myocardial infarction. The secondary outcomes included other complications. Chi‐squared tests were performed for categorical variables, and Welch's t‐test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 neurointerventionalists. We have 30‐day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), White (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) symptomatic intracranial hemorrhage, and 1 (0.07%) myocardial infarction. A statistically significant increase in all outcomes correlated with advanced age (P = 0.001), women (P = 0.013), aortic arch type 3 (P = 0.01), and higher preprocedural modified Rankin score (P = 0.006). Secondary outcomes were higher in Hispanic and Black patients (P = 0.007) and those with low diastolic blood pressure at stenting (P = 0.04). Conclusion CAS, conducted by fellowship‐trained neurointerventionalist physicians in comprehensive stroke centers, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy, and transcarotid artery revascularization literature. Physician training, higher frequency, and standardized stroke care in a comprehensive stroke center may contribute to this low complication rate.

Objectives: We evaluated all-cause healthcare utilization among those with vaccine-associated myocarditis, compared to vaccinees without postvaccination myocarditis. Methods: We conducted a retrospective cohort study in individuals aged 12 and older who received COVID-19 mRNA vaccination in British Columbia. Exposure was defined as an ED visit or hospitalization for myocarditis within 21 days postvaccination. The primary outcome was healthcare utilization. Ratios of rate ratios (RRRs) for exposure-associated healthcare utilization were calculated using a difference-in-differences (DiD) analysis. Results: In the postindex period, the exposed and unexposed groups showed substantial utilization rate difference (RD = 15.30 [95% CI, 14.47-16.13). A 51% overall increase in healthcare utilization was observed over 18 months among exposed individuals (RRR, 1.51 [95%CI, 1.08-2.11]). In the initial six months, healthcare utilization surpassed the 18-month estimate, exhibiting a 125% increase (RRR, 2.25 [95%CI, 1.43-3.52]), while the last 12 months showed no statistically significant change (RRR, 1.03 [95%CI, 0.72-1.47]). An additional 9.1 (95%CI, 8.53-9.71) visits per person were attributed to vaccine-associated myocarditis over 18 months (total excess = 938.26 healthcare visits). Conclusion: The initial surge in healthcare visits postexposure, mainly outpatient follow-ups, followed by a return to baseline rates, indicates a positive prognosis and supports the vaccine's safety profile.

BackgroundSocial media serves as a vast repository of data, offering insights into public perceptions and emotions surrounding significant societal issues. Amid the COVID-19 pandemic, long COVID (formally known as post–COVID-19 condition) has emerged as a chronic health condition, profoundly impacting numerous lives and livelihoods. Given the dynamic nature of long COVID and our evolving understanding of it, effectively capturing people’s sentiments and perceptions through social media becomes increasingly crucial. By harnessing the wealth of data available on social platforms, we can better track the evolving narrative surrounding long COVID and the collective efforts to address this pressing issue. ObjectiveThis study aimed to investigate people’s perceptions and sentiments around long COVID in Canada, the United States, and Europe, by analyzing English-language tweets from these regions using advanced topic modeling and sentiment analysis techniques. Understanding regional differences in public discourse can inform tailored public health strategies. MethodsWe analyzed long COVID–related tweets from 2021. Contextualized topic modeling was used to capture word meanings in context, providing coherent and semantically meaningful topics. Sentiment analysis was conducted in a zero-shot manner using Llama 2, a large language model, to classify tweets into positive, negative, or neutral sentiments. The results were interpreted in collaboration with public health experts, comparing the timelines of topics discussed across the 3 regions. This dual approach enabled a comprehensive understanding of the public discourse surrounding long COVID. We used metrics such as normalized pointwise mutual information for coherence and topic diversity for diversity to ensure robust topic modeling results. ResultsTopic modeling identified five main topics: (1) long COVID in people including children in the context of vaccination, (2) duration and suffering associated with long COVID, (3) persistent symptoms of long COVID, (4) the need for research on long COVID treatment, and (5) measuring long COVID symptoms. Significant concern was noted across all regions about the duration and suffering associated with long COVID, along with consistent discussions on persistent symptoms and calls for more research and better treatments. In particular, the topic of persistent symptoms was highly prevalent, reflecting ongoing challenges faced by individuals with long COVID. Sentiment analysis showed a mix of positive and negative sentiments, fluctuating with significant events and news related to long COVID. ConclusionsOur study combines natural language processing techniques, including contextualized topic modeling and sentiment analysis, along with domain expert input, to provide detailed insights into public health monitoring and intervention. These findings highlight the importance of tracking public discourse on long COVID to inform public health strategies, address misinformation, and provide support to affected individuals. The use of social media analysis in understanding public health issues is underscored, emphasizing the role of emerging technologies in enhancing public health responses.

Water scarcity is increasingly driven by socio-economic dynamics, climate change, and population growth. Conflicts among water users, including states, complicate sustainable water management, necessitating collaborative solutions. Building on important studies in water resource management, this study integrates the Water Evaluation and Planning (WEAP) model with the Nash bargaining solution to develop a fair water allocation system, which we apply to the Lower Bari Doab area of Punjab, Pakistan. This case study area is characterized by high demands for agricultural, domestic, industrial, and environmental water. To ensure fair allocation of water resources, we analyze future water trends, anticipate demands, and address supply-demand gaps under various scenarios. Our findings demonstrate that by utilizing WEAP in conjunction with the Nash bargaining solution, we can effectively achieve a balance between water demand and supply. This approach enables us to compare various water-use strategies and ensures fair distribution among agricultural stakeholders, who often have lower priority compared to the domestic, industrial, and environmental sectors. More importantly, we demonstrate that Nash bargaining solutions can be mutually beneficial and can maximize overall coverage of water demand. This approach ensures that all agents are better off compared to a non-cooperative outcome, promoting fairness and equity by balancing the needs of all parties. This integrated approach provides a robust framework for sustainable water management and is applicable to other regions facing similar challenges.

This study reports novel three-step electrochemical fabrication of CoCr2O4/graphene-oxide nanocomposite on glassy carbon electrode including sequential synthesis of graphene-oxide using modified Hummer's method, CoCr2O4 nanoparticles using sol-gel method and the cost-effective co-precipitation technique for nanocomposite formation. The resulting nanocomposite was subjected to comprehensive analytical and morphological analysis. X-ray diffractometry (XRD) confirms nanocomposite formation with reduced average crystallite size value of 26.9 nm whereas SEM indicates spherical grains existence within nanocomposite. Energy-dispersive X-ray spectrometry (EDS) confirms no impurity peak existence whereas Raman spectroscopy clearly indicated D and G band existence at 1345 and 1587 cm−1 respectively. Photoluminescent spectra reveals decreasing trend in band gap value about 3.49 eV. The electrochemical properties of CoCr2O4/graphene-oxide nanocomposite electrode explored, showcasing remarkable capacitance with a surface area of merely 0.068 cm2, 574.8 F/g specific capacitance in alkaline 1M KOH and 488.6 F/g specific capacitance in acidic 0.1M H2SO4 electrolyte. Moreover, synthesized nanocomposite demonstrates remarkable electrochemical stability resulting capacitance retention about 95 % after 100 cycles in 1M KOH electrolyte. GCD analysis reveals impressive power and energy density values of 2489 W/kg and 14.88 Wh/kg respectively. These outstanding properties make the nanocomposite an attractive material for next-generation supercapacitors and energy storage solutions.

Hard candies with spirulina (Arthrospira platensis) and chlorella (Chlorella vulgaris) biomass were prepared. Their characterization include pH, moisture, hardness, color, total soluble solids, antioxidant, phenols, and flavonoid content. Safety tests were conducted on rats to examine protective effects of these candies against arsenate poisoning. Algal hard candies were slightly acidic, had low moisture content, and achieved optimal hardness. These candies contain 0.4 GAE mg/g phenols and 0.5 CAE mg/g flavonoids. Upon in-vivo analysis, algae candies increased acetyl cholinesterase, malondialdehyde, catalase, superoxide dismutase, and glutathione concentration in blood serum. Histopathology analysis revealed significant restoration in the liver, kidneys, and brain of Wistar rats treated with algal candies following arsenate poisoning. The phenolic and flavonoid content along with activation of antioxidative enzymes reveals radical scavenging activity of hard candies. Spirulina and chlorella candies may boost immune system, improving gut health, and enhancing antioxidant defense mechanisms and can be used as functional food.