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Alaa Dweikat,1 Arkan Jarrar,1 Mohammad Akkawi,2,3 Mohammad Shehadeh,2,3 Ammar Aghbar,3 Jamal Qaddumi,1 Maha Akkawi1 1Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 2Department of Special Surgeries, Faculty of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine; 3Ophthalmology Department, An-Najah National University Hospital, Nablus, PalestineCorrespondence: Mohammad Akkawi; Alaa Dweikat Email m.akkawi@najah.edu; alaadweikat43@gmail.comPurpose: This article aims to evaluate how the subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA) respond to the intravitreal injection of bevacizumab and to assess the correlation between these changes. It will also assess the use of the baseline SFCT as a predictor for BCVA changes in eyes of treatment-naive, diabetic macular edema (DME) patients.Methods: This retrospective, consecutive case series comprised 59 eyes of 39 treatment-naive DME patients. Complete slit-lamp assessment, swept-source optical coherence tomography (SS-OCT) scans to measure SFCT and BCVA values were performed at two stages: baseline and one month after the third monthly injection of intravitreal bevacizumab.Results: Patients’ ages ranged from 46.3 to 76.4 years (mean: 62.6 ± 2.3). The mean SFCT was 318 ± 82 μm at baseline, which decreased after 3 months to 300 ± 66 μm (P-value = 0.021). There was an improvement in the mean of the logMAR best-corrected visual acuity (BCVA) from 0.7 (decimal equivalent: 0.2) to 0.5 (decimal equivalent: 0.3) (P-value = 0.019). There was no association between SFCT changes and BCVA changes (P-value = 0.180). Wilcoxon signed-rank test disclosed that a better BCVA improvement was related to a greater subfoveal choroidal thickness at baseline P-value < 0.00.Conclusion: Eyes with a higher baseline subfoveal choroidal thickness (SFCT) attained greater BCVA improvement than eyes with a lower baseline SFCT. In addition to this, changes to SFCT do not appear to correlate with BCVA changes. These findings do not support using OCT SFCT changes as a prognostic factor for changes to BCVA after intravitreal bevacizumab treatment in evaluating treatment-naive DME eyes.Keywords: diabetic macular edema, subfoveal choroidal thickness, best-corrected visual acuity, bevacizumab, anti-vascular endothelial growth factor

The world has experienced a radical change due to the internet. Internet became a crucial element in our daily life, therefore, the security of our DATA could be threatened at any time. This safety is handled using systems to detect network intrusion called Intrusion Detection Systems (IDS). Machine learning techniques are being implemented to improve these systems. In order to enhance the performance of IDS, different classification algorithms are applied to detect various types of attacks. Choosing a good one for building IDS is not an easy task. The best method is to test the performance of the different classification algorithms. Nevertheless, most researchers have focused on the confusion matrix as measurements of classification performance. Therefore, many papers use this matrix to present a detailed comparison with the dataset, data preprocessing, feature selection technique, algorithms classification and performance evaluation. The goal of this paper is to present a comparison of application of different Machine Learning algorithms used to build and improve intrusion detection systems in terms of confusion matrix, accuracy, recall, precision, FAR, specificity and sensitivity using the UNSW-NB15 Dataset. Furthermore, we introduce some lesson learnt to shoot more researchers in their future works.

The world has experienced a radical change due to the internet. As a matter of fact, it assists people in maintaining their social networks and links them to other members of their social networks when they require assistance. In effect sharing professional and personal data comes with several risks to individuals and organizations. Internet became a crucial element in our daily life, therefore, the security of our DATA could be threatened at any time. For this reason, IDS plays a major role in protecting internet users against any malicious network attacks. (IDS) Intrusion Detection System is a system that monitors network traffic for suspicious activity and issues alerts when such activity is discovered. In this paper, the focus will be on three different classifications; starting by machine learning, algorithms NB, SVM and KNN. These algorithms will be used to define the best accuracy by means of the USNW NB 15 DATASET in the first stage. Based on the result of the first stage, the second one is used to process our database with the most efficient algorithm. Two different datasets will be operated in our experiments to evaluate the model performance. NSL-KDD and UNSW-NB15 datasets are used to measure the performance of the proposed approach in order to guarantee its efficiency.

Background: Patients who require emergency general surgery (EGS) are at a substantially higher risk for perioperative morbidity and mortality than patients undergoing elective general surgery. The acute care surgery (ACS) model has been shown to improve EGS patient outcomes and cost-effectiveness. A recent systematic review has shown extensive heterogeneity in the structure of ACS models worldwide. The objective of this study was to describe the current landscape of ACS models in academic centres across Canada. Methods: We sent an online questionnaire to the 18 academic centres in Canada. The lead ACS physicians from each institution completed the questionnaire, describing the structure of their ACS models. Results: In total, 16 institutions responded, all of which reported having ACS models, with a total of 29 ACS services described. All services had resident coverage. Of the 29, 18 (62%) had dedicated allied health care staff. The staff surgeon was free from elective duties while covering ACS in 17/29 (59%) services. More than half (15/29; 52%) of the services described protected ACS operating room time, but only 7/15 (47%) had a dedicated ACS room all 5 weekdays. Four of 29 services (14%) had no protected ACS operating room time. Only 1/16 (6%) institutions reported a mandate to conduct ACS research, while 12/16 (75%) found ACS research difficult, owing to lack of resources. Conclusion: We saw large variations in the structure of ACS models in academic centres in Canada. The components of ACS models that are most important to patient outcomes remain poorly defined. Future research will focus on defining the necessary cornerstones of ACS models. Contexte: Les personnes qui ont besoin d&apos;une chirurgie g n rale d&apos;urgence (CGU) sont expos es un risque nettement plus lev de morbidit et de mortalit p riop ratoires comparativement aux personnes soumises une chirurgie g n rale non urgente. Il a t d montr que le mod le de chirurgie en soins actifs (CSA) am liore le rapport co t-efficacit et les r sultats pour les personnes soumises une CGU. Selon une r cente revue syst matique, la structure des mod les de CSA est tr s h t rog ne dans le monde. L&apos;objectif de cette tude tait de d crire le paysage actuel des mod les de CSA dans les centres hospitaliers universitaires au Canada. M thodes: Nous avons fait parvenir un questionnaire en ligne aux 18 centres hospitaliers universitaires canadiens. Les m decins responsables des services de CSA de chaque tablissement ont r pondu au questionnaire et ont d crit la structure de leurs mod les de CSA. R sultats: En tout, 16 tablissements ont r pondu et tous ont indiqu qu&apos;ils disposent de mod les de CSA; 29 services de CSA ont ainsi t d crits. Des m decins r sidents assuraient la couverture de tous ces services. Sur les 29 services de CSA, 18 (62%) disposaient d&apos;une quipe soignante d di e. La chirurgienne ou le chirurgien en poste tait relev de ses fonctions non urgentes pendant sa couverture des services de CSA dans 17 services sur 29 (59%). Plus de la moiti (52%) des services ont d clar r server du temps pour la CSA au bloc op ratoire, mais seulement 7 sur 15 (47%) disposaient d&apos;un bloc op ratoire r serv la CSA du lundi au vendredi. Quatre services sur 29 (14%) ne disposaient pas de temps r serv au bloc op ratoire pour la CSA. Un seul tablissement sur 16 (6%) s&apos;est fait confier le mandat de faire de la recherche sur la CSA, tandis que 12 sur 16 (75%) ont d plor un manque de ressources, ce qui rend la recherche sur la CSA difficile. Conclusion: Nous avons observ une grande h t rog n it structurale entre les diff rents mod les de CSA appliqu s dans les centres hospitaliers universitaires canadiens et leurs l ments les plus importants pour les r sultats chez les patients demeurent mal d finis. La recherche devra se poursuivre sur les aspects incontournables des mod les de CSA., Patients who require emergency general surgery (EGS) represent a high-risk population, often with severe physiologic derangements, and require urgent timely intervention to prevent deterioration of their condition, including death. (1-3) [...]

INTRODUCTION: Although prompt treatment of status epilepticus is standard of care, the effect of timing of rescue therapy administration for seizure clusters in epilepsy remains unknown. Seizure clusters are a rare but clinically important condition, and benzodiazepines are the cornerstone rescue therapy for seizure clusters in epilepsy. We characterized temporal patterns from a large dataset of treated seizure clusters in the safety study of diazepam nasal spray. METHODS: This post hoc analysis used timing data of treated seizure clusters recorded by care partners and patients in seizure diaries during a 1-year safety study. Data analysis used time from seizure start to administration of diazepam. RESULTS: From 4466 observations, 3225 had data meeting criteria for analysis. Overall, median times from seizure start to dose administration, dose administration to seizure termination, and total seizure duration were 2, 3, and 7 min, respectively. In seizure clusters treated in

Abstract Objectives Trauma registries are essential tools for improving trauma care quality and efficiency, but many fail to capture long-term patient-reported outcome measures (PROMs). Focusing on these outcomes is crucial for understanding the extent of disability patients experience and identifying potential post-discharge interventions to optimize recovery. Studies reflecting the experience from low- and middle-income countries in this area are limited. Therefore, we aim to develop a digital trauma registry in Pakistan to prospectively capture patient-reported outcome measures at one, three, six, and twelve months post-injury. Methods We will develop and implement a digital trauma registry at two tertiary care facilities in Karachi, Pakistan: Aga Khan University Hospital and Jinnah Postgraduate Medical Center. The registry will include all admitted adult trauma patients (≥ 18 years). Data collection will be conducted digitally using tablets, with mortality, level of disability, functional status, and quality of life as primary outcomes. Follow-up data will be collected through telephone interviews with patients and caregivers. We will employ descriptive statistics to summarize participant’s socio-demographic and clinical characteristics. Additionally, we will perform survival analysis using Kaplan-Meier curves and Cox proportional hazard models and utilize mixed-effects linear regression to adjust for potential confounders for primary outcomes. Discussion The trauma registry will fill the current gap in knowledge regarding long-term outcomes among trauma patients in low- and middle-income countries (LMICs). This study will delineate future direction for capturing post-discharge data, enhancing our understanding of recovery, and informing the design of interventions aimed at improving long-term outcomes.

Disruption in the business environment imposes undeniable realities that require effective strategic management; therefore, the need to develop a particular type of force capable of achieving proactive strategies, influencing competitors’ behavior, and balancing competitive forces has arisen. This study aimed to examine the impact of absorptive capacity on achieving strategic supremacy and the mediating role of organizational ambidexterity within Jordan’s commercial banking industry. It employs 513 questionnaires from middle and upper management through proportionate stratified random sampling. It adopts a quantitative approach through partial least squares structural equation modeling to construct a research model comprising factors affecting strategic supremacy and the mediating role of organizational ambidexterity and validate the research hypotheses. The study revealed that absorptive capacity significantly impacts organization ambidexterity (β = 0.764, t = 33.939, p = 0.000) with explanation power (R2 = 0.584). Organizational ambidexterity has a significant positive impact on strategic supremacy (β = 0.561, t = 12.469, p = 0.000). Absorptive capacity has a significant positive impact on strategic supremacy through organizational ambidexterity (β = 0.334, t = 6.963, p = 0.000) with high explanation power (R2 = 0.712), which means that 71.2% of the variance in strategic supremacy has been explained by absorptive capacity and organizational ambidexterity. Moreover, organizational ambidexterity partially mediates their relationship. It also found that the model’s predictive power was moderate. The study concludes that Jordanian commercial banks have placed high importance on identifying and acquiring valuable external knowledge and balancing their short-term and long-term opportunities to achieve strategic supremacy, leading to sustainable competitive advantage.

Background: Intraoperative molecular imaging (IMI) uses a cancer-targeted fluorescent agent injected into patients to localize tumor nodules. Pafolacianine is a folate receptor (FR)–targeted near-infrared fluorescent probe. Almost 10% of patients have false negative fluorescence findings intraoperatively. We hypothesized that tumor histology explains why lung cancer may not fluoresce. Methods: Adenocarcinoma (AC) (A549, LKR) and squamous cell carcinoma (SCC) (H127, H1264) cell lines were stained with pafolacianine. Near-infrared fluorescent microscopy was used to quantify mean fluorescence intensity. Tissue microarray slides of patients with AC and SCC were evaluated by immunohistochemistry for FR alpha (FRα) and beta (FRβ) expression. Finally, we retrospectively analyzed IMI data from clinical trials of patients with AC and SCC receiving pafolacianine. Results: AC (intensity 30.31) cell lines have a higher fluorescence intensity than SCC cell lines (intensity 5.4) (P < .001). On slide analysis, 93.8% of ACs expressed FRα compared with 44.4% of SCCs (P = .002). Finally, there were 326 patients enrolled in clinical trials: 211 had lesions localized in vivo, and 134 of these patients had pure AC or SCC. All 9 patients with SCC have a positive smoking history and a mean pack-year of 60.2 (SD 3,6), whereas 76% of patients with AC have a history of smoking and a mean pack-year of 29.3 (P = .02). The odds ratio for fluorescence of (AC/SCC) was 2.05 (P = .004) and 2.01 (P = .02) on univariate and multivariate logistic regression, respectively. Conclusions: During IMI with pafolacianine, a nonfluorescent nodule is more likely to be SCC than AC. AC has a high probability of fluorescing because of higher expression of FRα or FRβ, or both.

This paper investigates the potential for creating walkable communities in Riyadh using a qualitative research methodology. This approach encompassed: (1) systematic selection of international case studies renowned for their walkability strategies, (2) critical comparative analysis of these case studies, and (3) extraction of a Walkability model to derive strategic guidelines and recommendations tailored to Riyadh’s context. Through literature review, four international case studies emblematic of effective walkability practices were examined. Key themes and strategies that emerged from these analyses included integrated public transit, compact urban design, pedestrian infrastructure, community engagement, cultural considerations, and context-sensitive innovation. Based on these themes we threaded a comprehensive model for sustainable walkability in Riyadh. To assess such model, we extracted conceptual framework and suggested future hypotheses for future studies. By synthesising these findings, the research proposed a walkability model to advance Riyadh’s transformation into a walkable city.

Abstract Background Studies evaluating the patterns of antibiotic consumption are becoming increasingly necessary as a result of the increased use of antibiotics and development of antibiotic resistance globally. This study aimed to evaluate the use of antibiotics in in terms of both quantity and quality at the largest surgical hospital in the north of the West Bank, Palestine. Methods An observational retrospective study with a total population sampling method was conducted to collect data from the inpatients of the orthopedic departments of a large governmental hospital in the northern West Bank, Palestine. The data were collected from patients’ files and evaluated using the anatomical therapeutic chemical and defined daily dose (ATC/DDD) methodology, and the drug utilization 90% (DU90%) index. The ATC/DDD methodology, designed by the World Health Organization (WHO), as a well-trusted and standardized tool that allows measuring and comparing antibiotic utilization across different contexts. Antibiotic prescriptions were classified using the World Health Organization Access, Watch and Reserve classification (WHO AWaRe). Results Of the 896 patients who were admitted to the hospital in the year 2020 and included in the study, 61.9% were males, and 38.1% were females. The percentage of patients who received antibiotics was 97.0%, and the overall antibiotic usage was 107.91 DDD/100 bed days. The most commonly prescribed antibiotic was cefazolin (50.30 DDD/100 bed days), followed by gentamicin (24.15 DDD/100 bed days) and ceftriaxone (17.35 DDD/100 bed days). The DU90% segment comprised four different agents. Classification of antibiotics according to the WHO AWaRe policy revealed that 75.9% of antibiotics were prescribed from the access list. Conclusion This study comes as part of the efforts exerted to combat the growing problem of antibiotic resistance in Palestine. Our results showed that the consumption of antibacterial agents in the orthopedic unit at a large governmental hospital in Palestine was relatively high. The results of this study provide valuable insights for the decision-makers to create policies aimed at regulating antibiotic prescriptions. This study also aims to provide a look into the antibiotic prescription patterns, offering a clearer understanding of the current situation of antibiotic consumption in Palestine. It also emphasizes the need for antibiotic stewardship and surveillance programs.

Background: Titanium dioxide nanoparticles (TiO2NPs) are widely used in various commercial and industrial applications, posing potential risks to human body. Lycium barbarum polysaccharide (LBP) is renowned for its antioxidant and anti-inflammatory properties. This study aims to investigate the protective potential of LBP against TiO2 NPs-induced acute toxicity in splenic and pulmonary tissues. Methods: Forty rats were grouped as follows: Group I, the normal control, received daily 0.1% DMSO intraperitoneally (ip) and 0.5 mL PBS orally. Group II received LBP (100 mg/kg/day) by gavage for 14 days. Group III received a single ip injection of TiO2 NPs (972 mg/kg) on the 8th day. Group IV obtained both LBP and TiO2 NPs. Group V was treated with LBP, TiO2 NPs and Zinc protoporphyrin IX (ZnPPIX), the later was injected ip in a dose of 10 mg/kg/day one hour before LBP. Biochemical, histopathological, and immunohistochemical analysis were conducted on splenic and pulmonary tissues of all rats. Results: TiO2 NPs induced congestion, inflammation, macrophage proliferation, pyknosis and significantly increased caspase-3, CD68, NF-κB, TLR4 immunoexpression with upregulation of markers of oxidative stress, inflammation, apoptosis and fibrosis. Pretreatment with LBP mitigated TiO2 NPs-induced tissue damage but enhanced heme oxygenase-1 (HO-1) mRNA expression. Co-administration of ZnPPIX reversed LBP protective impact. Conclusion: LBP demonstrated the ability to alleviate splenic and pulmonary injuries caused by the acute TiO2 NPs toxicity. LBP prevents TLR4/NF-κB mediated injury triggered by TiO2 NPs through HO-1 upregulation. Further research is required to explore the preventative role of LBP against both acute and chronic toxicity brought by nanomaterials in general and TiO2 NPs in particular.

Mahmoud Hamdan,1,2 Amar Hisham Jaaffar,3,4 Omar Khraisat,5 Marwan Rasmi Issa,6 Mu’taman Jarrar7,8 1Quality Management and Patient Safety Administration, King Saud Medical City, Riyadh, Saudi Arabia; 2College of Graduate Studies (COGS), Universiti Tenaga Nasional (UNITEN), Putrajaya Campus, Kajang, Selangor, 4300, Malaysia; 3Institute of Energy Policy and Research (Iepre), Universiti Tenaga Nasional (UNITEN), Putrajaya Campus, Kajang, Selangor, 4300, Malaysia; 4College of Business Management and Accounting (COBA), Universiti Tenaga Nasional (UNITEN), Putrajaya Campus, Kajang, Selangor, 43000, Malaysia; 5Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan; 6Skills Development Training Center, King Saud Medical City, Riyadh, 12746, Saudi Arabia; 7Medical Education Department, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia; 8Vice Deanship for Development and Community Partnership, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Mahmoud Hamdan, College of Graduate Studies (COGS), Universiti Tenaga Nasional (UNITEN), Putrajaya Campus, Jalan IKRAM-UNITEN, Kajang, Selangor, 4300, Malaysia, Tel +966580405515, Email Mahmoud_hamdan84@yahoo.comBackground: To ensure best possible patient outcomes, patient safety is a major component of healthcare delivery system that needs to be prioritized. Safety practices among nurses are essential to maintain patient safety, especially the practices of medication administration, handover, patient falls and unplanned extubations prevention.Purpose: To investigate the mediating effect of patient safety culture between the relationship of transformational leadership and safety practices among nurses.Methods: The data in this cross-sectional study were gathered from a survey targeted clinical nurses using a random sampling technique. The study was conducted in a medical city in Saudi Arabia, and two hundred nurses were surveyed. The Multifactor Leadership, Hospital Survey on Patient Safety Culture, and Nursing Safety Practice questionnaires were used in the study.Results: The results revealed significant positive associations between transformational leadership, patient safety culture, and nursing safety practices. Moreover, patient safety culture mediates the association between transformational leadership and safety practices among nurses.Conclusion: Enhancing transformational leadership capabilities among nurse managers should be considered in order to improve nursing safety practices. Additionally, patient safety culture should be measured and improved periodically to ensure better nursing safety practices.Keywords: nurses, safety practices, transformational leadership, patient safety, culture

This study aimed at furthering the research on the relationship between social communication apprehension, self-esteem and Facebook addiction. To measure the three variables, a questionnaire comprised of The Personal Report of Communication Apprehension (PRCA-24), The Rosenberg Self-Esteem Scale (RES), and The Bergen Facebook Addiction Scale (BFAS) was administered to 654 university students in Uganda. Pearson's correlation analysis and multiple linear regression coefficient analysis were carried out. A positive significant relationship between communication apprehension and Facebook addiction and a negative significant relationship between self-esteem and Facebook addiction were reported. Findings further revealed that self-esteem and communication apprehension significantly predicted Facebook addiction.

This study sheds light on the effect of insulin, insulin-like growth factors (IGF), and their signalling receptors (IR and IGF-1R) on the progression of lymphoma. We report a case of a 64-year-old male with type 2 diabetes mellitus and a prior diagnosis of diffuse large B-cell non-Hodgkin lymphoma (DLBCL) treated with chemotherapy and local radiotherapy. Incredibly, four years post-treatment, the patient's DLBCL relapsed in the subcutaneous fatty tissue adjacent to the deltoid muscle of both the proximal left and right upper extremities, which were the sites he used to inject insulin. Insulin/IGF dysregulation can lead to tumour growth via angiogenesis. This mechanism is not limited to lymphoma and may contribute to the development of various types of cancer. While it is possible that DLBCL may have developed at the injection site either coincidentally, as a result of chronic inflammation, or potentially due to other factors that promote tumour growth, as we suggest in our case presentation, it is beneficial to emphasise the importance of tumour screening in diabetic patients, especially those receiving insulin injections. We therefore believe that regular screening of the insulin injection site should be included in routine consultations for these patients.

BackgroundHome demolition is one of the issues that the Palestinian community faces as a result of Israeli procedures that can impact Palestinian mental health. This study aimed to measure the prevalence of Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and stress among Palestinian citizens whose homes were demolished.Materials and methodsA comparative cross-sectional design was adopted using a purposive sample of home demolished versus not home demolished Palestinian people. The Impact of Event Scale-Revised (IES-R) and the Depression and Anxiety Stress Scales (DASS) were used to assess the participants' levels of PTSD, depression, anxiety, and stress. The Statistical Package for the Social Sciences, Version 25, was applied to the statistical analysis.ResultsThis study showed that PTSD levels among people whose homes were demolished are significantly high, with a mean of 3.2, which could be indicative of a clinical concern. However, the PTSD level in the comparison group had no significance, with a mean of 1.48. Stress, depression, and anxiety levels were represented as 32.71, in their means, 32.61, and 32.08, respectively, among home-demolished people, compared to stress 18.46, depression 15.87, and anxiety 13.06 among the non home demolished group.ConclusionsThis study is one of the few that sheds light on one of the disadvantaged groups who suffer from home demolition and the severe mental problems that affect them, including PTSD, stress, depression, and anxiety). Furthermore, many related risk factors were studied in this research. As a future recommendation, further research is needed in this field, especially among disadvantaged groups. Stakeholders need to take action to improve the health system in Palestine.