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The obesity rate and its prevalence are increasing with many complications in the population. Obesity is a condition in which the bodyweight gain extended to the point where it causes obstacles to health. Usually, this extended body weight comes from excessive fat which consequences of the imbalance between calories expended and calories consumed. Pre-test questionnaire by utilizing validation of self-administration as a cross-sectional investigation was carried out to diagnose the overview of obesity and health issue risks among Koya technical staff. The height of the staff was calculated by supporting a measuring tape (Seca 206 body meter) and the mass of the body (kg) was measured by providing weighing scale TANTA. Overall, according to the findings of this study, we conclude that body overweight (54.7%) and obesity (18%) are clear among academics and administrate staff of Koya Technical Institute at Erbil Polytechnic University. While normal body weights are (25.3%) and underweight approximately (2%). Analyses of data showed that obesity is a significant difference between married and unmarried of participants, besides, there are many factors appear to have a great role and association with health situation and body overweight such as (age, gender, and level of education, type of work, income and physical activity). Physical activities and lifestyle have a strong relation with obesity, especially its reveal among administrates rather than academics, because of fewer activities and lack of regular exercise.

INTRODUCTION: Sepsis affects 25.2 million children per year globally and causes 3.4 million deaths, with an annual cost of hospitalisation in the USA of US$7.3 billion. Despite being common, severe and expensive, therapies and outcomes from sepsis have not substantially changed in decades. Variable case definitions, lack of a reference standard for diagnosis and broad spectrum of disease hamper efforts to evaluate therapies that may improve sepsis outcomes. This landscape analysis of community-acquired childhood sepsis in Australia and New Zealand will characterise the burden of disease, including incidence, severity, outcomes and cost. Sepsis diagnostic criteria and risk stratification tools will be prospectively evaluated. Sepsis therapies, quality of care, parental awareness and understanding of sepsis and parent-reported outcome measures will be described. Understanding these aspects of sepsis care is fundamental for the design and conduct of interventional trials to improve childhood sepsis outcomes. METHODS AND ANALYSIS: This prospective observational study will include children up to 18 years of age presenting to 12 emergency departments with suspected sepsis within the Paediatric Research in Emergency Departments International Collaborative network in Australia and New Zealand. Presenting characteristics, management and outcomes will be collected. These will include vital signs, serum biomarkers, clinician assessment of severity of disease, intravenous fluid administration for the first 24 hours of hospitalisation, organ support therapies delivered, antimicrobial use, microbiological diagnoses, hospital and intensive care unit length-of-stay, mortality censored at hospital discharge or 30 days from enrolment (whichever comes first) and parent-reported outcomes 90 days from enrolment. We will use these data to determine sepsis epidemiology based on existing and novel diagnostic criteria. We will also validate existing and novel sepsis risk stratification criteria, characterise antimicrobial stewardship, guideline adherence, cost and report parental awareness and understanding of sepsis and parent-reported outcome measures. ETHICS AND DISSEMINATION: Ethics approval was received from the Royal Childrens Hospital of Melbourne, Australia Human Research Ethics Committee (HREC/69948/RCHM-2021). This included incorporated informed consent for follow-up. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER: ACTRN12621000920897; Pre-results.

While technology has undoubtedly improved and has become an essential component of modern life, technological advances' consequences have both beneficial and detrimental impacts on students' writing skills in the classroom. Technology has accelerated and simplified work for students, but it has also instilled the belief that there is no need to put significant effort into the texts they write. This study examines the effects of technology and auto-correction on students' writing skills at three different universities in Sulaimaneyah city, Iraq. Case studies and research into the impact of electronic and communication devices on English writing skills among university students has been analyzed to determine the effect of autocorrection on grammar, vocabulary, spelling, and punctuation. Furthermore, the study also aims to show that auto-correction affects students' writing and to compare auto-correction and handwriting to prove that students make mistakes while writing due to technology. In addition, the study examines writing tasks undertaken by students in the English language to assess students' lack of writing skills, particularly in spelling. Finally, the study identifies why students have poor writing skills and corroborate previous research into an auto-corrections negative impact on students' writing abilities.

AIMS: Invasive haemodynamic assessment with a pulmonary artery catheter is often used to guide the management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting haemodynamic parameters in CS. METHODS AND RESULTS: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018-2022) who underwent invasive haemodynamic assessment within 24 h of CICU admission were included. Associations of haemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score. Among the 3603 admissions with CS, 1473 had haemodynamic data collected within 24 h of CICU admission. The median cardiac index was 1.9 (25th-75th percentile, 1.6-2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66-86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for the intensity of background pharmacologic and mechanical haemodynamic support. These parameters were also associated with higher presenting serum lactate. CONCLUSION: In a contemporary CS population, presenting haemodynamic parameters reflecting decreased systemic arterial tone and right ventricular dysfunction are associated with adverse outcomes and systemic hypoperfusion.

Background Complex percutaneous coronary intervention (PCI) is increasingly performed in older adults (age ≥75 years) with stable ischemic heart disease. However, little is known about clinical outcomes. Methods and Results We derived a cohort of older adults undergoing elective PCI for stable ischemic heart disease across a large health system. We compared 12-month event-free survival (freedom from all-cause death, nonfatal myocardial infarction, stroke, and major bleeding), all-cause death, target lesion revascularization, and bleeding events for patients receiving complex versus noncomplex PCI and derived risk estimates with Cox regression models. We included 513 patients (mean age, 81±5 years). Patients receiving complex PCI versus noncomplex PCI did not significantly differ across a host of clinical characteristics including cardiovascular disease features, noncardiac comorbidities, guideline-directed medical therapy use, and frailty. Patients receiving complex PCI versus noncomplex PCI experienced worse event-free survival (80.4% versus 86.8%), which was not significant in adjusted analyses (hazard ratio [HR], 1.38 [95% CI, 0.88-2.16]). All-cause death at 1 year for patients undergoing complex PCI was nearly double that seen for patients receiving noncomplex PCI (10.2% versus 5.9%), and the risk was significant in models adjusted for clinical characteristics (HR, 1.97 [95% CI, 1.02-3.79]). Target lesion revascularization risk was lower for patients receiving complex PCI (2.2% versus 3.5%, adjusted HR), but bleeding events were not statistically different between groups (25.3% versus 20.5%; P=0.19). Conclusions Complex PCI in older adults with stable ischemic heart disease was associated with lower risk of target lesion revascularization but higher all-cause death compared with noncomplex PCI.

Background: Laparoscopic cholecystectomy has now become gold standard treatment for gallstone diseases. Although few recent articles suggest that after laparoscopic cholecystectomy gall bladder (GB) retrieval from umbilical port is better, but the evidence is inconsistent. The objective of this study was to compare specimen retrieval from epigastric vs. umbilical port in terms of postoperative pain, time taken, and ease of retrieval. Methods: Total 200 patients aged 16-80 years were randomized by drawing lottery slips by a third person from a box containing 200 sealed envelopes (100 for each group). Those with acute cholecystitis, empyema, mucocele, suspected malignancy, and conversion to open and chronic analgesic users were excluded. Surgery was done by consultant surgeon under standard general anesthesia with four-port technique and GB was extracted either through epigastric or umbilical port as per draw. The difficulty in specimen retrieval was graded by operating surgeon on subjective linear scale and postoperative port site pain was assessed by resident blinded to intervention with Visual Analog Scale. Results: Both groups were well matched regarding age, sex, body mass index, and comorbidities. Mean time taken to retrieve in epigastric group was 36.76 ± 6.26 vs. 22.48 ± 5.76 seconds in umbilical group (P < .01). We observed easy retrieval via umbilical port compared to epigastric (score 2.72 ± 1.42 vs. 6.48 ± 1.32, P. 001). Epigastric group patients had Visual Analog Scale 6.56±0.768, 5.60 ± 1.225, 4.56 ± 1.325, and 2.72 ± 1.308 vs. 4.16 ± 1.214, 2.72 ± 1.275, 1.76 ± 1.234, and. 92±0.759 at 1, 6, 12, and 24 hours in umbilical group. The P value at different timings were. 001, thus indicating less pain in umbilical group. Conclusion: Umbilical port is better than epigastric port in terms of time taken for GB retrieval, ease of retrieval, and postoperative pain.

This research aims to give a clear image of coursebook evaluation in the English department of Komar University of Science and Technology (KUST) in Iraqi Kurdistan. The focus of this paper is to show the advantages and disadvantages of six coursebooks that are used in the English department of KUST. For this purpose, the researchers conducted interviews with the instructors and a survey with the students of these courses. These interviews and the survey show the good sides and the shortcomings of the studied coursebooks by asking different types of questions related to the contents of the books. The research took place in Fall-Winter 2019. The study results show that two-thirds of the teachers were satisfied with the coursebooks chosen to teach in the department of English to a large degree, and most of the students were satisfied with their coursebooks.

INTRODUCTION: There are limited data on comparative risk of infections with various biologic agents in older adults with inflammatory bowel diseases (IBDs). We aimed to assess the comparative safety of biologic agents in older IBD patients with varying comorbidity burden. METHODS: We used data from a large, national commercial insurance plan in the United States to identify patients 60 years and older with IBD who newly initiated tumor necrosis factor-α antagonists (anti-TNF), vedolizumab, or ustekinumab. Comorbidity was defined using the Charlson Comorbidity Index (CCI). Our primary outcome was infection-related hospitalizations. Cox proportional hazards models were fitted in propensity score-weighted cohorts to compare the risk of infections between the different therapeutic classes. RESULTS: The anti-TNF, vedolizumab, and ustekinumab cohorts included 2,369, 972, and 352 patients, respectively, with a mean age of 67 years. The overall rate of infection-related hospitalizations was similar to that of anti-TNF agents for patients initiating vedolizumab (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.84-1.04) and ustekinumab (0.92, 95% CI 0.74-1.16). Among patients with a CCI of >1, both ustekinumab (HR: 0.66, 95% CI: 0.46-0.91, p-interaction

BACKGROUND AND AIMS: We aimed to compare the risk of frailty in older adults with incident inflammatory bowel disease (IBD) and matched non-IBD comparators and assess the association between frailty and future hospitalizations and mortality. METHODS: In a cohort of patients with incident IBD ≥60 years of age from 2007 to 2016 in Sweden identified using nationwide registers, we defined frailty using Hospital Frailty Risk Score. We compared prevalence of frailty in patients with IBD with age, sex, place of residency- and calendar year-matched population comparators. In the IBD cohort, we used Cox proportional hazards modeling to examine the associations between frailty risk and hospitalizations or mortality. RESULTS: We identified 10,590 patients with IBD, 52% female with a mean age of 71 years of age, matched to 103,398 population-based comparators. Among patients with IBD, 39% had no risk for frailty, 49% had low risk for frailty, and 12% had higher risk for frailty. Mean Hospital Frailty Risk Score was 1.9 in IBD and 0.9 in matched comparators (P < .01). Older adults with IBD at higher risk for frailty had a 20% greater risk for mortality at 3 years compared with those who were not frail. Compared with nonfrail older patients with IBD, patients at higher risk for frailty had increased mortality (hazard ratio [HR], 3.22, 95% confidence interval [CI], 2.86-3.61), all-cause hospitalization (HR, 2.42; 95% CI, 2.24-2.61), and IBD-related hospitalization (HR, 1.50; 95% CI, 1.35-1.66). These associations were not attenuated after adjusting for comorbidities. CONCLUSIONS: Frailty is more prevalent in older adults with IBD than in matched comparators. Among older patients with IBD, frailty is associated with increased risk for hospitalizations and mortality.

The aim of this article is to study a problem of thermomechanical deformation in a homogeneous, isotropic, micropolar thermoelastic half-space based on the Moore-Gibson-Thompson heat equation under the influence of nonlocal and hyperbolic two-temperature (HTT) parameters. The problem is formulated for the considered model by reducing the governing equations into 2D and then converting to dimensionless form. Laplace transform and Fourier transform techniques are employed to obtain the system of differential equations. In the transformed domain, the physical quantities like displacement components, stresses, thermodynamic temperature, and conductive temperature are calculated under the specific types of normal force and thermal source at the boundary surface. A numerical inversion technique is used to recuperate the equations in the physical domain to exhibit the influence of nonlocal and HTT in the form of graphs. Particular cases of interest are also discussed in the present problem. The present study finds applications in a wide range of problems in engineering and sciences, control theory, vibration mechanics, and continuum mechanics. Key words: Moore-Gibson-Thompson, micropolar thermoelastic, nonlocal, hyperbolic two-temperature (HTT), stresses, 1. Introduction The theory of thermoelasticity gained a lot of attention in the last decade, as it predicts the thermal stresses and strains that result from temperature changes in a [...]

Abstract In this paper, Gaussian Process Regression (GPR)‐based models which use the Bayesian approach to regression analysis problem such as load forecasting (LF) are proposed. The GPR is a non‐parametric kernel‐based learning method having the ability to provide correct predictions with uncertainty in measurements. The proposed model provides an hourly and monthly load forecast for an Australian city and four Indian cities in the Maharashtra state. Twelve GPR models are trained with historical datasets including hourly load and environmental data. To evaluate the trained model, the actual and predicted load demand curve is plotted and mean average percentage error (MAPE) is calculated corresponding to different kernel functions of the GPR model. To the best of the author's knowledge, the prediction of load demand using GPR for Indian cities of Maharashtra state has been made for the first time. The calculated MAPE in LF is 0.15% for Australia and 0.002%, 0.209%, 0.077%, and 0.140% for Indian cities viz. Nasik, Bhusawal, Kolhapur, and Aurangabad, respectively. The test results illustrate that minimum MAPE in load prediction is obtained using the proposed model that is GPR with ‘Exponential’ kernel functions. Furthermore, the comparative analysis with the existing approaches confirms the dominance of the proposed model.

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Background: This qualitative study aimed to investigate the barriers that hinder men’s utilisation of healthcare services in the Sedibeng district of South Africa. Methods: The study was conducted using flyers with questions posted on the Best Health Solutions’ Facebook page for two weeks. A convenience sampling method was used and a total of 104 comments were collected from 64 respondents. The authors analysed the participants’ self-reported data thematically on demographics, geographic area, and reasons for men not using healthcare services. Results: The findings revealed that sociocultural norms played a significant role in men’s reluctance to seek medical help, as it was perceived as a sign of weakness. The scarcity of male healthcare professionals hinders open discussions. Stigma and discrimination were identified as substantial barriers. Convenience, trust, and confidentiality concerns, along with the influence of intimate partners, also influence men’s decision-making. Conclusion: This study highlights the complex interplay between various barriers that impact men’s utilisation of healthcare services in the district. By addressing these factors, healthcare providers and policymakers can enhance healthcare access and promote better health outcomes for men in Sedibeng district. Contribution: The manuscript’s primary contribution lies in uncovering multifaceted barriers to men’s healthcare utilisation in Sedibeng district. It explores socio-cultural norms, healthcare worker demographics, stigma, discrimination, convenience factors, trust, confidentiality concerns, and the influence of intimate partners on men’s healthcare choices. These insights illuminate the complex factors affecting men’s healthcare access, providing valuable knowledge for healthcare providers and policymakers.

Objectives: This study compares the precision of cone beam computed tomography (CBCT) and two-dimensional radiography for mini-implant implantation. Materials and Method: For 30 sites (in 15 patients between the ages of 13 and 26 years), the buccal interradicular region among the 2nd premolar and 1st molar was found to be the best location for mini-implants. Next, two groups of the mini-implant implantation process were created. Mini-implants were positioned at the CBCT data-identified sites in the CBCT group. Mini-implants were inserted in the RVG group by using two-dimensional digital radiography and a specially constructed guide. To assess the precision of the mini-implant implantation, post-placement CBCT images were acquired. The obtained data were statistically analyzed. Result: The two groups showed a statistically considerable variation in the mini-implant placement's departure from the optimal height. Due to the smaller interradicular space and decreased convenience in the posterior mandibular area, two out of 15 mini-implants in the RVG group demonstrated root contact in the mandibular jaw. Conclusion: The two-dimensional intraoral radiograph of the interradicular area provides sufficient information for mini-implant placement even though CBCT accurately visualizes the interradicular space in three dimensions.

A subluxated lens is often associated with zonular weakness, which makes surgery with lens extraction and implantation of an intraocular lens particularly challenging. A 40-year-old healthy male presented with idiopathic partial anterior subluxation of lens without any signs of pupillary block glaucoma, corneal endothelial damage, or uveitis. Due to the absence of adequate zonular support, lens extraction with anterior vitrectomy and retropupillary iris claw lens implantation was done in this patient with good visual outcome. Lens extraction with anterior vitrectomy and retropupillary iris claw implantation can be a good surgical option in such cases.

The number of Americans 65 years or older in 2060 will be more than double what it was in 2014. Approximately 40% of patients seen in gastroenterology (GI) and hepatology practices in the United States are 60 years or older. Adapting care delivery models, curating data on shifting risk-benefit decisions with geriatric syndromes, understanding appropriate assessments, and focusing on tailored implementation strategies are challenges that are actively confronting us as we provide care for a burgeoning population of older adults. Limited availability of geriatric specialists results in an onus of specialists caring for older adults, such as gastroenterologists, to innovate and develop tailored, comprehensive, and evidence-based care for adults in later life stages. In this article, we present the 5M framework from geriatrics to achieve age-friendly healthcare. The 5Ms are medications, mind, mobility, multicomplexity, and what matters most. We apply the 5M framework to 2 chronic conditions commonly encountered in clinical GI practice: inflammatory bowel diseases and cirrhosis. We highlight knowledge gaps and outline future directions to expand evidence-based care and advance the creation of age-friendly GI care.