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Background and Aim: Cranial cruciate ligament (CrCL) injuries are a prevalent orthopedic issue in dogs, typically managed through surgical interventions such as tibial plateau leveling osteotomy and tibial tuberosity advancement. However, these techniques have limitations, including high costs and extended recovery periods. This study introduces an innovative CrCL repair method employing an autologous lateral digital extensor muscle tendon graft and evaluates the effects of platelet-rich plasma (PRP) on tissue healing. Materials and Methods: Twenty-four healthy, male, local-breed dogs were divided into two groups. Group A underwent the surgical procedure without PRP, while Group B received intra-articular PRP during surgery. Outcomes were evaluated through clinical assessments of lameness, post-operative complications, and histological analysis over 10, 20, 30, and 40 days. Results: The PRP-treated group demonstrated statistically significant improvements in post-operative complication scores (p = 0.0025) and histological outcomes (p = 0.0002). However, graft maturation was unaffected by PRP treatment but improved over time (p = 0.0013). PRP-treated dogs exhibited faster recovery and enhanced tissue regeneration, with reduced inflammation and improved graft-bone attachment. Conclusion: This novel surgical approach demonstrates significant potential for improving outcomes in CrCL repair by combining autologous tendon grafting with PRP. The technique offers reduced complications and enhanced healing, providing a promising alternative to traditional methods. Further studies are recommended to validate its efficacy in clinical settings.

Abstract Background Mobile devices are now widely and extensively used by university students. With the rapid advancement in technology, mobile learning has become an important educational model, particularly for health schools’ students. This research aims to investigate the attitudes of health schools’ students in Jordan towards mobile learning, as well as their perceptions of mobile learning advantages and disadvantages compared to the traditional face-to-face learning model. Methods A quantitative research design was employed, with data collected through a web-based cross-sectional descriptive questionnaire using Google® Forms. The questionnaire was distributed to 703 students across the five health schools at the University of Jordan, with 690 students completing it, resulting in a response rate of 98.2%. Results Among the participants, 92.6% reported using smartphones as their primary device for mobile learning, and 98.8% relied on YouTube as their main educational website. Over two-thirds of the surveyed students expressed concerns about feeling isolated during mobile learning. A majority (64.9%) believed that there is a need for developing learning applications with offline accessibility, while 62.3% emphasized the importance of adapting exam platforms to be compatible with all mobile devices. Approximately 63% of the participants felt that mobile learning should complement face-to-face learning. Significant differences (p

Bursty traffic patterns require precise classification, modeling, and comprehension to ensure adequate resource allocation, improved network security, and Quality of Service (QoS) assurance. This study introduces a methodology integrating three critical correlation metrics with scheduler algorithms, demonstrating adaptability and improved network performance. Our approach highlights the handling of irregular patterns, contributing to the development of systems that can quickly adapt to changes, significantly enhancing network performance in the context of scheduler algorithms, resource allocation, correlation metrics, and bursty traffic.

Abstract Community-led, shared book reading programs may help improve refugee children’s reading abilities and attitudes towards reading. We Love Reading (WLR)—a light-touch, community-led, shared book reading program—was evaluated in a pre-registered, wait-listed, randomised controlled trial (AEARCTR-0006523). 322 Syrian refugee mother–child dyads (children: 4–8-year-olds, 50.0% female) in Jordan were tested at two timepoints, 15 weeks apart. WLR did not significantly affect child literacy or child-reported child attitudes toward reading (ps > 0.05). Mothers did report improved child attitudes toward reading from WLR (p = 0.046, η 2 = 0.013). The intervention did not lead to improvements in family relationships (ps > 0.05). WLR may have promise in improving attitudes toward reading in forcibly displaced children but did not affect literacy or child-reported attitudes toward reading; these results provide insight into what changes are needed for effective shared book reading interventions in this population.

هدف البحث الى التعرف على مدى تأثير هذه الاستراتيجية في مستوى اداء المهارة، اذ استخدمت الباحثة المنهج التجريبي لملائمته طبيعة المشكلة، وتصميم المجموعتين المتكافئتين ذات الاختبار القبلي البعدي وكانت عينه البحث طالبات المرحلة الرابعة في كلية التربية البدنية وعلوم الرياضة / جامعه ميسان، وكانت اهم الاستنتاجات هي معرفة تأثير استراتيجية التعلم من اجل التمكن في تعلم مهاره الارسال بالكرة الطائرة, و كانت اهم التوصيات هي استخدام مصادر تعلم متنوعة مثل الفيديوهات التعليمية، والألعاب التعليمية، والأنشطة العملية التي تناسب مختلف أنماط التعلم.

In recent decades, emerging pharmaceutical contaminants, such as personal care items, pharmaceuticals, and disinfectants, have increased alarmingly in aquatic ecosystems. The efficacy of wastewater treatment plants in eliminating these contaminants has been demonstrated. This study aims to find an alternative method, such as using the fluidized bed reactor (FBR) with bacteria to remove amoxicillin from wastewater. The active bacteria Acinetobacter baumannii and Klebsiella pneumoniae were isolated from one of the pharmaceutical factories in Baghdad, Iraq, from Al-Jazeera wastewater, which was used in FBR technology to decompose the antibiotic amoxicillin. The study examined several operational parameters, including pH, total organic carbon (TOC), dissolved carbon dioxide (CO2) concentration, airflow rate, amoxicillin concentration, and bacterial number, while maintaining a constant temperature. High-performance liquid chromatography (HPLC) was used to find the reaction route. The maximum amoxicillin removal efficiency was 93% and 91% for Acinetobacter baumannii and Klebsiella pneumoniae, respectively. For both bacterial species, the pH decreased due to the formation of amino acids and CO2. The suitable operation condition was 5 mg/L of amoxicillin concentration, flow rate of 30 m/s, and the number of bacteria 47 x 105 cfm/mL and 40 x 105 cfm/mL for Acinetobacter baumannii and Klebsiella pneumoniae, respectively. After treatment, the number of bacteria increased due to the degradation of amoxicillin. The steady-state time is found at 64 hours. The organic matter reaction pathway ends at the aromatic amino acid lysine, which kills gram-negative bacteria. This method was found to be successful in removing amoxicillin in low concentrations by using Acinetobacter baumannii. In the future, treating amoxicillin in wastewater using FBR technology with gram-positive bacteria is recommended.

Background: Attention deficit hyperactivity disorder (ADHD) is a widespread neuropsychiatric disorder in both children and adolescents, which is associated with social isolation and poor academic performance. Complement proteins are regarded as a major player in inflammation and disease development for several neuropsychiatric diseases such as schizophrenia and bipolar diseases. As clarified by previous data, increased levels of complement molecules and other immunological markers as cytokines were demonstrated in these disorders. Limited studies have investigated complement proteins particularly terminal complement complex or membrane attack complex (C5b-9) among ADHD patients. The present research aims to elucidate the association between C5b-9 complex protein and ADHD.Methods: This is a cross-sectional study. Sera were collected from Al-Hussain Teaching Medical City in Holy Karbala, Iraq, during 2019-2020. Sera were tested for C5-b9 using commercial kits by enzyme-linked immunosorbent assay (ELISA). Results: In 90 participants included in the study, a significant increment in C5b-9 levels among ADHD patients (P=0.019) was observed. Patients with positive C5b-9 levels had a 2.76 times higher risk of developing ADHD than control subjects. The diagnostic utility for C5b-9 was statistically significant with 71.11% sensitivity, 55.6% specificity, and a high negative predictive value (97.3%).Conclusion: The study concluded elevation of the C5b-9 terminal complements complex levels in ADHD patients, which could point to the association of complement proteins as inflammatory markers with the ADHD disease process.

Introduction Electronic cigarettes (e-cigarettes) have become one of the most common forms of nicotine delivery used by youth and young adults worldwide. Given the lack of epidemiologic data in Kuwait, this study sought to estimate the prevalence of e-cigarette use, assess perceptions of harm and addictiveness of e-cigarettes, measure the level of dependence on e-cigarettes and assess factors associated with dependence level among adults. Methods A cross-sectional study enrolled adults (n=3032, aged ≥18 years) living in Kuwait using a web-based questionnaire. Participants self-reported ever and current (past 30-day) e-cigarette use and self-completed the 10-item Penn State E-cigarette Dependence Index. Associations were evaluated using multinomial logistic regression. Results The prevalence of ever and current e-cigarette use was estimated to be 40.2% (1220/3032) and 29.4% (892/3032), respectively. The prevalence of current e-cigarette use was higher in males compared to females (47.6% vs 14.4%, p

Purpose: To characterize changes in subfoveal choroidal thickness in preterm infants from 30 to 60 weeks' postmenstrual age (PMA). Design: The prospective, observational Study of Eye Imaging in Preterm infantS (BabySTEPS) enrolled infants eligible for retinopathy of prematurity screening per the American Association of Pediatrics guidelines. Subjects: Infants imaged with an investigational, handheld OCT at ≥ 4 distinct imaging sessions between 30 to 60 weeks' PMA as part of BabySTEPS. Methods: Average choroidal thickness across the central subfoveal 1 mm in each eye at each time point was measured using custom segmentation software, and errors were manually corrected by a trained grader. We prospectively collected birth history data. A segmented mixed model was used to analyze the change in choroidal thickness as a function of PMA, birth weight, and gestational age (GA). Main Outcome Measures: Characterization of normative subfoveal choroidal thickness values and choroidal growth rate between 30 to 60 weeks' PMA. Results: We included 592 imaging sessions of 79 preterm infants (152 eyes). Mean (± standard deviation) GA was 27.5 ± 2.5 weeks. Mean choroidal thickness was 141.4 ± 34.5 μm at 30 weeks, 272.2 ± 83.9 μm at 38 weeks, and 306.2 ± 77.4 μm between 56 and 60 weeks. Between 30 and 60 weeks' PMA, choroidal growth followed a biphasic model, with a linear growth rate of 14.8 μm per week (95% confidence interval [CI], 13.6–16.0) from 30 until 38.4 weeks, then cessation of growth, with a growth rate of 0.3 μm per week (95% CI, −1.1 to 1.6) from 38.4 to 60 weeks. Infants with extremely low birth weight (ELBW; < 1000 g) and extremely preterm (GA < 28 weeks) infants had significantly slower initial growth rates compared with very low and low birth weight and very preterm and preterm infants (ELBW 13.0 vs. 21.0 μm per week; P < 0.0001 and extremely preterm 13.2 vs. 18.0 μm per week; P = 0.003). Conclusions: Preterm infant choroidal thickness experiences rapid linear growth from 30 to 38 weeks' PMA, at which time growth nearly stops. These foundational measurements and identification of the impact of extremes of low birth weight and prematurity on choroidal development will be essential as researchers begin to understand the role of choroidal development in ocular and retinal health in human infants. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Breast cancer (BC) stands as the most prevalent form of carcinoma among women, ranking as the second leading cause of cancer-related mortality in the female population. The objective of this study is to assess the expression of miR-10b and determine its diagnostic and prognostic significance in breast cancer patients across various disease stages. The investigation was carried out in Baghdad at the Oncology Teaching Hospital within Baghdad Medical City and the Oncology Unit at Al-Yarmouk Teaching Hospital. A total of 150 samples were included and divided into two groups: the blood group consisting of 90 samples (including control subjects, localized BC patients, and those with metastatic and locally advanced BC) and the tissue group comprising 60 samples (representing both benign and malignant BC cases). The study spanned from March 2022 to January 2023, with patients’ ages ranging from 24 to 75 years. The primary focus of this investigation was to identify the gene expression of miRNA-10b in all sample types. This was achieved by measuring gene expression levels and normalizing them to the level of a housekeeping gene (U6), and quantification was carried out considering the ΔCt value and the fold change method (2−ΔΔCt). The results revealed an upregulated fold expression of miRNA-10b, particularly in locally advanced and metastatic BC, where the expression was significantly higher compared to the other groups, with a fold expression of 1.770±0.1070. In localized breast cancer, the fold expression was 1.624±0.064, and in malignant tissue, it measured 1.546±0.06754, all relative to apparently healthy control subjects. In summary, our research provides compelling evidence supporting the classification of miRNA-10b as an oncogenic factor in BC. The central involvement of miRNA-10b in the tumorigenic processes of BC highlights its reference for developing novel targeted therapeutic interventions and detection biomarkers for BC treatment. Notably, elevated expression of miRNA-10b was observed in BC tissues, correlating with an unfavorable distant metastasis-free survival outcome.

Acute myeloid leukemias (AML) are severe hematomalignancies with dismal prognosis. The post-translational modification SUMOylation plays key roles in leukemogenesis and AML response to therapies. Here, we show that TAK-981 (subasumstat), a first-in-class SUMOylation inhibitor, is endowed with potent anti-leukemic activity in various preclinical models of AML. TAK-981 targets AML cell lines and patient blast cells in vitro and in vivo in xenografted mice with minimal toxicity on normal hematopoietic cells. Moreover, it synergizes with 5-azacytidine (AZA), a DNA-hypomethylating agent now used in combination with the BCL-2 inhibitor venetoclax to treat AML patients unfit for standard chemotherapies. Interestingly, TAK-981+AZA combination shows higher anti-leukemic activity than AZA+venetoclax combination both in vitro and in vivo, at least in the models tested. Mechanistically, TAK-981 potentiates the transcriptional reprogramming induced by AZA, promoting apoptosis, alteration of the cell cycle and differentiation of the leukemic cells. In addition, TAK-981+AZA treatment induces many genes linked to inflammation and immune response pathways. In particular, this leads to the secretion of type-I interferon by AML cells. Finally, TAK-981+AZA induces the expression of natural killer-activating ligands (MICA/B) and adhesion proteins (ICAM-1) at the surface of AML cells. Consistently, TAK-981+AZA-treated AML cells activate natural killer cells and increase their cytotoxic activity. Targeting SUMOylation with TAK-981 may thus be a promising strategy to both sensitize AML cells to AZA and reduce their immune-escape capacities.

Background:The technology of nanoparticles has been expanded to many aspects of modern life. Titanium dioxide nanoparticles were of many nanomaterials utilized in biomedical applications. The interactions between nanoparticles and proteins are believed to be the base for the biological effect of the nanoparticles. The oxidation reaction of many substances is catalyzed by oxidizing enzymes called peroxidases. The activity of salivary peroxidase is elevated with periodontal diseases. the aim ofthis study is to examine the action of titanium dioxide nanoparticles on salivary peroxidase activity.Material and method75 participants were enrolled in this study—Periodontitis group with 44 participants and the non-periodontitis group with 31 participants. The participants' age range was 35 to 50 years for both groups. The clinical parameters of plaque index, gingival index, probing pocket depth and clinical attachment level were used in this study to determine the presence or absence of the periodontal disease. Unstimulated saliva was collected from all participants and analyzed for the activity of peroxidase enzyme under the effect of titanium dioxide nanoparticles. ResultsThe Periodontitis group showed higher peroxidase enzyme activity than the non-periodontitis group and the activity of salivary peroxidase showed no correlation with the clinical parameters. Titanium dioxide nanoparticles increased salivary peroxidase activity. ConclusionThis study demonstrated that the solid surface of nanoparticles could induce changes in the attached protein molecule which in turn causes changes in the effect of the nanoparticles on living tissue or organism. The titanium dioxide nanoparticles Play a role in increasing the activity of salivary peroxidase within the saliva of chronic periodontitis patients.

The porpose of this study is to solve public doubts about the security of personal data in the PeduliLindungi application. This study uses a normative research method that is oriented to the rule of law and a case approach. The law in Indonesia has not regulated the violation of personal data leakage, so there are no strict sanctions against the perpetrators who leak personal data. Because there is no legal certainty in the protection of personal data, there are many crimes and result in the misuse of personal data. Currently the guarantee of personal data protection is only based on the ITE Law but there are no criminal provisions against perpetrators of spreading personal data. Because there is a legal vacuum, a draft law on the protection of personal data has been made, rules that can protect citizens’ personal data have been made, but these regulations have not been ratified. The government should provide provisions so that legal certainty is achieved. In this era of technological development 4.0, the government is required to be firm in establishing regulations related to cyber crime. Another way is to add the KTP function to replace the PeduliLindungi application to track the spread of the Corona virus because the KTP has guaranteed the security of one’s personal data.

Objectives: Throughout history, people have lived through various situations of security, peace, recovery, and war, as well as the cruelty over the diversity, intensity, duration, or shortness of life. This study aimed to assess the self-esteem of amputees living in Hilla City, Babylon Province, in Center of Iraq. Methods: A descriptive correlational study was conducted to determine the association between body image and self-esteem of amputees. By a purposive sampling method, 200 subjects from both genders and different age groups (25-35, 36-46, 47-57, 58-68, and >69 years) were recruited. The study data were collected through the modified questionnaire of multidimensional body-self relations questionnaire, Rosenberg self-esteem scale, and interviews with the patients individually. The obtained data were collected and analyzed with descriptive and inferential statistics. Results: Most participants were male patients aged between 58 and 68 years. The lower limbs were the most amputation site caused by the war for less than five years. The majority of amputees had negative responses toward their body image. As well as depicts (39%) as a majority response of amputated patients were never feel with their self-esteem. There was a high reverse association between body image and self-esteem (P

A conventional vapor compression refrigeration cycle is among the most effective technology in refrigeration systems. In the present experimental study, thermal performance and the effect of the condenser temperature have been analyzed. With the decrease in the condenser temperature, the overall performance of the refrigeration cycle is increased. However, the cooling power and efficiency of conventional vapor pressure air conditioning units can experience a significant reduction when operating in extreme weather (hot and dry). This drop is mainly affected by the increase in the temperature (and pressure) of the condenser with an increase in the ambient air temperature. Unfortunately, Iraq experiences the most extreme summer seasons especially in the months of June and July when the temperature reaches or exceeds 50° C. So, ground cooling has been used in areas with a hot environment for split system air conditioners. Evaporative cooling was also performed to lower the coolant temperature of the AC unit used inside the condenser area. Experimental results showed that when using a geothermal heat exchanger, the temperature of the condenser is reduced from 116 to 110 ° C and the coefficient of performance (COP) is improved by 41%. In addition to this when the system uses evaporative cooling the temperature of the condenser is reduced from 110 ° C to 88° C. Moreover, a 65% improvement was made in the COP of the conventional vapor compression refrigeration cycle. Furthermore, with a decrease in the evaporator temperature from 6 to 3.5 °C there was an increase in refrigeration capacity by an average of 52%.

BackgroundSeasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR).MethodsA cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH.ResultsAlmost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p

Internet of Things (IoT) is the new paradigm to the scaling nature of things and their elements, interconnected, exchanging data over a network supported with nodes. The Ubiquitous use of tiny devices and embedded sensor frameworks has pushed IoT to the forefront of emerging technologies used in many applications like peer-to-peer networks, smart energy grids, home and building automation, vehicle to vehicle communication, and wearable computing devices. This massive growth and extensive use brought forth security risks that could hinder its commencement in many novel applications. The number of interconnected devices leads the way to several entry points for intruders and, along with it, security risks. The sensitive nature of the IoT applications such as health, automation, and energy grids cannot afford security risks. Traditional security mechanisms will not design or develop to secure such an emerging technology as IoT. Existing technologies have to be relied on with the non-existence of security mechanisms for this purpose. Distributed Ledger Technology (DLT) is one such technology that can reduce the security risks in IoT. The central node vulnerability that can compromise the whole system can be mitigated by eliminating the need for a central node by using the distributed ledger. Blockchain, a distributed ledger technology, has attracted tremendous attention and harnessed in itself a real-world value. However, computationally costly with limited scalability is not entirely suited for the IoT environment. IoT Application (IOTA) technology is the distributed ledger technology that can provide unlimited scalability specifically suitable for the IoT industry. This survey provides an in-depth introduction to how blockchain performs and its constraints in its nature as a generic platform for DLT. In contrast, IOTA is introduced as the technology for IoT, the next-generation blockchain overcoming blockchain’s limitations for its use in IoT.

Effective Healthcare Facility Management (HFM) remain a crucial concern for high quality built healthcare sectors, both in the public and private areas. The anticipated resource efficiencies, complex systems, and maintenance are all driving up demand for efficiency and flexibility. However, it has been almost impossible with limited human and machinery resources to cope with the healthcare sector’s demands. The added value of Digitization will assist organizations overcoming the limited resources issue to deal with the increasing healthcare demands. Based on an extensive literature review, the aim of this paper is to suggest innovative digital and facility management methods that improve the healthcare sector experience. The same literature has been used to extract significant variables to build a causal loop diagram (CLD) that assists in better understanding the interrelationship between those variables within healthcare systems. Furthermore, to prepare for the technology adoption, the paper conducted a cross-sectional survey to forecast the acceptance level in 550 participants from Qatar’s healthcare sector. It also discusses applying the most innovative healthcare artificial intelligence techniques through an organized digital transformation process to guarantee delivering the healthcare services efficiently while optimizing resources and costs.

In order to solve one of the most important problems, especially in a large and crowded city like Baghdad, is finding an empty and secure car parking space. In this work, an intelligent Smart Parking System (ISPS) has been investigated and developed by providing information about the empty lots and helping the driver to get to his parking spot with a rotary parking system to reduce the traffic in the parking area. The ISPS Park implements a car number plate recognition system as a security system for car identification. Moreover, for increased security, a fence with a Fiber-Optic vibration system has also been used to prevent any object from entering a parking space without a license. The ISPS was run with the pre-programmed controller to make minimum human involvement in the parking system to ensure access control in restricted places. Matlab with Arduino tools has been used for the car plate number recognition process and car entering control. The system shows that using RFID for entering and leaving is so fast and informative. A Fiber SenSys program has been used with the Alarm Processing Unit (APU) to prevent any unlicensed person from trying to cut, climb or crawl under a fence.

BackgroundThe brain and retina share many neuronal and vasculature characteristics. We investigated the retinal microvasculature in patients with a monogenic vasculopathy using optical coherence tomography angiography (OCTA). OCT-A is a novel precise non-invasive imaging method that may provide biomarkers suitable for diagnosis and follow-up of small vessel diseases.MethodsIn this exploratory cross-sectional study, eleven RVCL-S patients and eleven age-matched healthy control participants were included. The size of the foveal avascular zone (FAZ) and the vascular density of the superficial capillary networks in the retina were measured by OCT-A.ResultsThe symptomatic and presymptomatic patients showed significantly lower vascular density values than controls in the foveal region [median (IQR) 18.2% (15.8–18.6) vs. 24.4% (21.5–26.8) (p < 0.001), 29.8% (29.6–30.8) vs. 33.2% (32.0–33.6) (p = 0.002), respectively]. The FAZ was significantly larger in the symptomatic RVCL-S patients than in the control group [13,416 square pixels [7,529–22,860] vs. 1,405 square pixels [1,344–2,470] (p < 0.001)]. No significant difference was identified in measurements of FAZ comparing presymptomatic and controls.ConclusionOur findings with OCT-A demonstrated that RVCL-S causes an increase in the size of the FAZ in symptomatic RVCL-S patients compared to healthy participants. Moreover, there is a decrease in vessel density in the superficial capillary networks in both symptomatic and presymptomatic patients. In the future, newly developed precise objective instruments such as OCT (-A) may provide important tools in determining disease activity for follow up of common small vessel diseases.

Introduction: Dental education quality is reflected by assessing graduating students' professional preparedness. Coronavirus disease 2019 (COVID-19) has had many challenges for dentistry some of which may have further long-term impacts on clinical practice, dental education, and dental research. Impact on education can be directly reflected on graduates' preparedness. Aim: The aim of this study is to study self-perceived preparedness of dental school graduates and the impact of COVID-19 on their preparedness. Materials and Methods: An online survey was designed and sent electronically to 5th year students who were graduating in 2020, dentists who graduated in 2019 and were doing their prelicensure training, and dentists who graduated before 2019. The survey was self-designed and validated by an experienced professor in the school then tested by couple of participants. The survey composed of multiple sections. Four-point Likert scale was used to assess participants' perception in all the survey sections. Results and Discussion: A total of 209 participants responded to the online questionnaire. The mean total preparedness score (TPS) for the 209 participants was 97.6 (standard deviation ± 9.7) with a range of 69–120. The mean TPS of the different classes of participants was 99.5 for the class graduated before 2019, 98.1 for the 2020 class, and 95.1 for the 2019 class. Participants felt they are confident and extremely confident doing most of the required competencies. Weakness was mainly reported in surgical extraction for 2020 graduates due to the 8 weeks loss of their training. COVID-19 had considerable impact on 59.7% of the participants and marginal to no impact on 40.3%. The highest prevalence of those who thought it had some to severe impact on their confidence was those who graduated in year 2019 (73.4%). Conclusions: The graduates who participated in the survey felt confident in performing the majority of general dentistry procedures. COVID-19 pandemic negatively impacted the confidence of all the classes of participants even those graduated before 2019.

Objective: To compare the amount of mercury in new and old dental amalgam restorations. Material and Methods: This study analyzed twenty samples of dental amalgam restorations, dividing into two groups. Group 1 consisted of samples of new dental amalgam restoration (n=10) and group 2 consisted of samples of old dental amalgam restoration (5-years old) (n=10). In each group, the mercury involved in the dental amalgam restoration was calculated using the cloud point extraction (CPE) method. The new dental amalgam restorations are taken from the patients' mouth after condensation and analyzed directly after setting. The old dental amalgam restorations are removed from the patients' mouth, after 5 years of use by the patients, and then they are analyzed. The independent-samples t-test was used to analyze the differences (p

With the rising demand for virtual learning, districts are establishing virtual schools to offer more flexible education. This study investigates K-12 virtual learner characteristics, examines trends and issues in virtual academies, and outlines opportunities and challenges faced by stakeholders in a southeastern U.S. state. The study used a mixed-method design, combining quantitative survey data and qualitative interviews with virtual academy leaders. Results reveal that virtual learners opt for this mode of schooling due to busy extracurricular schedules, a desire to avoid crowded schools or health concerns. These students include those with special needs and high-achieving individuals. Collaboration between parents and teachers plays a crucial role. Essential factors include reliable internet access, teacher tech proficiency, and diverse curriculum development approaches. However, diverse curricular methods require additional implementation support. Balancing instructional flexibility with accountability poses a significant challenge. Virtual teachers need resources, professional development, and time, especially when transitioning from traditional to digital curriculum. Effective communication and interpersonal interactions are vital. Involving home learning coaches and community partnerships enhances the educational experience. While virtual schools offer flexible and personalized support, they encounter challenges related to resource access, social isolation, and student motivation.

There are too few teachers and schools to meet the need for quality universal basic education. Therefore, alternative approaches to education provision need to be explored, such as open and distance learning methods and development and provision of curriculum-based Open Educational Resources (OER). However, distribution of printed materials is increasingly costly, and distribution of digital resources remains a challenge in areas with little or no connectivity. This case study explores the potential of using offline strategies to share digital OER. It suggests it is possible to provide access to digital learning resources even in the most remote areas by using appropriate technology, like the Commonwealth of Learning's Aptus device.

IntroductionDICER1 syndrome encompasses a variety of benign and malignant manifestations including multinodular goitre, which is the most common manifestation among individuals carrying pathogenic DICER1 variants. This is the first study estimating the prevalence of pathogenic DICER1 variants in young individuals with multinodular goitre.MethodsDanish individuals diagnosed with nodular goitre based on thyroidectomy samples in 2001-2016 with the age limit at time of operation being ≤ 25 years were offered germline DICER1 gene testing.ResultsSix of 46 individuals, 13% (CI [3.3;22.7], p

Background and Aims: Colovaginal fistula (CVF) in cancer patients can cause significant morbidity. In addition to causing local symptoms and infections, the constant stool leakage contributes to a poor quality of life, psychological distress, and possible social isolation. Patients with CVFs often have advanced disease, poor nutrition, and complex anatomy, making them poor candidates for major surgical interventions. Advancement in endoscopic tools has made endoscopic management possible. Endoscopic management is less invasive, is associated with prompt recovery, and can significantly improve the quality of life of patients and possibly allow them to resume systemic therapy. Methods: In this video case series, 3 cases of CVF patients treated endoscopically are presented to demonstrate the use of the currently available tools and techniques. The strategy used for the closure of the 3 CVFs was dependent on the size and etiology of the fistulas. Results: Technical and clinical success was achieved in all 3 situations. There were no procedure-related adverse events. Conclusion: These cases demonstrate the use of the cap to perform vaginal endoscopy; the use of the over-the-scope clips, covered stents, and endoscopic suturing; and how they can facilitate the closure of fistulas in patients who are poor surgical candidates.

One of the new concrete technology applications that had to get increased importance as repairing and retrofitting technique is slurry infiltrated fiber concrete (SIFCON). This research aims to investigate some of the mechanical properties of SIFCON and its role in improving the useful life of normal concrete. The research consists of two parts; in the first part, three mixes are prepared with 0%, 1.5%, and 6% volume fraction steel fiber content. Compressive strength, flexural strength, total absorption and apparent density tests are made for each mix. In the second part, a composite section of normal concrete and SIFCON mix with 6% steel fiber is prepared. Different thicknesses of SIFCON layer had been casted to assess its benefits in repair and/or to strengthen of defected buildings. Flexural strength, toughness, ductility and load-deflection curve are examined for the composite sections. The results showed that the flexural strength of SIFCON with 6% steel fiber content increased up to 600% and 200% compering to those recorded with the reference mix and 1.5% steel fiber concrete respectively. The results also indicated that the increase of SIFCON layer thickness would improve the mechanical properties of the composite section. Also, the maximum increase in flexural strength was greater than four times the reference mix. Better behavior is also recorded in load deflection and toughness of SIFCON composite section.

Background: Active vitreous seeds in eyes with retinoblastoma (Rb) adversely affects the treatment outcome. This study aimed to investigate the safety and efficacy of intravitreal melphalan chemotherapy (IViC) as a treatment for recurrent and refractory vitreous seeds in patients with Rb.Methods: We used a retrospective non-comparative study of patients with intraocular Rb who had vitreous seeds and were treated by IViC (20–30 μg of melphalan) using the safety-enhanced anti-reflux technique. Tumor response, ocular toxicity, demographics, clinical features, and survival were analyzed.Results: In total, 27 eyes were treated with 108 injections for recurrent (16 eyes) or refractory (11 eyes) vitreous seeds after failed systemic chemotherapy. A total of 15 (56%) were males, and 20 (74%) had bilateral disease. At diagnosis, the majority (n = 21) of the injected eyes were group D, and n = 6 were group C. Vitreous seeds showed complete regression in 21 (78%) eyes; 100% (n = 10) for eyes with focal seeds; 65% (n = 11/17 eyes) for eyes with diffuse seeds (p = 0.04); 7 (64%) eyes with refractory seeds; and 14 (87%) eyes with recurrent seeds showed complete response (p = 0.37). In total, 16 (59%) eyes developed side effects: retinal toxicity (48%), pupillary synechiae (15%), cataracts (30%), iris atrophy (7%), and retinal and optic atrophy (4%). Only one child was lost to follow-up whose family refused enucleation and none developed orbital tumor recurrence or distant metastasis.Conclusion: IViC with melphalan is effective (more for focal than diffuse seeding) and a relatively safe treatment modality for Rb that can improve the outcomes of eye salvage procedures. However, unexpected toxicity can occur even with the standard dose of 20–30 μg.

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management.Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded.Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death.Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

The COVID-19 pandemic has had both short- and long-term impacts on the institution of schooling, as well as on teachers and students who experienced it. While much has been learned about the impact of the pandemic, including in physical education, less is known about how physical education teachers navigated the sociopolitical realities of their work as they were socialized through the pandemic. Adopting occupational socialization theory, the purpose of this study was to examine the experiences of Midwestern US physical educators during the COVID-19 pandemic and the lasting implications for their careers. Participants were 30 in-service physical education teachers (20 female and 10 male) from one state in the US Midwest who each participated in a semi-structured interview. Semi-structured interviews were audio-recorded and analyzed using a multiphase collaborative qualitative analysis method grounded in analytic induction and deduction and focused on thematic development. Data analysis resulted in four themes: (a) changing instructional modalities was challenging but prompted creativity and growth; (b) resources were scarce, and marginalization was intensified through the pandemic; (c) recognizing and responding to changes in teacher and student health; and (d) stressors associated with COVID-19 may influence teachers' career trajectories. This study not only adds to the literature related to COVID-19 but also is important for understanding how the schools' culture changes through times of crisis. It is likely that other local, regional, national, or international events will cause disruptions in teachers' work and the nature of student learning in the future.

The increase in cement production as a result of growing demand in the construction sector means an increase in energy consumption and CO2 emissions. These emissions are estimated at 7% of the global production of CO2. Ultra-high-performance concrete (UHPC) has excellent mechanical and durability characteristics. Nevertheless, it is costly and affects the environment due to its high amount of cement, which may reach 800–1000 kg/m3. In order to reduce the cement content, silica fume (SF) was utilized as a partial alternative to cement in the production of UHPC. Nevertheless, SF is very expensive. Therefore, the researchers investigated the use of supplementary cementitious materials cheaper than SF. Very limited review investigates addressed the impact of such materials on different properties of UHPC in comparison to that of SF. Thus, this study aims to summarize the effectiveness of using some common supplementary cementitious materials, including fly ashes (FA), ground granulated blast furnace slag (GGBS), metakaolin (MK) and rice husk ashes (RHA) in the manufacturing of UHPC, and comparing the performance of each material with that of SF. The comparison among these substances was also discussed. It has been found that RHA is considered a successful alternative to SF to produce UHPC with similar or even higher properties than SF. Moreover, FA, GGBS and MK can be utilized in combination with SF (as a partial substitute of SF) as a result of having less pozzolanic activity than SF.

To broaden efforts for improving diversity, equity, and inclusion (DEI) in biomedical engineering (BME) education--a key area of emphasis is the integration of inclusive teaching practices. While BME faculty generally support these efforts, translating support into action remains challenging. This project aimed to address this need through a 3-phase inclusive teaching training, consisting of graduate students, faculty, and engineering education consultants. In Phase I, graduate students and faculty participated in a 6-week learning community on inclusive teaching ("Foundational Learning"). In Phase II, graduate students were paired with faculty to modify or develop new inclusive teaching materials to be integrated into a BME course ("Experiential Learning"). Phase III was the implementation of these materials. To assess Phases I & II, graduate student participants reflected on their experiences on the project. To assess Phase III, surveys were administered to students in IT-BME-affiliated courses as well as those taking other BME-related courses. Phases I & II: graduate students responded positively to the opportunity to engage in this inclusive teaching experiential learning opportunity. Phase III: survey results indicated that the incorporation of inclusive teaching practices in BME courses enhanced the student learning experience. The IT-BME project supported graduate students and faculty in learning about, creating, and implementing inclusive teaching practices in a collaborative and supportive environment. This project will serve to both train the next class of instructors and use their study of inclusive teaching concepts to facilitate the creation of ideas and materials that will benefit the BME curriculum and students.

IntroductionIn the UK, over 7000 amputations are performed each year because of diabetes. Up to 80% of these are preceded by a foot ulcer and could therefore be prevented with improvements in ulcer care. Peripheral arterial disease is an important risk factor for the development of diabetic foot ulceration. However, its diagnosis in diabetes is challenging due to the presence of neuropathy and arterial calcification. Commonly used bedside tests either have low sensitivities or little supporting evidence to justify their use. Duplex ultrasound (DUS) has good correlation to angiography findings but a full scan is difficult to learn and time consuming to perform. We have previously demonstrated that a focused DUS of the distal anterior and posterior tibial arteries at the ankle (podiatry ankle duplex scan (PAD-scan)) can be readily learnt by novices and performed rapidly and accurately. The primary aim of this study is to determine the diagnostic accuracy of the PAD-scan and other commonly used bedside tests in detecting arterial disease in diabetes.Methods and analysisThe study will include 305 patients presenting to diabetic foot clinics at two centres. Arterial assessment will be performed using the following index tests: the PAD-scan, pulse palpation, audible handheld Doppler, Ankle Brachial Pressure Index, Toe Brachial Pressure Index and transcutaneous pressure of oxygen. Patients will then undergo a full lower limb arterial DUS by a blinded vascular scientist as a reference test.Ethics and disseminationApproval was gained from NRES Committee London (REC reference 17/LO/1447). Findings will be disseminated by various methods including international presentations and publication in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT04058626).

Institution of machine learning (ML) in the pathology clinical domain has gained momentum and is rapidly advancing. As ML-based clinical decision support (CDS) systems continue to mature, laboratories will increasingly [...], * Context.-Machine learning applications in the pathology clinical domain are emerging rapidly. As decision support systems continue to mature, laboratories will increasingly need guidance to evaluate their performance in clinical practice. Currently there are no formal guidelines to assist pathology laboratories in verification and/or validation of such systems. These recommendations are being proposed for the evaluation of machine learning systems in the clinical practice of pathology. Objective.-To propose recommendations for performance evaluation of in vitro diagnostic tests on patient samples that incorporate machine learning as part of the pre-analytical, analytical, or post-analytical phases of the laboratory workflow. Topics described include considerations for machine learning model evaluation including risk assessment, predeployment requirements, data sourcing and curation, verification and validation, change control management, human-computer interaction, practitioner training, and competency evaluation. Data Sources.-An expert panel performed a review of the literature, Clinical and Laboratory Standards Institute guidance, and laboratory and government regulatory frameworks. Conclusions.-Review of the literature and existing documents enabled the development of proposed recommendations. This white paper pertains to performance evaluation of machine learning systems intended to be implemented for clinical patient testing. Further studies with real-world clinical data are encouraged to support these proposed recommendations. Performance evaluation of machine learning models is critical to verification and/or validation of in vitro diagnostic tests using machine learning intended for clinical practice. (Arch Pathol Lab Med. 2024;148:e335-e361; doi: 10.5858/arpa.2023-0042-CP)