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BACKGROUND: Quality of life (QOL) is a critical factor in decision-making for advanced breast cancer (ABC). There is a need to improve how QOL and treatment-related side effects (SEs) that impact it are clinically assessed. We examined healthcare professionals (HCPs) and patients perspectives on the importance of QOL discussions and the impact of SEs on QOL in clinical settings. PATIENTS AND METHODS: A cross-sectional online survey was conducted (7/2020-5/2021) among oncologists, nurses, and patients with HR+/HER2- ABC in 7 countries. RESULTS: The survey was completed by 502 HCPs and 467 patients. Overall, 88% of oncologists and 49% of patients recalled QOL discussions at follow-up. In the first- through fourth-line (1L, 2L, 3L, and 4L) settings, respectively, 48%, 57%, 79%, and 85% of oncologists reported QOL was very important; 73% and 45% of patients receiving 1L and 2L treatment and 40% receiving 3L+ treatment indicated QOL was important. Patients reported that insomnia, anxiety, back pain, fatigue, diarrhea, hot flashes, low sexual interest, and loss of appetite had a moderate/severe impact on QOL. Of patients experiencing certain SEs, ≥64% did not discuss them with HCPs until there was a moderate/severe impact on QOL. In patients receiving a CDK4/6 inhibitor, SEs, including insomnia, diarrhea, back pain, and fatigue, had a moderate/severe impact on QOL. CONCLUSIONS: This survey discovered disconnects between HCPs and patients with ABC on the importance of QOL discussions and the impact of SEs on QOL. These data support the use of ABC-specific QOL questionnaires that closely monitor SEs impacting QOL.

Children with SOX2 deficiency develop ocular disorders and extra-ocular CNS anomalies. Animal data show that SOX2 is essential for retinal and neural stem cell development. In the CNS parenchyma, SOX2 is primarily expressed in astroglial and oligodendroglial cells. Here, we report a crucial role of astroglial SOX2 in postnatal brain development. Astroglial Sox2-deficient mice develop hyperactivity in locomotion and increased neuronal excitability in the corticostriatal circuit. Sox2 deficiency inhibits postnatal astrocyte maturation molecularly, morphologically, and electrophysiologically without affecting astroglia proliferation. Mechanistically, SOX2 directly binds to a cohort of astrocytic signature and functional genes, the expression of which is significantly reduced in Sox2-deficient CNS and astrocytes. Consistently, Sox2 deficiency remarkably reduces glutamate transporter expression and compromised astrocyte function of glutamate uptake. Our study provides insights into the cellular mechanisms underlying brain defects in children with SOX2 mutations and suggests a link of astrocyte SOX2 with extra-ocular abnormalities in SOX2-mutant subjects.

We present a novel fabrication approach to an integrated nanophotonic platform, based on a III-V membrane bonded to a Si substrate with benzocyclobutene (BCB). The process incorporates a hybrid lithography strategy combining deep-UV and electron-beam lithography on the same wafer. We report for the first time the usage of deep-UV scanner lithography for the fabrication of the active-passive tapers and sub-micron waveguides on the same wafer, which enables better critical dimension control, uniformity, and reproducibility. The platform uses an active-passive butt-joint interface and includes components such as distributed feedback (DFB) and distributed Bragg reflector (DBR) lasers, electro-optical (EO) and electro-absorption (EA) modulators, and sub-micron ultra-confined passive waveguides, all monolithically integrated into a single membrane layer. The active devices have a heat sink achieved by ultra-thin BCB bonding. Lasers demonstrate up to 26 mW of optical power in the waveguide and a direct modulation bandwidth of up to 21 GHz. The modulators show static extinction up to 28.8 dB.

This study investigates the effect of marketing via Instagram on Generation Z’s preference for gyms in Jordan, so it would be helpful for marketers of gyms to be aware of using Instagram to attract Generation Z as their potential customers. Moreover, a sample questionnaire was carried out with 138 respondents, which were mostly female respondents (74%) and male respondents (26%). Additionally, 51% of the total number of respondents were 21-24 years old. Therefore, the data was analyzed by applying various statistical techniques such as Cronbach’s alpha for testing the reliability of the data, and multiple regression using SPSS version 22 for examining the hypotheses. Likewise, the results showed that Instagram and these variables (entertainment, interaction, trendiness, and customization) have an effect on customers' brand choice, but trendiness did not have a significant effect on the consumer's brand choice, but after testing the effect of the brand image, it became clear that it has significant effect, and therefore it was concluded that brand image has an important effect on customer’s brand choice.

BACKGROUND: The widely recognized phenomenon known as 'medical student syndrome' refers to the tendency of many medical students to develop fears and symptoms of illnesses they are studying. Extensive research has underscored the substantial psychological pressure that medical students endure due to factors like a demanding workload, exam-related stress, anxiety arising from new clinical experiences, and the competitive academic environment. Given its classification as a mental health issue, 'medical student syndrome' has been investigated in multiple countries. Consequently, our study aims to delve deeper into this phenomenon among medical students, considering various demographic factors. METHODS: A cross-sectional study was conducted. The survey includes sociodemographic questions and attitudes toward the syndrome, adapted from a Polish study. Data was using SPSS, with statistical tests conducted at a 95% confidence level. RESULTS: A total of 1,050 participants completed the questionnaire for this study, with 67.3% being females. The average age was 20.91 years, and the majority were unmarried (98.2%). Most participants reported a monthly income of less than 500 JDs, and only 16.2% identified as smokers. Clinical students accounted for 33.6% of the sample, while 11.2% indicated a history of mental illnesses. Additionally, 36.3% had taken previous courses related to mental illnesses, and 13.7% had sought psychiatric consultation. Furthermore, 15.6% had utilized psychiatric or psychotherapeutic counseling for other reasons, and 26.6% expressed a desire to visit a psychiatrist or psychologist due to their fear of falling ill. Mann–Whitney U and Kruskal–Wallis tests were conducted to explore potential differences in total scores based on demographic and mental background factors. Preclinical students had significantly higher mean scores compared to clinical students (41.68 vs. 39.35, p = 0.001). Respondents who had used psychiatric or psychotherapeutic counseling for reasons other than those inquired had significantly higher scores than those who did not (43.85 vs. 40.35, p < 0.001). Similarly, respondents planning to visit a psychiatrist/psychologist due to their fear of falling ill scored significantly higher than those who did not share this intention (43.85 vs. 39.96, p < 0.001). Multiple linear regression analysis revealed that the "year of study" variable was the only significant predictor of the total score, with a coefficient of -3.196, a t-statistic of -4.057, and a p-value < 0.001. This negative coefficient suggested that as the year of study increased, the total score tended to decrease significantly. However, the model had relatively weak explanatory power, with R² indicating that it explained only about 3.5% of the variance in the dependent variable, and R²adj accounting for approximately 2.7% after adjusting for model complexity. CONCLUSION: In summary, the study included a diverse group of participants with varying demographic and mental background factors. Preclinical students tended to have higher scores, and those with a history of seeking mental health services or expressing an intention to do so had higher scores. The year of study was a significant predictor of the total score, suggesting that as students progressed in their studies, their scores tended to decrease. However, the model's overall explanatory power was relatively limited.

Waheeb Radman Al-Kubati,1 Hanan Rihani,2 Abdelaziz Zeadat2 1Surgery Department, 21st September University, Sana’a, Yemen; 2General Surgery, King Hussein Medical Centre, Amman, JordanCorrespondence: Ass. Prof. Waheeb Radman Al-Kubati, MBBS JBS ABS IMRCSI ASCRS ACPGBI ISID ISUCRS. Surgery Department, 21st September University, Sana’a, Yemen, Tel +967773738130, Email waheebradman@yahoo.comBackground: Chylous Ascites is a rare condition. It develops as a result of iatrogenic injury to the cisterna chyli, thoracic duct, or their major tributaries. It leads to an increase in chyle release. Subsequently, obstruction of lymphatic return from abdomen. It is more prevalent after major abdominal procedures involving retro-peritoneum.Case Presentation: A 65 years old female patient was admitted with a history of pain at epigastric and left upper abdominal quadrant via the emergency department at King Hussein Medical Centre. She was planned for elective Whipple’s procedure for cancer head of pancreas. This case report considers the impact of intraoperative injury to major lymphatic system leading to chylous ascites and death following her pancreatic resection. Retrospective evaluation of her records revealed an intraoperative iatrogenic injury to the cisterna chyli had occurred during Whipple’s Procedure. The injured lymphatic duct was discovered and repaired intraoperatively. The chyle drainage was resolved temporarily after 3 weeks of conservative management. Despite its resolution, it recurred after massive upper GI bleeding, which was managed operatively after failed endoscopic and embolization. The patient failed to recover and died as a direct result of her poor general condition due to the effects of an iatrogenic injury of Cisterna Chyli. We report this case of intraoperative injury to the cisterna chyli, subsequent development of chylous ascites, and its post-operative sequelae. This article considers, even if discovered and repaired intraoperatively, the impact of such injury on development of postoperative chylous ascites, nutritional insufficiency, poor prognosis, and subsequent death.Conclusion: Chylous ascites is a rare complication of Whipple’s Procedure. It usually progresses due to iatrogenic operational trauma to a significant lymphatic channel. Even if such injury to cisterna chyli is discovered and managed intraoperatively, it carries a poor prognosis and subsequent death.Keywords: Whipple’s Procedure, WP, Chylous ascites, CA, Pancreatico-Duodenectomy, PD, Cisterna chyli, CC

The main objective of this study was to investigate the photodegradation of azo dye Cibacron Brilliant Yellow 3G-P using Anatase, Degussa-P25 and ZnO. These semi-conductors were characterized using XRD, BET and TEM-EDX. The variation of the amount of semi-conductors significantly affect the rate of color removal. The decolorization rate increased as the catalyst dosage was increased. Other parameters were also studied, such as stirring speed, pH, and initial dye concentration. It was found that the rate of decolorization increases with the increase of stirring speed. Decolorization of about 30, 60 and 80% was respectively achieved in the case of Anatase, Degussa-P25 and ZnO at low stirring speed (50rpm). At pH = 3, the degradation rate was found to be higher than the alkaline pH, about 95.58 and 85.71% of color has been decolorized with Anatase and Degussa-P25 respectively. While using ZnO, the color removal reached maximum in acidic and alkaline solutions, more than 95% of dye was decolorized. The concentrations dye solutions less than 80ppm led to the removal rate of about 95% in the case of ZnO, while it was only about 8–15% in the case of TiO2 with the concentration more than 20 ppm. HIGHLIGHTS Decolourization and photocatalytic degradation of Cibacron Brilliant Yellow 3G-P under UV light radiation.; Anatase displayed higher photocatalytic efficiency than Degussa-P25 and ZnO.; The photocatalytic degradation efficiency of Anatase and Degussa-P25 was observed to be higher at pH = 3.;

We report on the effect of rapid thermal annealing (RTA) on GaAs1−x−Nx layers, grown by molecular beam epitaxy (MBE), using room temperature spectroscopic ellipsometry (SE). A comparative study was carried out on a set of GaAs1−x−Nx as-grown and the RTA samples with small nitrogen content (x = 0.1%, 0.5% and 1.5%). Thanks to the standard critical point model parameterization of the GaAs1−x−Nx extracted dielectric functions, we have determined the RTA effect, and its nitrogen dependence. We have found that RTA affects more samples with high nitrogen content. In addition, RTA is found to decrease the E1 energy nitrogen blueshift and increase the broadening parameters of E1, E1+Δ1, E′0 and E2 critical points.

Pediatric Differentiated Thyroid Cancer (pedDTC) is a rare pediatric malignancy with an increasing incidence over time. To date, there is a paucity of literature specifically addressing pedDTC within the context of Middle Eastern ethnicity. This retrospective study aimed to assess the risk-stratifying factors for overall survival (OS) and event-free survival (EFS) in pediatric DTC patients from Iraq and Jordan. The medical records of 81 patients from two tertiary cancer institutes were retrieved. Kaplan–Meier analysis was employed to investigate OS and EFS, and the Cox proportional hazards model was employed to estimate hazard ratios. All patients underwent surgery and radioactive iodine therapy, with a median age of 14 and an interquartile range of 12–15. Lymph node involvement was observed in 55% of cases, while distant metastases were present in 13.5%. After a median follow-up period of 68 months, the 10-year survival rate was determined to be 94%, while the 10-year EFS rate was 58%. EFS was negatively impacted by cervical lymph node metastases and early age of diagnosis (p ≤ 0.01, each). Therefore, pediatrics with initial cervical lymph node metastases and those diagnosed before puberty tend to experience poorer EFS, which may justify the need for more aggressive management plans.

The present study aimed at optimizing the combined effect of enzymatic and thermo-chemical pretreatment hydrolysis of bread waste (BW) for enhancing the yield of reducing sugars (RS). Statistical optimization of enzymatic and thermochemical pretreatment processes was performed using the central composite design (CCD) tool of response surface methodology (RSM) using four process parameters (waste bread ratio, alpha-amylase concentration, temperature and pH) on total sugars yield as response variable. It was found that the optimal conditions for maximally RS yield were at bread ratio of 0.03 g/mL, alpha-amylase concentration of 0.2 mL/L, temperature of 100 °C and pH 5.3. Under these conditions, the yield of RS reached 90%, with bioethanol concentration of about 85.8 g/L after 72 h of batch fermentation. The modified Gompertz equation was used to describe the cumulative bioethanol production. A good agreement was found between simulated and experimental data. HIGHLIGHTS Enzymatic and thermochemical pretreatments increased the bread waste hydrolysis.; The maximum total sugars yield was achieved at bread ratio of 0.03 g/mL, alpha-amylase concentration of 0.2 mL/L, temperature of 100 °C and pH 5.3.; The yield of RS reached 90%.; The bioethanol concentration reached 85.8 g/L after 72 h of batch fermentation.;

IntroductionJordan hosts one of the highest numbers of refugees per capita in the world, with the Syrian crisis leading to an influx of displaced persons to the already vulnerable population. However, limited resources and a lack of cancer-care strategies have made it difficult for refugees in Jordan to access quality cancer care. The King Hussein Cancer Center (KHCC) and Foundation (KHCF) have played a pivotal role in providing financial and medical support for displaced children with cancer, treating 968 non-Jordanian children with cancer between 2011-2022, with a median age of 6 years. Of these, 84% were fully funded by KHCF, and nationalities included Syrians (29%), Palestinians (26%), Iraqis (23%), and Yemenis (17%). Cancer diagnoses included solid tumors (44%), leukemia (23%), lymphoma (13%), bone sarcomas (9.5%), and retinoblastoma (9.1%). The median cost of treatment was JOD 18,000 (USD 25,352), with a total estimated cost of JOD 23.8 million (USD 33.5 million). More recently, in partnership with St. Jude Children’s Research Hospital (SJCRH), two successive humanitarian funds (HF) were established to optimize cancer care for displaced children in Jordan.ResultsBetween February 2018 and September 2022, 51 children were fully treated on KHCC-SJCRH-HF, with a median age of 6 years and nationalities including Syrians (80%), Iraqis (6%), and Yemenis (8%). The most common cancer diagnoses were leukemia (41%), lymphoma (25%), solid tumors (24%), retinoblastoma (6%), and brain tumors (4%). Of these, 94% are alive and 51% are still receiving coverage. The median coverage for patients was JOD 21,808 (USD 30,715), and the total cost of treatment on KHCC/KHCF-SJCRH/American Lebanese Syrian-Associated Charities HF1 and HF2 was JOD 1.44 million (USD 1.97 million) and JOD 1.18 million (USD 1.67 million), respectively.ConclusionThis experience highlights the high burden of displaced children with cancer in Jordan, and the importance of local foundations like KHCC/KHCF and partnerships with international partners like SJCRH in providing lifesaving humanitarian initiatives and quality cancer care. Innovative cancer-care delivery models and sustainable financing are essential to ensure continuous coverage and access to cancer care for displaced persons in Jordan.

Abstract Introduction T‐cell acute lymphoblastic leukemia (T‐ALL) accounts for approximately 15% of all newly diagnosed ALL in children and adolescents and is associated with worse outcomes compared to pre‐B ALL. We aimed to decrease T‐ALL relapses by intensifying our regimen. Methods Patients with T‐ALL were treated using two different regimens; before September 2014, patients were treated per St. Jude Total XV protocol; subsequently, a major change was adopted by adding two intensive blocks: FLAG and Reintensification. Cranial radiation was limited to patients with WBC ≥ 100 k/μl at diagnosis and/or patients with CNS2/CNS3 status. Results Between June 2005 and April 2020, a total of 100 patients (76 males) were treated and followed up for a median of 70 months (range 14–181). Median age at diagnosis was 9 years (range 0.5–17.8). Forty‐eight patients were diagnosed after September 2014 and received the augmented regimen; their median follow up was 46 months (range 14–74). The 5‐year‐EFS estimates for patients who received the augmented regimen versus standard regimen were 87% ± 4.9% versus 67% ± 6.8% (p = .03); and the 5‐year‐OS estimates were 87% ± 5.1% versus 71% ± 6.3% (p = .06), respectively. Treatment related mortality (TRM) was reported in two patients treated per standard regimen but none for patients who received the augmented regimen. Conclusions We implemented a novel approach with early intensification added to a backbone of modified St. Jude Total‐XV regimen for patients with T‐ALL that resulted in improved outcome with no treatment related mortality.

Abstract Drug safety is generally established from clinical trials, by pharmacovigilance programs and during observational phase IV safety studies according to drug intended or approved indications. The objective of this study was to estimate the risk of potential adverse drug events (ADEs) associated with drugs repurposed for coronavirus disease 2019 (COVID‐19) treatment in a large‐scale population. Drug claims were used to calculate a baseline medication risk score (MRS) indicative of ADE risk level. Fictitious claims of repurposed drugs were added, one at a time, to patients’ drug regimens to calculate a new MRS and compute a level of risk. Drug claims data from enrollees with Regence health insurance were used and sub‐payer analyses were performed with Medicare and commercial insured groups. Simulated interventions were conducted with hydroxychloroquine and chloroquine, alone or combined with azithromycin, and lopinavir/ritonavir, along with terfenadine and fexofenadine as positive and negative controls for drug‐induced Long QT Syndrome (LQTS). There were 527,471 subjects (56.6% women; mean [SD] age, 47 years [21]) were studied. The simulated addition of each repurposed drug caused an increased risk of ADEs (median MRS increased by two‐to‐seven points, p

The aim of this study is to investigate the use of ultrasound pretreatment as potential technique to solubilize organic matter and fermentation of fruit juice effluents in anaerobic batch reactor. The efficacy of ultrasound pretreatment has been assessed at low frequency of 20 kHz and at different sonication times (20, 40 and 60 min). Compared with control, the amount of biogas produced increased by 47, 57 and 60% for sonication times of 20, 40 and 60 min, respectively. Methane content of the produced biogas was about 59% in the control and 64% in the case of effluent subjected to ultrasonication for 60 min. After 20 days of anaerobic digestion of the fruit juice effluents, the efficiency of chemical oxygen demand (COD) increased by 9, 31 and 35% with respect to control for sonication times of 20, 40 and 60 min, respectively, corresponding to total sugars uptake efficiency of about 35, 51 and 54%, respectively. The modified Gompertz equation was used to describe the cumulative biogas production. A good agreement was found between simulated and experimental data. HIGHLIGHTS Biogas production from fruit juice processing industry.; Ultrasound pretreatment to improve biogas production.; High methane content is obtained for prolonged sonication time.; The COD removal increased by 35% for sonication time of 60 min.;