Search

Abstract Since the 1990s, China’s engagement beyond its geographical periphery, especially with Asian regions, has grown exceptionally, which is best evident in the Gulf sub-region and Western Asian nations. Indeed, energy-based interactions were the first to be established with Gulf Arab countries, and today, more than two decades after the Cold War, such relationships have evolved into tighter partnerships and engagement networks. Thus, in the last decade, China has increased its economic and political footprint in the Gulf region, as it has become one of the region’s largest external investors and trade partners. In its relations with the Gulf Cooperation Council (GCC) states, China faces varying challenges as each country pursues its interests, making the Chinese strategy in the region more complex. The Gulf countries have had to balance their relationship between the US as a security guarantor and China as an important economic partner. They strive to maximize their political and economic interests in the process. The main contention of this paper is that the GCC should not be viewed as a homogenous entity and that the Belt and Road Initiative (BRI) is a flexible approach designed to bolster China’s economic objectives in each Gulf country. Our research scrutinizes China’s geo-economic strategy and geopolitical aims about the Gulf States’ aspirations to maximize their economic ties with China. Against this background, this paper discusses the political and economic relationships between the People’s Republic of China and the Gulf Arab states: Bahrain, Kuwait, Qatar, Oman, the Kingdom of Saudi Arabia (KSA), and the United Arab Emirates (UAE).

Abstract Background Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia. Methods This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality. Results During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

Glioblastoma is the most common malignant primary brain tumor in adults. The prognosis is extremely poor even with standard treatment of maximal safe resection, radiotherapy, and chemotherapy. Recurrence is inevitable within months, and treatment options are very limited. Chimeric antigen receptor T-cell therapy (CART) and bispecific T-cell engagers (TCEs) are two emerging immunotherapies that can redirect T-cells for tumor-specific killing and have shown remarkable success in hematological malignancies and been under extensive study for application in glioblastoma. While there have been multiple clinical trials showing preliminary evidence of safety and efficacy for CART, bispecific TCEs are still in the early stages of clinical testing, with preclinical studies showing very promising results. However, there are multiple shared challenges that need to be addressed in the future, including the route of delivery, antigen escape, the immunosuppressive tumor microenvironment, and toxicity resulting from the limited choice of tumor-specific antigens. Efforts are underway to optimize the design of both these treatments and find the ideal combination therapy to overcome these challenges. In this review, we describe the work that has been performed as well as novel approaches in glioblastoma and in other solid tumors that may be applicable in the future.

We offer a new angle to explain the comprehension of mathematical infinity. We use Action-Process-Object-Schema (APOS) theory to explore the construction of different aspects of the cognitive Object related to this notion. We focus our attention on different ways of interacting with infinity, and how to act on infinite entities. Our aim is to shed light on the nature of mental constructions that take place when individuals deal with mathematical infinity. An infinite union of finite subsets of N provides the context for our theoretical analysis and the design of interviews conducted with graduate students and instructors. In this study we identify three types of Actions with different complexity levels. When these Actions are performed, they lead to the construction of different facets of the associated Object. We question the construction of an Object conception in infinity-related situations and offer an explanation that might change the way we think about the learning of certain mathematical concepts. We discuss the implications of our research for the advancement of APOS theory. We also offer pedagogical suggestions related to the comprehension of mathematical infinity.

Heat is a leading weather-related cause of death worldwide and heat waves are increasing globally in terms of frequency, duration, and intensity. Global heat-related deaths could quadruple by midcentury. As with many environmental hazards, numerous factors impact how heat might affect any given person and there are significant gaps in our understanding related to indoor heat and its effect on health. Despite growing interest in establishing standards and guidelines, there is currently no clear consensus on a safe maximum upper limit for indoor temperature. There is conclusive evidence of links between high outdoor temperatures and human health yet research on this correlation does not typically explicitly consider indoor heat exposure. Considerably more research has been completed on healthy, active individuals than for more heat-susceptible populations and the impacts of moderate heat stress on the health of large populations are not well understood. We conducted a literature review on the impact of indoor thermal conditions on health, recognizing that air temperature alone cannot describe thermal exposure. We introduce the concept of a standardized maximum safe indoor temperature, defined for still air conditions, 50% relative humidity and mean radiant temperature equal to air temperature. Equivalent temperatures with respect to the thermal load on the body can then be calculated for various air velocities, humidities or mean radiant temperatures using the standard effective temperature (SET) model. For U.S. policymakers, we propose adopting a standardized maximum safe indoor temperature of 28 °C. We recognize that the adoption of standardized maximum safe indoor temperatures may vary around the world, but the framework we propose to adjust the standardized upper limit for humidity, air motion, and radiant temperature could be used globally. We also identify important knowledge gaps to guide future research on the relationships between heat and health that could support informed cost-benefit analyses.

Solitary fibrous tumors are fibroblastic mesenchymal neoplasms that also include what was previously known as hemangiopericytoma. Dedifferentiation of solitary fibrous tumors is rare and usually manifests as a high-grade sarcoma. We report a case of dedifferentiation of an intracranial leptomeningeal solitary fibrous tumor to a rhabdomyosarcoma in a 65-year-old female. The initial biopsy demonstrated a purely STAT6 positive leptomeningeal anaplastic hemangiopericytoma overlying the occipital lobe with no evidence of a rhabdomyosarcomatous component. Four years later, a biopsy of the recurrent tumor contained both solitary fibrous tumor and rhabdomyosarcoma elements intertwined. The following year at autopsy, only a rhabdomyosarcoma remained. The rhabdomyosarcoma grew predominately in a leptomeningeal pattern as did the antecedent solitary fibrous tumor, however, the autopsy also showed invasion of the brain parenchyma via the Virchow-Robin spaces indicative of increased aggressive behavior. Solitary fibrous tumors and their counterpart, hemangiopericytoma, are generally considered stable neoplasms with a characteristic STAT6 mutation. However, they may rarely undergo dedifferentiation to high grade sarcomas with a variety of morphologies including rhabdomyosarcoma. Our case is unique given the tumor’s leptomeningeal location and its differentiation to rhabdomyosarcoma lacking any solitary fibrous tumor component.

This qualitative action research study explores six reading strategies to engage students in more dynamic reading through the implementation of workshops focused on the cross-curricular approach to develop critical reading skills among ninth graders at a public school. The study was conducted with 22 students selected, in the city of Manizales, Colombia. The data collection instruments were students' artifacts, teachers' field notes, focus group questionnaires, survey questionnaires, and documentary analysis. The findings demonstrate that the use of reading strategies within a cross-curricular approach facilitates the development of critical reading in students. In addition, the design of materials (workshops), based on topics related to the students' environment, has an impact that not only contributes to improving their knowledge of English but also to expanding their knowledge in other areas of the academic field.

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.

The operational carbon emissions intensity of the electricity used in a building is commonly treated as a fixed value but grid carbon emissions factors have temporal and geographical variations, which makes building operating emissions dependent on when and where electricity is used. Grid electricity carbon characteristics can be quantified by either average or marginal emission rates, leading to an increasing debate about which metric provides more accurate results for determining the effect of various decarbonization strategies. We advocate for the use of the marginal operating emissions rate (MOER) to evaluate the impacts of demand-side management because it considers the generating plants' dispatch order and is able to reflect the change in emissions induced by demand management. In this study, we examined the benefits of emission-based load-shifting strategies by first analyzing the annual temporal variations of the Northern California grid region and developed a virtual chiller load shift strategy similar to demand response but interacting with the grid MOER signal. We then assessed its effect on the case study building by calculating the avoided emissions on a seasonal and annual basis through a numerical simulation. As a result, we found that for the Northern California region, shifting load is most effective during the spring season with 18% avoided carbon emissions when the grid has more renewable supply. However, the simulated annual result shows 2% avoided carbon emissions indicating the seasonal characteristics of the proposed strategy and the limitation of considering load shift strategy as the single solution to decarbonize.

High thermal mass radiant systems as a hydronic thermal mass activation method have many opportunities for cost-effective demand management. The system is regarded with the possibility of long-term transferring peak heating and cooling loads to off-peak hours and peak load reductions. This study conducted over 300,000 case calculations for a sensitivity analysis of load shifting parameters in radiant space conditioning systems across 16 climate zones in California, 14 different climatic cities outside California. The parameters analyzed include building geometric parameters (building length, width, window-to-wall ratio, orientation), internal heat source levels (from people, lights, plugs), control parameters (start and stop times), and the design construction of radiant terminals. A comparative analysis was also conducted across cities in different climatic conditions to explore the impact of climate on the load shifting capabilities of radiant space conditioning. The results of this study will aid in the formulation of strategies and the optimization design for load shifting in radiant cooling systems.

Extreme heat causes more weather-related deaths in the United States than any other natural hazard, and these events are projected to increase in frequency, intensity, and duration. As a result, it is critical to ensure safe thermal conditions in homes while minimizing excessive cooling energy use. In California, where the median age of homes is 45 years and nearly 40% lack mechanical cooling, this deficiency undermines one of the most essential goals of housing: to shelter people from outdoor weather of a warming planet. We aim to quantify the overheating risk in the housing sector to support the development of public policies related to maximum safe indoor thermal limits and building energy use. Using the ResStock modeling framework, we created over 52,000 building models to represent California's residential housing stock and assessed overheating risks by simulating indoor temperatures and analyzing the energy impacts of adding cooling systems.Our findings reveal significant regional disparities. Southern counties face the highest overheating risk, while coastal areas are less vulnerable due to oceanic temperatures. Inland counties, such as the Sierra Nevada region, are also less affected due to higher altitudes. Approximately 1.6 million homes will require retrofitting with cooling systems, which could increase peak electricity demand by 2%. Our sensitivity analysis showed that increasing the threshold temperature reduces the number of homes subject to overheating risk. These results significantly impact the electricity grid, emphasizing the need to consider passive cooling options like shading and cool roofs or energy-efficient cooling options like fans and evaporative coolers.

Our study uses EnergyPlus simulations to examine whole-building demand and energy end-use profiles for different design options and then uses these outputs to evaluate cost and carbon impacts of each scenario in Xendee, a modeling platform designed to “right size” and balance investments in distributed energy resources (DER). Our results show that efficiency measures are key to meet the ambitious performance metrics for this project; however, most of the technology potential occurs for heating, ventilation and air conditioning (HVAC) or domestic hot water (DHW) loads which are a relatively small portion of a mid-rise multifamily building’s overall energy use. The most meaningful strategies to reduce or shift loads for this building include DHW load shifting, energy recovery ventilation, dynamic ventilation, and ceiling fans. Envelope strategies improve overall annual building performance but become an issue when lower heat loss increases cooling during the critical afternoon peak. Compared to efficient, packaged air source heat pumps, a hydronic heating and cooling system (also serving DHW loads) with thermal energy storage has the best energy performance, highest load shifting capability, and best thermal resilience during outages. But because heating and cooling demands are small and hydronic systems are expensive, the net benefits of thermal energy storage are not substantial. Sizing on-site generation and storage systems to cover the “worst case” outage conditions significantly drives up system size and cost. Even small deviations from 100% coverage (95%, or 99%) can dramatically reduce size and cost without a very meaningful change in resilience.

OBJECTIVES: To determine the role of keratin 17 (K17) as a predictive biomarker for response to chemotherapy by defining thresholds of K17 expression based on immunohistochemical tests that could be used to optimize therapeutic intervention for patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: We profiled K17 expression, a hallmark of the basal molecular subtype of PDAC, by immunohistochemistry in 2 cohorts of formalin-fixed, paraffin-embedded PDACs (n = 305). We determined a K17 threshold of expression to optimize prognostic stratification according to the lowest Akaike information criterion and explored the potential relationship between K17 and chemoresistance by multivariate predictive analyses. RESULTS: Patients with advanced-stage, low K17 PDACs treated using 5-fluorouracil (5-FU)-based chemotherapeutic regimens had 3-fold longer survival than corresponding cases treated with gemcitabine-based chemotherapy. By contrast, PDACs with high K17 did not respond to either regimen. The predictive value of K17 was independent of tumor mutation status and other clinicopathologic variables. CONCLUSIONS: The detection of K17 in 10% or greater of PDAC cells identified patients with shortest survival. Among patients with low K17 PDACs, 5-FU-based treatment was more likely than gemcitabine-based therapies to extend survival.

To decarbonize the buildings and electricity sectors at a pace consistent with state and national climate goals, buildings must become grid resources, capable of morphing load profiles to accommodate variable renewable generation, facilitate cost-effective grid decarbonization, and help ensure reliable power system operation. Simultaneously, the changing climate poses increasing risks of extreme weather events and resulting power outages that developers, designers, and building operators must plan for. This yield s new questions around the best approaches to achieve these outcomes, what it costs, who benefits, and what barriers there are to widespread adoption.We seek to answer these questions by adopting a futuristic set of grid-interactive design requirements for a mid-rise affordable housing, mixed-use development: to sustain critical loads during an outage and to consume no grid electricity for residential end-uses between 4-9pm every day. We present an approach that achieves these requirements, working to decarbonize the grid and maximize resilience for the facility and its residents while also addressing shortfalls in housing supply. Our work includes detailed building energy and economic optimization combined with construction cost analysis and carbon impacts. We find that achieving the requirements comes at a ~5% cost premium, an amount not likely to be acceptable for affordable housing under current policies and industry standards. We then generalize our design into a replicable ‘recipe’ to optimize the integrated use of distributed energy resources and explore the challenges to widespread adoption. We suggest many barriers could be overcome with policy changes that would bring benefits to under-resourced populations and society as a whole.

BackgroundIt is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID.MethodsNon-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo.FindingsParticipants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53-0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID.InterpretationAmubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID.FundingNational Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.

We evaluated the HIV-1 DNA reservoir in peripheral blood mononuclear cells (PBMC) and cerebrospinal fluid (CSF) in people with HIV (PWH) and associations to cognitive dysfunction. Using the intact proviral DNA assay (IPDA), an emerging technique to identify provirus that may be the source of viral rebound, we assessed HIV DNA in CSF and PBMC in PWH regardless of antiretroviral therapy (ART). CSF was used as a sampling surrogate for the central nervous system (CNS) as opposed to tissue. IDPA results (3' defective, 5' defective, and intact HIV DNA) were analyzed by compartment (Wilcoxon signed rank; matched and unmatched pairs). Cognitive performance, measured via a battery of nine neuropsychological (NP) tests, were analyzed for correlation to HIV DNA (Spearman's rho). 11 CSF and 8 PBMC samples from PWH were evaluated both unmatched and matched. Total CSF HIV DNA was detectable in all participants and was significantly higher than in matched PBMCs (p ​= ​0.0039). Intact CSF HIV DNA was detected in 7/11 participants and correlated closely with those in PBMCs but tended to be higher in CSF than in PBMC. CSF HIV DNA did not correlate with global NP performance, but higher values did correlate with worse executive function (p ​= ​0.0440). Intact HIV DNA is frequently present in the CSF of PWH regardless of ART. This further supports the presence of an HIV CNS reservoir and provides a method to study CNS reservoirs during HIV cure studies. Larger studies are needed to evaluate relationships with CNS clinical outcomes.

Frailty is classically associated with advanced age but is also an important predictor of clinical outcomes in comparatively young adults with cirrhosis. We examined the association of biological aging with frailty and post-transplant outcomes in a pilot of adults with cirrhosis undergoing liver transplantation (LT). Frailty was measured via the Liver Frailty Index (LFI). The primary epigenetic clock DNA methylation (DNAm) PhenoAge was calculated from banked peripheral blood mononuclear cells; we secondarily explored two first-generation clocks (Hannum; Horvath) and two additional second-generation clocks (GrimAge; GrimAge2). Twelve adults were included: seven frail (LFI ≥ 4.4, mean age 55 years) and five robust (LFI

BACKGROUND: The immune microenvironment impacts tumor growth, invasion, metastasis, and patient survival and may provide opportunities for therapeutic intervention in pancreatic ductal adenocarcinoma (PDAC). Although never studied as a potential modulator of the immune response in most cancers, Keratin 17 (K17), a biomarker of the most aggressive (basal) molecular subtype of PDAC, is intimately involved in the histogenesis of the immune response in psoriasis, basal cell carcinoma, and cervical squamous cell carcinoma. Thus, we hypothesized that K17 expression could also impact the immune cell response in PDAC, and that uncovering this relationship could provide insight to guide the development of immunotherapeutic opportunities to extend patient survival. METHODS: Multiplex immunohistochemistry (mIHC) and automated image analysis based on novel computational imaging technology were used to decipher the abundance and spatial distribution of T cells, macrophages, and tumor cells, relative to K17 expression in 235 PDACs. RESULTS: K17 expression had profound effects on the exclusion of intratumoral CD8+ T cells and was also associated with decreased numbers of peritumoral CD8+ T cells, CD16+ macrophages, and CD163+ macrophages (p

Effective use of resources in healthcare research is essential in meeting the United Nation’s Sustainable Development Goal (SDG) 3 to achieve universal health coverage, increase retention of healthcare workers, and strengthen the capacity of all countries to reduce risk and manage global health risks; the World Health Organization (WHO) also identifies nursing research as an important piece of the framework for improving global healthcare. Determining research priorities to reduce redundancy and ensure a solid evidence base for practice is especially critical in resource-limited countries or those facing healthcare crises such as those in the Middle East. To identify regional research priorities for nursing, focus group discussions composed of hospitalbased nurses were conducted in Egypt, Oman, and Saudi Arabia. Forty-eight percent of research priorities were nearly the same as those identified as critical by regional nursing leadership in a previous study, demonstrating consistency between clinicianand administrator-identified research priorities, and suggesting healthcare administrators are well attuned to the research needs of clinicians. Both groups identified critical gaps in population and community health research. Across countries, research priorities identified were related to nursing workforce, health systems research, and quality of care, representing critical issues needing investigation to build a solid evidence base for nursing practice.