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Abstract Due to its nutritional value and health benefits, the date palm (Phoenix dactylifera L.) is an essential dietary food crop throughout Middle Eastern and African countries. Consumers are concerned about the possible microbial contamination of dates, especially since most dates arriving in local markets are unprocessed. The absence of processing increases the possibility of microbial contamination, which raises the probability of microbial contamination. This study aims to analyze and evaluate the variability of fungal and bacterial microbiota identified in the most popular date palm fruits in Saudi Arabia. The study assessed ten date variety fruits from the most popular date palm varieties for consumption in Saudi Arabia and analyzed the microbial count. Morphological and molecular characterization and comparison of nuclear ribosomal DNA internal transcribed spacer (ITS) sequences identified 78 fungi, including 36 distinct species across 15 fungal genera. Alternaria, Fusarium, Curvilaria, Aspergillus, and Penicillium were the most frequent genera among the ten fruit cultivars studied, according to ITS-rDNA sequence analysis. Furthermore, 36 bacterial isolates were obtained from ten date varieties studied, each with a unique colony morphology. These isolates were identified based on sequence alignment and comparison of their 16S rDNA internal spacer regions to those available in public databases. The results showed that the bacterial isolates included 15 species from five bacterial genera. The results suggested that Bacillus, Stenotrophomonas, and Brucella were the prevailing genera among the ten tested fruit varieties. Some bacterial genera, such as Brucella, Achromobacter, and Stenotrophomonas, are well-known potential human pathogens. Chaetomium globosum was also recognized as air pollution causing adverse health effects such as allergies and as the causal agent of human fungal infections among the tested date varieties; the Rashodiah type exhibited the highest fungal contamination, whereas the Sagai variety displayed the lowest fungal contamination. Conversely, the Sukkari, Barhi, and Mejdool varieties were the most contaminated with bacteria among the ten tested varieties, while the Khalas variety showed the least bacterial contamination. To the best of the authors' knowledge, this study provides the initial comprehensive account of the molecular and morphological identification of all fungal and bacterial genera associated with date palm (P. dactylifera) fruits.

According to their respective positions, participants at the local, regional, and global actors within the poultry farming sector play strategic roles according to their respective positions. While these roles may integrate and overlap, they can also generate conflicts of interest at both the actor and institutional levels. This study analyses the actors and power relations in laying hen farming in Blitar Regency, East Java, Indonesia. The data were collected using structured interview techniques (interview guides and Matrix of Alliances and Conflicts: Tactics, Objectives and Recommendations questionnaires), observation, documentation, and focus group discussions. The research informants were chosen deliberately based on various sources including farmers, farmer groups, cooperative, central and local government, companies, and traders. This was in addition to informants obtained using the snowball sampling technique such as middlemen, poultry shops (PSs) and other additional breeders. Data validity was determined using source triangulation and method triangulation. The results revealed that the individuals and entities engaged in layer hen farming encompass a diverse range of actors. These include farmers of various scales (small, medium, and large), institutions such as farmer groups and cooperatives, governmental bodies at both central and regional levels, industry representatives such as companies, PSs, distributors involved in producing and marketing day-old chick (DOC), feed, medicines, and vaccines, as well as market participants including local traders and traders operating across different regions. Small-scale and medium-scale farmers have the strongest relationships due to their high dependence on inputs such as DOC, feed, vaccines, and access to markets. The presence of various actors and power relations in laying hen business institutions creates both collaboration and competition in the supply of DOCs, animal feed, medicine, and even in the marketing of eggs from a food security and sustainability perspective.

Cold stress has an immediate impact on plant structure and function. A large number of free radicals cause oxidative stress in plants. Cold stress causes altered membrane permeability, lipid peroxidation, and DNA damage. It denatures enzymes and disrupts plant metabolism. Different methods are being investigated for acclimatizing plants subjected to cold stress. Nanobiotechnology and bacterial strains are growing agricultural strategies. Nanoparticles’ (NPs) unique qualities (small size, high mobility, biocompatibility, low cost, and increased reactivity) make them ideal candidates in agriculture. NP and bacterial applications maintain plastid structure and function, enhance antioxidant activities, secondary metabolites, and hormone expression, and reduce electrolyte leakage. They increase the number and content of proteins involved in oxidation–reduction reactions, hormone pathways, stress signaling, and reactive oxygen species detoxification under cold stress conditions. Chitosan, zinc oxide, and titanium dioxide NPs can help plants with cold stress. Meanwhile, bacterial strains in the genus Bacillus and Pseudomonas have been tested for cold tolerance. These strategies also upregulate antifreeze proteins, which are essential for the storage of plant products. Nano-bio-fertilizers should be prepared for the sustainable development of plants under low temperatures.

BackgroundDrug-resistant epilepsy (DRE) impacts a significant portion, one-third, of individuals diagnosed with epilepsy. In such cases, exploring non-pharmacological interventions are crucial, with the ketogenic diet (KD) standing out as a valuable option. KD, a high-fat and low-carb dietary approach with roots dating back to the 1920s for managing DRE, triggers the formation of ketone bodies and modifies biochemistry to aid in seizure control. Recent studies have increasingly supported the efficacy of KD in addressing DRE, showcasing positive outcomes. Furthermore, while more research is needed, limited data suggests that KD May also be beneficial for specific genetic epilepsy syndromes (GESs).ObjectiveThis study aimed to assess the short-term efficacy of KD among pediatric patients diagnosed with GESs.Materials and methodsThis is a multi-center retrospective analysis of pediatric patients with GESs diagnosed using next-generation sequencing. The enrolled patients followed the keto-clinic protocol, and the KD efficacy was evaluated at 3, 6, and 12-month intervals based on seizure control and compliance. The collection instrument included demographic, baseline, and prognostic data. The collected data was coded and analyzed promptly.ResultsWe enrolled a cohort of 77 patients with a mean current age of 7.94 ± 3.83 years. The mean age of seizure onset was 15.5 months. Notably, patients experienced seizures at a younger age tended to have less positive response to diet. Overall, 55 patients responded favorably to the diet (71.4%) while 22 patients (28.6%) showed no improvement. Patients with genetic etiology showed a significantly more favorable responses to the dietary intervention. Patients with Lennox–Gastaut syndrome showed the most significant improvement (14/15) followed by patients with Dravet syndrome (6/8), and West syndrome (3/4). The number of used anti-seizure medications also played a significant role in determining their response to the diet. While some patients experienced mild adverse events, the most common being constipation, these occurrences were not serious enough to necessitate discontinuation of the diet.ConclusionThe study revealed a high improvement rate in seizure control, especially among younger patients and those with later seizure onset. The success of dietary treatment hinges greatly on early intervention and the patient’s age. Certain genetic mutations responded favorably to the KD, while efficacy varied among various genetic profiles.

Careful study of applied sciences and their development requires us to expand the scope of analytical studies. We aim during introducing the current manuscript to rediscover and present Grüss inequality in a new framework. In order to do that, we use the recently generalized proportional fractional integral operator for a certain function with respect to another continuous and strictly increasing function. Furthermore, we prove some new related inequalities using the current fractional integral operator. Some special cases of the presented results will be discussed.

This research paper presented a novel investigation into an implicit coupled system of fractional variable order, which has not been previously studied in the existing literature. The study focused on establishing and developing sufficient conditions for the existence and uniqueness of solutions, as well as the Ulam-Hyers stability, for the proposed coupled system without using semigroup property. By extending the existing conclusions examined for the Atangana-Baleanu-Caputo (ABC) operator, we contributed to advancing the understanding of variable-order fractional differential equations. The paper provided a solid theoretical foundation for further analysis, numerical simulations, and practical applications. The obtained results have implications for designing and controlling systems modeled using fractional variable order equations and serve as a basis for addressing a wide range of dynamical problems. The transformation techniques, qualitative analysis, and illustrative examples presented in this work highlight its unique contributions and potential to serve as a foundation for future research.

Objective. To examine the postnatal predictors of survival and adverse outcome among Congenital Diaphragmatic Hernia (CDH) infants. Method. Six-year retrospective review of CDH infants born at tertiary neonatal unit. Results. Forty infants with CDH were included; 27 (67.5%) survived to discharge. Non-survivors had a higher best, mean, and highest oxygenation index (OI) ( P

ObjectiveTo explore the relationship between Oxygenation Index (OI) and Oxygen Saturation Index (OSI) among infants with Congenital Diaphragmatic Hernia (CDH), both within the first 24 h after birth and in extended observations in those who survived until their surgical intervention.MethodsSeven- years retrospective review of CDH cases at a single Level III neonatal intensive care unit. The correlations of various combinations of OI-OSI pairs were assessed using the Spearman's rho Correlation Coefficient. Additionally, during the initial 24 h, the correlations between admission (first), best (lowest), highest, and mean OI and OSI values were determined. The predictive ability of the first 24 h oxygen and oxygen saturation indices for mortality and other adverse outcomes were assessed using the Area Under the Curve (AUC) analysis.ResultsThirty-seven infants with CDH were included in the analysis. A strong correlation was observed between all pairs of OI/OSI (2,289) (Spearman's rho = 0.843), matched pairs of Postductal OI/OSI (1,232 pairs) (Spearman's rho = 0.835) and the unmatched pairs of Postductal OI and Preductal OSI (1,057 pairs) (Spearman's rho = 0.852). Using the regression equations for all pairs, matched and unmatched OI/OSI pairs, we deduced that for clinically pertinent OI thresholds of 10, 15, 20 and 40, the corresponding OSI values were 5, 8, 11, and 23, respectively. Furthermore, in the first 24 h, strong correlations were evident between OI/OSI: at admission (Spearman's rho = 0.783), best OI/OSI (Spearman's rho = 0.848), and highest OI/OSI (Spearman's rho = 0.921). The most robust correlation was observed between the mean OI/OSI with a Spearman's rho of 0.928. First (AUC = 0.849), best (AUC = 0.927), highest (AUC = 0.942) and mean day 1 OI (AUC = 0.946) were all predictive of mortality. Similarly, first (AUC = 1.00), best (AUC = 0.989), highest (AUC = 1.00) and the mean OSI in day 1 (AUC = 0.978) were all predictive of mortality. All of the OIs and OSIs in day 1 except for the admission OSI (AUC = 0.683) were predictive of pulmonary hypertension. Additionally, all of OI and OSI indices in the first 24-hour except for the best day 1 OI (AUC = 0.674) were predictive of the need for rescue HFOV.ConclusionThere were a strong correlation between the OI and OSI in infants with CDH. Oxygenation indices and OSI in the first 24 h were predictive of mortality and other adverse outcomes in infants with CDH.

The primary focus of this paper is to thoroughly examine and analyze a class of a fractional quadratic integral equation via generalized fractional integral. To achieve this, we introduce an operator that possesses fixed points corresponding to the solutions of the fractional quadratic integral equation, effectively transforming the given equation into an equivalent fixed-point problem. By applying the Banach fixed-point theorems, we prove the uniqueness of solutions to fractional quadratic integral equation. Additionally, The Adomian decomposition method is used, to solve the resulting fractional quadratic integral equation. This technique rapidly provides convergent successive approximations of the exact solution to the given fractional quadratic integral equation, therefore, we investigate the convergence of approximate solutions, using the Adomian decomposition method. Finally, we provide some examples, to demonstrate our results. Our findings contribute to the current understanding of fractional quadratic integral equation and their solutions and have the potential to inform future research in this area.

Introduction: Imposter syndrome is common among health disciplinary students, leading to serious consequences. However, the impact of imposter syndrome on self-esteem and quitting intention among respiratory therapy students has not been well researched. Objective: To report on the prevalence of imposter syndrome and assess its impacts on self-esteem and quitting intention among respiratory therapy students in Saudi Arabia. Methods: A nonprobability cross-sectional questionnaire using the Clance Impostor Phenomenon Scale and the Rosenberg Self-Esteem Scale was self-administered and distributed among respiratory therapy students between October 2022 and April 2023. Data analysis was performed using Descriptive and inferential statistics. Results: Of the 1500 respiratory therapy students invited to participate in the study, 901 surveys were completed; and thus, included in the final analysis. Of whom, 92% were presented with imposter syndrome: 44% with moderate, 35% with frequent, and 13% with intense feelings. In addition, 60% of respiratory therapy students and interns experienced low self-esteem, while only 0.5% indicated high self-esteem. More than 50% of the study participants thought about quitting the respiratory therapy program, and 30% have been diagnosed with psychological disorders. Furthermore, there was a significant association between imposter syndrome and low self-esteem, p 0.005). Conclusion: Imposter syndrome and low self-esteem are prevalent among respiratory therapy students, both of which are associated with considering leaving the respiratory therapy program. Effective interventions should be implemented to ameliorate the symptoms imposter syndrome and low self-esteem; thus, improving the academic experience of respiratory therapy students.

Objective . To describe heated humidified high-flow nasal cannulas (HHHFNC) utilization in level III neonatal intensive care units (NICUs) in Saudi Arabia. Methods . A prospective cross-sectional study using an electronic web-based questionnaire. The survey targeted level III NICUs hospitals using HHHFNCs, covering HHHFNC availability, protocols, patient characteristics, and indications. It also collected opinions on the benefits of HHHFNCs compared to nasal continuous positive airway pressure (nCPAP). Results . Out of 47 government-level III neonatal intensive care units, 35 (74%) responded to the survey. Among the included units, 46% had guidelines for HHHFNC use. Additionally, 51% reported using HHHFNC in infants of all gestational ages. The primary indication for HHHFNC use was weaning off nCPAP (34%), with 60% of the respondents noting its advantages for kangaroo care and breastfeeding. Conclusion . HHHFNC are increasingly prevalent in NICUs in Saudi Arabia. However, there remain no clear policies or guidelines regarding their use in preterm infants.

Egyptian Jallab (EJ) is a conical candy (light to dark brown), manufactured from a part of sugar cane juice, that is used in the black honey industry. EJ is considered an unrefined sugar or a non-centrifugal form of sugar. The traditional use of Jallab is as candy, but it can also be used for making ice cream, cupcakes, biscuits, and toffee, as well as being used in other food applications. In this study, EJ was used as a sugar substitute in ice cream at 0, 25, 50, 75, and 100%. Total solids, titratable acidity, pH, protein, ash, fat, specific gravity, weight per gallon, viscosity, color attributes, total antioxidant activity, total phenolic content, and total flavonoid contents, as well as microbiological analyses, were tested. The total solids, protein, and ash in the Egyptian Jallab ice cream (EJIC) increased from 39.30, 4.85, and 0.87 to 41.19, 6.36, and 1.42, respectively. The gradual sugar substitution led to a significant increase in specific gravity and weight per gallon in pounds. The lightness (L*) of the ice cream decreased significantly due to the substitution of EJ for sugar. Moreover, there was a significant increase in a* (from 0.147 in control samples to 5.52 in treatment 4, which had 100% EJ). The changes in the b* values of Jallab ice cream samples were significantly increased due to the substitution of EJ for sugar. The control samples had a low value of antioxidant activity (21.53%) when compared with the treatment, which has EJ (88.82, 89.96, 91.98, and 92.14%) for EJIC1, EJIC2, EJIC3, and EJIC4, respectively. The total phenolic contents are 2.07, 3.03, 4.14, and 4.68 fold higher in the treatments with EJ substituted for sugar than in the control samples. Total flavonoid contents increased from 5.73 mg QE g−1 in control samples (TC) to 14.68, 21.54, 30.48, and 34.15 mg QE g−1 in EJIC1, EJIC2, EJIC3, and EJIC4 mg QE g−1 in ice cream samples, respectively.

Introduction Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. Methods Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). Results The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. Conclusions Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use.

This study aims to examine the dynamics of subsidized fertilizer management in rice production areas in Sidrap and Wajo districts, South Sulawesi province. Using a case study approach with qualitative analysis, the study combined primary data from in-depth interviews and secondary data derived from various studies and reports from government organizations. The results show that there is a considerable gap between the government’s fertilizer budget and farmers’ actual needs, leading to coverage of only 37%, thus forcing farmers to purchase more expensive non-subsidized fertilizers. The inefficient distribution system results in delays and scarcity. As a result, there will be market and price dualism between subsidized and non-subsidized markets, as well as subsidized and non-subsidized prices. Enforcement of pricing regulations faces hurdles due to the black market. In addition, farmers use the “foster father” system to obtain credit. To improve fertilizer management, the study recommends a multifaceted approach: increased budget allocation, efficient distribution, strong enforcement of pricing regulations, and innovative financing solutions such as the Tani Card. These strategies, along with improved inter-agency coordination, aim to address challenges and increase the effectiveness of subsidized fertilizer policies.

This research paper provides a comprehensive review of the utilization of high-flow nasal cannula (HFNC) therapy as a means of respiratory support in extremely premature infants. The paper elucidates the underlying mechanisms of HFNC, which encompass the provision of distending pressure, reduction of respiratory effort, facilitation of carbon dioxide elimination, and optimization of gas conditioning. Noteworthy advantages of HFNC in comparison to invasive ventilation include enhanced oxygenation, improved lung compliance, and promotion of bonding, while simultaneously mitigating the occurrence of complications. Nevertheless, it is important to acknowledge potential drawbacks associated with HFNC, such as heightened morbidity, inadequate support necessitating reintubation, and an elevated risk of air leaks. Further investigations are imperative to refine HFNC protocols, conduct comparative analyses with alternative interventions, and enhance overall patient outcomes. In summation, HFNC represents an efficacious noninvasive respiratory treatment modality for premature infants, albeit with certain limitations. The optimization of benefits can be achieved through meticulous monitoring and standardization of practices.

Introduction There is a paucity of studies on e-cigarette use among adults with chronic lung disease. In the present study, we aimed to assess whether psychosocial or cognitive factors elucidate the relationship between chronic lung disease (CLD) and susceptibility to e-cigarette use and whether the relationship between CLD and e-cigarette use is conditional on the presence of respiratory symptoms. Methods We recruited adults aged ≥18 years in Alabama with CLD from university medical clinics (n=140) and individuals without CLD (n=123 as a reference group). Information on sociodemographics, susceptibility to e-cigarette use, psychosocial factors, and cognitive factors were collected. Mediation analysis was used to assess whether the psychosocial factors or cognitive factors explained the association between CLD and susceptibility to using e-cigarettes, and moderation analysis was conducted to determine if respiratory factors would change the association between CLD and susceptibility to e-cigarette use. Results Psychosocial factors (stress, depression, anxiety) and e-cigarette positive expectancy were notably high among individuals with CLD. Having CLD was associated with a lower likelihood of susceptibility to e-cigarette use. Higher levels of stress, being a smoker, boredom, taste/sensorimotor manipulation, and social facilitation were associated with higher odds of susceptibility to using e-cigarettes among individuals with CLD. Mediation analysis indicated a statistically significant indirect effect of CLD on the susceptibility to using e-cigarettes through stress and boredom reduction. We did not find a statistically significant interaction between CLD and respiratory symptoms affecting susceptibility to using e-cigarettes. Conclusions Individuals with CLD often exhibit stress, depression, and a positive view of e-cigarettes but are generally less inclined to use them. Stress, smoking habits, boredom, taste, and social influence can increase their susceptibility to e-cigarette use. Our findings call for further exploration to evaluate the temporal relationship between CLD status, psychosocial factors, cognitive factors, and susceptibility to using e-cigarettes. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov, on 5 November 2019. Identifier: NCT04151784

Abstract Background Autoimmune/type 1 diabetes mellitus (T1DM) is a recently described rare occurrence following the administration of adjuvants such as coronavirus disease 2019 (COVID-19) vaccines. This systematic review aimed to review all available literature on the potential association between COVID-19 vaccines and T1DM. Methods The Directory of Open Access Journals, MEDLINE, Google Scholar, and Scopus were systematically searched for all published studies from inception to July 2022. Articles reporting T1DM development within 8 weeks of administration of COVID-19 vaccine were included. Two reviewers independently performed the risk of bias assessment following the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. Results Eight eligible studies were retrieved, comprising 12 patients diagnosed with T1DM after being vaccinated with a COVID-19 vaccine. Six patients (50%) reported T1DM after receiving the second dose. Five patients (41.7%) presented with diabetic ketoacidosis, of which four presented within the first eight days after vaccination. Five patients (41.7%) had genetic susceptibility, with RNA binding motif protein 45 (RBM45/DRB1) and major histocompatibility complex, class II, DQ beta 1 (HLA-DQB1) mutations being prominent. Interpretation In this review, we have shown a small number of new-onset diabetes cases coincidently occurring soon after the COVID-19 vaccine, especially in those with genetic susceptibility. Despite being older, these patients had a similar phenotype to T1DM. While there might be a causal relationship between COVID-19 vaccines and T1DM development, this should not influence decisions regarding vaccination since the overall benefit outweighs the risk. Further larger prospective trials are needed to assess causal relationship and to clarify the potential roles of COVID-19 vaccine-derived antigens in autoimmune disease development. Protocol registration PROSPERO-CRD42022342093.