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Background: Since the introduction of Erector Spinae Plane Block (ESPB) in 2016 it has been used with success in various thoracic, abdominal, and back surgeries. Many theories have been suggested for its mechanism of action, although the exact mechanism remains unknown. Spine surgeries result in significant postoperative pain, while using postoperative opioids provide adequate pain control in most of the cases, some cases still suffer from uncontrolled pain and patients receiving multiple doses of opioids suffer from various side effects including postoperative nausea and vomiting, constipation, and delayed ambulation. The aim of the study was to compare between the adjuvant effect of dexmedetomidine and magnesium sulfate given along with bupivacaine 0.25% in ESPB. Methods: This was a prospective randomized single blinded study including 52 patients divided in 2 groups; one receiving ESPB with a combination of bupivacaine 0.25% and magnesium sulfate and the other receiving the same block with a combination of bupivacaine 0.25% and dexmedetomidine. Statistical analysis for data collected was done using the (Statistical Package for the Social Sciences) version 26. Shapiro-Wilk test was used to check the normality of the data distribution. Quantitative variables were expressed as mean and standard deviation, median, inter-quartile range, minimum and maximum as appropriate. Results: The group receiving bupivacaine and dexmedetomidine showed a significant decrease in intraoperative pulse and blood pressure compared to the other group (p< 0.05). They showed a prolonged postoperative analgesia duration as well and a decreased total opioid consumption (p< 0.05). Conclusion: Although dexmedetomidine results in prolonged postoperative analgesia duration compared to magnesium sulfate when combined with bupivacaine 0.25% in ESPB, its negative effects on hemodynamics should be considered. Trial registration: This trial was registered retrospectively on Clinicaltrials.gov registry (NCT05694897) on 23/1/2023.

Over the past 50 years the capability of technology to improve surgical care has been realised and while surgical trainees and trainers strive to deliver care and train; the technological ‘solutions’ market continues to expand. However, there remains no coordinated process to assess these technologies. The FOS:TEST Report aimed to (1) define the current, unmet needs in surgical training, (2) assess the current evidence-base of technologies that may be beneficial to training and map these onto both the patient and trainee pathway and (3) make recommendations on the development, assessment, and adoption of novel surgical technologies. The FOS:TEST Commission was formed by the Association of Surgeons in Training (ASiT), The Royal College of Surgeons of England (RCS England) Robotics and Digital Surgery Group and representatives from all trainee specialty associations. Two national datasets provided by Health Education England were used to identify unmet surgical training needs through qualitative analysis against pre-defined coding frameworks. These unmet needs were prioritised at two virtual consensus hackathons and mapped to the patient and trainee pathway and the capabilities in practice (CiPs) framework. The commission received more than 120 evidence submissions from surgeons in training, consultant surgeons and training leaders. Following peer review, 32 were selected that covered a range of innovations. Contributors also highlighted several important key considerations, including the changing pedagogy of surgical training, the ethics and challenges of big data and machine learning, sustainability, and health economics. This summates to 7 Key Recommendations and 51 concluding statements. The FOS:TEST Commission was borne out of what is a pivotal point in the digital transformation of surgical training. Academic expertise and collaboration will be required to evaluate efficacy of any novel training solution. However, this must be coupled with pragmatic assessments of feasibility and cost to ensure that any intervention is scalable for national implementation. Currently, there is no replacement for hands-on operating. However, for future UK and ROI surgeons to stay relevant in a global market, our training methods must adapt. The Future of Surgery: Technology Enhanced Surgical Training Report provides a blueprint for how this can be achieved.

Background: Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients' KAP towards unused medications in homes may help manage the associated risks. Objective: To develop, translate, and validate a questionnaire for the assessment patients' KAP towards unused medications in Qatar homes (i.e., QUM-Qatar). Setting: This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020. Method: Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach's alpha. Statistical analyses were performed using STATA 15 statistical software. Main outcome measure: The psychometric properties of the QUM-Qatar assessment instrument. Results: An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach's alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained. Conclusion: The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications. Impacts on practice. There is now a valid and reliable English/Arabic language questionnaire to assess patients' KAP towards unused medications. Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal. To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment. 2021 The Authors We would like to express our heartfelt gratitude to Dr. Laith Abu-Raddad and special thanks to Ms. Hiam Chemaitelly for their analytical, result interpretation and infrastructure support provided under the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine-Qatar. The statements made herein are solely the responsibility of the authors. Scopus

The objective of this paper is to present a comprehensive analysis of hybrid excitation synchronous machines, including an examination of various structures found in scientific and technical literature, along with their advantages and drawbacks. Additionally, different methods of classification for these structures will be explored. The paper also delves into the contributions of the hybrid excitation principle for both motoring and generating modes and provides an overview of various models used in designing these structures.

EEG inverse problem is underdetermined, which poses a long standing challenge in Neuroimaging. The combination of source-imaging and analysis of cortical directional networks enables us to noninvasively explore the underlying neural processes. However, existing EEG source imaging approaches mainly focus on performing the direct inverse operation for source estimation, which will be inevitably influenced by noise and the strategy used to find the inverse solution. Here, we develop a new source imaging technique, Deep Brain Neural Network (DeepBraiNNet), for robust sparse spatiotemporal EEG source estimation. In DeepBraiNNet, considering that Recurrent Neural Network (RNN) are usually 'deep' in temporal dimension and thus suitable for time sequence modelling, the RNN with Long Short-Term Memory (LSTM) is utilized to approximate the inverse operation for the lead field matrix instead of performing the direct inverse operation, which avoids the possible effect of the direct inverse operation on the underdetermined lead field matrix prone to be influenced by noise. Simulations on various source patterns and noise conditions confirmed that the proposed approach could actually recover the spatiotemporal sources well, outperforming existing state of-the-art methods. DeepBraiNNet also estimated sparse MI related activation patterns when it was applied to a real Motor Imagery dataset, consistent with other findings based on EEG and fMRI. Based on the spatiotemporal sources estimated from DeepBraiNNet, we constructed MI related cortical neural networks, which clearly exhibited strong contralateral network patterns for the two MI tasks. Consequently, DeepBraiNNet may provide an alternative way different from the conventional approaches for spatiotemporal EEG source imaging Refereed/Peer-reviewed

The conventional autoregressive (AR) model has been widely applied in the various electroencephalogram (EEG) analyses such as spectrum estimation, waveform fittings, and in classification tasks. Nevertheless, evoked EEG is usually inevitably contaminated by multiple background activities (ongoing EEG) as well as the strong outliers which may distort the AR estimates of various AR estimation methods including LS, Yule-Walker, and Burg. Moreover, current AR approaches perform well only when the length of the time-series is much larger than the number of brain sites studied, which is exactly the reverse of the situation in neuroimaging whereby relatively short time-series are measured over thousands of voxels thus the need for penalized methods to obtain sparse solutions. In this paper, we introduce a novel ADMM-based AR estimator termed LAPPS (Least Absolute LP (0

Background: diabetes is well studied in Saudi Arabia; however, there seems to be little research in the area of awareness, education and health care delivery. Objectives: to assess the awareness about diabetes mellitus among attendees of primary health care centers, Makkah, Saudi Arabia. Subjects and Methods: a cross-sectional study was conducted among a representative random sample of adult attendees of primary health care centers (diabetic and non-diabetics), Makkah Al-Mokkaramah, the kingdom of Saudi Arabia during the study period (1-31 November, 2016). An Arabic self-administered questionnaire was used for data collection. It includes 31 questions with sections of demographic data, community awareness regarding diabetes definition, risk factors, signs and symptoms, and complications community awareness regarding diabetes prevention. Results: the study included 662 adult patients. Approximately one-third of them (32.2%) aged 60 years or more. Females represent 51.1% of them. More than one-fifth of them (21%) were university graduated whereas 6.3% were illiterates. Prevalence of diabetes among the participants was 33.7% and majority of them (97.9%) had family history of diabetes. The most frequent sources were mass media (57.4%), health sector (29.9%) and educational sector (10.6%). Overall sufficient awareness regarding diabetes mellitus was reported among majority of the participants (91.2%). Among studied factors, only marital status and income were significantly associated with sufficient awareness. Conclusion: population in Makkah AL-Mokkaramah has enough knowledge of the general knowledge of diabetes regarding risk factors, symptoms, etc. However, they are not very well aware of the diabetes associated secondary complications.

BACKGROUND The aim of our study was to report our experience regarding the safety, efficacy of duplex-guided polidocanol (POL) foam sclerotherapy on the overall status of signs and symptoms in patients with venous malformations (VMs). METHODS Thirty seven patients with symptomatic extratruncular VMs were treated with duplex-guided POL foam sclerotherapy using Tessari's method. Twenty five patients had limited VMs, while twelve had infiltrating VMs. Postsclerotherapy surveillance was done 6 months after the last sclerotherapy session and comprised both clinical and duplex evaluation. Clinical evaluation entailed a patient self-assessment questionnaire using a four-point scale to rate the degree of symptoms improvement as follows: disappeared, decreased, worsened, or recurred. Findings obtained by duplex scanning were divided into four groups: 1) disappeared group; 2) partially recanalized group; 3) totally recanalized group; and 4) worsened group. RESULTS There were 20 males and 17 females with mean age of 22.8±5.5 years. There was a significant reduction in the total amount of POL (P=0.0037), the number of sclerotherapy sessions was significantly lesser (P=0.0019), and treatment success was significantly higher (P=0.0495) in patients with limited VMs in comparison to those with infiltrating VMs. No major complications related to sclerotherapy were encountered in both groups. CONCLUSIONS Polidocanol foam sclerotherapy is effective, and safe for treatment of VMs, with high success rate and low risk of major complications. Although associated with relatively high recurrence rate compared with ethanol sclerotherapy, this can be overcome by additional treatment sessions, given the relative simplicity, speed, and safety.

Most legislation, whether international or national, deals with electronic agents in a way that does not reflect the certainty of their features. In the past, only a human being could perform the functions that electronic agents do at present. Such electronic agents that are considered ‘Intelligent’ ramble quickly into various places, search for information, and carry out various stages of a transaction from product and merchant brokering through to negotiation, sales, distribution and payment. Nevertheless, legislations have classified them as communication tools. Perhaps such terminology has been chosen because of the lack of difficulty in its implementation or lack of legislation having the legal tools to recognize clearly the acts of electronic agents. In this paper, the concept ‘electronic agent’ is scrutinized and the feasibility of granting them ‘legal personality’ investigated, particularly under Islamic law. In particular, the question is asked: does the concept ‘legal personality’ really exist under Islamic law? If so, then how is it defined? In addition, in light of the definition(s) presented, how can ‘legal personality’ be attributed to electronic agents?

This paper describes a portion of a research project to investigate the potential application of expert systems for operations planning at Manitoba Hydro. The emphasis in this paper is on the verification and validation issues of an expert system for water-resources engineering. Verification during the research explored the use of interactive computer graphics and the cause-and-effect method of verification. The verification process is illustrated by a Manitoba Hydro case study, using an expert-system module to test the validity of a hydraulic network consisting of a system of hydroelectric generating stations produced by consultation with the expert system Energy Management and Maintenance Analysis (EMMAES). Issues in developing the representation scheme for an interactive user interface are discussed. Coupling of the computer graphics with the expert-system module, and use of the cause-and-effect method for verification is addressed in detail. This combination proved to be an efficient approach for verification of expert systems in the water-resources domain.

In the current mechanistic-empirical (M-E) design procedures for flexible pavements, the primary transfer functions are those that relate (a) maximum tensile strain in the hot-mix asphalt (HMA) surface layer to fatigue cracking and (b) compressive strain at the top of the subgrade layer to rutting at the surface. These functions, called fatigue and rutting equations, are usually derived from statistically based correlations of pavement condition with observed laboratory specimen performance, full-scale road test experiments or by both methods. Hot-mix asphalt fatigue behavior is an important component of a M-E design procedure; unfortunately, most of the existing models do not reflect field fatigue behavior. This is manifested in the fact that HMA fatigue failure is achieved much faster under a laboratory setting than in a field environment. This difference has been typically accounted for by the use of a single shift factor based mainly on engineering experience. The flexible pavement portion of the Virginia Smart Road includes 12 different flexible pavement designs. Each section is approximately 100m long. The sections are instrumented with pressure cells, strain gages, time-domain reflectometry probes, thermocouples, and frost probes. The instruments were embedded as layers were built. Laboratory fatigue tests of field cores and field-mixed laboratory-compacted specimens along with measured response from the instrumented pavement sections at the Virginia Smart Road were used to quantify the differences between laboratory and field environments. Four shift factors were identified to correlate field and lab fatigue behavior: stress-state, material difference, traffic wander, and healing. Field-measured critical strains and strain energy exerted during truck loading were both used to determine the stress state shift factor. Strain measurements of truck loading distribution (wander) were used to determine the wander shift factor. Finally, results from laboratory fatigue tests on cores and laboratory compacted specimens were used to evaluated a shift factor to account for the difference in compaction procedures. While the derived shift factors utilize the measured stresses and strains at the Virginia Smart Road, calculated strains and stresses, based on appropriate pavement and loading modeling, may also be used. Ph. D.